Comparison of three different techniques of endotracheal tube cuff inflation: just seal, stethoscope guided and pressure volume loop: a prospective randomized study

Background: Cuffed endotracheal tubes not only ensure a proper seal during positive pressure ventilation, but at the same time also prevent aspiration of gastric secretions. The aim of this prospective, randomized study was to compare three methods of ETT cuff inflation-- palpation of the leak in suprasternal notch (Just seal), a stethoscope guided method of tracheal tube cuff inflation and PVL guided cuff inflation.Methods: After approval by institutional ethical committee, 192 patients of either sex in age group of 18-50 years belonging to ASA physical status I or II were enrolled. Each patient was randomly allocated into one of three groups: one group received standard 'just seal' method of tracheal cuff inflation (JS), the second group, the stethoscope-guided method (SG) and in third group cuff was inflated using Pressure Volume Loop (PVL). Volume of air introduced into the cuff and pressure within the cuff was recorded.Results: A total of 192 patients were recruited to the study. The median (IQR [range]) tracheal cuff pressure was 12 (10-22 [6-28]) cm H2O, 16 (12-24[6-38]) and 14 (10-22[8-32]) cmH2O in JS, SG and PVL group respectively. Cuff pressures within the recommended range of 20-30 cm H2O fell in 25% of the patients in both JS and SG group and 31% patients in PVL group. The mean volumes of air introduced in the cuff and the resultant mean cuff pressure in all groups was found to be statistically insignificant (p= 0.4, 0.18 respectively). Tidal volume discrepancy was more and 75% of cuff pressures were less than the recommended range in JS than the other two groups.Conclusions: Real time PVL displayed on most modern anaesthesia machine is a good alternative to check for proper ETT cuff inflation, avoid high cuff pressure and monitor air leak.

Contribution of hepatitis E virus in acute sporadic hepatitis in north western India.

Background & objectives: Hepatitis E virus (HEV) causes acute viral hepatitis. Majority of the documented studies on hepatitis E have been focused on the incidence of this disease in northern and south central India. Limited data are available on HEV infection among acute sporadic hepatitis cases in north western India. The present study was undertaken to investigate the contribution of hepatitis E virus infection in sporadic hepatitis cases in Rajasthan and neighbouring States. Methods: Seven hundred and thirty six patients suspected to have viral hepatitis were screened for the hepatotropic viral markers, hepatitis A, B, C and E by using commercial enzyme immunoassay kits with a high sensitivity and specificity. The acute nature of HEV infection was also confirmed by the detection of HEV RNA by nested RT-PCR. Results: Hepatitis E was found to be the major cause of acute sporadic viral hepatitis (49.7%) in this region of India. Mixed infections of HEV-HAV (1.2%), HEV-HBV (6.1%), and HEV-HCV (1.7%) were also detected. No viral marker was detected in 32 per cent cases. Interpretation & conclusion: HEV was found as the major aetiological agent of acute sporadic viral hepatitis in Rajasthan (north western India). It is important to screen primarily for all the common enterically and parenterally transmitted hepatotropic viral markers in acute sporadic viral hepatitis. There is a need to do additional serological and molecular tests to identify the aetiological agent in the cases of acute hepatitis.

Genotypic variation in Brassica juncea (L.) Czern. cultivars in growth, nitrate assimilation, antioxidant responses and phytoremediation potential during cadmium stress.

Four cultivars of Brassica juncea i.e. TM-4, TM-2, RH-30 and T-59 were screened for seed germination and seedling growth up to 15 days in the presence of 0.5-1.5 mM cadmium (Cd). The exposure to Cd reduced seed germination and seedling growth (root and shoot length and dry weight) in all four cultivars; the effect being more severe in TM-2 and RH-30 than in TM-4 and T-59 and at 3 d than at 7 d and 15 d. The cultivars TM-4 and T-59, with higher tolerance to Cd toxicity, were selected for further analysis including the estimation of nitrate reductase (NR) and peroxidase (POD) activities, total organic nitrogen (TON), total soluble proteins, proline levels and Cd accumulation. The NR activity and total soluble proteins decreased upon Cd exposure in a concentration dependent manner, whereas TON increased significantly in 3 d seedlings upon Cd exposure. The activity of POD and proline level increased significantly as compared to the respective controls. The level of Cd accumulation was higher in T-59 than in TM-4. Therefore, T-59 was found to be the most tolerant cultivar to Cd than other three cultivars possibly due to a better capacity to transport Cd in their vacuolar sink. The variety T-59, thus, appears to be suitable for Cd phytoremediation.