Comparison between stylet and bougie with the C-MAC D-blade in cervical simulated immobility. A prospective randomized controlled trial

Introduction The C-MAC D-blade was designed for difficult airway intubation scenarios. To facilítate easier and faster endotracheal intubation in the laryngoscopy paradox, an introducer is preferred. Hence, we decided to conduct a study to compare the 60° angled C-MAC stylet and the gum elastic bougie as aids to intubation while using the C-MAC D-blade laryngoscope in a simulated difficult airway setting. Objective To compare the ease of oral intubation with the use of the C-MAC stylet (60° angled stylet) versus intubation performed over a bougie inserted using the C-MAC D-blade guidance in patients with simulated restricted cervical mobility. Method Prospective, randomized controlled single-center study. Intubation using the C-MAC D-blade laryngoscope was performed in 48 surgical patients randomly assigned to 2 groups of 24 each: Stylet group, Group S (using 60° angled stylet) and Bougie group, Group B (using bougie) after providing manual in-line stabilization to restrict cervical mobility. The Mann-Whitney U test and the Chi square test were used as applicable. Results The use of stylet resulted in easier (Group S 75% vs. Group B 16.7%) and faster (Group S 26.83 ± 8.61s vs. Group B 47.18 ± 16.46s) intubation with fewer attempts compared to group B. Both groups experienced a similar hemodynamic stress response to intubation. Conclusions The 60° angled C-MAC Stylet is a more effective and time-saving intubation aid with C-MAC D-blade compared to bougie.

Introducción: El videolaringoscopio C-MAC D-blade se diseñó para los casos de intubación de la vía aérea difícil. Para facilitar una intubación más rápida y sencilla en la paradoja de la laringoscopía se prefiere un introductor. Por tanto, decidimos realizar un estudio para comparar el estilete de 60° C-MAC y el bougie elástico de goma como ayudas para la intubación utilizando el laringoscopio C-MAC D-blade en una situación simulada de vía aérea difícil. Objetivo: Comparar la facilidad de intubación oral mediante el uso del estilete del C-MAC (estilete angulado de 60°) con la intubación realizada sobre un bougie insertado con la guía del C-MAC D0-blade en pacientes con restricción simulada de la movilidad cervical. Métodos: Estudio prospectivo, aleatorizado y controlado realizado en un solo centro. Se realizó intubación utilizando el laringoscopio C-MAC D-blade D en 48 pacientes quirúrgicos asignados aleatoriamente a 2 grupos de 24 cada uno: grupo de estilete, grupo S (con el estilete angulado de 60°) y el grupo de bougie o grupo B (con bougie) después de establecer una estabilización manual del eje para restringir la movilidad cervical. Se aplicaron las pruebas U de Mann-Whitney U y de Chi cuadrado según correspondiera. Resultados: Con el estilete fue más fácil (Grupo S 75% vs. Grupo B 16.7%) y más rápida (Grupo S 26.83 ± 8.61s vs. Grupo B 47.18 ± 16.46s) la intubación, requiriéndose un menor número de intentos en comparación con el Grupo B. Los dos grupos experimentaron un estrés hemodinámico similar en respuesta a la intubación. Conclusiones: El estilete angulado de 60° C-MAC es una ayuda más efectiva y ahorra más tiempo con el C-MAC D-blade en comparación con el bougie.

Assessment of Predictors for Severity in Scrub Typhus-A Case-Control Study

Objective: Scrub typhus is a rickettsial febrile condition caused by bacteria called Orientia tsusugamushi. It spreads to people through bites of infected larval mites. The objective of this study was to predict the severity of scrub typhus. Methods: A case-control study was done at Kasturba Medical College Hospital (2012-2015) retrospectively on patients admitted with scrub typhus. Patient demographics, lab parameters, investigations and treatment courses were noted. Subjects were divided into two groups, non-severe and severe group. Patient clinical details and laboratory parameters were compared in both the groups. The lab parameters associated with the severity of disease and mortality were also analyzed. A total of 210 patients out of which 140 controls (non-severe group) and 70 were cases (severe group). Results: The overall mortality due to scrub typhus infection was 14.3%. Eschar was present in 21.4% of the patients. Among the cases, the common symptoms were cough, chest pain, abdominal pain and distension, pedal edema and facial puffiness. Lymphadenopathy was observed with non-severe cases of scrub typhus and was statistically significant whereas, icterus, maculopapular rash, and hepatomegaly were associated with severe scrub typhus infection. Hemoglobin, platelet count and serum albumin were considerably lower in patients who died, whereas AST, aPTT, serum urea and creatinine were higher in them. Conclusion: Lower levels of hemoglobin, platelet count, serum albumin and higher levels of total leucocyte count, hepatic transaminases and serum creatinine correlated with severity. Doctors need to be watchful for such lab parameters and act quickly.

Cerebrospinal fluid lactate dehydrogenase and glutamine in meningitis.

The cerebrospinal fluid concentration of Glutamine and Lactate dehydrogenase (LDH) were studied in patients with pyogenic and tubercular meningitis. Significant increase in Glutamine and LDH level (P<0.001) were observed in the test group when compared to the control group. LDH and glutamine may not be useful in differentiating viral from other meningitis. It may act as corroborative evidence of meningitis.

Cytokine expression in meconium-induced lungs.

OBJECTIVE: In this article the authors present relationship between meconium exposure and inflammatory cytokine release in newborn lungs. METHODS: The authors used forty 2-week-old rabbit pups for the study. One-half of the group were instilled with meconium and the other half with saline. Rabbits were sacrificed at 0, 2, 4, 8, and 24 hrs after installation and lung lavage was obtained and was examined for cytokine mRNA expression using RT-PCR and for cytokine proteins using ELISA technique. The data were collected in each of the study group. RESULTS: Meconium instillation caused significant expression of inflammatory cytokines TNFalpha, IL-6, and IL-8 (p < 0.05) with a peak at 8 hrs after meconium instillation. Levels of IL-10 were insignificant (p > 0.05). Also, we found significant increase in necrotic cells and neutrophils (p < 0.05), compared to the control, saline instilled rabbit lungs. CONCLUSION: The present studies demonstrates that meconium induces inflammatory response and cytokines gene and protein expression in the lungs.