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Background: Heart failure (HF) is a complex clinical syndrome that results from any structural or functional impairment of ventricular filling or ejection of blood. There are range of factors that predict the mortality, morbidity, and outcome in congestive HF (CHF) patients. Objectives: The objective was to study the clinico-epidemiological characteristics and predictors of inhospital mortality of elderly patients ≥60 years hospitalized for HF. Subjects and Methods: A complete medical history of enrolled patients and physical examination inclusive of etiology, New York Heart Association (NYHA) grade, heart rate (HR), and systolic blood pressure (SBP) were noted. Complete blood count, blood urea, serum creatinine, serum sodium, serum potassium, 12-lead electrocardiogram, X-ray of the chest, and echo were obtained in all patients. Outcomes were analyzed till the study endpoints. Results: Compared to normal comparators, a higher mortality was observed in patients with age >75 years (33.3%), HR >100 beats per min (27.14%), SBP 1.30 mg/dl (29.17%), serum sodium

The induction of posterior vitreous detachment (PVD) is an important step in the successful outcome of vitreoretinal surgery for various indications. This may pose a significant challenge intraoperatively in cases of strong adhesion between the posterior hyaloid and retina. Various techniques to achieve intraoperative PVD have been described which involve active aspiration as well as non-aspiration techniques to achieve a plane of separation between the posterior hyaloid and retina. Very frequently, combinations of these techniques might be necessary to achieve successful PVD induction. We describe a novel instrument that combines aspiration as well as non-aspiration techniques for PVD induction, Bapaye aspiration scraper. It is also useful in various vitreoretinal interface procedures due to its design and is compatible with small-gauge vitrectomy systems which are commonly used in modern vitreoretinal surgery.

Globally, hypertension is a common problem in the elderly, and its prevalence increases with increasing age. Isolated systolic hypertension (ISH) subset is more common in the very elderly population, and as the population ages, its prevalence will rise more and more. In the past, treatment of hypertension (HT) in the very elderly was controversial and either no treatment or complications of treatment risk overweigh the benefits observed. The inclusion of elders in various clinical trials has demonstrated a better understanding and rational approach toward optimal management of HT. Systolic blood pressure (BP) is more important in predicting adverse cerebrovascular outcomes and decline in renal function in elderly patients with ISH. Early detection, protection of target organs, correction of high BP will develop, promote, and corroborate healthy aging.

Acetoin is an important bio-product useful in the chemical, food and pharmaceutical industries. Microbial fermentation is the major process for the production of bioacetoin, as the petroleum resources used in chemical methods are depleting day by day. Bioacetoin production using wild microorganisms is an easy, eco-friendly and economical method for the production of bioacetoin. In the present study, culture conditions and nutritional requirements were optimized for bioacetoin production by a wild and non-pathogenic strain of B. subtilis subsp. subtilis JJBS250. The bacterial culture produced maximum bioacetoin (259 mg L−1) using peptone (3%) and sucrose (2%) at 30 °C, 150 rpm and pH 7.0 after 24 h. Further supplementation of combinatorial nitrogen sources, i.e., peptone (1%) and urea (0.5%), resulted in enhanced titre of bioacetoin (1017 mg L−1) by the bacterial culture. An approximately 46.22–fold improvement in bioacetoin production was achieved after the optimization process. The analysis of samples using thin layer chromatography confirmed the presence of bioacetoin in the culture filtrate. The enzymatic hydrolysate was obtained by saccharification of pretreated rice straw and sugarcane bagasse using cellulase from Myceliophthora thermophila. Fermentation of the enzymatic hydrolysate (3%) of pretreated rice straw and sugarcane bagasse by the bacterial culture resulted in 210 and 473.17 mgL−1 bioacetoin, respectively. Enzymatic hydrolysates supplemented with peptone as a nitrogen source showed a two to four-fold improvement in the production of bioacetoin. Results have demonstrated the utility of wild type B. subtilis subsp. subtilis JJBS250 as a potential source for economical bioacetoin production by making use of renewable and cost-effective lignocellulosic substrate. Therefore, this study will help in the sustainable management of agricultural waste for the industrial production of bioacetoin, and in combating environmental pollution.

Background and Objectives: COVID-19 pandemic took a significant toll on all, especially elderly individuals, who seem to have a higher risk for severe disease and mortality. We aim to study the clinicoepidemiological profile of COVID-19 in elderly patients of South-Eastern Rajasthan and to assess its severity and outcome. Methods: A retrospective analysis of 200 reverse transcription-polymerase chain reaction confirmed COVID-19 patients aged ≥60 years admitted between May and October 2020 in the dedicated COVID hospital of a tertiary care center of South-Eastern Rajasthan was done. Results: The median age of patients was 66 years (interquartile range [IQR]: 63–72 years). Twenty-five percent, 26.5%, and 48.5% cases fell under mild, moderate, and severe disease, respectively, with 52 nonsurvivors. The mean age of severe (68.78 ± 7.20 years) cases was significantly more than that of mild ones (65.96 ± 5.29 years, P = 0.048). Males (70.5%) and urban population (90%) were more affected than females (29.5%) and the rural ones (10%). 67.5% patients had comorbidities. The presence of multiple comorbidities was significantly associated with increased severity (P = 0.03). The median duration of symptoms was 4 days (IQR: 3–7 days). 19% presented asymptomatically. Complications included acute respiratory distress syndrome (47%), renal impairment (31%), hepatic dysfunction (30%), myocardial injury (30%), shock (10.5%), stroke (2%), encephalopathy (2%), acute STEMI (1.5%), deep vein thrombosis (1%), and heart failure (1%). The presence of dyspnea (P = 0.000), desaturation (P = 0.000), leukocytosis (P = 0.000), neutrophilia (P = 0.000), lymphopenia (P = 0.000), high neutrophil-to-lymphocyte ratio (P = 0.000), hyperglycemia (P = 0.015), renal impairment (P = 0.024), elevated creatine kinase-MB (P = 0.020), raised transaminases (P = 0.002), hypoproteinemia (P = 0.003), hypoalbuminemia (P = 0.000), A:G ratio reversal (P = 0.000), low high-density lipoprotein cholesterol (P = 0.000), and higher computed tomography severity score (P = 0.000), all were associated with both increased severity and mortality. Need of vasopressor support was significantly associated with older age (P = 0.022). Conclusion: Increasing age, multiple comorbidities, severe category, and complications are associated with poor prognosis in elderly patients.

Objective: To compare and assess the primary and secondary closure techniques following extraction of impacted third molars for post-operative complications. Material and Methods: In total, 30 patients ranging between 18-30 years of age and of either sex who had bilaterally impacted mandibular third molars were randomly selected. Split mouth study method was used so that the participants served as their own control. Group 1 consisted of primary closure of left mandibular impacted third molars and Group 2 consisted of secondary closure of right mandibular impacted third molars. Basement evaluations were recorded for each patient along with subjective and objective evaluations for postoperative 7 days. Data analysis was carried out by SPSS 17.0 software using Mann-Whitney U test, Wilcoxon matched-pairs test and t-test. A p-value ≤ 0.05 was assigned as statistically significant. Results: When compared to group 1, group 2 revealed statistically less pain and swelling following the secondary closure of wound from day 1 to 7. There was a significant improvement in mouth opening in Group 2 at day 1 (p=0.0005) and at day 7 (p=0.00001). Conclusion: Secondary wound closure after disimpaction of mandibular third molar results in better postoperative recovery than primary closure.

Introduction: Increasing geriatric population imposes a significant burden on health-care resources. Compromised immunity and decreased organ reserves make them vulnerable for morbidity and mortality from various diseases. We aim to study the clinical profile of elderly patients hospitalized with systemic inflammatory response syndrome (SIRS) and identify factors predicting inhospital mortality. Materials and Methods: One hundred and two elderly patients (>60 years) fulfilling two or more SIRS criteria admitted between March 2019 and January 2020 in a tertiary care hospital of North India are prospectively studied. Results: The mean age of patients is 69.7 years. Hypertension (32.35%), chronic obstructive pulmonary disease (27.45%), and diabetes mellitus (20.58%) are common comorbidities. 65.6% of patients have SIRS with one or more organ dysfunction, and 29.4% have septic shock. Fever (73.52%) and cough (56.86%) are the most common presenting symptoms. The respiratory system is affected in 78 (76.47%) patients, followed by renal involvement in 66 (64.70%) patients. Thirty-nine (38.23%) patients need intensive care unit (ICU) care, 25 (24.50%) patients require mechanical ventilation, and 30 (29.11%) patients require inotropic support. Overall mortality is 35.3%. Factors associated with inhospital mortality need ICU care, organ dysfunction, septic shock, and need for mechanical ventilation and vasopressors. Conclusion: Geriatric patients hospitalized with SIRS have a high prevalence of multiple organ dysfunction, septic shock, ICU occupancy, and need for advanced life support along with increased overall and ICU mortality rate. This signifies the need for specialized geriatric ICUs and focused policymaking and allocation of health-care resources for geriatric care.

Primitive Neuroectodermal Tumour (PNET) is a member of small round cell “Blue tumour” family. The overall incidence of PNET is

Objective: To study all aspects of delirium including occurrence, risk factors, precipitating causes and outcome in tertiary care hospital catering geriatric medicine services. Methods: A prospective observational study was done among 100 cases of delirium recruited from 520 patients admitted in geriatric block of general medicine ward during a calendar year. Patients were screened for delirium by confusion assessment method. Prevalent delirium and incident delirium was calculated. A set of predisposing risk factors were sought on admission. The cause of delirium was ascertained after full evaluation of patients by taking history, doing physical examination including neurological examination and appropriate investigations. Outcomes were measured in terms of length of hospital stay and inpatient mortality. Results: Out of 520 patients admitted in Geriatric ward during the study period, 100 patients had delirium (study prevalence 19.23%) and out of these, 7 patients developed delirium during hospitalization (study incidence 1.34%). The most common precipitating causes of delirium was infections (41%), followed by stroke (17%) and electrolyte imbalance (11%). Among infections, UTI was the most common cause. The most common predisposing risk factors for delirium were infections (52%), sensory impairment (51%), immobility/ being bedridden (40%), incontinence (32%), hypoxia (29%), electrolyte disturbances (hyponatremia- 22%), dehydration (21%), and poly pharmacy (15%). At the end of the study, mortality was 24% and 38 (38%) patients were recovered from the delirium. Conclusion: Delirium was found in 19.23% admitted geriatric patients and associated with considerable mortality (24%). The most common precipitating and predisposing causes of delirium was infection. After effective management, 38 (38%) patients recovered from delirium and were discharged in stable condition.

We report a case of Broken Heart Syndrome in a 56 year old Postmenopausal woman suffered while undergoing simple biopsy procedure for vocal cord polyp that lead to physical, mental and financial burden both for the patient as well as the doctors. A team of cardiologists based on clinical and echocardiographic findings made the diagnosis of this case.

We report a case of 18-year-old female patient with large patent ductus arteriosus (PDA)-preductal coarctation of descending thoracic aorta. She underwent large PDA closure with a prosthetic graft from ascending aorta to descending thoracic aorta by mid-sternotomy on cardiopulmonary bypass machine under total hypothermic circulatory arrest.

Purpose: The present study compared the efficacy of two different doses of labetalol, for attenuation of hemodynamic response to laryngoscopy and intubation in hypertensive patients. Patients and methods: 75 hypertensive patients, aged 18–60 years undergoing elective surgical procedures, require general anesthesia and orotracheal intubation. Patients were allocated to any of the three groups (25 each), Group C (control) 5 ml 0.9% saline. Group L1 (labetalol) 0.15 mg/kg diluted with 0.9% saline to 5 ml. Group L2 (labetalol) 0.3 mg/kg diluted with 0.9% saline to 5 ml. In the control group 5 ml of 0.9% saline was given i.v. 5 min prior to intubation. In the L1 group 0.15 mg/kg of labetalol was given i.v. 5 min prior to intubation. In the L2 group 0.3 mg/kg of labetalol was given i.v. 5 min prior to intubation. All the patients were subjected to the same standard anesthetic technique. Heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded prior to induction, at time of intubation and 1, 3, 5, and 10 min after intubation. Mean arterial pressure (MAP) and rate pressure product (RPP) were calculated. Results: Compared to placebo both the doses of labetalol (0.15 mg/kg) and (0.3 mg/kg) significantly attenuated the rise in heart rate, systolic blood pressure, and RPP during laryngoscopy and intubation. However, the difference was not statistically significant between both doses of labetalol at intubation, 1 min, 3 min and 10 min post-intubation. Conclusion: Both doses of labetalol (0.15 mg/kg and 0.3 mg/kg) attenuate hemodynamic response to laryngoscopy and intubation in dose dependent manner.

Autonomic dysreflexia is a potentially dangerous clinical emergency associated with spine injury at or above T6 level. Identification of triggering factor and its removal is a very important for the management of this condition. We hereby report a rare presentation of autonomic dysreflexia in a 57-year-old male, a case of D9–L1 arteriovenous malformation (AVM) with prolapsed intervertebral disc L3–L4 who underwent laminectomy from D6 to L4 level followed by excision of the AVM under general anaesthesia. He developed symptoms and signs suggestive of autonomic dysreflexia following application of intermittent compression pneumatic stockings which were reversed after the removal of the stimulus. Application of intermittent compression pneumatic stockings is an unusual cause of autonomic dysreflexia.

Objectives-Optimum Revascularization strategy in very elderly population with Acute Coronary Syndrome (ACS) is currently unclear. There is reluctance on the part of physicians to recommend Percutaneous Coronary Interventions (PCI) in India because of financial constrains and fear of the complications. In this retrospective analysis we aimed to identify the demographic profile and acute outcomes of very elderly patients who have undergone percutaneous coronary intervention as compared to those treated conservatively. Material and Methods -Out of total cohort of 198 patients more than 80 years of age, data of 45 patients (23%) who underwent percutaneous coronary intervention were retrospectively analyzed for demographic profile, treatment strategy and short term outcomes compared with 153 conservatively treated patients. Results- Over a period of 3.5 year, 198 patients in the very elderly group were admitted with ACS. PCI was performed in 23% of them. Patients treated with PCI were younger (84 vs 87 year), had less number of diseased vessels (1.8 vs 2.4), better LV function at admission (EF 51.3% vs 43.0%) and had less co- morbidities. In-hospital and 1 month post discharge mortality was lower in patients treated with PCI (8.8% vs 22.2% and 11.1% vs 26.1%). They also had lower re-hospitalization rate for heart failure than those treated conservatively (8.9% vs 23.5%). Conclusion- PCI may yield better results than conservative treatment strategy in carefully selected octogenarians with one or two vessel disease with preserved ejection fraction and minimal co-morbidities who are not at a very high risk of acute contrast induced kidney injury.

The importance of evidence in health care teaching in order to orient the practitioners to the great amount of scientific information, and to support clinical decisions, is well established in health care, including density. The practice of evidence-based medicine is a process of lifelong, self-directed, problem-based learning which leads to the need for clinically important information about diagnosis, prognosis, therapy and other clinical and health care issues. Nowadays the practice of dentistry is becoming more complex and challenging because of the continually changing dental materials and equipments, an increasingly litigious society, an increase in the emphasis of continuing professional development, and information explosion and the consumer movement associated with advances on the internet. Aim of evidence-based practice is the systematic literature review, which synthesizes the best evidences and provides the basis for clinical practice guidelines.

In recent years, there has been an increase in the number of livestock-associated methicillin resistant Staphylococcus aureus (LA-MRSA) clonal complex (CC) 398 recovered from S. aureus isolated animals in the UK. To determine possible origins of 12 LA-MRSA CC398 isolates collected after screening more than a thousand S. aureus animal isolates from the UK between 2013- 2015, , whole genome sequences (WGS) of CC398 European, including UK, and non-European isolates from diverse animal hosts were compared. Phylogenetic reconstruction applied to WGS data to assess genetic relatedness of all 89 isolates, clustered the 12 UK CC398 LA-MRSA within the European sub-lineages, although on different nodes; implicating multiple independent incursions into the UK, as opposed to a single introduction followed by clonal expansion. Three UK isolates from healthy pigs and one from turkey clustered within the cassette chromosome recombinases (ccr)C S. aureus protein A (spa)-type t011 European sub-lineage and three UK isolates from horses within the ccrA2B2 t011 European sub-lineage. The remaining UK isolates, mostly from pigs, clustered within the t034 European lineage. Presence of virulence, antimicrobial (AMR), heavy metal (HMR), and disinfectant (DR) resistance genes were determined using an in-house pipeline. Most, including UK isolates, harboured resistance genes to ≥3 antimicrobial classes in addition to β-lactams. HMR genes were detected in most European ccrC positive isolates, with >80% harbouring czrC, encoding zinc and cadmium resistance; in contrast ~60% ccrC isolates within non-European lineages and 6% ccrA2B2 isolates showed this characteristic. The UK turkey MRSA isolate did not harbour φAVβ avian prophage genes (SAAV_2008 and SAAV_2009) present in US MSSA isolates from turkey and pigs. Absence of some of the major human-associated MRSA toxigenic and virulence genes in the UK LA-MRSA animal isolates was not unexpected. Therefore, we can conclude that the 12 UK LA-MRSA isolates collected in the past two years most likely represent separate incursions into the UK from other European countries. The presence of zinc and cadmium resistance in all nine food animal isolates (pig and poultry), which was absent from the 3 horse isolates may suggest heavy metal use/exposure has a possible role in selection of some MRSA.

Introduction: Most of the children suffer from severe anxiety and apprehension when they are separated from their parents or family members for the induction of anaesthesia. Materials and Methods: In a prospective randomized double blind study, the intra-nasal and sub-lingual administration of midazolam in paediatric patients who were undergoing root canal procedures which required general anaesthesia was evaluated in 60 children who were aged between 2-6 years, with ASA physical status I and II by using a new midazolam atomiser spray. The patients were divided into two groups of 30 patients each and they received midazolam 0.3mgkg-1 either intranasally or sub-lingually in a randomized manner. The heart rate, oxygen saturation (spo2), respiratory rate and the degree of sedation before and at 5 min, 10 min and 15 min (separation score) after the drug administration, during the mask application (mask acceptance score), before induction (induction score) and during the recovery at 10 min, 20min and 30mins (recovery score) were recorded and compared. Results: In our study, 60% of the paediatric patients cried during the administration of midazolam by the intra-nasal route, while only 16% of the paediatric patients cried during its administration by the sub-lingual route. A bitter taste was observed in 45% (14/30) of the patients who received midazolam by the sublingual route. Although there was a slight increase in the heart rate in the intra-nasal group, no statistically significant variation in the heart rate, the respiratory rate and the oxygen saturation was found from the baseline in both the groups (P>0.05). A sedation score of >3(approx) was achieved in both the groups within 10 minutes of the drug administration. The response to the child parent separation, the mask application score , the induction score and the recovery score did not differ significantly between the two groups ( P >0.05). Conclusion: Both the intra-nasal and sub-lingual administration of midazolam as a Pre-medication is safe and equally effective in paediatric patients.

The putative virulence and antimicrobial resistance gene contents of extended spectrum β-lactamase (ESBL)-positive E. coli (n=629) isolated between 2005 and 2009 from humans, animals and animal food products in Germany, The Netherlands and the UK were compared using a microarray approach to test the suitability of this approach with regard to determining their similarities. A selection of isolates (n=313) were also analysed by multilocus sequence typing (MLST). Isolates harbouring bla(CTX-M-group-1) dominated (66%, n=418) and originated from both animals and cases of human infections in all three countries; 23% (n=144) of all isolates contained both bla(CTX-M-group-1) and bla(OXA-1-like) genes, predominantly from humans (n=127) and UK cattle (n=15). The antimicrobial resistance and virulence gene profiles of this collection of isolates were highly diverse. A substantial number of human isolates (32%, n=87) did not share more than 40% similarity (based on the Jaccard coefficient) with animal isolates. A further 43% of human isolates from the three countries (n=117) were at least 40% similar to each other and to five isolates from UK cattle and one each from Dutch chicken meat and a German dog; the members of this group usually harboured genes such as mph(A), mrx, aac(6')-Ib, catB3, bla(OXA-1-like) and bla(CTX-M-group-1). forty-four per cent of the MLST-typed isolates in this group belonged to ST131 (n=18) and 22% to ST405 (n=9), all from humans. Among animal isolates subjected to MLST (n=258), only 1.2% (n=3) were more than 70% similar to human isolates in gene profiles and shared the same MLST clonal complex with the corresponding human isolates. The results suggest that minimising human-to-human transmission is essential to control the spread of ESBL-positive E. coli in humans.

Objectives: The purpose of the study was to establish the role of ultrasonography in determining the involvement of specific fascial spaces in maxillofacial region and the stage of infection, in indicating the appropriate time for surgical intervention and to compare clinical and ultrasonographic findings.Material and Methods: Twenty five patients with fascial space infection in maxillofacial region were subjected to ultrasonographic examination following a detailed clinical and radiological examination. Ultrasonography guided needle aspiration was performed. Based on the findings, patients diagnosed with abscess were subjected to incision and drainage and those with cellulitis were subjected to medical line of treatment.Results: More than one fascial space was involved in all patients. On clinical examination 64 spaces were involved, of them 34 spaces had abscess formation and 30 spaces were in the stage of cellulitis. On ultrasonography examination, 28 spaces were reported to have abscess formation and 36 spaces were diagnosed to be in the stage of cellulitis. On comparative analysis of both clinical and ultrasonographic findings, ultrasonography was found to be sensitive in 65% of the cases and having specificity of 80%. It was registered statistically significant (P < 0.001) agreement between these two methods of assessment (kappa index = 0.814).Conclusions: Ultrasonography is a quick, widely available, relatively inexpensive, and painless procedure and can be repeated as often as necessary without risk to the patient. Thus ultrasonography is a valuable diagnostic aid to the oral and maxillofacial surgeon for early and accurate diagnosis of fascial space infection, their appropriate treatment and to limit their further spread.

The title compound, C14H21Br2N2+·C7H7O3S−, features a salt of protonated bromhexine, a pharmaceutical used in the treatment of respiratory disorders, and the p-toluenesulfonate anion. The crystal packing is stabilized by intermolecular N—H...O, N—H...Br and C—H...O hydrogen bonds.