ABSTRACT
Children with special needs form a unique subset with regards to visual function and examination techniques needed to assess them. With more awareness among the general public, neurologists, and pediatricians, these children are referred for assessment to the ophthalmologist or optometrist and sometimes even to the rehabilitation professional at an early age. This clinical practice guideline and review gives a systematic approach for examining the visual functions of a child with special needs. It outlines the procedures to be followed with equipment needed in clinical practice. Functional vision assessment guidelines are also included. This is the first part in a two-part series, with the first part presenting clinical examination guidelines and the second presenting intervention and vision enhancement techniques.
ABSTRACT
Context: Helicobacter pylori is associated with the development of a variety of gastroduodenal diseases which varies with ethnicity and the type of strains that infect the population. Aims: This study aims to evaluate the prevalence of H. pylori cagA and vacA genotypes in our region and to determine their relationship to the severity of the lesions that they cause. Settings and Design: This study was an observational cross-sectional study. Subjects and Methods: DNA was extracted from 165 gastric biopsies from patients evaluated for dyspepsia. PCR was used to detect cagA and vacA (s1, s2, m1, m2) genes of H. pylori. Statistical analysis of associations was performed between endoscopy findings and virulence genes. Statistical Analysis Used: Pearson Chi-square test and Fischer's exact test. Results: The prevalence of H. pylori infection was 37% and the dominant genotypes was vacA s1 cagA-positive strain (54.1%) in this study. The vacAs1 subtype was found in all patients with peptic ulcer disease (PUD). The entire normal study group had VacA s2 variant only. This clearly shows that vacA s1 is a significant virulence marker and patients harboring s1 strains are more prone to develop ulcers (P = 0.007). There was a significant association of cagA with s1 strain rather than s2. Variation in VacA m genotype did not seem to have any association with disease status. There was a statistically significant association between the presence of cagA gene and PUD rather than the nonulcer dyspepsia (P = 0.027). Conclusion: The predominant genotype in our population was cagA positive vacA s1, which was found to be significantly associated with patients with gastric diseases, especially PUD. VacA s1 can serve as a single best virulence marker of the disease manifestation.
ABSTRACT
Food and nutrition security are intimately interconnected, since only a food based approach can help in overcoming malnutrition in an economically and socially sustainable manner. Food production provides the base for food security as it is a key determinant of food availability. This paper deals with different aspects of ensuring high productivity and production without associated ecological harm for ensuring adequate food availability. By mainstreaming ecological considerations in technology development and dissemination, we can enter an era of evergreen revolution and sustainable food and nutrition security. Public policy support is crucial for enabling this.
ABSTRACT
Uterine sex cord tumour is a very rare tumour with uncertain management strategies and prognosis. A 61-year-old, nulliparous, who was not on hormone replacement therapy, presented with first episode of postmenopausal bleeding. A transvaginal scan revealed an enlarged uterus with thick endometrial lining and features of multiple degenerated fibroid. Endometrial biopsy was negative for malignancy. Computed tomography of the abdomen and pelvis confirmed the mass, with atrophic ovaries and incidental finding of bilateral hydronephrosis requiring stentings. Otherwise, there were no pelvic lymph nodes enlargement. Our impression was a uterine sarcoma and we decided for total abdominal hysterectomy with bilateral salpingooophorectomy. Surprisingly, the histology report confirmed uterine sex cord tumour. There are less cases of recurrence and there is no general consensus on the management. However, we decided for adjuvant chemotherapy (BEP regime) as the malignant cells infiltrated more than half of myometrial thickness, with good outcome.
ABSTRACT
To compare the haemodynamic effects and intubating conditions of rocuronium and vecuronium, 20 patients of either sex with poor left ventricular function (ejection fraction <35%) scheduled for coronary artery bypass surgery were randomly divided into two equal groups. All patients were premedicated with lorazepam and morphine and induced with morphine, midazolam, thiopentone and either vecuronium (0.1 mg/kg) or rocuronium (0.6 mg/kg) as muscle relaxant. All patients were intubated after 3 minutes in the vecuronium group and 90 seconds in the rocuronium group by the same anaesthesiologist. Monitoring in all cases included neuromuscular (train of four- TOF), systemic and pulmonary arterial pressures, cardiac output and calculated haemodynamic variables. Demographic (age, sex and mean ejection fraction) and haemodynamic variables were comparable in both the groups. A significant suppression of the TOF in the vecuronium group was observed despite better intubating conditions in the rocuronium group. The heart rate at 3 minutes and mean arterial pressure at 1 minute was higher in the vecuronium group as compared to the rocuronium group. There were no other significant haemodynamic differences in both the groups. We conclude that rocuronium does provide better intubating conditions at 90 seconds than vecuronium at 3 minutes with no significant differences in the haemodynamic parameters between the two; however, the train of four response does not correlate with intubating conditions.
ABSTRACT
The Internet is expanding very rapidly with more people joining hands and minds everyday. The encouraging news is that a lot of these people are medical professionals. This makes for a scientific community with better interaction and understanding of problems relating to health care. As anaesthesiologists, we are at an advantage that our discipline allows maximal interaction with related subjects like paediatrics, critical care, pulmonology, cardiology and emergency medicine. This article will deal with some interesting websites relating mainly to fields associated with cardiovascular anaesthesia.
ABSTRACT
To assess the leucocyte depleting characteristics of the Pall leukogard-6 arterial line leucocyte depleting filter, it was incorporated in the extracorporeal circuit of 30 patients with normal left ventricular function scheduled for elective coronary artery bypass grafting. The Intersept Medtronic 40 micro arterial line filter which is normally used at our centre was used in 29 similar patients. Blood samples were drawn for estimation of total and differential leucocyte and platelet counts, blood gas analysis, superoxide dismutase levels and renal function tests at various time points. Ventilation time, length of ICU stay and incidence of infection were recorded. No significant difference was observed between the two groups regarding total leucocyte count, percentage of neutrophils and lymphocytes, platelet count, arterial oxygen and carbon dioxide tensions, pulmonary vascular resistance, ventilation time and postoperative infection. A significant difference was observed between the prebypass levels of superoxide dismutase 89.63 +/- 49.69 SOD units/ml, and 24 hours post bypass levels 66.62 +/- 36.23 SOD units/ml, (p<0.01), in the control group. In the leukogard filter group, the difference between pre bypass levels of superoxide dismutase 82.47 +/- 50.58 SOD units/ml and 24 hours post bypass 73.44 +/- 41.10 SOD units/ml, (p>0.05), was not significant. This indicated less free radical activity in the leukogard filter group, but this beneficial effect of the leukogard-6 filter did not correlate with any clinical parameter. In this study, the leukoard-6 filter did not exhibit leucocyte depleting characteristics following cardiopulmonary bypass and is unlikely to be of significant advantage when incorporated in the extracorporeal circuit for coronary artery bypass grafting, in patients with normal ejection fraction.