Intraoperative crush cytology in the diagnosis of neurosurgical cases

Intraoperative cytologic smears in neurosurgery are easy to perform and inexpensive and permit reasonably high diagnostic accuracy. Even very tiny specimens, especially of soft consistency are suitable for this technique, which is extremely important in operation of tumours localized in functionally important brain areas. The cytologic diagnosis could be made based on the presence of characteristic cytomorphological features. Very high accuracy can be archived in certain tumours like nerve sheath tumour, germinoma, meningioma, metastasis, grade II astrocytoma, pituitary adenoma and oligidendroglioma. However, the accuracy is low in high grade glioma, medulloblastoma and ependymoma. In the absence of their diagnostic cytomorphological features, the correlation with clinicoradiological features might help in arriving at the correct diagnostic and increase their diagnostic accuracy. Further studies involving more number of cases is needed to find out the value of crush cytology in diagnosing the rare tumours and inflammatory lesions. In cytology examination, presence of pure normal glial tissue has high negative predictive value. This helps in guidance during targeting the lesions including steriotactic biopsy and also during the resection of infiltrative lesions for definition of tumour margins

BRIDGING FUNCTIONAL AND PHYLOGENETIC DIVERSITY OF MARINE HETEROTROPHIC PROTISTS VIA SINGLE-CELL TRANSCRIPTOMICS

The comprehensive description of unicellular heterotrophic protists is essential for understanding the functioning of marine ecosystems and defining evolutionary relationships within marine microbial communities. For that reason, new insights into the functional genes of key protists, such as ciliates and dinoflagellates, are needed to complement the increasing taxonomic complexity and bridge the gap between various eco-functional processes in the ocean. In this study, single-cell transcriptomic sequencing proved to be an efficient method to create a snapshot of expressed genes of unicellular heterotrophs. We sequenced 65 single-cell transcriptomes from 20 fresh field samples collected from Sub-Arctic and North Sea waters. These 13 ciliate and 52 dinoflagellate transcriptomes will generally contribute to a greater understanding of functional and evolutionary processes of these marine protists. Further, we generated multi-gene phylogenies of several dozen genes to unravel the relationships of these heterotrophic taxa to other dinoflagellates and ciliates, respectively. These approaches also helped to elucidate the evolution of functional genes and traits for these understudied essential groups. Additionally, the datasets were incorporated into our metatranscriptomic reference database to fill the gap (of approx. 50%) of genomic information of heterotrophic organisms and their functional processes. Overall, identifying the phylogenetic relationships and functional diversity of heterotrophic and mixotrophic protists will clarify paramount marine microbial food web processes and provide clues to the system's sensitivity to climate change

Early versus delayed initiation of antiretroviral therapy for Indian HIV-Infected individuals with tuberculosis on antituberculosis treatment

BACKGROUND: For antiretroviral therapy (ART) naive human immunodeficiency virus (HIV) infected adults suffering from tuberculosis (TB), there is uncertainty about the optimal time to initiate highly active antiretroviral therapy (HAART) after starting antituberculosis treatment (ATT), in order to minimize mortality, HIV disease progression, and adverse events. METHODS: In a randomized, open label trial at All India Institute of Medical Sciences, New Delhi, India, eligible HIV positive individuals with a diagnosis of TB were randomly assigned to receive HAART after 2-4 or 8-12 weeks of starting ATT, and were followed for 12 months after HAART initiation. Participants received directly observed therapy short course (DOTS) for TB, and an antiretroviral regimen comprising stavudine or zidovudine, lamivudine, and efavirenz. Primary end points were death from any cause, and progression of HIV disease marked by failure of ART. FINDINGS: A total of 150 patients with HIV and TB were initiated on HAART: 88 received it after 2-4 weeks (early ART) and 62 after 8-12 weeks (delayed ART) of starting ATT. There was no significant difference in mortality between the groups after the introduction of HAART. However, incidence of ART failure was 31% in delayed versus 16% in early ART arm (p = 0.045). Kaplan Meier disease progression free survival at 12 months was 79% for early versus 64% for the delayed ART arm (p = 0.05). Rates of adverse events were similar. INTERPRETATION: Early initiation of HAART for patients with HIV and TB significantly decreases incidence of HIV disease progression and has good tolerability. TRIAL REGISTRATION: CTRI/2011/12/00226

Randomized trial on the effect of an oral spleen tyrosine kinase inhibitor in the treatment of IgA nephropathy

Introduction We reported increased spleen tyrosine kinase (SYK) expression in kidney biopsies of patients with IgA nephropathy (IgAN) and that inhibition of SYK reduces inflammatory cytokines production from IgA stimulated mesangial cells. Methods This study was a double-blind, randomised, placebo-controlled phase 2 trial of fostamatinib (an oral SYK inhibitor) in 76 patients with IgAN. Patients were randomised to receive placebo, fostamatinib at 100 mg or 150 mg twice daily for 24 weeks on top of maximum tolerated dose of renin-angiotensin system inhibitors (RASi). The primary end point was reduction of proteinuria. Secondary endpoints included change from baseline in eGFR and kidney histology. Results While we could not detect significant reduction in proteinuria with fostamatinib overall, in a pre-determined subgroup analysis, there was a trend for dose-dependent reduction in median proteinuria (from baseline to 24 weeks by 14%, 27% and 36% in the placebo, fostamatinib 100 mg and 150 mg groups respectively) in patients with baseline urinary protein to creatinine ratios (UPCR) more than 1000 mg/g. Kidney function (eGFR) remained stable in all groups. Fostamatinib was well tolerated. Side effects included diarrhea, hypertension and increased liver enzymes. Thirty-nine patients underwent repeat biopsy showing reductions in SYK staining associated with therapy at low dose (-1.5 v 1.7 SYK+ cells/glomerulus in the placebo group, p<0.05). Conclusions There was a trend towards reduction in proteinuria with fostamatinib in a predefined analysis of high risk patients with IgAN despite maximal care, as defined by baseline UPCR greater than 1000 mg/g. Further study may be warranted

A STAFANLike Functional Testability Measure for Register-Level Circuits

STAFAN (Statistical Fault Analysis) is a well known testability analysis program which predicts the fault coverage of a digital circuit under the stuck-at fault model, without actually performing fault simulation. STAFAN offers speed advantage over other testability analysis programs such as SCOAP; further, it explicitly predicts the fault coverage for a given test set, unlike other testability measures which are harder to interpret. STAFAN works on gate-level digital circuits composed of basic logic gates. In this work, we show how a STAFAN-like testability analysis program can be constructed for circuits built out of register-level modules. With the proliferation of high-level synthesis and testability-driven synthesis, it is becoming more and more important to have fast testability analysis tools which operate on register-level components such as adders, multipliers, multiplexers, busses, and so on. Our testability analysis algorithm, which we call F-STAFAN, fills this void. We have implemented F-STAFAN on a Sun/SPARC workstation and describe its performance on several register-level circuits.

Intra and postoperative outcome of adding clonidine to bupivacaine in infraorbital nerve block for young children undergoing cleft lip surgery

Aims and Context: To evaluate the efficacy of adding clonidine to bupivacaine in bilateral infraorbital nerve block for hemodynamic changes, requirement of opioids, volatile agent, and muscle relaxants intraoperatively and relief of pain postoperatively . Setting and Design: Prospective, randomized, double-blind study. Methods: Fifty pediatric patients aged less than 24 months undergoing elective cleft lip repair were randomly allocated to two groups of 25 each. After tracheal intubation, group A received bilateral infraorbital nerve block with 1 ml solution of clonidine (1 μg/kg) and bupivacaine 0.25%, and group B received 1 ml of 0.25% bupivacaine. Hemodynamic parameters, intraoperative requirement of volatile anesthetic agent, muscle relaxant, and analgesic were recorded. Pain was assessed postoperatively using the Face, Legs, Activity, Cry, Consolability scale till the first rescue drug was given. Statistical Analysis: Two sample unpaired t-test and the correlation r test. Results: The duration of analgesia from the time of administration of block in group A was 667.72 ± 210.74 min compared to 558.48 ± 150.28 min in group B (P<0.05). Conclusion: Addition of clonidine as an adjunct to local anesthetic significantly decreased the requirement of other anesthetic drugs and significantly prolonged the duration of postoperative analgesia without any adverse effects

Anesthesia for opioid addict: Challenges for perioperative physician

Opioid addiction is on a rise globally. Such a patient presents to an anesthesiologist as well as to the surgeon with an array of challenges. We present the case of an opioid addict (pentazocine) who presented for debridement and grafting of eschars and old healed scars. Initially he was medically managed for opioid addiction followed by a planned anesthesia. We hereby discuss the challenges faced during perioperative period