We undertook a quality improvement project to address challenges with pulmonary artery catheter (PAC) line maintenance in a setting of low-baseline central-line infection rates. We observed a subsequent reduction in Staphylococcal PAC line infections and a trend toward a reduction in overall PAC infection rates over 1 year.

Background: Despite advances in neonatal care, neonates with moderate to severe HIE are at high risk of mortality and morbidity. we report the impact of a dedicated NNCC team on short term mortality and morbidities. Methods: A retrospective cohort study on neonates with moderate to serve HIE between July 1st 2008 and December 31st 2017. primary outcome : a composite of death and/or brain injury on MRI. Secondary outcomes: rate of cooling, length of hospital stay, anti-seizure medication burden, and use of inotropes. A regression analysis was done adjusting for gestational age, birth weight, gender, out-born status, Apgar score at 10 minutes, cord blood pH, and HIE clinical staging Results: 216 neonates were included, 109 before NNCC implementation, and 107 thereafter. NNCC program resulted in reduction in the primary outcome (AOR: 0.28, CI: 0.14-0.54, p<0.001) and brain injury (AOR: 0.28, CI: 0.14-0.55, p<0.001). It decreased average length of stay/infants by 5 days (p=0.03), improved cooling rate (73% compared to 93% , p <0.001), reduced: seizure misdiagnosis (71% compared to 23%, P <0.001), anti-seizure medication burden (P = 0.001), and inotrope use (34% compared to 53%, p=0.004) Conclusions: NNCC program decreased mortality and brain injury , shortened the length of hospital stay and improved care of neonates with significant HIE.

The analysis of axial dispersion of solute is presented in a pulsatile flow of Casson fluid through a tube in the presence of interfacial mass transport due to irreversible first-order reaction catalysed by the tube wall. The theory of dispersion is studied by employing the generalized dispersion model proposed by Sankarasubramanian & Gill (Proc. R. Soc. Lond. A, vol. 333 (1592), 1973, pp. 115–132). This dispersion model describes the whole dispersion process in terms of three effective transport coefficients, i.e. exchange, convection and dispersion coefficients. In the present study, the effects of yield stress of Casson fluid ${\it\tau}_{y}$, wall absorption parameter ${\it\beta}$, amplitude of fluctuating pressure component $e$ and Womersley frequency parameter ${\it\alpha}$ on the dispersion process are discussed under the influence of pulsatile pressure gradient. In a pulsatile flow, the plug flow radius changes during the period of oscillation and it has an effect on the dispersion process. Even with the Casson fluid model also, in an oscillatory flow, for small values of ${\it\alpha}$, the dispersion coefficient $K_{2}$ is positive, but when the value of ${\it\alpha}$ is as large as 3, $K_{2}$ takes both positive and negative values due to the fluctuations in the velocity profiles. This nature becomes more predominant for ${\it\tau}_{y}$, $e$ and ${\it\beta}$. It is observed that initially, for small time, the amplitude and magnitude of fluctuations of $K_{2}$ becomes more rapid and increases with time but it decreases after certain time and reaches a non-transient state for large time. Like in the case of Newtonian model, double frequency period for $K_{2}$ is observed at small time for large values of ${\it\alpha}$ with the Casson model for blood. It is seen that critical time for which $K_{2}$ reaches a non-transient state is independent of ${\it\tau}_{y}$ and $e$ but is dependent on ${\it\alpha}$. It is also observed that the axial distribution of mean concentration $C_{m}$ of solute depends on ${\it\tau}_{y}$ and ${\it\beta}$. But the effect of $e$ and ${\it\alpha}$ on $C_{m}$ is not very significant. This dispersion model in non-Newtonian pulsatile flow can be applied to study the dispersion process in the cardiovascular system and blood oxygenators.

The stability of Soret-driven thermosolutal convection in a shallow horizontal layer of a porous medium subjected to inclined thermal and solutal gradients of finite magnitude is investigated theoretically by means of a linear stability analysis. The horizontal components of these gradients induce a Hadley circulation, which becomes unstable when vertical components are sufficiently large. We employed a two-term Galerkin approximation for various modes of instability. The effect of the Soret parameter on the mechanism of instability of the thermosolutal convection is investigated. Results are presented for various values of the governing parameters of the flow. It is observed that the Soret parameter has a significant effect on convective instability and this is discussed.

In rural women in Andhra Pradesh, major determinants of early menopause are poor health status, particularly low haemoglobin and protein levels, increased parity, and pathological conditions including infection by bacteria, fungi and viruses. Early menopause leads to increased likelihood of extramarital sexual relations by husbands, resulting in family disharmony. As remedial measures, a greater age difference between prospective spouses, education in sexual hygiene, improvement of health and nutritional status, and limitation of conception are indicated.

A large outbreak of hepatitis E occurred in 2005 in Hyderabad, Andhra Pradesh, India. A total of 1611 cases were reported between 1 March and 31 December 2005 (attack rate 40/100 000). The epidemic curve suggested a continuing common source outbreak. Cases were centred around open sewage drains that crossed the old city. The attack rate was significantly higher in neighbourhood blocks supplied by water supply lines that crossed open drains (203/100 000) than in blocks supplied by non-crossing water pipes with a linear trend (38/100 000, P<0·00001). Crossing water pipelines were repaired and the attack rates declined.

The study was aimed at developing better orally active albendazole (ALB) formulations. Six formulations (ALB-1 to ALB-6) were prepared and tested against Brugia malayi in Mastomys coucha and jird (Meriones unguiculatus) at 200 mg/kg, orally, for 5 consecutive days. The anti-filarial efficacy was assessed against microfilariae (mf), adult worms and female reproductive potential. Three of the 6 ALB formulations showed greatly improved female worm sterilizing potential (ALB-1: 90%; ALB-3: 63%; ALB-4: 77% of untreated control) in B. malayi – M. coucha model. Sterilization efficacy of ALB-1 was also better than that shown by pure-ALB (P<0·001) or its marketed tablet formulation, Zentel (P<0·01), while that of ALB-4 was better than pure-ALB (P<0·05). The activity of ALB-3, pure-ALB and Zentel was, however, comparable. ALB-1 also showed late microfilaricidal activity with a maximum of 78% fall in microfilarial count. In contrast, neither the pure ALB nor Zentel showed any microfilaricidal activity. In the jird – B. malayi model, ALB-1 and ALB-4 showed marginal sterilizing efficacy whereas pure ALB or Zentel were ineffective. In conclusion the anti-filarial efficacy of ALB-1 was found to be superior to pure-ALB or Zentel.

Matrix-mediated in situ synthesis of monodispersed magnetite and maghemite nanoparticles (2–16 nm) was carried out using the cavities present in gels of globular proteins such as egg white and bovine serum albumin. Under stringent conditions, spatial-charge-distribution-assisted molecular recognition of proteins for inorganic ions led to the site- and polymorph-specific synthesis of superparamagnetic iron oxide particles. A transformation from magnetite to maghemite as a nucleating phase could be observed by partially denaturing the egg white protein, signifying the delicate role of quaternary structure of proteins under different reaction conditions, in determining the size and shape of the polymorph.

A prospective study was carried out on 52 patients with allergic rhinitis, during March 1993–January 1995. This was to analyse the occurrence of bronchial asthma among them and to correlate the symptoms, signs and pathological findings of allergic rhinitis with that of bronchial asthma in those patients with both the disorders. The therapeutic benefits with regard to the symptoms of bronchial asthma in these patients were assessed after treatment of their nasal allergy for a period of at least four months.

A definite aetio-clinico-pathological correlation could be established between allergic rhinitis and bronchial asthma and it could be concluded from the study that prompt attention to nasal symptoms in cases with co-existent bronchial asthma helps to a large extent in curbing the symptoms of the latter.

Humoral immune responses of the Indian leaf monkey (Presbytis entellus) experimentally infected with Brugia malayi and exhibiting disease manifestations were studied. Microfilaraemia, filaria-specific IgG and circulating immune complexes (CICs) were determined in the monkeys at different time-points after inoculation of B. malayi 3rd-stage larvae. Sera were analysed for recognition pattern of adult parasite antigen molecules by immunoblotting. More than 60% of the infected monkeys developed episodic or persistent limb oedema with or without fever and with low or no microfilaraemia. While both CIC and filaria specific IgG levels were comparable in animals showing no disease symptoms (asymptomatics) and some animals showing symptoms (symptomatics), IgG levels peaked during pre-patent stage in symptomatics and during latent stage in asymptomatic animals. However, some of the symptomatic animals showed a low level of filaria-specific IgG as compared to asymptomatic and other symptomatic animals. The immunoblot analysis showed non-reactivity of 17 and 55 kDa antigens with sera of symptomatic animals. The results thus suggest that humoral immune responses as measured in the present study do not precede the development of the manifestations. However, 2 non-reactive antigen molecules identified by symptomatic sera need further study to establish their possible involvement, if any, in the development of acute disease manifestations in this model.

The crystal structure of a covalently cross-linked Lactobacillus casei thymidylate synthase has been determined at 2.8 Å resolution. The sites for mutation to achieve the bis-disulfide linked dimer were identified using the disulfide modeling program MODIP. The mutant so obtained was found to be remarkably thermostable. This increase in stability has been reasoned to be entirely a consequence of the covalent gluing between the two subunits.

Two cases of bilateral moderate to severe sensorineural hearing loss due to oral administration of metronidazole are reported. There has been only one case report of deafness following metronidazole therapy in the world literature. The hearing loss recovered gradually in a period of four to six weeks following withdrawal of drug and oral steroid therapy. The possible mechanism of ototoxicity is discussed. Awareness by the treating physician of ototoxicity due to any drug is stressed.

A 56-year-old man presented with the difficulty of swallowing and respiratory distress due to a large tumour arising from the tongue and occupying the entire oral cavity. Histological examination revealed it to be an extraskeletal osteogenic sarcoma. The tumour was excised. After six weeks, he came back with massive local recurrence and bleeding from the tumour, but died despite chemotherapy. Review of the literature revealed only four other such cases of this rare tumour. A brief review of these four cases is also made.

The need for, and choice of, radiological staging investigations for distant metastases in the management of head and neck squamous cell carcinoma is a contentious issue. To address this problem a retrospective audit of routine computerized tomography (CT) and ultrasound scanning of the chest and abdomen respectively was undertaken. The records of 103 patients who, over a six and a half year period, underwent major surgery for head and neck squamous cell carcinoma were reviewed. A total of 57 patients (59 per cent) had CT scanning of the chest of whom two were identified as having synchronous tumours. In both cases, the lesions were identified on chest X-ray prior to scanning. Seventy patients (68 per cent) had routine ultrasound scanning of the abdomen. In none of these was metastatic disease identified. As a result of the audit findings routine CT and ultrasound scanning of the chest and abdomen has been discontinued.

In an attempt to attenuate the cardiovascular pressor response to laryngoscopy and intubation, 30 patients presenting for routine ophthalmic surgery were studied and were randomly allocated into two groups: group A (n=15) received direct laryngeal/tracheal lignocaine spray immediately before intubation; and group B (n=15) received orolaryngeal lignocaine spray before the induction of anaesthesia. In both groups, general anaesthesia was induced with thiopentone 3–5 mg kg−1, followed by atracurium 0.6 mg kg−1 to facilitate tracheal intubation. Laryngoscopy and endotracheal intubation caused a significant increase in heart rate, by 28% in group A and 23% in group B (P<0.05 in both), and in diastolic blood pressure, by 28% in group A and 24% in group B (P<0.05 in both). In group A, the systolic blood pressure also increased significantly (by 18%) after intubation, but there was no significant change in group B. In addition, the plasma lignocaine concentrations remained well below the toxic range in both groups. It was concluded that topical lignocaine administration as an orolaryngeal spray before the induction of anaesthesia is effective in reducing but not abolishing the pressor response to laryngoscopy and endotracheal intubation