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Introduction: Difficulty in mask ventilation is quitechallenging to an anaesthesiologist because mask ventilation isthe primary technique of ventilation and the rescue techniqueif the tracheal intubation fails. Unanticipated difficulty in maskventilation is even more challenging to the anaesthesiologist.Case report: Here we report a case of unanticipated difficultmask ventilation due to cystic swelling on left side ofepiglottis.Conclusion: Prudent and cautious corrective measures takenat the right time, ensures patient safety
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Objectives: The purpose of the study is to investigate p16 protein expression and promoter methylation of p16 gene and their association with molecular subtypes based on parameter such as estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2). Materials and Methods: A total of 114 breast cancer tissue biopsies were collected for methylation-specific polymerase chain reaction (MSP) and immunohistochemical (IHC) analysis. Results: Seven tissue microarrays were constructed. p16 protein expression was studied in 114 cases, of which 35/114 (30.7%) cases showed strong expression and the majority of them had ER-positive tumor (57.6%), and it was statistically significant (P < 0.0074). Similarly, p16 expression was reduced in the majority of PR-negative tumors (83.9%) and the association was statistically significant (P = 0.0026). p16 methylation was studied in 114 cases and was positive in 71.0% cases. Conclusion: High p16 protein expression was associated with ER-positive, PR-negative, and HER2-negative tumors which is associated with poor prognosis. p16 protein expression may be used as a prognostic indicator to predict treatment response to hormonal therapy.
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Background: Topical corticosteroids (TC) have a reputation as anti-acne, anti-blemish effects and popularly used as fairness creams. In India, there has been a rise in misuse of TC in last10 years. The present study was conducted to analyse the magnitude of adverse effects of topical corticosteroids abuse in dermatology outpatient department of a tertiary care hospital.Methods: A retrospective observational study was conducted on patients after categorizing them as a TC misuser by dermatologists. The socio-demographic data, chief complaints, details of drugs misuse and adverse drug reaction outcome was collected.Results: A total of 1240 patients was screened, out of which 80 patients misused TC without dermatologist prescription for their skin disease. TC was mainly misused by teenagers (43.8%). Misuse of topical corticosteroids was more common among females (76.3%). Betamethasone valerate (72.5%) was most common TC misused. Most common source of advice of TC misuse was friends (37.5%). Most common purpose of TC misuse was acne (55%) followed by cosmetic purposes (21.3%). The most common morphological varieties of adverse drug reactions were burning and itching sensation (53%) followed by increase severity of acne (44%).Conclusions: TC misuse was more common in teenage females. Most common adverse effect reported is burning and itch sensation followed by increase severity of acne. The study data indicates a significance of problem and requirement of urgent measures to control TC misuse.
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Background: Obesity and Diabetes mellitus are well knownrisk factors for cardiovascular diseases (CVD). Though bodyfat appears to play important role in insulin resistance, the waybody fat is distributed is also significant. Waist circumference(WC), calf circumference (CC), and wait to calf ratio (WCR)can be used as predictors of risk of CVD. This study aims toevaluate the utility of WCR as a simple non-invasive, cheaper,easy to use and non-instrumental modality which can be usedas screening tool and as an indicator of coronaryatherosclerosis and resulting cardiovascular risk in patients(OPD as well as Inpatients) with Diabetes mellitus bycorrelating WCR with Carotid Intima Media Thickness (CIMT)which itself is an established indicator for risk of CVD.Methods: 100 adult patients with Type-2 diabetes werediagnosed on the basis of latest ADA criteria. Detailed history,clinical examination, anthropometric measurements,biochemical indices were assessed for all the selectedpatients. Carotid atherosclerosis was measured by scanningthe bilateral common carotid arteries using a high resolutionUSG system with 10 MHz linear transducer. The carotid intimamedia thickness (CIMT) was measured at three points on farwall of mid and distal CCA and 1 cm proximal to dilation ofcarotid bulb. Mean value of six measurements from right andleft CCA were used.Results: There is an expected negative correlationbetween calf circumference and prevalence of abnormal CIMT(p<0.011). WCR correlated with CIMT more strongly than theindependent measures with (p<0.001) and is a good predictorof CIMT abnormality as AUC (area under the curve) is 97.7%Conclusion: Waist to calf circumference ratio is a simple noninvasive, cheaper, easy to use and non-instrumental modalitywhich can be used as screening tool in assessment ofatherosclerotic burden of the vasculature at an early stage intype 2 diabetic OPD as well as in patients. WCR will serve assurrogate marker of coronary artery disease.
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Background: A meniscal tear is the most common injury to theknee, occuring from both athletic events and activities of dailyliving. Generally, the results of repair have been good, withhigh long-term success rates. This study aims to compare thefunctional result of arthroscopic meniscal repair andarthroscopic meniscectomy.Materials & Methods: This study was carried out in theDepartment of Orthopaedics, Mahatma Gandhi MedicalCollege and Hospital, Jaipur for comparing the functionaloutcome of arthroscopic meniscectomy and meniscal repair. 47of Meniscectomy and 35 of Meniscal Repair was done in ourstudy. Statistical analysis was done using SPSS (Statisticalpackage for Social science) 16.0 software. Categoricalvariables are expressed as frequencies and percentages.Results: Our study showed that the mean age for MeniscalRepair was 32.86 vs 29.89 for Meniscectomy. There was nosignificant gender specific difference while comparing bothgroups with a p-value of 1.0. The mean follow-up for both thegroups were same of 1.2 years with a non-significant p-value of0.78. The duration of surgery was 84.5 minute in meniscalrepair as compared to 45.6 minute. There is significantdifference in surgical time required with p-value of 0.0001. Nosignificant differences for Lysholm Score and Tegner activitylevel reduction, hkss, womac and vas scores in such a shortterm follow up.Conclusion: We concluded that more randomized studies withlarger sample sizes and longer follow-up are needed to furthershow the benefits of meniscal repair in terms of patientsperceptions of the outcome and prevention of posttraumaticosteoarthritis.
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The liver and skin are the organs most commonly involved in serious adverse drug reactions. Rarely a drug reaction can affect both organs concurrently. The association of drug induced liver injury (DILI) and toxic epidermal necrolysis (TEN) is even rarer and may be rarely reported. This is a case report on development of both TEN and DILI following use of piperacillin / tazobactam. We describe our experience of DILI occurring in association with TEN including the etiological agent responsible, its clinical/ biochemical characteristics and ultimate outcome.
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@#BACKGROUND: Penetrating injuries of the perineum are rare but very dangerous. Since the genitourinary and colorectal organs may be injured, how to evaluate surgical management of the injury is very important. METHODS: The present report presents a case of penetrating injury of the perineum by a wooden stick when the patient fell on the upright wooden stick from a tree. The three feet long stick entered the perineal region just left lateral to the anal opening. Upon reaching the thoracic cavity, it broke and only a foot stick was left in the subcutaneous plane. These injuries are potentially serious with risk of damage to multiple organs. Exploratory laprotomy was done, and bladder injury was repaired. The entry wound and the track of stick was thoroughly washed and allowed for secondary intention healing. RESULTS: The post operative period was uneventful and the patient recovered fully. CONCLUSION: Meticulous evaluation and surgical management of perineal injuries are the key to prevent devastating complications.