Bronchial Blocker and Double?Lumen Endotracheal Tube Combination to Facilitate Lung Isolation during Esophagectomy

Lung isolation is an essential anesthetic technique utilized in thoracic surgeries. We present a patient undergoing esophagectomy that developed an iatrogenic injury to the left mainstem bronchus that damaged the bronchial cuff of a left?sided double?lumen endotracheal tube (DLETT). A bronchial blocker (BB) was placed in the tracheal lumen of the DLETT as a rescue method to facilitate continued lung isolation. This unusual combination of a DLETT and a BB proved useful once the bronchial cuff was compromised and may serve as a viable solution to maintain lung isolation in similar circumstances

Pediatric Appropriate Evaluation Protocol for India (PAEP-India): Tool for Assessing Appropriateness of Pediatric Hospitalization

Objectives: To develop and assess Pediatric AppropriatenessEvaluation Protocol for India (PAEP-India) for inter-rater reliabilityand appropriateness of hospitalization.Design: Cross-sectional study.Setting: The available PAEP tools were reviewed and adaptedfor Indian context by ten experienced pediatricians followingsemi-Delphi process. Two PAEP-India tools; newborn (?28 days)and children (>28 days-18 years) were developed. These PAEP-India tools were applied to cases to assess appropriateness ofadmission and inter-rater reliability between assessors.Participants: Two sets of case records were used: (i) 274cases from five medical colleges in Delhi-NCR [?28 days (n=51);>28 days to 18 years (n=223)]; (ii) 622 infants who werehospitalized in 146 health facilities and were part of a cohort (n=30688) from two southern Indian states.Interventions: Each case-record was evaluated by twopediatricians in a blinded manner using the appropriate PAEP-India tools, and ‘admission criteria’ were categorized asappropriate, inappropriate or indeterminate.Main outcome measures: The proportion of appropriatehospitalizations and inter-rater reliability between assessors(using kappa statistic) were estimated for the cases.Results: 97.8% hospitalized cases from medical colleges werelabelled as appropriate by both reviewers with inter-rateragreement of 98.9% (k=0.66). In the southerm Indian set ofinfants, both reviewers labelled 80.5% admissions as appropriatewith inter-rater agreement of 96.1% (k= 0.89).Conclusions: PAEP-India (newborn and child) tools are simple,objective and applicable in diverse settings and highly reliable.These tools can potentially be used for deciding admissionappropriateness and hospital stay and may be evaluated later forusefulness for cost reimbursements for insurance proposes.

Evaluation Of The Periodontal Disease In Individuals Involved In Night Duties.

Background: Shift duty or night duty is usually associated with various problems in the oral and general health of the individuals. The present study was planned to find the incidence of periodontal disease in night duty workers. Methodology: The study was carried on individuals involved in night duties as their profession. A total of 109 participants were involved in the study group. Also a control group of 109 individuals, who were working in day time, were taken. All the participants involved in the study were males. The periodontal condition of the study population was examined using periodontal disease index (PDI) and the scoring was done according to standard criteria. Statistical analysis was performed with the help of IBM SPSS statistics 20 by applying student’s t test. Results: The comparison of the periodontal condition of the control group and the study group had shown a statistically significant difference. This shown that the individuals involved in the night duties have more incidences of periodontitis. Conclusion: The results of the present study added focus on the oral health of the individuals with profession having shift duties or night duties.

Should we start all patients with diabetic retinopathy on fenofibrates?

There remains a need for strategies that are effective in preventing diabetic retinopathy [DR] or slowing down its progression, which is safe, well-tolerated, and more effective, have a lower risk profile, easy to perform, have more predictable results with less morbidity than the current regimens. Physicians caring for diabetic patients not only need to maximize glycemic control, but also closely monitor and treat other systemic conditions. The consistency of clinical data from the fenofibrate studies showed consistent beneficial effects with fenofibrate in slowing the progression of DR. They demonstrated significant benefit on micro-vascular [i.e., retinopathy and nephropathy] outcome, possibly independent of lipid levels. Can we combine the effectiveness of the current standard procedures with the prevention and slowing down of progression of DR that fenofibrates can offer? Knowledge of the primary mode of action of fenofibrate will be useful for both physicians and patients in determining how best to use this drug as an adjunct in the management of DR and ultimately facilitating the translation of clinical trial data to clinical practice

Fish diversity and its conservation in major wetlands of Mysore.

The paper highlights the fish diversity in major wetlands of Mysore district, Karnataka, India and its conservation status. Forty-five species of fishes belonging to 15 families, 31 genera have been identified. Fish species belonging to genus Puntius were more common in many of these lakes. However, it was observed that the fish diversity was decreasing since last two years unprecedently, mainly due to manifold human activities. Fish diversity in the lakes is becoming rare and about seven species were identified as endangered. Out of the 45 identified fishes, six fish species were identified as threatened species. Tor khudree, also known as Deccan mahseer and seven other species were identified as vulnerable fish species. Though there were 40 species of fish endemic to this region, their number decreased with introduction of more exotic species. Conservation of endemic fishes, propagation of endangered and threatened fishes should be therefore, undertaken to preserve and protect fish diversity in the wetlands of Mysore district.

Drug-eluting stents: a pharmacoclinical perspective.

In the 26 years since Gruntzig introduced a simple balloon angioplasty technique, percutaneous coronary intervention has made extraordinary progress and has now surpassed bypass surgery in frequency. The area of coronary stenting has been the focus of intense research. One of the major problems encountered after stenting is an exaggerated vascular neointimal proliferation called in-stent stenosis. The evolution of drug-eluting stents has helped in reducing the incidence of in-stent stenosis by almost half. A number of pharmacological agents have been tried in coronary stents with varying degrees of success; many more are being developed and tested. Serious doubts have been expressed about the pharmacoeconomics of drug-eluting stents compared with bare metal stents, because of the huge disparity in costs. Drug-eluting stents, which can be grouped under both device and instrument, have thrown up interesting challenges for clinical trials. The future could see the development of more compact devices with the help of diverse fields such as nanotechnology, microelectronics and advanced materials technology.

Rhinoentomophthoromycosis.

A sixty year old patient presented with a slowly progressive swelling of the nose, of one year duration, suggesting a clinical diagnosis of subcutaneous zygomycosis. On investigation, the tissue fungal culture grew Conidiobolus coronatus, confirming the diagnosis as rhinoentomophthoromycosis. He was treated with a combination of oral fluconazole and oral potassium iodide for a total period of 5 months. His symptoms subsided completely. Serial CT scanning of paranasal sinuses showed the gradual resolution of the swelling, in response to the treatment. Early detection of the disease and combination therapy gave rapid and good results. This is the first case of its kind to be reported from Kerala, the southern state of India.

X chemotherapy, myth and realities.

Cancer chemotherapy is slowly moving into the world of reality from the realms of myth. Surgery, radiation, chemotherapy, biologic therapy and a combination of these are some of the present modalities in treating cancer. The authors have briefly described in this article the chemotherapeutic aspects of therapy.

HIV-related knowledge, attitudes and risk perception amongst nurses, doctors and other healthcare workers in rural India.

BACKGROUND AND OBJECTIVE: People with HIV in India frequently encounter discrimination while seeking and receiving healthcare services. The knowledge and attitudes of healthcare workers (HCWs) influences the willingness and ability of people with HIV to access care, and the quality of the care they receive. Previous studies of HIV-related knowledge and attitudes amongst Indian HCWs have been conducted primarily in large urban hospitals. The objective of this study was to asses HIV-related knowledge, attitudes and risk perception among a group of rural north Indian HCWs, and to identify predictors of willingness to provide care for patients with HIV infection. METHODS: A cross-sectional survey of 266 HCWs (78% female) from seven rural north Indian health settings was undertaken in late 2002. A self-administered written questionnaire was made available in English and Hindi, and the response rate was 87 per cent. Information was gathered regarding demographic details (age, sex, duration of employment, job category); HIV-related knowledge and attitudes; risk perception; and previous experience caring for HIV-positive patients. Logistic regression modelling was undertaken to identify factors associated with willingness to care for patients with HIV. RESULTS: The HCWs in this study generally had a positive attitude to caring for people with HIV. However, this was tempered by substantial concerns about providing care, and the risk of occupational infection with HIV was perceived by most HCWs to be high. After controlling for confounding, HCWs willingness to provide care for patients with HIV was strongly associated with having previously cared for patients with HIV (P = 0.001). Knowledge of HIV transmission and perception of risk were not associated with willingness to provide care. INTERPRETATION AND CONCLUSION: The findings of this study showed a general willingness of HCWs to provide care for patients with HIV, tempered by concerns regarding provision of such care. Strategies to address HCWs concerns are likely to ameliorate the discrimination experienced by people with HIV when accessing healthcare services. These include the development of programmes to promote occupational safety of HCWs and involving people with HIV in awareness training of HCWs.

case of congenital Malaria in United Arab Emirates

This is report of a case of congenital malaria in a 20-day old neonate born to an immigrant Pakistani mother resident in UAE. The clinical presentation of fever irritability, frequent bowel motions and hepatosplenomegaly was suggestive of neonatal septicaemia. However laboratory tests confirmed the presence of Plasmodium vivax parasites in red blood cells and the infant responded to chloroquine therapy. This report highlights some of the clues to early diagnosis and treatment