Ball valving laryngeal masses: a difficult “ball” in the anaesthetists’ court

Dynamic airway obstruction (also called ball-valve effect) is a serious condition often seen in glottic lesions. This is an anesthetic challenge as total airway obstruction can occur after the induction of general anesthesia. We present a case of a middle aged female who had a large laryngeal mass which was showing ball-valve effect. The patient had refused for tracheostomy despite it being the safest procedure in the circumstances. We then performed videolaryngoscopy and managed to intubate the patient with the help of some improvisation. The patient underwent a succesful and uneventful surgery.

Robotic intraoperative tracheal repair during retrosternal malignant goiter excision: an anesthetic challenge

Thyroidectomy is the treatment of choice for large retrosternal goiters. These tumors often are large enough to require thoracotomy. Robotic surgery can help in avoiding thoracotomy and its associated post operative complications. Rarely, such tumors and their surgery can be complicated by tracheal tears. Such tears, especially those near the carina are difficult to repair and often require open thoracotomy. We described such a case where we avoided open thoracotomy and instead performed a minimally invasive robotic repair of tracheal tear. The maintenance of ventilation during this robotic repair was critical. A combination of several airway devices was used to allow the complex surgical repair to be executed without affecting ventilation.

Prevalence and epidemiological aspect of dengue fever in western Rajasthan in year 2018

Background: Dengue fever (DF) is a common mosquito borne disease caused by dengue virus and is transmitted by Aedes mosquito. It is one of the major public health problems in India which affects all levels of society, but the burden of disease is a higher in poor people who live together in communities.  Aim of present study is aimed to assess the prevalence and epidemiological characteristics of cases of DF in  Tertiary Care Hospitals in Jodhpur, Rajasthan.Methods: A cross-sectional study was conducted in all cases of DF registered in the associated group of Hospitals of Dr. S.N. Medical College, Jodhpur from 1st January 2018 to 31st December 2018. Rapid immune-chromatographic card test and MAC ELISA test method was used to detect dengue non-structural protein 1 (NS1) antigen and dengue immunoglobulin M (IgM) antibodies in the Viral Research Diagnostic Laboratory (VRDL) of Department of Microbiology, Dr. S.N. Medical College to confirm the diagnosis. Results: Out of 2701 patients, 541 patients were tested serologically positive for DF (NS1, IgM). The highest number of suspected cases (1061) was reported in the month of October, 2018 out of whom 228 were positive. Maximum number of dengue cases reported were males belonging to 31-40 years age group from urban area. Fever was the main complaint in all the cases followed by vomiting, headache, and abdominal pain.Conclusion: Dengue is one of the major public health problems in India. A large number of cases are reported in the monsoon and post-monsoon period in the months from  September to December. Measures can be taken both at personal and government level to reduce morbidity and mortality from dengue.

Prevalence of rheumatic heart disease in school children in Bikaner: an echocardiographic study.

OBJECTIVE: To determine prevalence of rheumatic heart disease (RHD) using clinical and echocardiographic criteria and to study influence of socioeconomic status (SES) we studied school children in a north-western Indian town. METHODS: 3292 school children, age range 5-14 years, in two private schools, ten middle SES government schools and six low SES government schools were invited to participate in the study. 3002 (1837 boys, 1165 girls) were clinically examined (response 91%) of which 1042 were in private schools, 1002 in middle SES schools and 958 in low SES schools. Prevalence of cardiac murmurs and RHD based on clinical diagnosis was determined in school by a trained team of physicians. Those with a murmur were further evaluated by Doppler-echocardiography in the hospital. Group-specific and age-specific rates (prevalence/thousand) of murmurs and cardiac lesions were determined. RESULTS: A significant cardiac murmur was observed in 55 subjects (18.3/1000) with similar prevalence in boys (20.7) and girls (14.6). The prevalence of murmur was significantly greater in children belonging to low SES schools (29.2/1000) as compared to middle SES (18.9) and higher SES schools (7.6). RHD prevalence based on clinical diagnosis was observed in 50 children (16.7/1000) and was similar in boys (19.1) and girls (12.9). Clinical RHD was more in the low SES school children (28.2/1000) as compared to middle (17.0) and high SES schools (5.8). RHD was demonstrated on echocardiography in 2 children (0.67/1000). Other prevalent cardiac lesions were congenital heart disease in 5 (1.66/1000) and mitral valve prolapse in 37 (12.3/1000). CONCLUSIONS: There is a low prevalence of RHD in school children in this region compared to previous Indian studies. Cardiac murmurs are more prevalent among low SES children.

Endoscopic variceal ligation using multiband ligator.

Esophageal variceal bleed in children is treated with endoscopic sclerotherapy (EST), which is associated with significant complications. Endoscopic variceal ligation (EVL) was found to be more effective and safe in adults. Use of EVL in children has not been studied much. Thirteen consecutive children (mean age 9.4 years) with variceal bleed were subjected to EVL by multi band ligator. Varices were eradicated in 2.8 sessions (range 2-4) and one patient had bleed during procedure. No other complications were noted. EVL could not be performed in 2 children less than 3 years of age.

Drug resistance in tuberculosis patients in Jodhpur district.

Drug resistant tuberculosis is a serious problem in control of tuberculosis. To assess this problem in Jodhpur district, Sputum samples of symptomatic quarry workers and cases of pulmonary tuberculosis attending District Tuberculosis Clinic (DTC) Jodhpur were tested for culture of Mycobacterium tuberculosis complex (MTB) and their sensitivity to antituberculous drugs, using proportion method. Primary drug resistance to isoniazid was observed in 16.67%, to streptomycin in 16.67%, to ethambutol in 6.67% and to rifampicin in 6.67%. Acquired resistance to isoniazid was 61.76%, to streptomycin was 51.52%, to rifampicin was also 70.59%, and to ethambutol was 39.39%. Proportion of Multi-drug resistant (MDR) TB defined as resistant to at least isoniazid and and rifampicin, was 3.3% in new cases (primary drug resistance) and 38.2% in old cases (acquired drug resistance), the later may be due to inadequate treatment, the the history of which was present in most cases. Adequate treatment of such cases with effective regimens is of vital importance to prevent the spread of MDR TB.

Serum copper in newborns and their mothers.

Serum copper levels in the cord blood of 100 newborns and the respective maternal serum copper at the time of delivery was estimated by atomic absorption spectrophotometer. The cases were classified into term AGA, term SGA, term LGA, preterm AGA and preterm SGA. The mean maternal serum copper level 152.42 +/- 2.06 micrograms/dl) was significantly higher than the mean cord serum copper level (39.84 +/- 1.19 micrograms/dl). There was positive correlation between the maternal serum copper level and cord serum copper level. The mean serum copper level of term neonates was (44.42 +/- 1.26 micrograms/dl) significantly higher (p < 0.001) than that of preterm neonates (30.30 +/- 1.14 micrograms/dl). There was a positive correlation between cord serum cooper level and gestational age. The mean cord serum copper levels of term AGA, term SGA, preterm AGA and preterm SGA neonates was 45.42 +/- 1.44 ug/dl, 39.22 +/- 2.45 ug/dl, 31.00 +/- 2.11 ud/dl and 29.47 +/- 2.08 ug/dl respectively. There was no statistically significant difference in the mean serum copper level of AGA and SGA group of both term and preterm neonates. The difference amongst mean maternal serum copper level of various neonatal groups was not significant.

Prevalence and pattern of mental health problems.

Three hundred and forty eight children of age group 5-15 years were studied. A reporting questionnaire was administered to the parents and then affected children were examined in detail by history, physical examination and mental status examination. Fifty out of 348 children were having mental health problems. Male and first born children were affected more. Common problems observed were poor scholastic performance, enuresis, hyperkinetic syndrome, speech disorders and sleep disorders. In males, poor scholastic performance, hyperkinetic syndrome and temper tantrums were common while in females enuresis, speech disorders and hysterical symptoms were more frequent. Among the adverse perinatal factors of etiological importance low birth weight, difficult deliveries, birth injuries, delayed cry, neonatal jaundice and convulsions were common. Predominant psychosocial stress factors were quarrels between parents, separated parents, deaths of parents, siblings or relatives and chronic illness in the family.