Coronary Artery Air Embolism.

Coronary artery air embolization is a rare event leading to catastrophic hemodynamic compromise within seconds after introduction of air emboli within the coronary arteries. The management of massive air embolism should be extremely quick so as to save life of the patient. We present a case of a 35-year-old, diabetic and hypothyroid female who had massive air embolism in both LAD and LCX arteries during coronary angiography, which resolved within a few minutes with prompt treatment.

Tobacco Smoking, Cigarette Butt Smoking: Markers for Early Intervention in Adolescents at School Level.

Introduction: Tobacco use in children and adolescents is reaching pandemic levels. The World Bank has reported that nearly 82,000-99,000 children and adolescents all over the world begin smoking every day. WHO Fact Sheet May 2010 reported the annual death toll of five million could rise to eight million by 2030 unless an urgent action is taken to control this “epidemic”. Preventive strategies are needed to be initiated on urgent basis focused towards adolescents. There is difficulty to enforce the laws and implementing preventive programs in the developing countries like India. Due to some constraints the Tobacco Free Initiative (TFI) is facing defeat in the third world. This study was conducted in high school students of Hapur, Ghaziabad (Dist.) of U.P. to identify the various correlates which induce these impressionable young adolescent minds to indulge in the use of tobacco. Material & Methods: Eight hundred seven high school children aged 12-18 years were surveyed by using an anonymous pre-tested self-report questionnaire. Personal indulgence in tobacco use over the period of one year was measured. A three point scale (yes / no / don’t know) was used. Consent / assent were duly taken from the student / teachers / principal. Results were tabulated and analysed. Results: The overall prevalence of smoking was found to be 31.97%. The use rate of tobacco was 53.53%. Among the tobacco users 59.72% were smokers. The prevalence of current smoking among tobacco users is 59.72%. The prevalence of smoking was 76.74% among male students and 23.25% amongst girls. Age of smoking initiation in both genders was mostly in 14+- 16 years. Parental (father) influence of smoking was noted to the extent of 36.04% in boys and 13.95% in girls, influence of teacher’s smoking was 39.90% in males but much less in females (23.25%). Poor academic performance and prolonged TV watching was noted as factor in both the genders. Even 13.95% females without pocket money indulged in the habit by using discarded cigarette butts (75%) which are freely available. Butt smoking was also found in boys (40%). They were aware that this habit was bad, yet indulged in it, indicating that curiosity (55% F) and peer pressure (56.56% M) and addictive nature of substance. Advertisements and promotional campaigns, mimicking their role model, were an important source of initiation of habit in both genders. Feeling of freedom from inhibitions and in females possible weight reduction to improve the looks also accounted for the habit was also noted. Our study highlights behavioural pattern of smoking as also the various factors identifying the first use and its perpetration up to habituation/ addiction. Monetary considerations and low availability of pocket money were found to be circumvented by the habit of using the discarded cigarette butts which are available for free, avoids detection, contains ash, partially burnt tobacco and paper, carbon particles, filter tissue, cellulose acetate etc. with harmful effects on lungs and other yet unidentified adverse health effects. The butt use was found in males (41.93%) and females (62.5%) and save them from deleterious effects of tobacco smoking. Conclusion: The markers thus identified in this study provide basis for early appropriate intervention of vulnerable school population and help in identification of modifiable risk factors and psychosocial clusters to provide the basis for intervention.

Effect of cataract surgery on retinal nerve fiber layer thickness parameters using scanning laser polarimetry (GDxVCC).

Purpose: To study the effect of cataract extraction on the retinal nerve fiber layer (RNFL) thickness, and assessment by scanning laser polarimetry (SLP), with variable corneal compensation (GDx VCC), at the glaucoma service of a tertiary care center in North India. Materials and Methods: Thirty-two eyes of 32 subjects were enrolled in the study. The subjects underwent RNFL analysis by SLP (GDx VCC) before undergoing phacoemulsification cataract extraction with intraocular lens (IOL) implantation (Acrysof SA 60 AT) four weeks following cataract surgery. The RNFL thickness parameters evaluated both before and after surgery included temporal, superior, nasal, inferior, temporal (TSNIT) average, superior average, inferior average, and nerve fiber index (NFI). Results: The mean age of subjects was 57.6 ± 11.7 years (18 males, 14 females). Mean TSNIT average thickness (μm) pre- and post-cataract surgery was 49.2 ± 14.1 and 56.5 ± 7.6 (P = 0.001). There was a statistically significant increase in RNFL thickness parameters (TSNIT average, superior average, and inferior average) and decrease in NFI post-cataract surgery as compared to the baseline values. Mean NFI pre- and post-cataract surgery was 41.3 ± 15.3 and 21.6 ± 11.8 (P = 0.001). Conclusions: Measurement of RNFL thickness parameters by scanning laser polarimetry is significantly altered following cataract surgery. Post the cataract surgery, a new baseline needs to be established for assessing the longitudinal follow-up of a glaucoma patient. The presence of cataract may lead to an underestimation of the RNFL thickness, and this should be taken into account when analyzing progression in a glaucoma patient.