Oxidative and osmotolerant effects in Salvator merianae (Squamata: Teiidae) red blood cells during hibernation

Hibernation is a natural condition of animals that lives in the temperate zone, although some tropical lizards also experience hibernation annually, such as the lizard native from South America, Salvator merianae, or “tegu” lizard. Even though physiological and metabolic characteristic associated with hibernation have been extensively studied, possible alterations in the red blood cells (RBC) integrity during this period remains unclear. Dehydration and fasting are natural consequences of hibernating for several months and it could be related to some cellular modifications. In this study, we investigated if the osmotic tolerance of RBCs of tegu lizard under hibernation is different from the cells obtained from animals while normal activity. Additionally, we indirectly investigated if the RBCs membrane of hibernating tegus could be associated with oxidation by quantifying oxidized biomolecules and the activity of antioxidant enzymes. Our findings suggest that RBCs are more fragile during the hibernation period, although we did not find evidence of an oxidative stress scenario associated with the accentuated fragility. Even though we did not exclude the possibility of oxidative damage during hibernation, we suggested that an increased RBCs volume as a consequence of hypoosmotic blood during hibernation could also affect RBCs integrity as noted.

TO EVALUATE EFFICACY OF LAPAROSCOPIC TRANSPERITONEAL PYELOLITHOTOMY FOR MANAGEMENT OF RENAL PELVIC STONES IN TERM OF POSTOPERATIVE HOSPITAL STAY

Background: To evaluate efficacy of laparoscopic transperitoneal pyelolithotomy for management of renal pelvic stones in term of postoperative hospital stay Methods: This study has been conducted in the Department of General surgery, Indira Gandhi Medical College, Shimla on selected patients of Renal pelvis stones admitted in institution Results: Mean hospital stay was 6.66 days in laparoscopic group and it was 8 days in laparoscopic completed by open method. Maximum no. of patients was discharged within 5 days. 6 (75 %) patients returned to normal activity in less than 30 days which included only successful laparoscopic group and 2 patients returned to normal activity in 40 days which included lap completed by open group. Conclusion: In the present study of Laparoscopic Transperitoneal Pyelolithotomy at Indira Gandhi Medical College, Shimla, the procedure showed a definite decrease hospital stay, early return to activity than who have undergone open surgery Keywords: Laparoscopic Transperitoneal Pyelolithotomy, Pelvic stone, Hospital stay.

Model-free detection of unique events in time series

Recognition of anomalous events is a challenging but critical task in many scientific and industrial fields, especially when the properties of anomalies are unknown. In this paper, we introduce a new anomaly concept called “unicorn” or unique event and present a new, model-free, unsupervised detection algorithm to detect unicorns. The key component of the new algorithm is the Temporal Outlier Factor (TOF) to measure the uniqueness of events in continuous data sets from dynamic systems. The concept of unique events differs significantly from traditional outliers in many aspects: while repetitive outliers are no longer unique events, a unique event is not necessarily an outlier; it does not necessarily fall out from the distribution of normal activity. The performance of our algorithm was examined in recognizing unique events on different types of simulated data sets with anomalies and it was compared with the Local Outlier Factor (LOF) and discord discovery algorithms. TOF had superior performance compared to LOF and discord detection algorithms even in recognizing traditional outliers and it also detected unique events that those did not. The benefits of the unicorn concept and the new detection method were illustrated by example data sets from very different scientific fields. Our algorithm successfully retrieved unique events in those cases where they were already known such as the gravitational waves of a binary black hole merger on LIGO detector data and the signs of respiratory failure on ECG data series. Furthermore, unique events were found on the LIBOR data set of the last 30 years.

Desarda versus Lichenstein repair in treatment of inguinal hernia: our experience in KVG Medical College and Hospital

Background: Desarda technique of inguinal hernia repair introduced in 2001 is still not considered standard tissue-based hernia repair technique. The aim of the study was to compare the tissue based Desarda technique with standard Lichtenstein repair in treatment of primary inguinal hernia.Methods: 72 cases were allocated into 2 groups. Desarda (D Group) had 36 and Lichtenstein (L Group) had 36 patients. Primary outcome factors included operative time measured from skin incision to skin closure. Post operative pain scores was using Sheffield scale. Ecchymosis, hematoma, seroma, surgical site infections, foreign body sensation etc. were evaluated as postoperative complications. A follow up examination was planned for 6 month to look for early recurrence (<6 month) and chronic groin pain.Results: Mean age in desarda’s group 44.94±15.5 years while Lichtenstein group was 45.47±13.12 years. The mean duration of surgery 42.83 min (D) versus 50.72 min (L). Duration of hospital stay 3.38 days (D) versus 4.08 days (L). Time taken to return to normal and work activities was significantly less in Desarda group (p=0.001). After 6-month mean follow up period 1 recurrence is noted in each arm (p=1).Conclusions: On comparison of Desarda with Lichtenstein repair. Desarda technique does not use a mesh. Patients after Desarda's operative procedure gets normal activity sooner as compared to the standard Lichtenstein mesh repair. Complications similar to standardized technique. We also found the use of Desarda technique in patients with indirect hernia is a technically sound option than Lichtenstein technique.

Efficacy of Bupivacaine Infiltration in Post Tonsillectomy Pain Relief

Background: Tonsillectomy is a common surgical procedure required to prevent recurrent infection, inflammation and related distress to the patients. Intervention in this highly vascularized area results in inflammatory responses and subsequent pain. Due to inadequate management 30-70% patients suffer from post-operative pain. Post tonsillectomy pain has its impact on analgesic consumption, hospital stay and return to normal activity. Methodology: This randomized control trial study design is a prospective randomized controlled including convenience sample of 32 patients of both genders, aged 4-30 years undergoing tonsillectomy.Tonsillectomy was performed by standard dissection method after giving general anesthesia to the patients. After completing the tonsillectomy on right side, surgeon infiltrated 6ml of 0.25 % bupivacaine in the tonsillar fossa on the right side. The surgeon did not infiltrate into the left side being observed as control. Postoperative pain score was recorded by asking patients on a VAS graded 1-10 scale (0= no pain and 10= maximum pain) after half an hour in recovery, 2 hours, 4 hours and 6 hours after the operation. Results: The mean age of the study patients was 14.08±7.32 years which included 20 (62.5%) females and 12(37.5%) males. The mean of duration of operation was 42.03±14.75 minutes. There was statistically significant difference between pain scores on VAS in infiltrated bupivacaine (right side) and control (left side) after ½, 2,4 and 6 hours respectively. Conclusion: Infiltration of 0.25% bupivacaine significantly reduces post tonsillectomy pain. Keywords: Tonsillectomy, Bupivacaine infiltration, Pain

A multicenter, randomized, double-blind, placebo-controlled phase ii trial of intravenous inflammasome inhibitor (NuSepin) for the treatment of COVID-19 patients

Purpose Here we evaluated whether a novel inflammasome inhibitor targeting GPCR19 (NuSepin) provides greater benefit than placebo in patients with COVID-19 pneumonia. Methods We conducted a double-blind, randomized, placebo-controlled phase ii trial of intravenous NuSepin, which is an NLRP3 inflammasome inhibitor targeting GPCR19, in adults who were hospitalized with COVID-19 pneumoniae in Romania from September 2020 to March 2021. The primary outcome was the time to clinical improvement, defined as a decline of two ordinal scales (OS) from randomization on a six-category OS that ranges from 1 (discharged with normal activity) to 6 (death) (=TTCI_P). In addition, clinical improvement was also assessed by aggregated National Early Warning Score 2 (NEWS2), and TTCI_S was defined by time to NEWS2=0 from randomization, which is maintained for 24 h. Results TTCI_P was different between groups numerically, but not statistically. The median difference in TTCI_S was 3.5 d between the NuSepin group and the placebo group (p = 0.016) in moderate-to-severe patients (with baseline NEWS2 ≥ 5) of the PP set [recovery rate ratio = 2.7, p = 0.02], which favored improved recovery in the NuSepin group. The overall recovery rate ratio was 3.4, which favors the NuSepin group in terms of recovery rate (p = 0.0026) when the effects of covariates (use of anti-viral drugs and baseline NEWS2 ≥ 5) were adjusted. Serious adverse events were reported in a patient who received 0.2 mg/kg NuSepin (4.5%), but this was found to be unrelated to NuSepin treatment. Conclusion Considering that NuSepin has a favorable and tolerable safety profile, clinical improvement of hospitalized moderate-to-severe patients might be achieved with 0.2 mg/kg NuSepin significantly faster than placebo.

AYURVEDIC CONCEPT OF VAGINAL DISCHARGE: (YONIGATA STRAVA)

Vaginal discharge is one of the major problems encountered in gynaecological practice. It is a very common con- dition that has been experienced by most women of all ages, especially in childbearing or reproductive age. Vaginal discharge is a condition that causes great discomfort to a woman and hampers her normal activity. It is believed that vaginal discharges produce loss of strength & confidence, also there is the presence of fear that it may be due to malignancy. Nowadays it is essential to study differential diagnosis of vaginal discharge. In Ayurvedic texts, various conditions giving rise to white discharge per vaginum had been described but the sub- ject was never dealt with as a separate entity. Therefore, in this study, an effort has been put forth to make a con- ceptual study covering almost all the aspects of Yonigata Strava as per Ayurveda as well as per modern. Keywords: Leucorrhoea, Vaginal Discharges, Yonigata Strava.

Atypical Hemolytic Uremic Syndrome after ChAdOx1 nCoV-19 Vaccination in a Patient with Homozygous CFHR3/CFHR1 Gene Deletion

Hemolytic uremic syndrome (HUS) is a thrombotic microangiopathy (TMA) affecting the kidneys. Compared with typical HUS due to an infection from shiga toxin-producing <i>Escherichia coli</i>, atypical HUS involves a genetic or acquired dysregulation of the complement alternative pathway. In the presence of a mutation in a complement gene, a second trigger is often necessary for the development of the disease. We report a case of a 54-year-old female, with a past medical history of pulmonary tuberculosis, who was admitted to the emergency service with general malaise and reduction in urine output, 5 days after vaccination with ChAdOx1 nCoV-19. Laboratory results revealed microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury. Given the clinical picture of TMA, plasma exchange (PEX) was immediately started, along with hemodialysis. Complementary laboratory workup for TMA excluded thrombotic thrombocytopenic purpura and secondary causes. Complement study revealed normal levels of factors H, B, and I, normal activity of the alternate pathway, and absence of anti-factor H antibodies. Genetic study of complement did not show pathogenic variants in the 12 genes analyzed, but revealed a deletion in gene CFHR3/CFHR1 in homozygosity. Our patient completed 10 sessions of PEX, followed by eculizumab, with both clinical and laboratorial improvement. Actually, given the short time lapse between vaccination with ChAdOx1 nCoV-19 and the clinical manifestations, we believe that vaccine was the trigger for the presentation of aHUS in this particular case.

OV17 LAPAROSCOPIC REPAIR OF A DIAPHRAGMATIC EVENTRATION

Aim Diaphragmatic eventration (DE) is a rare condition affecting 0,05% of general population. DE is the abnormal elevation of a portion of a entire hemidiaphragm due to a lack of muscle or nerve function. It can be congenital or acquired. The most common cause of DE is cardiac surgery. It can be asymptomatic or present mild symptoms as dispnea, palpitations, pneumonia. Material and Methods 61 years old male with medical history of arterial hypertension, DMII, Hyperlipidemia. He had a motor vehicle accident with 6 to 9 left ribs fractures. One month later complained of dyspnea with shortness of air to normal activity. Rx: elevation of left diaphragm. CT scan: elevation of left diaphragm without rupture, passive atelectasis of inferior left lobe of the lung. He initiated respiratory physiotherapy without improvement of the symptoms. 4 months after the accident, we had a stroke with right hemiparesis. This situation produced worsening of the dyspnea. Physiotherapy was reinforced with recuperation of the hemiparesis, but poor improvement of the dyspnea. 10 months after the accident, surgery was indicated for plication of the diaphragm to improve the respiratory function. Results The video shows the radiological exams and the surgery performed. Laparoscopic diaphragmatic plication with a reinforcement with a coated mesh (Uncoated monofilament polypropylene mesh on the anterior side with an absorbable hydrogel barrier). He was discharge 2 days after surgery. The patient improved significantly in his respiratory symptoms an imaging exams. Conclusions Posttraumatic DE must be treated surgically with low morbidity and good functional results.

Prevalence of protective haplotypes of the SLCO1B1 gene for statin transport in Mexican populations

Aim: To evaluate the genetic distribution of the rs4149056 and rs2306283 variants in the SLCO1B1 gene in Mexican Mestizo (admixed) and Native American groups. Materials & methods: We recruited 360 volunteers who were qPCR-genotyped with TaqMan probes. Results: Allele and genotype frequencies are reported. Among the expected rs4149056– rs2306283 haplotypes, T–A (42.35–58.47%) was the most prevalent which relates to the normal activity of the OATP1B1 transporter. This was followed by the T–G haplotype associated with further statin transport and cholesterol reduction (32.49–43.76%). Conclusion: Based on these SLCO1B1 gene variants, we confirmed that a minimum fraction of the Mexican study populations would be at risk from decreasing simvastatin transport and the development of statin-induced myopathy.