ABSTRACT
Coarctation of aorta is a connective tissue disorder, which accounts for a type of acyanotic congenital heart disease. A patient with surgically treated coarctation of aorta may present in adulthood with several cardiovascular and central nervous system problems which could pose considerable challenges in their anesthetic management. We present here our experience of the anesthetic and perioperative management of an operated case of coarctation of aorta taken up for inguinal herniorraphy
ABSTRACT
OBJECTIVES: WHO to examine the value of additional markers like history of previous respiratory distress and response to bronchodilator (BD) to redefine these guidelines. METHODS: Fifty (50) patients were analysed for presence of fever. Those who were febrile were put on antipyretic to look for resolution of tachypnea. Those who showed persistent tachypnea and those who were afebrile were analyzed for history of previous respiratory distress. Those who gave a positive history were challenged with BD. The association of persistent tachypnea and pulmonary infiltrates was recorded. RESULTS: Persistence of tachypnea after BD therapy was associated with pulmonary infiltrate in 7/8 (87.5%) whereas tachypnea persisted in 9/30 (30%) of those without infiltrates (p < 0.001). The proposed algorithm brings down the overuse of antibiotics from 78.9% to 26.3% (p <0.001) and also brings down the underuse of bronchodilators from 78.9% to 21.1 %(p<0.001). CONCLUSION: Adding simple markers like history of previous respiratory distress and response to BD therapy to the existing WHO guidelines it is possible to reliably differentiate pneumonia from acute exacerbation of asthma.
Subject(s)
Algorithms , Asthma/diagnosis , Biomarkers , Bronchodilator Agents/therapeutic use , Child, Preschool , Cough/etiology , Emergency Service, Hospital , Fever/diagnosis , Guidelines as Topic , Humans , Infant , Pneumonia/complications , Prospective Studies , Respiratory Sounds/etiology , Sleep Wake Disorders , World Health OrganizationABSTRACT
Expression of rbcS genes encoding small subunit of rubisco, most abundant protein in green tissue, is regulated by at least three parameters--tissue type, light conditions and stage of development. One of the green tissue-specific promoters of rbcS gene family was isolated from pigeonpea by PCR. Expression of uidA gene encoding beta-glucuronidase in the transgenic tobacco plants under the control of pigeonpea rbcS promoter, clearly showed that this promoter was as strong as pea rbcS3A promoter characterized earlier. Study of the sequence similarity with pea rbcS3A promoter, especially the region (boxes I and III) that is required for rbcS3A expression, showed more than 50% divergence. In contrast, pigeonpea promoter sequence isolated in the present study was more similar to that of spinach and rice rbcS promoters.