Functional Outcome And Associated Complications Of Intertrochanteric Fracture Treated With Trochanteric Femoral Nail: A Prospective Observational Study

Introduction: As age increases, fall becomes more often so as intertrochanteric fracture of femur. Because of early mobilization, The Trochanteric Femoral Nail (TFN) is found effective and suitable in Indian population as it is smaller in size than Proximal Femoral Nail (PFN).AIM: To clinically evaluate the functional outcome and associated complications of intertrochanteric fracture treated with trochanteric femoral nail. Methodology: Study was done in 30 patients with intertrochanteric fractures treated with trochanteric femoral nail. Patients were followed up at 6 wks, 3months, and 6 months. The intraoperative blood loss, duration of surgery, intra operative complications, post-operative complication, duration of hospital stay were studied. Functional outcome was assessed based on Kyle’ cri-teria. Results: In our series of 30 cases there were 22 male and 8 female, maximum age of 90 yrs and minimum age of 20 yrs, most of the patients were between 60 to 70 yrs. Mean age of 58 yrs. 63.3% of cases were admitted due to Domestic fall and 36.7% due to road traffic accidents with common predominance of both sides.AO Type 31A2 frac-ture accounted for 40 % of cases. Mean duration of hospital stay is 14 days and mean time of full weight bearing is 6 wks. Good to excellent results are seen in 81% cases, Fair in 16%, 3% case with poor results according to kyle’.s crite-ria. Conclusion::Trochanteric femoral nail to be more useful in unstable and reverse oblique patterns due to the fact that it has better axial telescoping and rotational stability. Intertrochanteric fractures treated with Trochanteric fem-oralnailhavebetterfunctionaloutcomewithlesscomplicationrate.

Development of polyvinylpyrrolidone/paclitaxel self-assemblies for breast cancer

The goal of this investigation was to develop and demonstrate a polymer/paclitaxel self-assembly (PTX-SA) formulation. Polymer/PTX-SAs were screened based on smaller size of formulation using dynamic light scattering analysis. Additionally, fluorescence microscopy and flow cytometry studies exhibited that polyvinylpyrrolidone (PVP)-based PTX-SAs (PVP/PTX-SAs) had superior cellular internalization capability in MCF7 and MDA-MB-231 breast cancer cells. The optimized PVP/PTX-SAs exhibited less toxicity to human red blood cells indicating a suitable formulation for reducing systemic toxicity. The formation of PVP and PTX self-assemblies was confirmed using fluorescence quenching and transmission electron microscopy which indicated that the PVP/PTX-SAs were spherical in shape with an average size range of 53.81 nm as detected by transmission electron microscopy (TEM). FTIR spectral analysis demonstrates incorporation of polymer and paclitaxel functional groups in PVP/PTX-SAs. Both proliferation (MTS) and clonogenic (colony formation) assays were used to validate superior anticancer activity of PVP/PTX-SAs in breast cancer cells over paclitaxel. Such superior anticancer activity was also demonstrated by downregulation of the expression of pro-survival protein (Bcl-xL), upregulation of apoptosis-associated proteins (Bid, Bax, cleaved caspase 7, and cleaved PARP) and -tubulin stabilization. These results support the hypothesis that PVP/PTX-SAs improved paclitaxel delivery to cancer cells.

Evaluation of normal range of mouth opening using three finger index: South India perspective study.

Aims: The frequency, with which restricted mouth opening is encountered in the clinical practice, makes it essential to establish what constitutes the normal range. This study was undertaken to evaluate the normal range of mouth opening in adult population in south India. Settings and Design: randomized clinical study conducted on dentate adult patients to evaluate the normal range of mouth opening. Materials and Methods: 500 healthy patients aged between 18-59 were randomly selected and divided into four groups according to their age ranges. The maximum inter-incisal distance and width of right and left three fingers at the first distal inter-phalanges were measured using vernier calipers. Statistical analysis used: ANOVA test, student t test and pearsons correlation test. Results: The mean value and range of maximum mouth opening of 50.3mm±6.26mm for males and 49.9mm±6.74mm for females was recorded. These values were significant and correlated with the width of three fingers. It was found that the greatest mean maximum mouth opening was recorded in youngest age group and lowest was recorded in older age group in both genders. Conclusions: The mean mouth opening value decreases with age and is lesser in females as compared to males of same age. This study demonstrated that individuals in all the four groups were able to vertically align their right and left three fingers between the upper and lower central incisors upto the first distal interphalangeal folds thus suggesting that, width of three fingers can be used as 'tool' to distinguish 'normal' from 'restricted' mouth opening.

Multiple drug resistant carbapenemases producing Acinetobacter baumannii isolates harbours multiple R-plasmids.

Background & objectives: The nosocomial human pathogen Acinetobacter baumannii has high propensity to develop resistance to antimicrobials and to become multidrug resistant (MDR), consequently complicating the treatment. This study was carried out to investigate the presence of resistant plasmids (R-plasmids) among the clinical isolates of A. baumannii. In addition, the study was performed to check the presence of common β-lactamases encoding genes on these plasmids. Methods: A total of 55 clinical isolates of A. baumannii were included in the study and all were subjected to plasmid DNA isolation, followed by PCR to check the presence of resistance gene determinants such as blaOXA-23, blaOXA-51, blaOXA-58 and blaIMP-1 on these plasmids that encode for oxacillinase (OXA) and metallo-β-lactamase (MBL) type of carbapenemases. Plasmid curing experiments were carried out on selected isolates using ethidium bromide and acridine orange as curing agents and the antibiotic resistance profiles were evaluated before and after curing. Results: All the isolates were identified as A. baumannii by 16SrDNA amplification and sequencing. Plasmid DNA isolated from these isolates showed the occurrence of multiple plasmids with size ranging from 500bp to ≥ 25 kb. The percentage of blaOXA-51 and blaOXA-23 on plasmids were found to be 78 and 42 per cent, respectively and 20 isolates (36%) carried blaIMP-1 gene on plasmids. Significant difference was observed in the antibiograms of plasmid cured isolates when compared to their parental ones. The clinical isolates became susceptible to more than two antibiotic classes after curing of plasmids indicating plasmid borne resistance. Interpretation & conclusions: Our study determined the plasmid mediated resistance mechanisms and occurrence of different resistance genes on various plasmids isolated from MDR A. baumannii. The present findings showed the evidence for antibiotic resistance mediated through multiple plasmids in A. baumannii clinical isolates. This indicates towards a need for preventive measures to avert the dissemination of plasmid resistance determinants in clinical environments.

Morphometric parameters of the human adult kidney: an anatomical study / Parámetros morfométricos del riñon humano adulto: un estudio anatómico

The purpose of this study was to determine the anatomic parameters of the kidney in adults. The Renal lengths, width at superior and inferior poles, thickness at the superior and inferior poles were measured in 151 adult cadaver kidneys. A digital vernier caliper was used for performing the measurements. The data were statistically analyzed. The mean renal length was 8.9 ± 0.9 cm on the right side and 9.1 ± 0.9 cm on the left side. The mean width of the superior pole of the right kidney was 4.9 ± 0.6 cm and the left kidney was 5 ± 0.7 cm. The width of inferior pole of the right and left kidneys were 4.8 ± 0.6 cm and 4.5 ± 0.7 cm respectively. The mean thickness of the superior pole of the right kidney was 3 ± 0.4 cm and left kidney was 3.2 ± 0.5 cm. The mean thickness of the inferior pole of the right and left kidneys were 3.1 ± 0.4 cm and 3.2 ± 0.5 cm respectively. There was no statistical significance with respect to the length of both the kidneys. However there was some data on width and thickness among the right and left side showed the difference which was significant statistically. The present study has provided additional information on the renal morphometry which will be of use to the surgeons and radiologists.

El propósito de este estudio fue determinar los parámetros anatómicos del riñon en los adultos. La longitud renal, ancho de los polos inferior y superior, y grosor de los polos superior e inferior se midieron en riñones de 151 cadáveres adultos. Se utilizó un caliper vernier digital para realizar las mediciones y los datos fueron analizados estadísticamente. La longitud media renal fue 8,9±0,9 cm en el lado derecho y 9,1±0,9 cm en el lado izquierda. El ancho promedio del polo superior del riñón derecho fue 4,9±0,6 cm y del riñón izquierdo fue 5±0,7 cm. El ancho promedio del polo inferior del lado derecho e izquierdo riñones fueron 4,8±0,6 cm y 4,5±0,7 cm, respectivamente. El grosor promedio del polo superior en el riñón del lado derecho fue 3±0,4 cm y el izquierdo 3,2±0,5 cm. El grosor promedio del polo inferior del riñon del lado derecho e izquierdo fueron 3,1±0,4 cm y 3,2±0,5 cm, respectivamente. No hubo diferencia significativa en relación con la longitud de los riñones. Sin embargo hubo algunos datos en ancho y grosor entre el lado derecho e izquierdo que mostraron diferencia significativa. El presente estudio ha proporcionado información adicional sobre la morfometría renal que puede ser de utilidad para los cirujanos y radiólogos.

Fluorescence amplified fragment length polymorphism for subtyping of genotypes of Acanthamoeba isolated from patients with keratitis.

Background & objectives: Acanthamoeba keratitis (AK) is a painful and vision-threatening ocular infection. The differentiation of Acanthamoeba at the species and subspecies level is complicated. Nearly all the AK isolates have been shown to belong to T4 genotype when analysed by ribosomal RNA gene sequences and there is no universally acceptable method for differentiation of different subtypes of T4. The purpose of this study was to attempt further discrimination of T4 genotypes. Methods: In the present investigation, 15 Acanthamoeba isolates obtained from cornea of keratitis patients were subjected to fluorescence amplified fragment length polymorphism (FAFLP) genotyping to differentiate T4 subtypes. Results: FAFLP profiles showed five distinct clusters (I to V) within T4 clonal complex which clearly depicted genetic differences among the isolates of T4 sequence type of Acanthamoeba. Interpretation & conclusions: Our study demonstrated the usefulness of FAFLP for reliable differentiation of T4 clonal complex of Acanthamoeba.

Correlations between genotyping and antibiograms of clinical isolates of Pseudomonas aeruginosa from three different south Indian hospitals.

Purpose : To compare the molecular relationships and antibiograms of nosocomial isolates of Pseudomonas aeruginosa obtained from three different genres of hospitals located in Southern India, two located at Hyderabad (one private hospital and an ophthalmic hospital) and one in Puducherry (tertiary care teaching hospital). Each of these hospitals, which follow different infection control strategies and various problems associated with it, were investigated. Materials and Methods : Antibiograms generated by disk diffusion susceptibility testing for clinically relevant antibiotics and genotyping through fluorescent amplified fragment length polymorphism analysis (fAFLP) were the tools used in the study. Results: Molecular genotyping revealed a heterogeneous group of unrelated molecular clusters of P. aeruginosa strains having higher resistance that are apparently being endemic throughout the tertiary care teaching hospital. In eye care hospital, only a few distinct strains of P. aeruginosa predominating the study period were shown to be responsible for outbreaks. The third private hospital witnessed a group of resistant and persistent strains that might have clonally originated from a diverse collection of strains. Conclusions : The divergent kind of strains in our study suggests that there may be a direct link between the infection control practices followed in each hospital and kind of strains isolated in that particular setup. The study also emphasizes the need for maintaining infection control practices in hospitals with superior standards, failure of which might result in thriving of persistent P. aeruginosa clones in the hospitals.

Detection of pneumolysin and autolysin genes among antibiotic resistant Streptococcus pneumoniae in invasive infections.

Purpose: To detect the presence of autolysin and pneumolysin genes among Streptococcus pneumoniae strains isolated from different disease entities among Indian patients. The study also attempted to determine antimicrobial susceptibility of the isolates. Materials and Methods: A total of 24 S. pneumoniae isolates were checked for the presence of lytA gene coding for autolysin and ply gene coding for pneumolysin using polymerase chain reaction (PCR). All the isolates were subjected to susceptibility testing by disc diffusion method for 10 different therapeutically relevant antibiotics. Minimum inhibition concentration (MIC) was determined using broth dilution method for ampicillin, penicillin and ciprofloxacin. Results: Eleven isolates from ocular infections and 13 isolates from different invasive diseases showed susceptibility to most of the antibiotics tested except chloramphenicol and ciprofloxacin. Fifty percentage of the isolates showed resistance to chloramphenicol and ciprofloxacin. A moderate level of resistance of 18% was noted for cefepime and ceftriaxone. Only 6% of resistance was observed for amoxicillin and ceftazidime. MIC levels ranged from 0.015 to 1 μg/mL for ampicillin and only one isolate had an MIC of 1 μg/mL. The MIC levels for penicillin ranged from 0.062 to 4 μg/mL, wherein nine isolates showed high levels of MICs ranging from 2 to 4 μg/mL. Six isolates had a very high resistance levels for ciprofloxacin with MIC ranging from 32-128 μg/mL. The presence of lytA was observed in 23 out of 24 isolates tested whereas only 17 isolates were positive for pneumolysin. Four ocular isolates and one isolate from ear infection were negative for pneumolysin. Conclusion: Emerging resistance observed for cefepime and ceftriaxone might be due their increased and frequent usage nowadays. Presence of pneumolysin appears to be more critical for pathogenesis of invasive infections than the ocular infections. However, presence of lytA gene in all the isolates signifies that irrespective of site of isolation, kind of infection caused, autolysin is an obligate necessity for this organism.

Correlation between biofilm production and multiple drug resistance in imipenem resistant clinical isolates of Acinetobacter baumannii.

PURPOSE: To study the qualitative and quantitative methods for the investigation of biofilm formation and to examine the correlation between biofilm and antibiotic resistance among the clinical isolates of Acinetobacter baumannii . We also verified the association between biofilm and presence of extended spectrum beta-lactamases, particularly, bla PER-1 . METHODS: A total of 55 isolates were subjected to susceptibility testing by disc diffusion method for 13 clinically relevant antibiotics. Screening for biofilm production was done by both qualitative and quantitative methods through tube and microtitre plate assay respectively. The presence of bla PER-1 was checked by PCR. RESULTS: A. baumannii isolates showed very high resistance (>75%) to imipenem, cephotaxime, amikacin and ciprofloxacin. Only cefoperazone, netillin and norfloxacin were found to be effective agents. Results of microtitre and tube methods were concordant with 34 isolates (62%) showing biofilm formation. Resistance to four antibiotics such as amikacin (82% vs. 17.6%, P < 0.001), cephotaxime (88% vs. 11%, P P < 0.001), ciprofloxacin (70% vs. 29%, P =0.005) and aztreonam (38% vs. 11%, P =0.039) was comparatively higher among biofilm producers than non-biofilm producers. Microtitre assay additionally detected 14 weakly adherent isolates. Only 11 isolates had bla PER-1 gene and among these two were strong biofilm producers, while remaining were weakly adherent isolates. CONCLUSION: Microtitre plate method was found to be a more sensitive method for biofilm detection. This study demonstrates a high propensity among the clinical isolates of A. baumannii to form biofilm and a significant association of biofilms with multiple drug resistance. Presence of bla PER-1 appears to be more critical for cell adherence than for biofilm formation.

The relationship between noise frequency components and physical, physiological and psychological effects of industrial workers.

A corollary to industrialization and urbanization is a significant increase in noise levels. In many industrial settings, the noise levels are such that they are potential health hazards. There are many studies which suggest that prolonged exposures to high noise levels have a negative impact on various aspects of human physiology. However, not much work has been conducted in studying the effects of various noise frequencies in the industrial environment. This paper has made an attempt to identify various noise frequency components to which the workers of six major industries in Mysore (Karnataka State, India) are being exposed, and their effects on the physical, physiological, and psychological systems of the working community with respect to their noisy industrial environment. The study results showed that the sampled industrial workers were repeatedly being exposed to noise of dominant low- and mid-octave band center frequencies. It is found that symptoms such as 'eye ball pressure,' 'awakening from sleep,' 'pains in neck,' 'frequent ear vibration,' 'chronic fatigue,' 'repeated headache,' 'backache,' and 'repeated ear pulsation' are observed to be highly associated with low- and mid-octave band center frequency noise exposure among the sampled workers. Furthermore, among the major psychological symptoms identified to be associated with octave band center frequencies, it is evident that 'irritability' is highly associated with low- and mid-octave band noise frequency characteristics.

Nosocomial infections due to Acinetobacter species: Clinical findings, risk and prognostic factors.

PURPOSE: Nosocomial infections caused by Acinetobacter species is of increasing concern in critically ill patients, and the risk factors for this infection are not well established. The present investigation was done to determine incidence of nosocomial Acinetobacter infections. Our study retrospectively attempts to find risk and prognostic factors for the nosocomial acquisition of Acinetobacter infection. METHODS: The medical records of 43 patients with Acinetobacter infection during two-year period (Oct1998-Oct2000) were reviewed to find the factors involved in the nosocomial acquisition of Acinetobacter. Acinetobacter isolates that were obtained from these patients were phenotypically typed using carbon assimilation tests. Antimicrobial susceptibility testing results were noted from the microbiology records. RESULTS: Acinetobacter baumannii accounted for 41.8% (n=18) of all the infections. By multivariate logistic regression analysis, only resistant antibiotype {(Ceftazidime- OR, 7.13 [95% CI, 1 to 46];p= 0.044); (Cefotaxime- OR, 6.09 [CI, 0.87 to 30];p = 0.045)} and mechanical ventilation (OR, 5.84 [CI, 0.83 to 31];p = 0.05) were found to be potential independent risk factors for mortality. Overall mortality rate was 33%. CONCLUSIONS: Most of A. baumannii isolates were multidrug resistant in our set up and infections due to them were associated with high mortality. Prevention of Multiple drug resistant (MDR) A. baumannii infections was achieved after discontinuation of cefotaxime in ICU. Infection with resistant clones and mechanical ventilation were found to be potential independent risk factors for mortality.

Epidemiological investigation of nosocomial Acinetobacter infections using arbitrarily primed PCR & pulse field gel electrophoresis.

BACKGROUND & OBJECTIVE: Nosocomial infections caused by Acinetobacter spp. are a significant problem worldwide. Information on epidemiological investigation of outbreaks caused by Acinetobacter species in India is lacking. The present investigation was carried out to elucidate molecular epidemiology of Acinetobacter species isolated from nosocomial infections in a tertiary care hospital in south India using two DNA-based typing methods. METHODS: The medical records of 43 patients with Acinetobacter infection during a period of 24 months were reviewed and Acinetobacter isolates obtained from these patients were characterized phenotypically by assimilation tests and genotypically by arbitrarily primed PCR (AP-PCR) and pulse field gel electrophoresis (PFGE). Susceptibility testing results of the Acinetobacter isolates were also analysed. RESULTS: Most of the infections were nosocomial, and the majority of these were acquired in intensive care units (ICUs). A. baumannii accounted for 41.8 per cent (n=18) of all pneumonia acquired in the ICU. AP-PCR with M13 primer distinguished 8 different PCR patterns comprising of 2 to 6 DNA fragments of 0.1 to 1.0 kb. PFGE identified 9 distinct profiles with five subvarients. By APPCR, epidemiologically unrelated strains could not be differentiated and often differences within biotypes of A. baumannii were not detectable. ApaI macrorestriction (PFGE) identified at least 4 outbreaks caused by 3 clones of A. baumannii and one clone of DNA group 13TU, one replacing the other in a well-defined temporal order. INTERPRETATION & CONCLUSION: Most of A. baumannii isolates were multidrug resistant. PFGE was more discriminatory [Discriminatory Index (DI)=0.96 than AP-PCR fingerprinting (DI=0.88)] in the present study. However, AP-PCR fingerprinting is more useful as a simple and rapid identification technique for epidemiological investigation of nosocomial Acinetobacter infections.

Foreign body in upper digestive tract.

OBJECTIVE: Foreign body ingestion is a common clinical problem, encountered in children. METHODS: A total number of 104 patients with ingested foreign body admitted in our hospital are reviewed. Endoscopic removal was done for all foreign objects impacted in esophagus. RESULT: In 84.6% cases, history of having swallowed the foreign body was most common symptom. Majority of patients (61.53%) presented within 24 hours after ingestion of foreign body. Coins were the most frequent offending agents in children (87.5%). Seventy six cases of coins were impacted in the postcricoid region. Complications of retropharyngeal abscess was seen in two cases (1.92%), which was associated with sharp foreign body. CONCLUSION: Early removal of these sharp foreign bodies must be considered to reduce the risk of this complication.

In vitro susceptibility pattern of acinetobacter species to commonly used cephalosporins, quinolones, and aminoglycosides.

PURPOSE: Acinetobacter spp. is an emerging important nosocomial pathogen. Clinical isolates of this genus are often resistant to many antibiotics. The in vitro susceptibility of Acinetobacter isolates obtained from patients were tested for currently used antibiotics. In addition, the study aimed at biotyping of Acinetobacter baumannii. METHODS: A total of 66 isolates were phenotypically characterised through a large panel of 25 carbon assimilation tests and susceptibility through disc diffusion method with 10 antimicrobial agents were tested. MICs were determined only for second line broad-spectrum drugs such as cefotaxime, ceftazidime, amikacin, ciprofloxacin, and ofloxacin using NCCLS guidelines. RESULTS: Multiple drug resistance (MDR) was only witnessed in A. baumannii and not in other Acinetobacter species. Aminoglycosides such as amikacin, netilmicin were most active against the MDR isolates tested (60% susceptibility). Ceftazidime was more active than cefotaxime. MDR A. baumannii strains were susceptible only to amikacin, netilmicin and ceftadizime. Ciprofloxacin had poor activity irrespective of isolates belonging to different DNA groups tested (58% resistance overall, 79% among A. baumannii). Strains of Biotypes 6 and 19 of A. baumannii showed broader resistance than those of biotype 10 and others. CONCLUSIONS: Strains of A. baumannii from patients in our hospital, were generally more resistant to quinolones, -lactam antibiotics, first and second generation cephalosporins and partially resistant to third generation cephalosporins and aminoglycosides. The strains belonging to other DNA groups of Acinetobacter were comparatively less resistant than A.baumannii, except ciprofloxacin. This study suggests that, a combination therapy, using a third generation cephalosporin and amikacin, would be best choice for treating Acinetobacter infections.

alpha-Lipoic acid ameliorates altered colonic contractility and intestinal transit in STZ-diabetic rats.

alpha-Lipoic acid treatment (100 mg/kg/day for 2 weeks after 6 weeks of untreated diabetes) of streptozotocin diabetic rats partially but significantly reversed both reduced contractile response of distal colon to acetylcholine and delayed transit of charcoal meal in small intestine compared to diabetic control. These effects of alpha-Lipoic acid were associated with complete reversal of diabetes induced increased plasma lipid peroxidation level. alpha-Lipoic acid had no effect on any of the parameters measured in non-diabetic rats. These findings demonstrate contribution of oxidative stress in the development of physiological changes of gut in diabetes.

Choanal atresia: transnasal endoscopic technique.

OBJECTIVE: This article attempts to address the controversy between, endoscopic and traditional approaches to neonatal choanal atresia. METHOD: Congenital choanal atresia has been recognized for over 200 years, first described by Roedere in 1775. This condition is uncommon, occurring in approximately 1 in 7000 live births. Unfortunately a single ideal procedure for this condition does not exist. RESULTS: Stankiewicz is credited with the first description of endoscopic techniques for choanal atresia repair. All patients diagnosed to have choanal atresia, treated between 1999 and 2000 were reviewed. Out of four patients two underwent endoscopic repair. CONCLUSION: Transnasal endoscopic technique is followed by stenting with endotracheal portex tubes for 4-6 weeks in the initial surgical procedure of choice.

Tracheobronchial foreign bodies.

OBJECTIVE: [corrected] Foreign body inhalation is an extremely serious problem in children and sometimes result in sudden death. The current mortality rate from foreign body inhalation is between 0% and 1.8% according to various studies. In spite of this, undiagnosed and unsuspected foreign bodies still occur in the airway. METHODS: Pediatric patients with documented foreign body inhalation, treated in the Department of Pediatrics, Bapuji Hospital, JJM Medical College during 1997-2000 are included in the analysis. Children with or without positive history of aspiration were examined and the diagnosis was made on the basis of history, clinical findings, radilogic evaluation and strong index of suspicion in those children where reasonable appropriate treatment failed to resolve the respiratory symptoms. Bronchoscopy was performed for a suspected foreign body on 165 children. RESULT: A review of 165 pediatric cases of suspected foreign body aspiration revealed, children between 1 and 3 years were found to be very vulnerable for aspiration. Majority of children were boys. Over 70% of the patients had positive history of inhalation. Only 60% of the patients presented immediately, that is within 24 hours after aspiration. Common symptoms were cough and respiratory distress. Physical examination showed abnormal finding in 91% of cases. Decreased air entry was the significant clinical sign. Obstructive emphysema was found in majority of the cases (49.5%). Rigid bronchoscopy under general anaesthesia was the preferred method for removal of aspirated foreign body. In 65 (61.9%) cases foreign body was lodged in the right main bronchus and majority of these were organic in nature, that is 96 (91.43%). CONCLUSION: Tracheobronchial foreign bodies should be strongly suspected in pediatric age group who present with a suggestive history, even when physical and radiographic evidence is absent. The modalities of diagnosis, management and outcome are discussed.