Awake Fiberoptic Assisted Nasotracheal Intubation in Oral Malignancies - A Comparison between Airway Blocks and LA Spray - A Randomized, Interventional Crossover Trial

Awake fiberoptic assisted nasal intubation is the gold standard for securing airway in cases of oral malignancy posted for radical surgeries. Different techniques such as airway blocks, LA gargles, spray, nebulization along with light sedation are in practice. We wanted to evaluate the efficacy of airway blocks over airway spray for intubation conditions, time taken to intubation, patient comfort and complications. METHODSThis randomized, interventional and crossover study was conducted at Chirayu Medical College and Hospital. A total of 60 patients of ASA grade I-II with Mallampati score 3 & 4 undergoing wide local excision and neck dissection were selected after fulfilling of the selection criterion and were divided into two groups, Airway Block (AB, n-30) and Airway Spray group (AS, n-30). AB group received bilateral superior and transtracheal recurrent laryngeal nerve blocks and group AS local anaesthetic spray through the working channel of the fiberoptic scope. Haemodynamics, time taken for intubation, intubating conditions, patients’ comfort, and complications if any were noted. All data was tabulated and analysed using software SPSS 17.0. RESULTSMean total time taken for intubation in seconds was less. Intubating conditions were optimal in 90 % cases. 5-point comfort during and 3-point score immediately after intubation were excellent in AB compared AS group. Haemodynamically both the groups were comparable. CONCLUSIONSCombined block of the superior and recurrent laryngeal nerves provides optimal conditions to facilitate a successful fibreoptic assisted awake nasotracheal intubation in anticipated difficult airway

Changing panorama for surveillance of device-associated healthcare infections: Challenges faced in implementation of current guidelines

Healthcare-associated infections (HAI) are preventable in up to 30% of patients with evidence-based infection prevention and control (IPC) activities. IPC activities require effective surveillance to generate data for the HAI rates, defining priority areas, identifying processes amenable for improvement and institute interventions to improve patient's safety. However, uniform, accurate and standardised surveillance methodology using objective definitions can only generate meaningful data for effective execution of IPC activities. The highly exhaustive, complex and ever-evolving infection surveillance methodology pose a challenge for effective data capture, analysis and interpretation by ground level personnel. The present review addresses the gaps in knowledge and day-to-day challenges in surveillance faced by infection control team for effective implementation of IPC activities.

Effect of methanolic extract of Asparagus racemosus willd. on lipopolysaccharide induced-oxidative stress in rats

Lipopolysaccharide [LPS] induced oxidative stress and impairment of normal physiological function generally categorized by increased anxiety and reduced mobility. Therefore, the present study was to find out the effect Methanolic extract of Asparagus racemosus [MEAR] in lipopolysaccharide [LPS]-induced oxidative stress in rats. LPS-induced oxidative stress in rats was measured by locomotor activity by photoactometer test, anxiety with elevated plus maze test and also studied the oxidative stress markers, nitric oxide and cytokines. The obtained data shows that LPS markedly exhausted [p<0.001] brain-reduced glutathione [GSH], superoxide dismutase [SOD] and catalase [CAT] significantly increased [p<0.001] the level of malondialdehyde [MDA], nitric oxide and the activity of cytokines in the brain. MEAR supplementation resulted in normalization of brain GSH and CAT and SOD and decreases in the levels of MDA with reduction of nitric oxide and cytokines in the brain. The action of the extract at dose of 200 mg/kg was almost similar to the standard drug, quercetin [100mg/kg, p.o.]. These present study conclude that MEAR administration significantly [P<0.05] reduced LPS- induced oxidative-stress and intensely suggest that Asparagus racemosus Willd. is a functionally newer type of cerebroprotective agent

Primary isolated echinococcal cyst of the seminal vesicle: a rare case

Hydatid disease of the organs other than liver and lung is extremely rare. Although hydatid disease is endemic in India, we report a rare case of hydatid cyst in a young male primarily involving the seminal vesicle and aim to highlight the management of such cases. A 23 year old male farmer diagnosed with primary isolated echinococcal cyst of the seminal vesicle has been presented. Thorough investigations with radiological methods such as ultrasonography [abdominal and trans-rectal], and magnetic resonance imaging were carried out to aid in the diagnosis. Surgical excision of the lesion was carried out with careful removal of the cyst to prevent any bursting and spillage, leaving the seminal vesicle preserved. The cystic lesion was subjected to histopathological examination. Histopathology confirmed the diagnosis of hydatid disease. Postoperative period was uncomplicated and patient was discharged on seventh postoperative day. Patient was put on albendazole [10 mg/kg/day] for three cycles of 21 days each with a gap of one week between each cycle. There was no evidence of recurrence or development of cysts elsewhere in the body during the 2 year follow-up. Hydatid cyst of seminal vesicle is rare and should be kept in differential diagnosis of a cystic lesion in pelvis especially in regions where hydatid disease is endemic. Proper surgical and medical management to avoid any recurrences, and a regular follow-up, are of utmost importance to detect any late complications such as local recurrence of the disease and development of hydatidosis at the primary sites

Frequency of chronic periodontitis in a cross section of Pak army personnel

To determine the frequency of periodontitis in lower ranks of Pakistan Army. A descriptive study. The study was conducted at Armed Forces Institute of Dentistry, Rawalpindi between Aug 2003 and Feb 2005. This is a in which Periodontal status of maxillary and mandibular incisors and permanent first molars in five hundred and fifteen personnel of the Pakistan Army was evaluated using plaque index, probing depths, attachment loss, bleeding upon probing, tooth mobility and presence of calculus. One hundred and sixty five [32.04%] subjects had 5 mm or deeper probing depths as well as associated attachment loss of at least 2 mm and were considered to be suffering from Chronic Periodontitis. The study detected that a noticeable percentage of subjects in this population had a substandard level of oral hygiene and consequently suffered from Chronic Periodontitis

Pattern of serum vitamin D in OPD patients

To find out the prevalence of Vitamin-D deficiency in conditions other than osteomalcia and rickets in our part of the world. Prospective and observational study from Feb. 2005 to Dec. 2006. Multi-centric including Civil Hospital and Abbasi Shaheed Hospital, Karachi. Only those patients were included who had any structural or biochemical changes in the body. Serum Vitamin-D level of all patients was sent for estimation from a single reputable laboratory, apart from serum calcium, phosphorus, alkaline phosphatase and routine blood investigations. All data was collected and processed on SPSS Version 10. Of the total 79 patients, 58[73%] were females and 21[27%] males. Minimum age was one year and maximum 90 years, with a mean age of 41.91 and standard deviation of 19.1. Majority of the patients were seen in the 4th, 5th and 6th decades of life, and most of them were house wives. The serum Vitamin-D level was found low in 73[92%] patients and the most severe form of deficiency was seen in patients with tuberculosis. Vitamin-D deficiency was seen in 92% of our patients, belonging to all age groups and suffering from different diseases

Intelocking versus kuntscher nails in the management of femoral shaft fractures

To compare the outcome of Femoral shaft fractures managed with Interlocking and Kuntscher intramedullary nails, in terms of healing time, full weight bearing and post-operative complications. Prospective, quasi-experimental study from March 1999 to May 2002. Orthopaedics Unit I, Civil Hospital, Karachi. A total of 200 cases of Femoral shall fractures. Half [100] the cases of Femoral shaft fractures were treated with Kuntscher intramedullary nails and the other half [100] with Interlocking nails, the cases being assigned randomly. The detailed data of the patients was recorded, computed and analyzed using Chi-square test and Students t-test. The main parameters compared included fracture healing time, full weight bearing time and post-operative complications. There was no significant difference between the two groups in terms of demographic data, fracture type and associated co-morbidities. The average operating time was 110 +/- 25 minutes for the Interlocking nail and 80 +/- 15.8 mins for the K-nail. All patients of K-nail group needed blood transfusion, while only 17 patients of interlocking group needed blood transfusion. The fill weight bearing time was significantly shorter [p < 0.005] in cases of Interlocking nail. Out of 200 fractures 182 [91%] healed with in six months while 18 [9%] did not. The latter included 6 [3%] cases treated with Interlocking nails and 12 [6%] with Kuntscher nails, p < 0.005. Interlocking intramedullary nailing is better than Kuntscher nailing in every respect

Current status of periodontal disease in the junior ranks of Army Units at Rawalpindi

Periodontal disease like dental caries is an important cause of loss of teeth in our country. 1400 army personnel aged 18-52 years were examined for their periodontal disease status and type of periodontal treatment required by recording Community Periodontal Index of Treatment Needs [CPITN]. Results showed that 98% of the subjects suffered from varying degrees of periodontal disease ranging from mild gingivitis to advanced periodontitis. 64% of subjects required simple treatment like scaling or oral prophylaxis and oral hygiene improvement. 31% required complex periodontal treatment including surgery due to the advanced disease. As bacterial plaque plays a major role in the aetiology of periodontal disease, effective plaque control procedures can prevent and arrest the disease progression

Current status of dental caries in the junior ranks

Dental caries is one of the most prevalent chronic bacterial disease of mankind responsible for extensive tooth loss in our country. To find out the prevalence of dental caries amongst our troops, 1500 Junior army personnel aged 18-50 years were examined and their DMF Index recorded. The results showed that 57.6% of the subjects suffered from dental caries, 74.4% had no missing teeth and 91.3% had no restorations in their mouth. The DMF Index ranged between 1.28 to 4.45 [mean=2.77]. A mean DMF Index of 2.77 in this study placed our subjects in a "moderate level" of dental caries status of WHO criteria. To reduce the dental caries in our troops, more emphasis should be laid on the preventive measures

Evaluation of limb salvage surgery in osteosarcoma

19 cases of osteosarcoma of stage 1113 were treated at Orthopaedic department, Lyari General Hospital and Civil Hospital, Karachi. The Neo adjuvant and adjuvant therapy were done by the different techniques i.e. custom made prosthesis, free fibular graft, fibular centraliziation, segment transportation, or tumor excision and Rotation plasty. There were 17 males and 2 females. Ranged from 10 years to 25 years, mean age was 18 years. The follow up period was from 13 months to 75 months and the mean period was 27 months. One case was lost to follow up. In the end of study there were 11 cases [61.11%] disease free survival, 3 [16.67%] survival with disease and 4[22.2%] died due to tumor. The disease free cases had mean 42.5 months of survival. It was concluded that males were 8 times more affected than the females. It was further observed that the treatment of choice for osteosarcoma is limb salvage. It was further observed that the limb salvage surgery along with pre operative chemotherapy, radiotherapy and postoperative chemotherapy has revolutionized the treatment out come of osteosarcoma. This treatment is more effective in terms of functional, cosmetic and emotional outcome

Effects of stress and food deprivation on catfish, Heteropneustes fossilis (Bloch).

No significant changes in plasma cortisol and plasma osmolarity (the indicators of primary and secondary response respectively) were observed when the blood samples were obtained from unanaesthetized, anaesthetized and stressed catfish, H. fossilis. The results suggest that the catfish is fairly hardy and not easily susceptible to stress by routine laboratory handling. The sustained plasma glucose levels and decreased liver and muscle glycogen concentrations during cessation of feeding of the catfish suggest that during period of food deprivation, it draws its energy through glycogenolysis. Hence, in any study dealing with carbohydrate metabolism, the catfish needs to be fed during acclimation and experimental periods.