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The utility of basic intensive care unit (ICU) training comprising a "1-day course" has been scientifically evaluated and reported in very few studies, with almost no such study from resource-limited settings.The study assessed the utility of basic ICU training comprising of a "1-day course" in increasing the knowledge of nonintensivist doctors.This is an observational study conducted at a medical university in North India in 2020. The participants were nonintensivist doctors attending the course. The course was designed by intensivists, and it had four domains. The participants were categorised on the basis of their duration of ICU experience and broad speciality. Pretest and posttest was administered, which was analysed to ascertain the gain in the knowledge score.A total of 252 participants were included, of which the majority were from the clinical medicine speciality (85.3%) and had ICU experience of 1-6 months (47.6%). There was a significant improvement in the mean total score of the participants after training from 14/25 to 19/25, with a mean difference (MD) of 5.02 (p 0.001). Based on ICU experience, in groups I (1 month), II (1-6 months), and III (6 months), there was a significant improvement in the total score of the participants after training with MD with 95% confidence interval (CI) limits of 5.27 (4.65-5.90), 4.70 (4.38-5.02), and 5.33 (4.89-5.78), respectively. In the clinical surgery specialty (n = 37), there was a significant improvement in the total score after training from 11/25 to 16.4/25 with an MD (95% CI limits) of 5.38 (4.4-6.3). Similarly, in the clinical medicine group (n = 215), the MD (95% CI limits) score after training was 4.95 (4.71-5.20), from 14.5/25 to 19.5/25. In feedback, more than half of the participants showed interest in joining ICU after training.Training nonintensivist doctors for 1 day can be useful in improving their knowledge, regardless of their prior ICU experience and speciality.

Background: There is insufficient evidence to guide ventilatory targets in acute brain injury (ABI). Recent studies have shown associations between mechanical power (MP) and mortality in critical care populations. We aimed to describe MP in ventilated patients with ABI, and evaluate associations between MP and clinical outcomes. Methods: In this preplanned, secondary analysis of a prospective, multi-center, observational cohort study (ENIO, NCT03400904), we included adult patients with ABI (Glasgow Coma Scale ≤ 12 before intubation) who required mechanical ventilation (MV) ≥ 24h. Using multivariable log binomial regressions, we separately assessed associations between MP on hospital day (HD)1, HD3, HD7 and clinical outcomes: hospital mortality, need for reintubation, tracheostomy placement, and development of acute respiratory distress syndrome (ARDS). Results: We included 1217 patients (mean age 51.2years [SD 18.1], 66% male, mean body mass index [BMI] 26.3 [SD 5.18]) hospitalized at 62 intensive care units in 18 countries. Hospital mortality was 11% (n = 139), 44% (n = 536) were extubated by HD7 of which 20% (107/536) required reintubation, 28% (n = 340) underwent tracheostomy placement, and 9% (n = 114) developed ARDS. The median MP on HD1, HD3, and HD7 was 11.9J/min [IQR 9.2-15.1], 13J/min [IQR 10-17], and 14J/min [IQR 11-20], respectively. MP was overall higher in patients with ARDS, especially those with higher ARDS severity. After controlling for same-day pressure of arterial oxygen/fraction of inspired oxygen (P/F ratio), BMI, and neurological severity, MP at HD1, HD3, and HD7 was independently associated with hospital mortality, reintubation and tracheostomy placement. The adjusted relative risk (aRR) was greater at higher MP, and strongest for: mortality on HD1 (compared to the HD1 median MP 11.9J/min, aRR at 17J/min was 1.22, 95% CI 1.14-1.30) and HD3 (1.38, 95% CI 1.23-1.53), reintubation on HD1 (1.64; 95% CI 1.57-1.72), and tracheostomy on HD7 (1.53; 95%CI 1.18-1.99). MP was associated with the development of moderate-severe ARDS on HD1 (2.07; 95% CI 1.56-2.78) and HD3 (1.76; 95% CI 1.41-2.22). Conclusions: Exposure to high MP during the first week of MV is associated with poor clinical outcomes in ABI, independent of P/F ratio and neurological severity. Potential benefits of optimizing ventilator settings to limit MP warrant further investigation.

This paper describes the emerging role of robots in health care and integrated environments with special concerns related to the management and control of the spread of novel coronavirus 2019. The primary use of such robots is to reduce human interaction and to ensure cleanliness, fertility, and support in the hospitals and facilities such as isolation. This will lead to a reduction in the life-threatening risk for medical professionals and physicians who have played a significant role in the management of infectious diseases like coronavirus. The purpose of this work is to highlight the importance of medical robots in general and to link their use in the field of medical assistance so that hospital administrators can use the medical robots for different treatment processes. The work involves the design and development of an AUTONOMOUS and IoT CONTROLLED MEDICAL ASSISTANCE ROBOT (AIMED) which is designed as a potential answer for any irresistible ailment particularly for Coronaviruses Outbreak. AIMED ROBOT is utilized to limit individual to-individual contact and to guarantee cleaning, sanitization and backing in emergency clinics and comparable offices, for example, food and medication conveyance in isolate emergency clinics/offices. Voice communication can also be established between control room and patient through wireless network. This data is sent to the doctor and staff using communication network which help in monitoring the patient condition without human interaction. Hand Sanitization, food delivery and waste collection system is also provided in the robot for quarantine zones. This is despite the popularity of telemedicine, which also applies to similar situations. In fact, the recent success of the Korean and Chinese health sectors in gaining effective control of the coronavirus epidemic would not have been possible without the use of state-of-the-art technology. Background: In the quick advancement of innovation, there are numerous sorts of robots with different details and capacities. The AIMED Robots are being developed for hospitals to deliver medicines, food and for taking live data from patient by self. A few issues are confronted in regards to the limitation of explicit places around and inside the clinic on the grounds that different robots were utilizing landmark recognition. Along these lines, to take care of this issue in which the robot can convey things to any patient from anyplace. Objective: The objective of this work is to highlight the importance of medical robots in general and to link their use in the field of medical assistance so that hospital administrators can use the medical robots for different treatment processes. Methods: The work involves the design and development of an AUTONOMOUS and IoT CONTROLLED MEDICAL ASSISTANCE ROBOT (AIMED) which is designed as a potential answer for any irresistible ailment particularly for Coronaviruses Outbreak. Results: AIMED Robot goes through three testing stages. In the final stage one complete embedded system is designed by embedding each tested sub-system and then this final embedded system is tested. All the project goals which was planned as ‘Solution to Problem Statement’, has been achieved properly. Conclusion: This paper provides an overview of the robotics and therapeutic potential of robotics in specific environments with COVID-19 epidemic control. The AIMED robot introduced in this paper is a piece of emergency clinic and care focus computerization framework. Multiple patients are placed for stop-over, doctor prescription regarding the patient health. It can be very useful to counter infectious disease like SARS, MERS or Covid-19 etc. This work confirms that the introduction of medical robots has significantly increased the safety and quality of health care systems compared to manual systems due to the digitalization of health care.

Background Diabetes is among the most prevalent diseases worldwide, of all the affected individuals a significant proportion of the population remains undiagnosed due to lack of specific symptoms early in this disorder and inadequate diagnostics. Diabetes and its associated sequela, i.e., comorbidity are associated with microvascular and macrovascular complications. As diabetes is characterized by an altered metabolism of key metabolites and regulatory pathways. Metabolic phenotyping can provide us with a better understanding of the unique set of regulatory perturbations that predispose to diabetes and its associated complication/comorbidities. Methodology The present study utilizes the analytical platform NMR spectroscopy coupled with Random Forest statistical analysis to identify the discriminatory metabolites in diabetes (DB = 38) vs. diabetes-related complication (DC = 35) along with the healthy control (HC = 50) subjects. A combined and pairwise analysis was performed to identify the discriminatory metabolites responsible for class separation. The perturbed metabolites were further rigorously validated using t-test, AUROC analysis to examine the statistical significance of the identified metabolites. Results The DB and DC patients were well discriminated from HC. However, 15 metabolites were found to be significantly perturbed in DC patients compared to DB, the identified panel of metabolites are TCA cycle (succinate, citrate), methylamine metabolism (trimethylamine, methylamine, betaine), -intermediates; energy metabolites (glucose, lactate, pyruvate); and amino acids (valine, arginine, glutamate, methionine, proline, and threonine). Conclusion The 1H NMR metabolomics may prove a promising technique to differentiate and predict diabetes and its complication on their onset or progression by determining the altered levels of the metabolites in serum.

Background: Diabetes is among the most prevalent diseases worldwide, of all the affected individuals a significant proportion of the population remains undiagnosed because of a lack of specific symptoms early in this disorder and inadequate diagnostics. Diabetes and its associated sequela, i.e., comorbidity are associated with microvascular and macrovascular complications. As diabetes is characterized by an altered metabolism of key metabolites and regulatory pathways. Metabolic phenotyping can provide us with a better understanding of the unique set of regulatory perturbations that predispose to diabetes and its associated comorbidities. Methodology: The present study utilizes the analytical platform NMR spectroscopy coupled with Random Forest statistical analysis to identify the discriminatory metabolites of diabetes (DB) and diabetes-related comorbidity (DC) along with the healthy control (HC) subjects. A combined and pairwise analysis was performed, between the serum samples of HC (n=50), and DB (n=38), and DC (n=35) individuals to identify the discriminatory metabolites responsible for class separation. The perturbed metabolites were further rigorously validated using t-test, AUROC analysis to examine the statistical significance of the identified metabolites. Results: The DB and DC patients were well discriminated from HC. However, 15 metabolites were found to be significantly perturbed in DC patients compared to DB, the identified panel of metabolites are TCA cycle (succinate, citrate), methylamine metabolism (trimethylamine, methylamine, betaine), -intermediates; energy metabolites (glucose, lactate, pyruvate); and amino acids (valine, arginine, glutamate, methionine, proline and threonine). The metabolites were further used to identify the perturbed metabolic pathway and correlation of metabolites in DC patients. Conclusion: The 1H NMR metabolomics may prove a promising technique to differentiate and predict diabetes and its comorbidities on their onset or progression by determining the altered levels of the metabolites in serum.

In this paper, we propose an automated approach that combines the generalized discriminant analysis (GDA) as feature reduction scheme with radial basis function (RBF) kernel and the online sequential extreme learning machine (OSELM) having Sigmoid, Hardlim, RBF and Sine activation function as binary classifier for detection of congestive heart failure (CHF) and coronary artery disease (CAD). For this analysis, 13 nonlinear features as Correlation Dimension (CD), Detrended Fluctuation Analysis (DFA) as DFA-[Formula: see text]1 and DFA-[Formula: see text]2, Bubble Entropy (BBEn), Sample Entropy (SampEn), Dispersion Entropy (DISEn), Lempel–Ziv Complexity (LZ), Sinai Entropy (SIEn), Improved Multiscale Permutation Entropy (IMPE), Hurst Exponent (HE), Permutation Entropy (PE), Approximate Entropy (ApEn) and Standard Deviation (SD1/SD2) were extracted from Heart Rate Variability (HRV) signals. For validation of proposed method, HRV data were obtained from standard database of normal sinus rhythm (NSR), CHF and CAD subjects. Numerical experiments were done on the combination of database sets such as NSR-CAD, CHF-CAD and NSR-CHF subjects. The simulation results show a clear difference in combination of database sets by using GDA having RBF, Gaussian kernel function and OSELM binary classifier having Sigmoid, RBF and Sine activation function and achieved an accuracy of 98.17% for NSR-CAD, 100% for NSR-CHF and CAD-CHF subjects.

Background: An evaluation of intrathecal hyperbaric ropivacaine without adjuvant and with adjuvant magnesium for lower abdominal surgeries.Methods: This was a prospective, randomized, double-blind study conducted among the patients aged 18 to 60 years planned for lower abdomen surgeries under spinal anaesthesia and ASA grade I or II. Patients were randomly allocated to two groups (30 in each): ropivacaine Group (R group): spinal anesthesia with 3ml of 0.6% hyperbaric ropivacaine (18mg )+ 0.5ml NS. hyperbaric ropivacaine + Magnesium Group (R+M group ): spinal anesthesia with 3ml of 0.6% hyperbaric ropivacaine (18mg) + 0.5ml magnesium sulphate (50 mg). All the patients scheduled for operation were given oral tablets ranitidine 150 mg and Alprazolam 0.25mg in the night before surgery.Results: There was no significant difference in the basic characteristics between the groups. The mean HR, MAP and SpO2 in both the groups decreased over the periods as compared to baseline. However, the trend of HR over the periods remains similar in both R and R+M groups. The bromage levels were significantly (p=0.0001) higher among the patients of Group R compared with R+M. The 2 segment sensory regression (min), Sensory regression S2 (hr), motor recovery (hrs) and long term mobilization after spinal anesthesia were significantly (p=0.0001) lower among the patients of Group R compared with R+M. The complications were lower in Group R+M than R.Conclusions: Magnesium may be more suitable drug in surgeries in which muscle relaxation has greater value in lower abdominal surgeries.

Background: The low-dose ropivacaine provides differential spinal block to reduce adverse hemodynamic effects in elderly patients. Addition of intrathecal fentanyl with ropivacaine may enhance analgesia and early postoperative mobility. The present study was performed to evaluate the efficacy of intrathecal ropivacaine alone and in combination with fentanyl in transurethral resection operation. Methods: Sixty male patients aged >50 years of ASA I-III scheduled for elective transurethral resection were included in a prospective, randomized, double-blinded study and they were divided in two groups of 30 each. Group A (n = 30) received intrathecal injection of ropivacaine 2 ml (0.75%) and Group B (n = 30) ropivacaine 1.8 ml (0.75%) with fentanyl 10 μg. The characteristics of onset and regression of sensory and motor blockade, hemodynamic stability, and side effects were observed. Student's t test (for parametric data) and Mann-Whitney U test (for non-parametric data) were used for statistical analyses. Results: There were no significant differences between the two groups for patient demographic data, intraoperative hemodynamic parameters, side effects, and satisfaction to patients and surgeon. The highest level of sensory block was at T10 in group A and T9 in group B (P = 0.001). Duration of motor block was longer in group B being 210.51 ± 61.25 min than in group A being 286.25 ± 55.65 min (P < 0.001). Conclusion: The addition of fentanyl to ropivacaine may offer the advantage of shorter duration of complete motor block, hemodynamic stability, and without any increase in the frequency of major side effects.

Objective: To compare the effect of intraperitoneal ropivacaine with placebo for post-operative pain management in patients undergoing laparoscopic cholecystectomy. Material and Methods: All patients were pre-medicated with glycopyrrolate 0.2 mg, ondansetron 4 mg and ranitidine 150 mg intravenously half an hour prior to induction of anesthesia. All patients were given standard general anaesthesia with propofol (2-2.5 mg/kg), fentanyl 2 μg/kg, and succinylcholine (2 mg/kg) to facilitate tracheal intubation. Anesthesia was maintained with 60% N2O in oxygen with 0.5% to 1% Halothane. Group A: Patients received 20 ml of 0.9% normal saline as placebo (n = 25). Group B: Patients received 20 ml of 0.5% ropivacaine (n = 25). Results: The age and sex distribution of both the groups was similar. The heart rate, systolic & diastolic blood pressure, mean blood pressure and mean trend of SpO2 in both groups remained similar over the periods. The mean VAS varied considerably within (between time) and between the groups (treatment) and was especially comparatively higher in Group A at initial hours 15 min to 30 min and at end hours 12-24 hrs as compared with Group B. On an average, the frequent dosing of rescue analgesia and mean No. of rescue analgesia doses were higher in Group A followed by Group B. In both groups, the treatment related adverse events were mostly emetic symptoms and shoulder pain with the highest being in Group A. Conclusion: We conclude that intraperitoneal instillation of local anaesthetic is an easy, cheap, and non-invasive method which provides good analgesia in the immediate postoperative period after laparoscopic surgery.

Objective: To compare the laryngoscopic view and the hemodynamic changes by using flexitip McCoy laryngoscope with Macintosh laryngoscope. Method: Study design-Prospective randomized controlled study. A total of 220 patients were included in the study. Patients were allocated on the basis of their airway anatomy in to two groups, one is predicted easy group and the other one was predicted difficult airway group. Among each group, half of the patient intubation was performed with Macintosh blade and the other half was intubated with the help of McCoy blade. The airway prediction was done on the basis of Mallampati grade, thyromental distance, inter incisor gap, jaw protrusion and weight of the patient. Larygoscopic view and hemodynamic changes were recorded. Results: The change in pulse rate was significantly (p = 0.01) higher among the patients of Group B (85.02 ± 10.13) as compared to Group A (79.20 ± 13.11) after induction in predicted easy patients. Similar observation was found for pulse rate after laryngoscopy among both predicted easy and difficult patients. The diastolic blood pressure was significantly (p = 0.0001) higher in Group B (86.34 ± 9.78) than Group A (77.12 ± 11.66) after induction among predicted easy patients. However, diastolic blood pressure was significantly (p = 0.0004) higher in Group A (82.00 ± 10.98) compared with Group B (75.00 ± 9.06) after induction among predicted difficult patients. The average time taken during laryngoscopy was in-significantly (p > 0.05) higher in Group B (13.90 ± 5.95) compared with Group A (12.42 ± 3.58) among predicted easy patients. However, the time taken was significantly (p = 0.0001) higher in Group A (20.83 ± 2.47) than Group B (12.66 ± 3.0) in predicted difficult patients. A majority of the patients of both the groups were in Grade I (Group A = 61.8%, Group B = 81.8%) followed by Grade II (Group A = 38.2%, Group B = 18.2%) among predicted easy patients. Conclusion: It was concluded that the McCoy blade may be an answer to Macintosh blade in difficult airway cases, but not the substitute of Macintosh blade in every case. The McCoy blade improved laryngeal view in patients with limited neck extension.

Background: Difficult intubation is always a nightmare for an Anaesthetist. This study was planned to study the alternative method of stylet use during difficult oro-tracheal intubation. Outcome measures assessed were ease of intubation, hemodynamic stability and reducing complications. Materials and Methods: A cohort of 60 patients of Mallampati class III patients was formed and patients were divided into two groups. In group 1 patients, conventional through tube method was used for inserting stylet, whereas, in group 2 patients, Murphy's eye was used for inserting malleable flexi tip stylet. Results: Hemodynamic stability in terms of mean arterial blood pressure and heart rate was observed in group 2. Intubating time, number of attempts of successful intubation and post operative pharyngo-laryngeal complications was also low in group 2 patients. Conclusion: The use of Murphy's eye to pass stylet during difficult airway manoeuvre is a safe alternative over conventional rail-road technique.

Different batches of bulk vaccine, final bulk at in-process level, finished freeze-dried and reconstituted Japanese encephalitis vaccine were assayed for their stability at temperatures of 22, 37 and 40 degrees C. After ultrazonal purification of 50 times concentrated brain suspension, JE Bulk vaccine was found to be stable for up to 2 years at 4 degrees C, however, the percentage loss in potency (log 10 N antibody titre) after 2.5 years was 24%. Three-times concentrated final bulk showed rapid deterioration by the fourth week at 37 and 40 degrees C. Freeze-dried JE vaccine maintained at 22 degrees C for 28 weeks did not show perceptible deterioration. At 37 degrees C, the same vaccine started showing deterioration (14%) after 8 weeks whereas at 40 degrees C the loss of potency was 24% after 8 weeks. The freeze-dried vaccine was found to be stable for up to 2 weeks duration at 40 degrees C.

Whipple's operation can be carried out either under general anaesthesia or continuous epidural anaesthesia with sedation. We report three cases that were managed successfully and we found that the combination of lumbar epidural analgesia with sedation is safer and beneficial as compared to those who undergo Whipple's operation under general anaesthesia. For the last three decades epidural analgesia has been the part of anaesthesia practice. Epidural analgesia can be a useful method of pain management various situations. It facilitates early mobilization and also avoids perioperative pulmonary complications especially after major thoracic or upper abdominal surgeries. The combination of continuous epidural analgesia with sedation has many advantages in prolonged major upper abdominal surgeries. Keywords- Whipple's operation, general anaesthesia, continuous epidural anaesthesia, sedation, upper abdominal surgery. I. Case Report We present 3 cases where regional anaesthesia technique combined with sedation for whipple's operation was employed successfully. Three patients with obstructive jaundice secondary to periampullary carcinoma posted for whipple's surgery. The diagnosis was confirmed by blood biochemistry, CT scan, ERCP and biopsy. General physical and systemic examination and vital parameters was essentially the same in all the patients. On pre-anaesthetic examination, an informed consent was taken and patients were thoroughly explained about the procedure and technique of lumbar epidural anaesthesia. After taking the patients in operation theater, patient were monitored for HR, BP, ECG, SpO2 and temperature. Intra Venous access was secured with 18 G cannula on the dorsum of hand and preloading was done with ringer's lactate solution 10-15ml kg-1. under full aseptic precaution an epidural catheter was inserted in the epidural space at L1-L2 level. The tip of catheter was advanced to T4. A test dose of 3 ml of 2% xylocaine with adrenaline 5 µg ml-1 was given after insuring correct placement the bolus dose of local anaesthetics (10ml of 2% lignocaine and 10ml of 0.5% bupivacaine and 50 micro g of fentanyl) was given followed by bolus dose of 6ml 0.5% bupivacaine hourly. Central venous cannulation was done and CVP maintained between 8-10 cm of normal saline. Opioids were not used. Urine output monitoring was done and maintained between 1.5-2 ml kg-1 hr-1. Blood loss was adequately replaced by PRBCs, FFP's and other IV fluids. Average blood loss in all 3 cases was 2-3 liters. The duration of surgery was approximately 8 hours. Propofol infusion 10ml hr-1 was used in all cases for sedation along with midazolam @ 2 ml/hour. Vital signs were monitered and maintained through out intraoperative period. All patients were fully conscious, oriented and with stable vitals. Postoperative x-ray Chest was normal in all cases. Postoperative pain relief was given with lumber epidural infusion. Bowel sounds were audible on 3rd postoperative day. Biochemistry, haematological and Blood Gas parameters was within normal limits. Patients remained comfortable, without pain and were discharged on 3-4th postoperative day from the ICU. epidural catheter was removed before discharge. All the 3 patients were ambulatory and with no complaint of pain.

Tracheal stenosis or tracheal injury is a distressing condition. The silicone tracheal T-tube presents a substitute for stent of this complicated disease. We have come across a case of tracheal perforation in which tracheoplasty was planned. After traceoplasty silicone tracheal T-tube was placed as a stent. We were not able to connect silicone tracheal T-tube with Bain circuit with ET TUBE No. 8.5, 8, 7.5, 7 connector and it was difficult to ventilate the patient now. We have tried other ET TUBE connector and finally we succeeded to connect ET TUBE No. 5.5 connector with Bain circuit and we were able to ventilate the patient.

Background: Hyperbaric ropivacaine produce more reliable sensory and motor block, with faster onset, better quality of muscles relaxation than isobaric ropivacaine. So, this study was designed to compare the efficacy of hyperbaric ropivacaine with isobaric ropivacaine in patients undergoing lower abdominal surgery. Methods: A randomized controlled double blind study in two groups of patients. group A (n=35) received 3 ml of isobaric ropivacaine 6 mg/ml (18 mg). Group B (n=35) received 3 ml of hyperbaric ropivacaine 6 mg/ml (18 mg). The onset and duration of sensory block at dermatome level T10, maximum upper and lower spread of sensory block, intensity, and duration of motor block were recorded. Statistical Analysis: Block characteristics were compared using the two-tailed Mann - Whitney U-test. The proportion of side effects was compared using the Chi-square test. Results: The median time of onset of sensory block at the T10 dermatome was 4.4±1.3 min in group B and 6.0±1.03 min in group A. The median time to maximum block height was 16.7±3.7 min in group A and 12.03±1.96 min in group B. The median duration of complete motor recovery (B0) was significantly shorter in the heavy ropivacaine group (166.5±11.7 min) compared with the isobaric ropivacaine group (192.9±9.6 min). Conclusions: Intrathecal hyperbaric ropivacaine provides more rapid, adequate, and good quality of sensory and motor block with rapid post-operative recovery as compare to isobaric ropivacaine.

The immunogenicity of different types of glutaraldehyde inactivated pertussis vaccine (GIPV) preparations made by inactivation of Bordetella pertussis organisms with different concentrations of glutaraldehyde for variable periods at room temperature and conventional heat inactivated pertussis vaccine (HIPV) was evaluated with regard to production of agglutinins and neutralizing antibodies against pertussis toxin (PT). The different types of GIPV preparations had variable intracerebral mouse potency which depended upon the conditions of inactivation with glutaraldehyde. The agglutinin production in mice against various types of GIPV preparations and HIPV were very similar irrespective of the potency of the preparations. The agglutinins were produced against all the three major agglutinogens 1, 2 and 3 as the preparations were made from B. pertussis strain 10536 (serotype 1,2,3). The titres of agglutinins produced against adjuvanted preparations were slightly higher than those against non-adjuvanted preparations. Neutralizing antibodies against PT were produced for eight out of nine types of GIPV preparations while these antibodies were not produced for conventional HIPV.

A total of 112 samples of adsorbed DPT vaccine were tested in mice for freedom from abnormal toxicity by three procedures: (a) single human dose by intraperitoneal route; (2) single human dose by subcutaneous route; and (3) half the single human dose by intraperitoneal route. The percentage of samples passing by the three methods was 25, 90 and 54.5, respectively. Method 3, which is being recommended now by the World Health Organization, is supported by the results of this study to be neither very stringent nor very lenient to pass the adsorbed DPT vaccine for freedom from abnormal toxicity.