Iatrogenic Tension Pneumothorax after Fiberoptic-guided Intubation in a Pediatric Patient: A Case Report

@#<p style="text-align: justify;">Fiberoptic-guided intubation (FOI) has been an indispensable component of difficult airway management especially in instances where anatomical limitations precluded use of conventional direct laryngoscopy. Its use, however, is not without risks.<br /><br />This paper presents a 4-year-old female with a limited mouth opening scheduled for an elective oral commissurotomy who developed signs and symptoms of tension pneumothorax immediately following a successful fiberoptic nasotracheal intubation. Passive insufflation of high-flow oxygen through a flexible fiberoptic bronchoscope preloaded with a tight-fitting endotracheal tube led to accumulation of air. This caused lung hyperinflation and subsequently, pneumothorax.</p>

Gallstone pancreatitis: general clinical approach and the role of endoscopic retrograde cholangiopancreatography

Gallstones account for majority of acute pancreatitis in the Western world. Increase in number and smaller size of the stones increases the risk for biliary pancreatitis. In addition to features of acute pancreatitis, these patients also have cholestatic clinical picture. Fluid therapy and enteral nutrition are vital components in management of any case of acute pancreatitis. During initial evaluation, a right upper quadrant ultrasonogram is particularly important. On a case-bycase basis, further advanced imaging studies such as magnetic resonance cholangiopancreatography or endoscopic ultrasound may be warranted. Acute management also involves monitoring for local and systemic complications. Patients are triaged based on predictors of ongoing biliary obstruction in order to identify who would need endoscopic retrograde cholangiopancreatography. Index cholecystectomy is safe and recommended, with exception of cases with significant local and systemic complications where delayed cholecystectomy may be safer.

Chair-side CAD/CAM fabrication of a single-retainer resin bonded fixed dental prosthesis: a case report

This clinical report describes designing and fabricating a single-retainer resin-bonded fixed dental prosthesis with a chair-side computer-aided design/computer-aided manufacturing system. The whole procedure, from tooth extraction to final placement of the prosthesis, was completed in one day, and a single clinic visit. No clinical complications were found at the 2-year follow-up after placement of the restoration, and satisfactory functional and esthetic results were achieved.

Evaluation of eye prescriptions for appropriateness and rationality in indoor patients: an observational prospective study

Background: In the branch of ophthalmology, there have been many developments of new ocular therapeutic agents. Indiscriminate use of topical drugs can lead to various unwanted effects. In order to improve drugs therapeutic efficacy, minimize adverse effects, and delay development of resistance, drug utilization trends and patterns need to be evaluated periodically. The objective of the study was to evaluate drug utilization pattern, appropriateness of use and rationality in indoor patients attending ophthalmology department.Methods: A prospective, observational study was conducted over a period of 15 months in the Ophthalmology Department of Tertiary care teaching Hospital after obtaining permission from IEC. Information of patients collected included age, sex, duration of stay, diagnosis, income per capita per month, information about drugs given- their dose, frequency, route and duration were recorded from the day of admission till discharge.Results: A total of 150 patients were enrolled in the study with M:F was 1.43:1. Mean hospitalization was 3.00±1.17 days. Most common disease were cataract (108, 72%) followed by pterygium (15, 10%). Mean of 16.35±4.25 medicines were prescribed. On most occasions (2274, 92.70%) the medicines were prescribed using brand names. Injection gentamicin 147 (98%) and flurbiprofen eye drops 145 (96.67%) were the most common drugs used. Majority (83.20%) of medicines were rational. Out of 125 medicines, 35 (28%) were FDC and 90 (72%) were single ingredient. All 100% medicine uses were appropriate with respect to dosage form, route of administration, dosage, frequency of administration and duration of therapy.Conclusions: Polypharmacy is common practice in eye department which increases inappropriateness and irrational use.

A study evaluating knowledge, attitude and practices of practitioners in the medicine department of tertiary care teaching rural hospital with respect to antihypertensives.

Background: The aim of this study was to evaluate knowledge, attitude and practices of practitioners in the medicine department of tertiary care teaching rural hospital with respect to antihypertensives and find out the disparity between the recommended and actual practices for pharmacological management. Methods: It was survey type of study, carried out using feedback questionnaire related to use of antihypertensives. Total 25 consultants were included in the study. Results: It was found that in mild hypertension single drug and two drugs in combination were preferred by 15 and 10 practitioners respectively. In moderate hypertension single drug, two drugs in combination, and greater than two drugs were preferred by 3, 13, and 7 practitioners respectively. In severe hypertension two drugs in combination and greater than two drugs were preferred by 16 and 9 practitioners respectively; none preferred single drug. Angiotensin converting enzyme inhibitors /angiotensin receptor blockers, beta blockers, Calcium channel blockers, diuretics were preferred as first line drug by 7, 4, 8, and 16 practitioners respectively. Most commonly preferred combination was Losartan and amlodipine by 16 practitioners. In pregnancy nifedipine was preferred as the first line drug while in elderly diuretics were preferred. In hypertensive patients with age less than 40 years all practitioners preferred ACEIs/ARBs. In diabetics ACEIs/ARBs was preferred by all practitioners. Each practitioner claimed to follow Joint National Committee (JNC) 7 criteria. Cost of drug was an important consideration in all their prescribing patterns. Conclusion: The knowledge, attitudes and practices followed by the practitioners of Dhiraj hospital were satisfactory and guidelines oriented.

Drug utilization pattern of analgesics in various departments of a tertiary care teaching rural dental hospital.

Background: The aim was to study drug utilization pattern of analgesics in various departments of a tertiary care teaching rural dental hospital. Methods: A prospective and observational study was undertaken in 150 patients from January 2014 to February 2014. Relevant information was obtained from the interview as well the hospital case record. Structured and pre-tested format were used for compiling the data. Results: The majority of the patients (46%) were in the age group 41-60 years. Common indications for analgesic use included endodontic diseases (61.3%), surgical procedures (41.33%), and periodontal diseases (27.33%). Three analgesic formulations were used leading to a total of 150 drug uses. Fixed-dose drug combination (FDC) of diclofenac sodium plus paracetamol (78.66%) was the most commonly prescribed analgesic formulation, followed by aceclofenac plus paracetamol (15.33%) and ibuprofen (6%). The average number of analgesics prescribed per patient was 1.94. Analgesics were prescribed for 3 days. Except ibuprofen, FDC of diclofenac sodium + paracetamol and aceclofenac + paracetamol have been included in the WHO model list of essential medicines. All analgesic drug formulations were prescribed by their brand names. Conclusions: Drug utilization data can help to formulate appropriate clinical guidelines for drug use and facilitate rational use of medicines in population.