OCD is generally believed to be one of the most distressing of all anxiety disorders. Some OCD patients remain refractory and run a chronic deteriorating course. Therapeutic option in this group was ...initially limited to ablative surgery like anterior capsulotomy or anterior cingulotomy. Current study is aimed to see the effect of deep brain stimulation of posterior and ventral part of internal capsule on severity of OCD symptoms after three months, six months and then yearly follow-ups. Present series consisted of two patients having intractable OCD. Two psychiatrists independently assessed each patient. Both the patients full filled the criteria for OCD (33.30) according to the Diagnostic and Statistical Manual of Psychiatric Disorders 4th edition (DSM IV). Both failed to improve following treatment with at least 3 selective serotonin reuptake inhibitors (SSRIs) and have completed Cognitive Behavior Therapy (CBT) Outcome of both the patients was measured by Y-BOCS scale (Yale-Brown Obsessive-Compulsive Scale), BDI (Beck Depression Inventory) and MMSE (Mini mental scale examination). The pre and post operative assessment was done by two clinical psychologists who independently assessed both the patients Target for stimulation was deep ventral at anterior limb of internal capsule just posterior to anterior commissure 5–6 mm from midline. Leads were implanted stereotactically on both sides under local anaesthesia and sedation. Quadripolar stimulating electrode (Model 3387 Medtronic) were used on both sides and they are connected to Pulse Generator (Medtronic) by connecting leads under general anaesthesia. In the first case non rechargeable pulse generator (Kinetra) was used while in the second case rechargeable pulse generator (Activa RC) was used. Programming of device was started after six weeks and continued for six to eight months till patient show significant improvement. Medications were kept unchanged. Neuropsychiatric evaluation was done after three months and six months. Afterwards yearly follow-up was done. Our primary aim of this study is to determine the efficacy of DBS for OCD and to compare its result to traditional anterior capsulotomy. The literature indicates that anterior capsulotomy produces a 35% improvement in OCD symptoms in about 45% of operated patients. Present series of two patients showed very significant improvement in both cases. Our first case reported 68.42% improvement in her OCD symptoms as her Y-BOCS score reduced from 38 to 12 and (45.45%) of improvement in BDI score after one year. Similar finding was observed in second patient where Y-BOCS reduced from 38 to 10 (73.68% improvement) and BDI improved to 70.83%. There was no change in MMSE score in both cases that signifies no adverse effect on mental status. Both the patients showed more than 35% improvement that was much superior to results achieved by bilateral capsulotomy. Very significant improvements in present series relates to the placement of leads that were more posterior and ventral. There was recurrence of symptoms of OCD in first patient after nineteen months related to depletion of battery that improved after replacement with newer one. This problem was rectified in second patient where rechargeable DBS system was used that has long battery life. Conclusion We conclude that DBS of VC/VS complex is very safe and effective in refractory OCD and the shows considerable promise for future. The long term result of this small controlled study is much better as compared to lesioning (capsulotomy).
As per W.H.O. 50 million patients are suffering from epilepsy and out of them 80% are in developing countries. In India 1% of population suffer from epilepsy. 30% of these patients become refractory ...to medication and would require either surgery or deep brain stimulation. Deep brain stimulation is an established therapy for Parkinson disease, essential tremor and certain form of Dystonia. Recently it has been used in intractable epilepsy with good outcome in a SANTE clinical trial. The electrical stimulation of anterior thalamus can significantly reduce the number of seizures and can improve the quality of life. Based on both animal studies and clinical trials, we subjected six patients to anterior thalamic stimulation for medically refractory epilepsy. All six selected patients were not suitable for epilepsy surgery. The age ranged from 20 years to 53 years. Bilateral anterior thalamic stimulation was done in all cases using ZD stereotactic frame under general anaesthesia. The target was calculated using fused images of CT Scan and MRI. The placement of electrodes was confirmed by microelectrode recording (thalamic burst) and intra-operative driving response obtained by scalp EEG. The post-operative CT scan was done to confirm the position of electrodes.In three patients Medtronic DBS system (Activa PC) was used while other three patients have St Jute device (Libra) device. Anticonvulsant medications were kept unchanged. The programming was started after one week using electro encephalography. The reduction or abolition of inter-ectal discharges and eeg desynchronization was kept as goal of programming. All the patients were follow-up 6 months to 4 years. Significant seizure reduction observed immediately after programming. Two patients became seizure free. Three patients have 60–80% seizure control. One patient did not get significant benefit. In three patients (good respondent) after a period of two years seizure frequency increased following battery depletion that required replacement using respectable rechargeable DBS system. Above study shows effectiveness of anterior thalamic stimulation for intractable epilepsy. Better result can only be achieved by effective eeg guided programming. Prolonged follow-up with more number of cases is required to establish deep brain stimulation of anterior thalamic nuclei as safe and effective therapy for refractory epilepsy patients who are otherwise not suitable candidate for conventional epilepsy surgery.
Main characteristics of gaseous yield from steam gasification have been investigated experimentally. Results of steam gasification have been compared to that of pyrolysis. The temperature range ...investigated were 600–1000
°C in steps of 100
°C. Results have been obtained under pyrolysis conditions at same temperatures. For steam gasification runs, steam flow rate was kept constant at 8.0
g/min. Investigated characteristics were evolution of syngas flow rate with time, hydrogen flow rate and chemical composition of syngas, energy yield and apparent thermal efficiency. Residuals from both processes were quantified and compared as well. Material destruction, hydrogen yield and energy yield is better with gasification as compared to pyrolysis. This advantage of the gasification process is attributed mainly to char gasification process. Char gasification is found to be more sensitive to the reactor temperature than pyrolysis. Pyrolysis can start at low temperatures of 400
°C; however char gasification starts at 700
°C. A partial overlap between gasification and pyrolysis exists and is presented here. This partial overlap increases with increase in temperature. As an example, at reactor temperature 800
°C this overlap represents around 27% of the char gasification process and almost 95% at reactor temperature 1000
°C.
The present work examines the equilibrium sorption of arsenic (III and V) from aqueous environment onto iron oxide-coated cement (IOCC) at 288, 298 and 308
K, and determines the equilibrium sorption ...isotherms. The equilibrium for both As(III) and As(V) was achieved in 2
h. The experimental isotherm data were analysed using Langmuir, Freundlich, Dubinin–Radushkevich (D–R), Toth and Temkin isotherm equations. In order to determine the best-fit isotherm for each system, both linear and non-linear regressions were carried out. For this, six error analysis methods were used to evaluate the data: the linear coefficient of determination, the sum of the squares of errors, the sum of absolute errors, the average relative error, the hybrid fractional error function and the Marquardt's percent standard deviation. The error values indicated that the Freundlich isotherm was able to provide the best quality of fit for all the experimental data, over the concentration range studied, for both As(III) and As(V) at 288, 298 and 308
K. The values of the parameter sets of the isotherms also indicated that the adsorption of arsenic onto IOCC is a temperature dependent phenomena with As(III) and As(V) exhibiting exothermic and endothermic nature of adsorption, respectively.
Glycosylation is a key modification of proteins and lipids and is involved in most intermolecular and intercellular interactions. The gastrointestinal mucus gel is continuous and can be divided into ...two layers: a secreted loosely associated layer and a layer firmly attached to the mucosa. In addition, the membrane-bound glycosylated proteins and lipids create a glycocalyx, which remains adherent on each cell and is dynamic and responsive to the physiological state and environment of the cell. The secreted glycans form a mucus gel layer that serves as a physicochemical sensor and barrier network and is primarily composed of mucins and associated peptides. These glycans protect gut epithelial cells from chemical, biological and physical insults and are continuously renewed. Pathogens colonise and invade the host epithelial cells using protein-protein and glycan-lectin interactions. During the process of colonisation and infection, the glycosylation state of both host and pathogen change in response to the presence of the other. This complex modulation of glycan expression critically determines pathogenesis and the host response in terms of structural changes and immune response. In addition, by influencing host immunity and gut glycosylation, the microbiota can further effect protection against pathogens. In this review, the roles of host glycosylation in interactions with two prevalent bacterial pathogens, Campylobater jejuni and Helicobacter pylori, are discussed to illustrate important concepts in pathogenesis.
Purpose: To compare observation versus subthreshold green laser (STL) in acute central serous chorioretinopathy (CSC) in terms of anatomical and functional outcomes. Methods: Prospective randomized ...interventional study. 30 eyes with the first episode of acute CSC underwent complete ophthalmologic examination, measurement of best-corrected Snellen visual acuity (BCVA), contrast sensitivity (CS), fundus fluorescein angiography (FFA), spectral-domain optical coherence tomography (SD-OCT), and multifocal electroretinography (mfERG) at baseline. Patients were randomized equally to group A (observation) or group B (STL using 532 nm wavelength applied to the leakage point). Outcome measures included BCVA, CS, central foveal thickness (CFT), and mean macular thickness (MMT) on SD-OCT and P1 amplitude and implicit time (IT) on mfERG. Patients were followed up for 6 months. Results: Mean BCVA was comparable between the two groups on follow up; however, mean CS was significantly higher in group B at 6 months (P = 0.032). CFT was significantly lower in group B at 1 month (P = 0.001) and 3 months (P = 0.049); however, this difference was not maintained at 6 months (P = 0.265). P1 amplitude and IT in all 5 rings were comparable between the two groups at baseline. On follow up, P1 amplitude of ring 1 became significantly higher in group B at 3 months (P = 0.036) and 6 months (P = 0.022). Conclusion: Immediate treatment of acute CSC with STL, as compared to conservative management, leads to more rapid resolution on SD-OCT and superior functional outcomes as evidenced by CS and mfERG.
The infection with SARS-CoV-2 is reported to be accompanied by the shedding of the virus in fecal samples of infected patients. Earlier reports have suggested that COVID-19 agents can be present in ...the sewage samples and thus it can be a good indication of the pandemic extent in a community. However, no such studies have been reported in the Indian context. Hence, it becomes absolutely necessary to detect the presence of the SARS-CoV-2 in the wastewater samples from wastewater treatment plants (WWTPs) serving different localities of Jaipur city. Samples from different WWTPs and hospital wastewater samples were collected and wastewater based epidemiology (WBE) studies were carried out using the RT-PCR to confirm the presence of different COVID-19 target genes namely S gene, E gene, ORF1ab gene, RdRp gene and N gene. The results revealed that the untreated wastewater samples showed the presence of SARS-CoV-2 viral genome, which was correlated with the increased number of COVID-19 positive patients from the concerned areas, as reported in the publically available health data. This is the first study that investigated the presence of SARS-CoV-2 viral genome in wastewater, at higher ambient temperature (45 °C), further validating WBE as potential tool in predicting and mitigating outbreaks.
Characteristics of syngas from the pyrolysis and gasification of food waste has been investigated. Characteristic differences in syngas properties and overall yields from pyrolysis and gasification ...were determined at two distinct high temperatures of 800 and 900
°C. Pyrolysis and gasification behavior were evaluated in terms of syngas flow rate, hydrogen flow rate, output power, total syngas yield, total hydrogen yield, total energy yield, and apparent thermal efficiency. Gasification was more beneficial than pyrolysis based on investigated criteria, but longer time was needed to finish the gasification process. Longer time of gasification is attributed to slow reactions between the residual char and gasifying agent. Consequently, the char gasification kinetics was investigated. Inorganic constituents of food char were found to have a catalytic effect. Char reactivity increased with increased degree of conversion. In the conversion range from 0.1 to 0.9 the increase in reactivity was accompanied by an increase in pre-exponential factor, which suggested an increase in gasifying agent adsorption rate to char surface. However, in the conversion range from 0.93 to 0.98 the increase in reactivity was accompanied by a decrease in activation energy. A compensation effect was observed in this range of conversion of 0.93–0.98.
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