Small Cell Type Undifferentiated Carcinoma of Gall Bladder with Pas Positive Hyaline Globule Masquerading as Liver Mass: A Case Report and Literature Review / 대한소화기학회지

An undifferentiated carcinoma (UC) of the gall bladder behaves aggressively and has a grave prognosis. Small cell type undifferentiated carcinoma of the gall bladder is a rare variant. This paper reports a case of UC of gall bladder with PAS-positive diastase-resistant eosinophilic hyaline globules present as liver mass (on imaging) in a male patient. The microscopic findings of the liver and gall bladder after a right tri-segmentectomy showed an un-differentiated malignant neoplasm composed of cells with round to oval nuclei, prominent nucleoli, and scanty neoplasm. No definite cell pattern was identified with these neoplastic cells. A section from the gall bladder revealed a tumor arising from the lining epithelium and infiltrating through the muscularis. This tumor was infiltrating the adherent liver tissue directly and forming a mass of undifferentiated malignant cells. The focal area within the tumor mass showed the presence of PAS-positive, diastase-resistant, eosinophilic hyaline globules within the neoplastic cells. The immunohistochemistry test was diffusely positive for perinuclear anti-neutrophil cytoplasmic antibodies and negative for chromogranin, vimentin, Desmin, alpha-fetoprotein, leukocyte common antigen, CD34, and bcl2. When the clinical and radiological data are inconclusive, careful analysis of the histological and immunophenotypic features is needed to make the final diagnosis of UC of the gall bladder. The biological behavior and prognosis of this tumor remain unclear because of its rarity. Further studies will be needed to understand the characteristics of this deadly tumor and to establish an effective therapy for it.

Exposure to Atmospheric Particulates and Associated Respirable Deposition Dose to Street Vendors at the Residential and Commercial Sites in Dehradun City

BACKGROUND: Street vendors spend relatively more time near roadways and are vulnerable to air pollution related health disorders. However, there is limited information on the quality of the air they breathe. The objectives of this present study were to calculate the mass concentration of atmospheric particulate matter (PM) in eight size fractions (PM0.4–0.7, PM0.7–1.1, PM1.1–2.1, PM2.1–3.3, PM3.3–4.7, PM4.7–5.8, PM5.8–9.0, and PM9.0-–0µm) at commercial (CML) and residential site (RSL) in Dehradun city from November 2015 to May 2016. To estimate the corresponding respiratory deposition dose (RDDs) in alveolar (AL), tracheobronchial (TB), and head airway (HD) region on street vendors working at CML and RSL. To find the association of atmospheric PM with RDDs and the incidence of respiratory related disorders among street vendors. METHODS: Andersen cascade impactor was employed for calculating the PM mass concentration. Questionnaire based health survey among street vendors were carried out through personal interview. RESULTS: A significant difference (p < 0.05; t-test) between the mean PM0.4–10µm mass concentration at CML and RSL was observed with (mean±SD) 84.05±14.5 and 77.23±11.7 µgm−3, respectively. RDDs in AL, TB and HD region at CML was observed to be 9.9, 7.8, and 7.3% higher than at RSL, respectively. Health survey revealed 1.62, 0.96, 0.04, and 0.57 times higher incidence of cold, cough, breathlessness, and chest pain, respectively with street vendors at CML compared to RSL. CONCLUSION: The site characteristics plays a major role in the respiratory health status of street vendors at Dehradun.

Comparison of surgical field quality and emergence time during endoscopic sinus surgery using propofol or desflurane: a randomized clinical trial

Objectives: Hypotensive anesthesia is necessary during endoscopic sinus surgery to achieve a bloodless surgical field. The aim of this study was to compare the quality of surgical field using propofol or desflurane anesthesia

Methodology: 40 patients of either sex, belonging to ASA physical status I and II, and age group of 18 - 60 years were randomized into two groups to receive either propofol and morphine or desflurane and morphine anesthesia. The target mean arterial pressure [MAP] was kept in a range of 65-75 mmHg. The quality of surgical field was assessed by using a validated scoring system [Fromme category scale] at every 15 min by the same surgeon in all the cases to avoid surgeon's bias

Results: The mean category scale value was 2.665 +/- 0.243 in propofol group and 2.200 +/- 0.410 in desflurane group [p=0.000]. The time to emergence was significantly less in desflurane group [9.35 +/- 1.27] as compared to propofol group [14.60 +/- 2.06 min]

Conclusion: We conclude that both the propofol and desflurane can be used to achieve a satisfactory surgical field quality but desflurane provides a rapid emergence as compared to propofol

Status of multidrug resistant tuberculosis [MDR-TB] among the Sahariya tribe of North Central India

Background: The incidence/prevalence of tuberculosis [TB] is reported to be high in the Sahariya tribe of North Central India. The outbreaks of different drug-resistant isolates of Mycobacterium tuberculosis emphasized the need for continuous monitoring of resistance to anti-tuberculosis drugs. This study aimed to assess the profile of multidrug resistant TB among the Sahariya tribe and their non-tribal neighbors for first line drugs through field-based investigations.

Methodology: A total of 274 sputum positive pulmonary TB individuals were enrolled and studied for their drug susceptibility profile by the proportion method. Results: A total of 21 cases from Sahariya and 6 from non-tribes were identified with MDR-TB. Thus Sahariya tribe showed a 1.95-fold increased risk of developing drug resistance than non-tribes. Significant differences were observed for developing drug sensitivity between Sahariya males and females when analyzed for resistance developed to any drug and overall drug resistance vs. sensitive isolates, respectively

A 4.46-fold risk was found for MDR-TB among the smokers of Sahariya tribe, whereas, the non-tribes did not show any significant association

Conclusion: The drug susceptibility profile developed in the present study indicates that drug-resistant tuberculosis is emerging as a serious public health concern in Sahariya tribe. Urgent and effective control measures and better management policies are needed for the prevention of MDR-TB in the tribe

Dexmedetomidine infusion as an anesthetic adjuvant to general anesthesia for appropriate surgical field visibility during modified radical mastectomy with i-gel®: a randomized control study / 대한마취과학회지

BACKGROUND: Modified radical mastectomy is associated with appreciable blood loss, while endotracheal intubation leads to elevated hemodynamic responses. The present study aimed to evaluate the clinical efficacy of dexmedetomidine infusion as an anesthetic adjuvant to general anesthesia during modified radical mastectomy with I-Gel. METHODS: Sixty adult consenting female patients, of American Society of Anesthesiologists physical status 1 to 2 and aged 4,065 years, were blindly randomized into two groups of 30 patients each. The patients in Group I received intravenous dexmedetomidine at a loading dose of 1 µg/kg over 10 min, followed by maintenance infusion of 0.4 to 0.7 µg/kg/h, while patients in Group II were administered an identical amount of saline infusion until 15 min prior to the end of surgery. The primary end point was bleeding at the surgical field and hemodynamic changes; requirement of isoflurane, intraoperative fentanyl consumption and recovery time were assessed as secondary outcomes. RESULTS: The patients receiving dexmedetomidine infusion showed significantly less bleeding at the surgical field (P < 0.05). A statistically significant reduction was also observed in the percentage of isoflurane required (0.82 ± 0.80%) to maintain the systolic blood pressure between 100 and 110 mmHg in patients receiving dexmedetomidine infusion compared with the Group II (1.50 ± 0.90%). The mean intraoperative fentanyl consumption in patients in the Group I was also significantly lower compared with that of the Group II (38.43 ± 5.40 µg vs. 75.12 ± 4.60 µg). The mean recovery time from anesthesia did not show any clinically significant difference between the groups. CONCLUSIONS: Dexmedetomidine infusion can be used safely to decrease the bleeding at the surgical field with smooth recovery from anesthesia.

Relationship of conventional and fluorescent microscopic technique to assess in vitro semen quality status of murrah buffalo males

In vitro fertility assessment using fluorescent technique is a better predictor of fertility status of bulls as compared to traditional semen quality assessment techniques, therefore, the study was planned to assess in vitro fertility status of bulls based on conventional and fluorescent techniques. Seventy-three ejaculates were collected from 12 Murrah buffalo bulls maintained at Artificial Breeding Research Centre, NDRI, Karnal, India for the experiment and subjected to statistical analysis using SYSTAT. The mean values of ejaculate volume [ml], mass activity, individual motility [%], sperm concentration [millions/ml], live sperm [%], total abnormalities [%], HOST [%] and acrosomal integrity [%] were 2.70 +/- 0.28, 2.8 +/- 0.14, 63.8 +/- 2.16, 1749.7 +/- 122.24, 77.3 +/- 2.48, 6.2 +/- 0.51, 75.1 +/- 1.81 and 84.5 +/- 2.26, respectively. The repeatability estimates were significant [P<0.05] for ejaculate volume [0.34 +/- 0.137], acrosomal integrity [0.29 +/- 0.134] and live percentage [0.28 +/- 0.133], indicating sufficient bull to bull variation for the parameters. The mean values of seminal attributes of fluorescent based criteria of CMA3 [Chromomycin A3], SYBR-PI and FITC-PNA [fluorescent isothiocynate-conjugated peanut agglutinin] were 5.25 +/- 0.41, 67.91 +/- 1.24 and 82.00 +/- 1.25 percent, respectively. Bulls were ranked on the basis of expected producing ability [EPA] for semen characteristics assessed by conventional and fluorescent criteria. Rank correlations were found to be significant for FITC with most of the parameters evaluated by conventional methods. In conclusion, among the conventional criteria, individual motility [%] revealed ranking of bulls almost similar to that of fluorescent criteria

Primary Tuberculosis of the Cheek: A Common Disease with a Rare Presentation

Tuberculosis of the extra-oral region is uncommon and is rarely primary. Extra-oral involvement of the cheek in the absence of tuberculosis elsewhere in the body is rare. To the best of our knowledge, we report here the first case of primary tuberculosis of the cheek in a 31-year-old male presenting as a nodular swelling of the cheek. Previous reported cases of extra-oral involvement of the cheek involved either fistula or sinus of the cheek. Excisional biopsy for tissue diagnosis and bacterial examination with culture should be performed for an early diagnosis as a delay in treatment can lead to devastating consequences.

Sign of Leser-Trelat: an association with benign swellings

Sign of Leser-Trelat [SLT] is defined by sudden eruption of numerous seborrheic keratosis or rapid increase in the number of pre-existing seborrheic keratosis. It has been reported as a paraneoplastic manifestation in literature but its position as a paraneoplastic manifestation has both strong opponents and proponents. We hereby, report a case of a 49-year-old male who presented to us with SLT-like lesions in association with benign swellings of neck and scrotum

Intrathecal fentanyl as an adjuvant to 0.75% isobaric ropivacaine for infraumbilical surgery under subarachnoid block: a prospective study

Subarachnoid blockade can be used in all surgical procedures carried out on the infraumbilical region. This study was aimed to evaluate the clinical efficacy and safety of intrathecal fentanyl as an adjuvant to 0.75% isobaric ropivacaine on onset, duration, intensity, and recovery time of sensory and motor blockade of subarachnoid block for infra umbilical surgery. One hundred sixty adult consented patients of either gender with American Society of Anesthesiologist ASA I and II scheduled for infraumbilical surgery were randomized into two groups of 80 patients each to receive either intrathecal study solution of 4 mL of 0.75% ropivacaine with 0.4 mL of 0.9% sodium chloride [Group I-Ropivacaine Control Group RC] or fentanyl [20 micro g] [Group II-Ropivacaine with Fentanyl RF]. The end points were hemodynamic variability, onset of analgesia at T 10, maximum sensory analgesic level, time to complete motor blockade, duration of sensory and motor blockade and adequacy of surgical anesthesia. The post-spinal nausea and vomiting, shivering, pruritus, respiratory depression or any other side-effects were also assessed. At the end of study, data were systematically complied and analyzed for statistically significance. The intrathecal fentanyl has accelerated the onset time to achieve sensory blockade to T10 dermatome and motor blockade. Small dose of intrathecal fentanyl with ropivacaine has prolonged the duration of analgesia in the early post-operative period when compared with intrathecal ropivacaine alone. The intraoperative hemodynamic variability showed no statistically significant differences between groups. Intrathecal fentanyl as an adjuvant to 0.75% isobaric ropivacaine demonstrated better clinical profile as compared to ropivacaine alone

Ipsilateral simultaneous fracture of the trochlea involving the lateral end clavicle and distal end radius: a rare combination and a unique mechanism of injury / 中华创伤杂志(英文版)

Isolated trochlea fracture in adults is a rare surgical entity as compared to its capitellar counterpart. It has been only mentioned sporadically in the literature as case reports. Fracture of the trochlea is accompanied by other elbow injuries like elbow dislocation, capitellum fracture, ulnar fracture and extraarticular condylar fracture. Here we report a unique case of isolated displaced trochlea fracture associated with fractures of the lateral end clavicle and the distal end radius. We propose a unique mechanism for this rare combination of injuries: typical triad of injury, i.e. fracture of the distal end radius with trochlea and fracture of the lateral end of the clavicle. Nonoperative treatment is recommended for undisplaced humeral trochlea fractures; but for displaced ones, anatomical reduction and internal fixation are essential to maintain the congruous trochlea-coronoid articulation and hence to maintain the intrinsic stability of the elbow.

Ecological attributes of Hepatozoon lacertilis Gupta et al., 2011 susceptibility in Indian lizards, Hemidactylus flaviviridis (Gekkonidae) and Calotes versicolor (Agamidae)

Ecological attributes of haematozoan parasites are poorly understood. In this study, we report haematozoan prevalence in two species of Indian lizards, Hemidactylus flaviviridis (Family: Gekkonidae) and Calotes versicolor (Family: Agamidae) under three macro-environmental variables: host location, weight and seasonal variations. Hemidactylus flaviviridis (n= 199) and Calotes versicolor (n= 34) were sampled from Bareilly, Chandausi and Mirzapur, Uttar Pradesh, India belonging to different weight groups [Group I (0-5 gm), Group II (5-10 gm) and Group III (10-15 gm)] and during various seasons [Summer (May-July), Rainy (August-October), Winter (November-January), Spring (February-April)] of the year. A haemogregarine, Hepatozoon Miller, 1908 was discovered from both host species. Test for identity of the parasites was conducted by feeding infected Culex quinquefasciatus (Diptera: Culicidae) on infection-free H. flaviviridis and C. versicolor and blood examinations on 22nd day (H. flaviviridis) and 25th day (C. versicolor) post feeding (pf) revealed similar haematozoan parasites and were identified as Hepatozoon lacertilis Gupta et al., 2011. Infectivity from different locations indicated a prevalence of 5.26% (Bareilly) and 16.36% (Mirzapur) in H. flaviviridis whereas infectivity was comparatively higher (19.23%) in C. versicolor. In different weight groups, Group III indicated highest infectivity in both lizards being 21.42% (C. versicolor) and 17.85% (H. flaviviridis). Parasites showed highest prevalence during spring season (H. flaviviridis : 9.52%; C. versicolor : 25%). Values of significance were determined by chisquare test to compare the prevalence within different variables (host location, weight and season). The study has importance for its contribution to the knowledge on the diversity of reptilian hosts infected by haemogregarines. It is the first record of Hepatozoon infectivity in both lizard species with respect to the three macro-environmental variables.

Effectiveness of vitiligo therapy in prospective observational study of 250 cases with review of consensus and individualized care perspective

Outcomes of six month therapy in 250 patients bearing varying disease profiles and treatment regimens delivered either in conformity or divergence from consensus guidelines were compared. Influence of trait variables of patients and disease on the outcomes was also examined. Consensus approach yielded superior rates of repigmentation and improved quality of life. The latter effect significantly influenced the former. Therapy adhering guidelines did not yield optimal benefit in patients of younger age, with disease of shorter standing and involving resistant sites. Steroids best benefited the localized disease as topical monotherapy. Combination of steroid with photochemotherapy adhering guidelines benefited less in moderate disease extent. Steroid overtreatment in extensive disease compromised the prospects of repigmentation. Localized short duration disease may better be first treated with steroid-alternative immunosuppressants. Wider spread more than 3% body surface may also respond to their combination with steroids, prior applying photochemotherapy. Additive therapies are prudent with steroid/photochemotherapy than injudicious steroid overuse in progressive extensive disease. Strategies to counter steroid unresponsiveness and adverse effects, psychiatric address to stress, nutrient and environmental interventions deserve emphasis

Sedation with propofol during combined spinal epidural anesthesia: comparison of dose requirement of propofol with and without BIS monitoring

Bispectral [BIS] monitoring provides an objective, non-invasive measure of the level of consciousness in sedated patients. Sedation has been shown to increase patient satisfaction during regional anesthesia. Propofol is extensively being used as a sedative, providing sedation while patients remain cooperative and can be easily aroused. In this study, we sought to determine whether BIS is a useful adjunctive manoeuvre to reduce the sedative dose of propofol by using BIS. Forty patients of ASA grade I and II, weighing between 30 to 60 kg, undergoing elective gynecological surgery of about 60 minutes duration were included in the study, and randomly divided into two groups. All patients received combined spinal epidural anesthesia [CSEA]. The patients in Group-P [n=20] received propofol without BIS monitoring and those in Group-PB [n=20], received propofol under BIS monitoring. Total doses of propofol consumed in all patients were calculated and compared using paired t-test. A p-value <0.05 was considered to be significant. The mean total dose of propofol consumed was 130.25 mg +/- 46.95 without BIS monitoring [Group-P] compared to 68.49 mg +/- 12.59 in patients [Group-PB] in which BIS was used to monitor the desired sedation level [P< 0.001]. Mean dose to reach required level of sedation was also reduced [68.35 +/- 21.10 vs 29.01 +/- 9.45, P< 0.001]. Use of BIS during propofol infusion reduces requirement of propofol for sedation during regional anesthesia

Hemiarthroplasty in high risk elderly patient under epidural anesthesia with 0.75% ropivacaine-fentanyl versus 0.5% bupivacaine-fentanyl: clinical trial

Anesthetic management of elderly patients is a challenge as aging makes them more susceptible to hemodynamic fluctuations during regional anesthesia. This study was aimed to compare the clinical efficacy of epidural 0.75% ropivacaine fentanyl [RF]- with 0.5% bupivacaine-fentanyl [BF] for hemiarthroplasty in high-risk elderly patients. Sixty elderly consented patients of either sex with American Society of Anesthesiologist ASA II and III, scheduled for elective hemiarthroplasty were randomized into two Groups of 30 patients to receive epidural study solution of 15 mL of 0.75% Ropivacaine or 0.5% Bupivacaine with 1 mL fentanyl [50 microg]. The hemodynamic variability with onset and duration of sensory and motor blocks were recorded. The adequacy and quality of surgical anesthesia were assessed. The post-epidural nausea and vomiting, shivering, respiratory parameters, or any other side effects were also recorded. There was no difference in the demographic profile between groups. The mean onset time to achieve sensory block to the T[10] dermatome was rapid in the Group BF [12.4 +/- 6.9 vs. 17.5 +/- 3.7 min in Group RF]. The mean time to achieve motor block was 17.5 +/- 3.4 min in Group BF versus 21.7 +/- 7.8 min in Group RF. The intraoperative hemodynamic fluctuations showed statistically significant differences between groups. The pruritis was observed in five patients but post-epidural shivering, nausea, vomiting, respiratory depression, or urinary retention were not observed in any patient. Epidural 0.75% Ropivacaine with fentanyl showed better clinical profile as compared to 0.5% Bupivacaine with fentanyl for hemiarthroplasty in elderly patients

Ocular chemical injuries and their management

Chemical burns represent potentially blinding ocular injuries and constitute a true ocular emergency requiring immediate assessment and initiation of treatment. The majority of victims are young and exposure occurs at home, work place and in association with criminal assaults. Alkali injuries occur more frequently than acid injuries. Chemical injuries of the eye produce extensive damage to the ocular surface epithelium, cornea, anterior segment and limbal stem cells resulting in permanent unilateral or bilateral visual impairment. Emergency management if appropriate may be single most important factor in determining visual outcome. This article reviews the emergency management and newer techniques to improve the prognosis of patients with chemical injuries.

Müllerian duct anomalies and their effect on the radiotherapeutic management of cervical cancer / 癌症

Radiotherapy plays a major role in the treatment of cervical cancer. A successful radiotherapy program integrates both external beam and brachytherapy components. The principles of radiotherapy are strongly based on the anatomy of the organ and patterns of local and nodal spread. However, in patients with distorted anatomy, several practical issues arise in the delivery of optimal radiotherapy, especially with brachytherapy. Müllerian duct anomalies result in congenital malformations of the female genital tract. Though being very commonly studied for their deleterious effects on fertility and pregnancy, they have not been recognized for their potential to interfere with the delivery of radiotherapy among patients with cervical cancer. Here, we discuss the management of cervical cancer among patients with Müllerian duct anomalies and review the very sparse amount of published literature on this topic.

Conservation and divergence of Grb7 family of Ras-binding domains

Ras proteins are signal-transducing GTPases that cycle between inactive GDP-bound and active GTP-bound forms. Ras is a prolific signaling molecule interacting with a spectrum of effector molecules and acting through more than one signaling pathway. The Ras-effector proteins contain a Ras-associating (RA) domain through which these associate with Ras in a GTP-dependent manner. The RA domain is highly conserved among the members of the growth factor receptor-bound (Grb) 7 family of proteins which includes Grb7, Grb10 and Grb14. Our laboratory has reported an unusual observation that RA domain of Grb14 binds to the C-terminal nucleotide binding site of cyclic nucleotide gated channel (CTRCNGA1) and inhibits the channel activity. Molecular modeling of the CTR-CNGA1 displays 50%-70% tertiary structural similarity towards Ras proteins. We named this region as Ras-like domain (RLD). The interaction between RA-Grb14 and RLD-CNGA1 is mediated through a simple protein-protein interaction temporally and spatially regulated by light and cGMP. It is interesting to note that Grb14 binds to GTPase-mutant Rab5, a Ras-related small GTPase whereas Grb10 binds only to GTP-bound form of active Rab5 but not to GTPase-defective mutant Rab5. These results suggest that Grb14 might have been evolved later in the evolution that binds to both Ras and nucleotide binding proteins such as CNGA1. Our studies also suggest that eukaryotic CNG channels could be evolved through a gene fusion between prokaryotic ion channels and cyclic nucleotide binding proteins, both of which might have undergone several sequence variations for functional adaptation during evolution.

Nephroprotective activity of Solanum xanthocarpum fruit extract against gentamicin-induced nephrotoxicity and renal dysfunction in experimental rodents

OBJECTIVE@#To evaluate nephroprotective potential of Solanum xanthocarpum (S. xanthocarpum) fruit extract(SXE) against gentamicin (GM) induced nephrotoxicity and renal dysfunction.@*METHODS@#Twenty-four Wistar rats were divided into four groups (n=6). Control rats that received normal saline (i.p.) and 0.5% carboxymethyl cellulose (p.o.) per day for 8 d. Nephrotoxicity was induced in rats by intraperitoneal administration of GM (100 mg/kg/d for 8 d) and were treated with SXE (200 and 400 mg/kg/d (p.o.) for 8 d). Plasma and urine urea and creatinine, kidney weight, urine output, blood urea nitrogen, renal enzymatic and non-enzymatic antioxidants and lipid peroxidation was evaluated along with histopathological investigation in various experimental groups of rats.@*RESULTS@#It was observed that the GM treatment induced significant elevation (P<0.001) in plasma and urine urea, creatinine, kidney weight, blood urea nitrogen, renal lipid peroxidation along with significant decrement (P<0.001) in urine output, renal enzymatic and non-enzymatic antioxidants. SXE 200 and 400 mg/kg treatment to GM treated rats recorded significant decrement (up to P<0.001) in plasma and urine urea and creatinine, renal lipid peroxidation along with significant increment (up to P<0.001) in renal enzymatic and non-enzymatic antioxidants. Histological observations of kidney tissues too correlated with the biochemical observations.@*CONCLUSIONS@#These finding powerfully supports that S. xanthocarpum fruit extract acts in the kidney as a potent scavenger of free radicals to prevent the toxic effects of GM both in the biochemical and histopathological parameters and thus validates its ethnomedicinal use.

Dexmedetomidine premedication for fiberoptic intubation in patients of temporomandibular joint ankylosis: a randomized clinical trial

Fiberoptic intubation is the gold standard technique for difficult airway management in patients of temporomandibular joint. This study was aimed to evaluate the clinical efficacy and safety of dexmedetomidine as premedication with propofol infusion for fiberoptic intubation.Consent was obtained from 46 adult patients of temporomandibular joint ankylosis, scheduled for gap arthroplasty. They were enrolled for thisdouble-blind, randomized, prospective clinical trial with two treatment groups - Group D and Group P, of 23 patients each. Group D patients had received premedication of dexmedetomidine 1microg/kg infused over 10 min followed by sedative propofol infusion and the control Group P patients were given only propofol infusion to achieve sedation. Condition achieved at endoscopy, intubating conditions, hemodynamic changes and postoperative events were evaluated as primary outcome. The fiberoptic intubation was successful with satisfactory endoscopic and intubating condition in all patients. Dexmedetomidine premedication has provided satisfactory conditions for fiberoptic intubation and attenuated the hemodynamic response of fiberoptic intubation than the propofol group. Fiberoptic intubation was found to be easier with dexmedetomidine premedication along with sedative infusion of propofol with complete amnesia of the procedure, hemodynamic stability and preservation of patent airway

Validity and reliability of haemoglobin colour scale and its comparison with clinical signs in diagnosing anaemia in pregnancy in Ahmedabad, India

This study compared the validity of the haemoglobin colour scale [HCS] and clinical signs in diagnosing anaemia against Sahli's haemoglobinometer method as the gold standard, and assessed the reliability of HCS. The sample comprised 129 pregnant women recruited from 6 urban health centres in Ahmedabad. The prevalence of anaemia was 69.8% by Sahli's method, 78.3% by HCS and 89.9% by clinical signs; there was no statistically significant difference between Sahli's method and HCS whereas there was between Sahli's method and clinical signs. The mean haemoglobin level by Sahli's method and HCS differed significantly. The sensitivity, specificity, positive predictive value and negative predictive value of HCS was 83.3%, 33.3%, 74.3% and 46.4% respectively and that of clinical signs was 91.1%, 12.8%, 70.7% and 38.5% respectively. Interobserver agreement for HCS was moderate [K= 0.43]. Clinical signs are better than HCS for diagnosing anaemia. HCS can be used in the field provided assessors are adequately trained