Postoperative delirium in the elderly is common and associated with poor outcomes, but often goes unrecognized. Delirium screening tools, validated in postoperative settings are lacking. This study compares two screening tools [Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and Nursing Delirium Symptom Checklist (NuDESC)] with a DSM-IV-based diagnosis of delirium, conducted by neuropsychiatric examination in postoperative settings.
Consecutive English-speaking patients, ≥70 yr, undergoing surgery with general anaesthesia and capable of providing informed consent, were recruited. Diagnostic test characteristics were compared for each screening tool vs neuropsychiatric examination, both in the Post-Anaesthesia Care Unit (PACU), and daily during inpatient hospitalization, adjusting for repeated measures.
Neuropsychiatric examination identified delirium in 45% of 91 patients evaluated in the PACU and in 32% of 166 subsequent delirium assessments on the ward in the 58 admitted patients. The sensitivity [95% confidence interval (CI)] of delirium detection of the CAM-ICU in the PACU, and in all repeated assessments was 28% (16–45%) and 28% (17–42%), respectively; for the NuDESC (scoring threshold ≥2), 32% (19–48%) and 29% (19–42%), respectively, and the NuDESC (threshold ≥1), 80% (65–91%) and 72% (60–82%), respectively. Specificity was >90% for both the CAM-ICU and the NuDESC (threshold ≥2); specificity for the NuDESC (threshold ≥1), in the PACU was 69% (54–80%) and 80% (73–85%) for all assessments.
While highly specific, neither CAM-ICU nor NuDESC (threshold ≥2) are adequately sensitive to identify delirium post-operatively; NuDESC (threshold ≥1) increases sensitivity, but reduces specificity.
aged; delirium; neuropsychological tests; perioperative period; sensitivity and specificity
CR-39 detectors, widely used for neutron dosimetry in accelerator radiation environment, have also been applied in tissue microdosimetry by generating the linear energy transfer (LET) spectrum. In this work, the neutron dose has been estimated via LET spectrometry for 9Be (p, n) reaction which is useful for personnel monitoring around particle accelerators and accelerator based therapy facilities. Neutrons were generated by the interaction of protons of 6 different energies from 4–24 MeV with a thick Be target. The LET spectra were obtained from the major and minor radii of each track and the thickness of removed surface. From the LET spectra, the absorbed dose (DLET) and the dose equivalent (HLET) were estimated using Q-L relationship as given by International Commission on Radiological Protection (ICRP) 60. The track density in CR-39 detector and hence the neutron yield was found to be increasing with the increase in projectile (proton) energy. Similar observations were also obtained for absorbed dose (DLET) and dose equivalents (HLET).
LET spectrometry; 9Be (p, n) reaction; CR-39; neutron dosimetry
Electromechanical above-knee prosthetics are widely available, and are reliant on repetitive knee movements of fixed length/angle. This work explores the viability of developing adaptive movements on existing prototypes, through embedded controls from 8051-class 8-bit microcontroller units (MCUs). The system includes an integrated goniometer, intended for measuring the knee angle of the sound limb. The phase delay is subsequently processed to bring about kinematic coordination in the proposed echo-controlled prosthetic.
Kinematic coordination; Embedded control; Phase detection; Adaptive movement
Background & objectives:
Regular practice of slow breathing has been shown to improve cardiovascular and respiratory functions and to decrease the effects of stress. This pilot study was planned to evaluate the short term effects of pranayama on cardiovascular functions, pulmonary functions and galvanic skin resistance (GSR) which mirrors sympathetic tone, and to evaluate the changes that appear within a short span of one week following slow breathing techniques.
Eleven normal healthy volunteers were randomized into Pranayama group (n=6) and a non-Pranayama control group (n=5); the pranayama volunteers were trained in pranayama, the technique being Anuloma-Viloma pranayama with Kumbhak. All the 11 volunteers were made to sit in similar environment for two sessions of 20 min each for seven days, while the pranayama volunteers performed slow breathing under supervision, the control group relaxed without conscious control on breathing. Pulse, GSR, blood pressure (BP) and pulmonary function tests (PFT) were measured before and after the 7-day programme in all the volunteers.
While no significant changes were observed in BP and PFT, an overall reduction in pulse rate was observed in all the eleven volunteers; this reduction might have resulted from the relaxation and the environment. Statistically significant changes were observed in the Pranayama group volunteers in the GSR values during standing phases indicating that regular practice of Pranayama causes a reduction in the sympathetic tone within a period as short as 7 days.
Interpretation & conclusions:
Beneficial effects of pranayama started appearing within a week of regular practice, and the first change appeared to be a reduction in sympathetic tone.
Galvanic skin resistance; Pranayama; sympathetic tone
A series of 4-(2,5-dimethylpyrrol-1-yl)/4-pyrrol-1-yl benzoic acid hydrazide analogs, some derived triazoles, azetidinones, thiazolidinones, and pyrroles have been synthesized in good yields and structures of these compounds were established by IR, 1H NMR, 13C NMR, mass spectral, and elemental analysis. These compounds were evaluated for their preliminary in vitro antibacterial, antifungal, and antitubercular activity against Mycobacterium tuberculosis H37 Rv strain by the broth dilution assay method. Twenty one of these compounds displayed good antimicrobial activity, with a MIC value of 1-4 μg/ml. Several compounds 4c, 8-10, 15b-15h, and 16b-16d exhibited good in vitro antitubercular activity with MIC value 1-2 μg/ml. Further, some title compounds were also assessed for their cytotoxic activity (IC50) against mammalian Vero cell lines and A549 (lung adenocarcinoma) cell lines using the MTT assay method. The results revealed that these compounds exhibit antitubercular activity at non-cytotoxic concentrations.
Pyrroles; acid hydrazide derivatives; antibacterial activity; antitubercular activity; antifungal activity; broth dilution assay method; cytotoxicity
AL amyloid; Congo red; hepatomegaly
Reduced exercise capacity in diabetics has been attributed to limitations in cardiac function and microvascular dysfunction leading to impaired oxygen supply and nutritive perfusion to exercising muscles.
To study changes in cardiac function and microvascular utilisation during exercise in diabetic individuals compared to age-matched controls.
Diabetics with glycosylated haemoglobin (HbA1c) <8 (n = 31), diabetics with HbA1c ⩾8 (n = 38) and age-matched non-diabetic controls (n = 32) performed exercise at 50 W for 10 minutes followed by recovery, with continuous monitoring of cardiac function by impedance cardiography and regional flow and oxygen saturation by laser Doppler and white light spectroscopy.
In the diabetics, cardiac reserve during exercise and cardiac overshoot during recovery are significantly reduced because of reduction in capacity to increase stroke volume. Regional flow to the exercising muscle is reduced and there is also disproportionately greater desaturation of the regional flow. Abnormalities in cardiac function and regional perfusion are related to the severity of diabetes.
Cardiac response to exercise is attenuated significantly in diabetic individuals. Simultaneously, there is impairment in the regional distribution. These changes could be the harbinger of reduced exercise capacity in diabetics.
The aim of this study is to examine arsenic accumulation by Pseudomonas stutzeri and its response to some thiol chelators, DMPS and MiADMSA.
Determination of arsenic accumulation by Pseudomonas sp. was carried out using an atomic absorption spectrophotometer, a TEM and an EDAX. Arsenate reductase enzyme assay was carried out from a cell-free extract of Pseudomonas sp. The effect of chelating agents on arsenite accumulation was analyzed. Total cellular proteins were analyzed using 1-D SDS-PAGE.
Pseudomonas sp. exhibited a maximum accumulation of 4 mg As g−1 (dry weight). TEM and EDAX analysis showed the presence of As-containing electron-dense particles inside the cells. Data on arsenate reductase enzyme kinetics yielded a Km of 0.40 mM for arsenate and a Vmax of 5,952 μmol arsenate reduced per minute per milligram of protein. The chelating agents MiADMSA and DMPS were found to reduce the arsenic accumulation by 60 and 35%, respectively, whereas the presence of both chelating agents in medium containing cells pretreated with arsenite reduced it by up to 90%. The total protein profile of the cellular extract, obtained by 1-D SDS-PAGE, indicated five upregulated proteins, and three of these proteins exhibited differential expression when the cells were grown with MiADMSA and DMPS.
This study shows a new approach towards arsenic detoxification. A combination treatment with MiADMSA and DMPS may be useful for removing intracellular arsenic. The proteins that were found to be induced in this study may play an important role in the extrusion of arsenic from the cells, and this requires further characterization.
Arsenic bioaccumulation; Arsenate reductase; Chelating agent; Arsenic removal; Arsenic-induced protein/s
hepatosplenomegaly; hepatic fibrosis; intrahepatic biliary ducts; Caroli’s disease; autosomal recessive polycystic kidney disease; congenital hepatic fibrosis
non-Hodgkin’s lymphoma; T cell lymphoma; ulcerative colitis
1,2,4-Trihydroxybenzene (THB) is an intermediate in the Phanerochaete chrysosporium degradation of vanillate and aromatic pollutants. A P. chrysosporium intracellular enzyme able to oxidatively cleave the aromatic ring of THB was purified by ammonium sulfate precipitation, hydrophobic and ion-exchange chromatographies, and native gel electrophoresis. The native protein has a molecular mass of 90 kDa and a subunit mass of 45 kDa. The enzyme catalyzes an intradiol cleavage of the substrate aromatic ring to produce maleylacetate. 18O2 incorporation studies demonstrate that molecular oxygen is a cosubstrate in the reaction. The enzyme exhibits high substrate specificity for THB; however, catechol cleavage occurs at approximately 20% of the optimal rate. THB dioxygenase catalyzes a key step in the degradation pathway of vanillate, an intermediate in lignin degradation. Maleylacetate, the product of THB cleavage, is reduced to beta-ketoadipate by an NADPH-requiring enzyme present in partially purified extracts.
Under secondary metabolic conditions the white rot basidiomycete Phanerochaete chrysosporium rapidly mineralizes 2,4,5-trichlorophenol. The pathway for degradation of 2,4,5-trichlorophenol was elucidated by the characterization of fungal metabolites and oxidation products generated by purified lignin peroxidase (LiP) and manganese peroxidase (MnP). The multistep pathway involves cycles of peroxidase-catalyzed oxidative dechlorination reactions followed by quinone reduction reactions to yield the key intermediate 1,2,4,5-tetrahydroxybenzene, which is presumably ring cleaved. In the first step of the pathway, 2,4,5-trichlorophenol is oxidized to 2,5-dichloro-1,4-benzoquinone by either MnP or Lip. 2,5-Dichloro-1,4-benzoquinone is then reduced to 2,5-dichloro-1,4-hydroquinone. The 2,5-dichloro-1,4-hydroquinone is oxidized by MnP to generate 5-chloro-4-hydroxy-1,2-benzoquinone. The orthoquinone is in turn reduced to 5-chloro-1,2,4-trihydroxybenzene. Finally, the 5-chlorotrihydroxybenzene undergoes another cycle of oxidative dechlorination and reduction reactions to generate 1,2,4,5-tetrahydroxybenzene. The latter is presumably ring cleaved, with subsequent degradation to CO2. In this pathway, the substrate is oxidatively dechlorinated by LiP or MnP in a reaction which produces a quinone. The quinone intermediate is recycled by a reduction reaction to regenerate an intermediate which is again a substrate for peroxidase-catalyzed oxidative dechlorination. This pathway apparently results in the removal of all three chlorine atoms before ring cleavage occurs.
Under ligninolytic conditions, the white rot basidiomycete Phanerochaete chrysosporium mineralizes 2,4-dinitrotoluene (I). The pathway for the degradation of I was elucidated by the characterization of fungal metabolites and oxidation products generated by lignin peroxidase (LiP), manganese peroxidase (MnP), and crude intracellular cell extracts. The multistep pathway involves the initial reduction of I to yield 2-amino-4-nitrotoluene (II). II is oxidized by MnP to yield 4-nitro-1,2-benzoquinone (XII) and methanol. XII is then reduced to 4-nitro-1,2-hydroquinone (V), and the latter is methylated to 1,2-dimethoxy-4-nitrobenzene (X). 4-Nitro-1,2-hydroquinone (V) is also oxidized by MnP to yield nitrite and 2-hydroxybenzoquinone, which is reduced to form 1,2,4-trihydroxybenzene (VII). 1,2-Dimethoxy-4-nitrobenzene (X) is oxidized by LiP to yield nitrite, methanol, and 2-methoxy-1,4-benzoquinone (VI), which is reduced to form 2-methoxy-1,4-hydroquinone (IX). The latter is oxidized by LiP and MnP to 4-hydroxy-1,2-benzoquinone, which is reduced to 1,2,4-trihydroxybenzene (VII). The key intermediate 1,2,4-trihydroxybenzene is ring cleaved by intracellular cell extracts to produce, after reduction, beta-ketoadipic acid. In this pathway, initial reduction of a nitroaromatic group generates the peroxidase substrate II. Oxidation of II releases methanol and generates 4-nitro-1,2-benzoquinone (XII), which is recycled by reduction and methylation reactions to regenerate intermediates which are in turn substrates for peroxidase-catalyzed oxidation leading to removal of the second nitro group. Thus, this unique pathway apparently results in the removal of both aromatic nitro groups before ring cleavage takes place.
Rheumatic disorders like Amavata, Sandhivata and Vatarakta are elaborately described in ayurvedic literature. Preliminary survey of literature shows that about 247 formulations are recommended for these rheumatic disorders. These formulations generally include guggulu compounds, compounds of plant powders, decoctions, medicated ghees, oils, electuaries etc. Therapeutic potential of ayurvedic concepts and a brief review of Ayurvedic formulations are also discussed.
This study deals with Asavarishta preparations of the Ayurvedic System of medicine and scans various classical texts to find out the different types of constituents required for their preparation along with their proportions, the method of preparation, the time required to complete the process, the fermentations pots, the fermenting materials, the place and time (season) of fermentation etc. with a view to develop certain common norms for their preparation.
A study on Kutajarista’ was carried out and it was tested for anti-amoebic action which is presented in this paper.
To Substantiate the claims of Ayurvedic classics, animal experimentation with modern technology has been carried out in this paper. Various methods have been described for induction diabetes Mellitus or any other disease. Now it is the duty of an Ayurvedist to select the suitable method on the guidelines of Ayurvedic aetiology to produce a condition stimulating to Prameha (Madhumeha) and the best suitable method (Folin-Wu) for estimating the sugar content of blood is adopted. Besides this one must do experiment in all species and should confirm the finding by clinical evaluation. Side by side toxicity studies are also necessary.
Swarna – Vanga, an Ayurvedic preparation, is used in the treatment mainly of Pramehas (genitor urinary and metabolic disorders), Sveta Pradara (Leucorrhoea), Kasa – Swasa (Respiratory disorders), etc. The drug contains tin and sulphur as major components along with traces of mercury, iron and aluminum. According to modern point of view certain metals have been claimed toxic to both human and animal. Since Svarna – Vanga contains these metals, it is essential to screen out its toxic effect, if any, although it is claimed in Ayurveda that when a metal is processed as prescribed, it become non – toxic or the least toxic. Considering the above facts, an animal experiment was carried out for short duration (14 days) to screen the toxic effects of Svarna – Vanga (SV) in increasing doses of the drug starting from the maximum therapeutic dose (12.5 mg / 100 gm b.wt / day). The drug was found to have no toxic effects in tissues of the animal at doses of 12.5 mg and 25 mg / 100 gm b.wt. / day. Fine fatty vacuolization in liver and focal superficial mucosal degeneration and necrosis of small intestine confined to one animal each at dose of 50 mg / 100gm b.wt. and 100 mg/ 100 gm. b.wt. / day were observed. Our study indicates that the drug has no toxic effect on tissues at therapeutic dose.
Vanga bhasma, a popular Ayurvedic Medicine is prepared from Tin metal. This drug is claimed to have ‘Sukrala’ (Semenaugmentator), ‘vrsya’ (good for testis) properties in the literature and is widely in vogue for genito – urinary disorders in Ayurvedic practice. An experimental evaluation of the claim has been undertaken and the results have been presented in this paper. The drug in reference is found to have testicular regenerative potential on cadmium induced testicular degeneration in albino tats, when administered orally. This effect on ‘Sukravaha Srotomula’ (testis) appears to corroborate “Sukrala” and “Vrsya” properties attributed to the drug in Ayuredic literature.
Vanga bhasma; Sukrala; Vrsyam Sukravaha Srotas; Cadmium induced partial testicular degeneration; zinc sulphate
Svarna Vanga, an important Ayurvedic tin preparation having mercury as one of its ingredients, is mainly indicated in the treatment of Pramehas (genitourinary disorders). What role does mercury play in its preparation is not known. Hence present study has been planned with a view to prepare SvarnaVanga using mercury in different amounts. It was observed that the amount of mercury atleast in half proportion to in tin Kajjali, is considered necessary in making the standard Svarna-Vanga preparation.
Vangabhasma is a popular and effective dosage form prepared from tin metal in Ayurvedic practice. Since modern literature attributes certain toxicity to tin salts, an attempt is made to screen the acute and sub-acute toxicity of Vangabhasma in the form, dose and route as is in the practice or Ayurveda. In this paper, dose-effect relation of Vangabhasma on Digestive system (G.I. T., Liver and Pancreas) has been presented. But for local irritation, no significant toxicity attributable to Vangabhasma has been observed even in eight times higher dose than therapeutic dose, on exposure to the drug for ten days.