Evaluation of Acromio-Axillary-Suprasternal Notch Index in Predicting Difficulty in Visualization of Larynxs in Adult Patients

In medical specialty, expertise in airway management is essential. Maintaining the airway and providing oxygenation is the responsibility of the anaesthesiologist. He is also responsible for reducing the morbidity, and mortality related to difficult intubation. To reduce the risk associated with difficult visualization of larynx, preoperative assessment of airway is required. To protect patient’s airway, endotracheal intubation is the gold standard. Direct laryngoscopy easily enables the securing the airway. This study was for predictive validity of the current system called acromio-axillo-suprasternal notch index in the assessment of difficult airway management. METHODSA total of 60 adult patients, of either gender, aged 18 - 65 years, of ASA class 1 and 2, undergoing elective surgery under general anaesthesia requiring tracheal intubation participated in this prospective, comparative, observational study. AASI was used for preoperative assessment of airway. Sensitivity, and specificity were calculated for AASI. In this study, data analysis was done using chi- square. p < 0.05 was considered statistically significant. RESULTSDifficult Visualization of Larynx was observed in 3.6 % [95 % confidence interval (1.9 – 5.4 %)] patients. Our study found that sensitivity and specificity were 75 % and 95.7 % respectively. CONCLUSIONSAcromio-Axillary-Suprasternal Notch Index (≥ 0.5) is a clear indicator of difficult larynx visualization with direct laryngoscopy.

Effectiveness of Transverse Abdominis Plane Block as a Method of Regional Anaesthesia in Unilateral Inguinal Hernia Repair

The Transverses Abdominis Plane (TAP) block is a relatively new regional technique which is often used for sensory blockade of the lower abdominal wall mainly for post-operative pain relief. It causes sensory blockade mainly because of injection of local anaesthetic between the internal oblique and the transverse abdominis muscle. TAP block was performed using a blind landmark technique in the lumbar petit triangle. Nowadays USG guided TAP block is being performed in many centers. TAP block is known to improve postoperative pain, reduce the opioid demand, and also reduce the time to rescue analgesia in patients undergoing lower abdominal surgeries. In our study, we have used TAP block as a main anaesthetic technique in patients posted for unilateral inguinal hernia repair under elective conditions. TAP Block in this study was given with 0.5 % bupivacaine. Duration of anaesthesia / analgesia, effectiveness of block, period of block, cardiac stability and haemodynamic stability were studied. METHODSA prospective observational study was conducted on 30 randomly selected individuals posted for elective inguinal hernia repair who belonged to American Society of Anaesthesiologists classification 1 and 2; age group between 20 and 70 years; satisfying all inclusion and exclusion criteria. All the patients received 0.5 % bupivacaine for TAP block, dose not more than 2.5 mg / Kg body weight. RESULTSWe have found that TAP block gives good anaesthesia for patients posted for inguinal hernia repair with good haemodynamic stability. With inj. Bupivacaine 0.5 % having an onset of anaesthesia at about 7.45 + / - 2.32 minutes (p value < 0.001). The block was complete and effectively elevated nociceptive stimuli. The block lasted till the end of surgery in all cases, with no complications. CONCLUSIONSTAP block other than being the main anaesthetic technique for lower abdominal surgery, also provides good post-operative analgesia with minimal post-operative analgesic requirement with less haemodynamic variations.

Population-based incidence and patterns of cancer in Kamrup Urban Cancer Registry, India.

Background. Cancer is not a notifiable disease in India. The Indian Council of Medical Research (ICMR) initiated the National Cancer Registry Programme in 1982 to measure the burden and pattern of cancer in India. However, no data were available from the northeastern region till 2001 when a WHOsponsored, ICMR project showed a relatively high frequency of microscopically diagnosed cases of cancer in the region. A population-based cancer registry was established in January 2003 in Guwahati to cover the Kamrup Urban district in the northeastern region of India. We report the data generated in the first 6 years of the registry (2003–08). Methods. Information on cancer was obtained by voluntary participation of different sources including major hospitals, diagnostic centres, state referral board and birth and death registry centres within the registry area. A total of 6608 cases were registered during the 6-year period (1 January 2003– 31 December 2008); 3927 were men and 2681 women. Results. The age-adjusted incidence rates were 167.9 per 100 000 among men and 133.8 per 100 000 among women. The oesophagus was the leading site of cancer among men, comprising 18.3% of all cancers with an age-adjusted rate of 30.7 per 100 000. Among women, the breast followed by the cervix uteri were the leading sites of cancer. These two cancers comprised 30% of all cancers among women. Tobacco-related cancers accounted for 58.2% of cancers among men and 26.9% of cancers among women. Conclusion. The patterns observed from the analysis of data from the cancer registry at Guwahati provide comprehensive information on occurrence of cancer and can be valuable for planning cancer control programmes in the region.

In-vitro scolicidal activity of Mallotus philippinensis (Lam.) Muell Arg. fruit glandular hair extract against hydatid cyst Echinococcus granulosus

OBJECTIVE@#To investigate new scolicidal agent from natural resources to cope with the side effects associated with synthetic drugs in Echinococcosis.@*METHODS@#The scolicidal potential of methanolic fruit powder extract (10 and 20 mg/mL) of Mallotus philippinensis (M. philippinensis) was investigated. Viability of protoscoleces was confirmed by trypan blue exclusion method, where mortality was observed at concentration of 10 and 20 mg/mL in 60 min treatment against Echinococcus granulosus (E. granulosus), under in-vitro conditions with reference to the known standard drug Praziquantel®.@*RESULTS@#At concentration 10 and 20 mg/mL, the mortality rate was observed 97% and 99% respectively for 60 min treatment; while up to 93% mortality was observed with 20 mg/mL for only 10 min treatment. The concentration above 20 mg/mL for above 2 h showed 100% mortality, irrespective of further incubation.@*CONCLUSIONS@#As compared with the standard anti-parasitic drug Praziquantel our extract has significant scolicidal activity with almost no associated side effects.

A giant syphilitic aneurysm in a young human immunodeficiency virus sero-positive individual.

A 35-year-old, human immunodeficiency virus sero-positive male presented with huge mediastinal mass for evaluation. After contrast enhanced computed tomography (CECT) angiogram, aneurysm of arch of aorta was diagnosed. The patient also proved to be co-infected with syphilis, which is the aetiological cause of aneurysm in this case. The present report highlights the need to suspect, diagnose and treat dual infections in individuals with high risk behaviour.