Comparison of Epidural Analgesia with Ultrasound?Guided Bilateral Erector Spinae Plane Block in Aorto?Femoral Arterial Bypass Surgery

Objective:Thoracic Epidural Analgesia (TEA) was compared with ultrasound?guided bilateral erector spinae plane (ESP) block in aorto?femoral arterial bypass surgery for analgesic efficacy, hemodynamic effects, and pulmonary rehabilitation. Design: Prospective randomized. Setting: Tertiary care centre. Participants: Adult patients, who were scheduled for elective aorto?femoral arterial bypass surgery. Interventions: It was a prospective pilot study enrolling 20 adult patients who were randomized to group A (ESP block = 10) and group B (TEA = 10). Monitoring of heart rate (HR) and mean arterial pressure (MAP) and pain assessment at rest and deep breathing using visual analog scale (VAS) were done till 48?h post?extubation. Rescue analgesic requirement, Incentive spirometry, oxygenation, duration of ventilation and stay in Intensive Care Unit (ICU) were reported as outcome measures. Statistical analysis was performed using unpaired Student T?test or Mann?Whitney U test. A value of P < 0.05 was considered significant. Results: HR was lower in group B than group A at 1 and 2 h post? surgery and at 0.5, 16, 20, and 32 h post?extubation (P < 0.05). MAP were lower in group B than A at 60, 90, 120, 150, 180, 210, 240, 270 minutes and at 0 hour post?surgery and at 4 hours, every 4 hours till 32 hours post?extubation (P < 0.05). Intraoperative midazolam and fentanyl consumption, ventilatory hours, VAS at rest, incentive spirometry, oxygenation, and ICU stay were comparable between the two groups. VAS during deep breathing was more in group A than B at 0.5, 4 hours and every 4 hours till 44 hours post?extubation. The time to receive the first rescue analgesia was shorter in group A than B (P < 0.05). Conclusion: Both ESP block and TEA provided comparable analgesia at rest. Further studies with larger sample size are required to evaluate whether ESP block could be an alternative to TEA in aorto?femoral arterial bypass surgery

Uranium in drinking water from the south coast districts of Kerala, India

The South-west coast of India is known to have very high levels of natural background radiation due to the monazite beach sand. Uranium is the heaviest trace element found in all terrestrial substances at varying levels with chemical and radio toxicities. It supports several short-lived radioisotopes in its decay series including radium. Uranium in drinking water is important in terms of the ingestion dose. The present study reports the results of uranium analysis of 346 drinking water samples from the three costal districts of Kerala using fission track registration technique. Results obtained show that uranium concentrations vary from 0.31 micro g/l to 4.92 micro g/l equivalent to the specific activity of 3.9 Bq/m3 and 62 Bq/m3, respectively. The estimated daily intake of uranium through drinking water is lower than the recommended limits. The distribution of uranium in water bodies shows a heterogeneous nature of distribution

case-control study of bidi smoking and bronchogenic carcinoma

To evaluate the risks imposed by tobacco smoking, in particular, bidi smoking, in the development of lung cancer. Two hundred eighty-four histologically confirmed patients of bronchogenic carcinoma and 852 controls matched for age, sex, and socioeconomic status were interviewed according to a predesigned questionnaire. Effects of individual variables defining the various aspects of tobacco smoking, in particular, bidi smoking, were assessed using logistic regression models. 81.3% cases of bronchogenic carcinoma were ever smokers as compared with 42.2% among controls. The odd ratios for ever smoking, bidi smoking, and cigarette smoking were 5.9 [confidence interval [CI] 4.3, 8.4], 6.1 [CI 4.3, 8.7], and 5.3 [CI 2.7, 10.4], respectively. Bidi smoking poses a very high risk for lung cancer even more than that of cigarette smoking

case-control study of tobacco smoking and tuberculosis in India

To evaluate the role of smoking as a risk factor for the development of pulmonary tuberculosis. A total of 111 sputum smear-positive patients of pulmonary tuberculosis and 333 controls matched for age and sex were interviewed according to a predesigned questionnaire. The adjusted odd ratio of the association between tobacco smoking and pulmonary tuberculosis was 3.8 [95% confidence interval, 2.0 to 7.0; P value, <.0001]. A positive relationship between pack years, body mass index and socioeconomic class was also observed. There is a positive association between tobacco smoking and pulmonary tuberculosis

Spontaneous pneumothorax: An unusual complication of pregnancy - A case report and review of literature

Spontaneous pneumothorax complicating pregnancy is rare. Only 55 cases have been reported till now. We describe a case of a 30-year-old Indian woman with spontaneous pneumothorax during her 28[th] week of pregnancy

Correlation of Patient Weight and Cross-Sectional Dimensions with Subjective Image Quality at Standard Dose Abdominal CT

OBJECTIVE: We evaluated the association between patients' weight and abdominal cross-sectional dimensions and CT image quality. MATERIALS AND METHODS: We prospectively evaluated 39 cancer patients aged more than 65 years with multislice CT scan of abdomen. All patients underwent equilibrium phase contrast-enhanced abdominal CT with 4 slices (from top of the right kidney) obtained at standard tube current (240 280 mA). All other scanning parameters were held constant. Patients' weight was measured just prior to the study. Cross-sectional abdominal dimensions such as circumference, area, average anterior abdominal wall fat thickness and, anteroposterior and transverse diameters were measured in all patients. Two subspecialty radiologists reviewed randomized images for overall image quality of abdominal structures using 5-point scale. Non-parametric correlation analysis was performed to determine the association of image quality with patients' weight and cross-sectional abdominal dimensions. RESULTS: A statistically significant negative linear correlation of 0.46, 0.47, 0.47, 0.58, 0.56, 0.54, and 0.56 between patient weight, anterior abdominal fat thickness, anteroposterior and transverse diameter, circumference, cross-sectional area and image quality at standard scanning parameters was found (p< 0.01). CONCLUSION: There is a significant association between image quality, patients' weight and cross-sectional abdominal dimensions. Maximum transverse diameter of the abdomen has the strongest association with subjective image quality.

Stone composition, metabolic profile and the presence of the gut-inhabiting bacterium oxalobacter formigenes as risk factors for renal stone formation

To examine stone composition, metabolic evaluation and colonization of Oxalobacter formigenes as risk factors for renal stone formation. Subjects and Eighty patients with renal stones and 70 healthy controls were enrolled in the study. Of the 80 patients, 48 were first-time stone formers [FSF] and 32 were 'recurrent' stone formers [RSF], recurrent indicating 2 or more episodes of stone formation. Stone analysis by X-ray crystallography, 24-hour urine metabolic profile and detection of O. formigenes-specific DNA by PCR were performed for each patient. Detection of O. formigenes was also performed on 45 and urinary metabolic profile on an additional 25 controls. Calcium oxalate monohydrate was the major component of stones, hyperoxaluria and hypocitraturia were the most common urinary abnormalities in the 80 patients, 46% of RSF patients had hypercalciuria. Urinary abnormalities were far less frequent in the controls, with the exception of hypocitraturia [40%]. Of the urinary metabolites, only calcium levels were significantly different [p < 0.05] between FSF [6.50 +/- 4.08 mmol/24 h] and RSF [8.21 +/- 5.26 mmol/24 h] patients. Colonization of O. formigenes was higher in controls [62.2%] than in FSF [33.3%] or RSF [28%] patients, it was least in patients with more than 4 episodes [7%] of stone formation. The findings indicate that lack of colonization of O. formigenes may be an important risk factor for recurrence of stone formation [calcium oxalate monohydrate]