Comparison of three different techniques of endotracheal tube cuff inflation: just seal, stethoscope guided and pressure volume loop: a prospective randomized study

Background: Cuffed endotracheal tubes not only ensure a proper seal during positive pressure ventilation, but at the same time also prevent aspiration of gastric secretions. The aim of this prospective, randomized study was to compare three methods of ETT cuff inflation-- palpation of the leak in suprasternal notch (Just seal), a stethoscope guided method of tracheal tube cuff inflation and PVL guided cuff inflation.Methods: After approval by institutional ethical committee, 192 patients of either sex in age group of 18-50 years belonging to ASA physical status I or II were enrolled. Each patient was randomly allocated into one of three groups: one group received standard 'just seal' method of tracheal cuff inflation (JS), the second group, the stethoscope-guided method (SG) and in third group cuff was inflated using Pressure Volume Loop (PVL). Volume of air introduced into the cuff and pressure within the cuff was recorded.Results: A total of 192 patients were recruited to the study. The median (IQR [range]) tracheal cuff pressure was 12 (10-22 [6-28]) cm H2O, 16 (12-24[6-38]) and 14 (10-22[8-32]) cmH2O in JS, SG and PVL group respectively. Cuff pressures within the recommended range of 20-30 cm H2O fell in 25% of the patients in both JS and SG group and 31% patients in PVL group. The mean volumes of air introduced in the cuff and the resultant mean cuff pressure in all groups was found to be statistically insignificant (p= 0.4, 0.18 respectively). Tidal volume discrepancy was more and 75% of cuff pressures were less than the recommended range in JS than the other two groups.Conclusions: Real time PVL displayed on most modern anaesthesia machine is a good alternative to check for proper ETT cuff inflation, avoid high cuff pressure and monitor air leak.

Serum Magnesium in Overweight Children.

Objective: To determine whether overweight children and adolescents have lower serum concentration and lower dietary intake of magnesium compared to those with normal weight; and to study the correlation of serum magnesium levels with components of metabolic syndrome in children and adolescents. Design: Cross-sectional, comparative study. Setting: General/Pediatric Endocrinolgy OPD tertiary care medical centre. Study done from July 2007 to March 2009 Participants: 55 overweight and 53 normal weight children and adolescents aged 4 years to 14 years. Methods: We compared fasting levels of serum magnesium, insulin, glucose, total and HDL-cholesterol, triglycerides and dietary magnesium intake. Results: The serum magnesium levels were significantly lower in overweight (2.12 ± 0.33 mg/dL) compared to normal weight group (2.56 ± 0.24 mg/dL, P<0.001), while the dietary intake of magnesium (adjusted for calorie intake) was higher in overweight group (0.20 ± 0.06 mg/ kcal) compared to normal weight (0.17 ± 0.05 mg/kcal; P= 0.005). Serum magnesium levels were inversely correlated with body mass index, systolic blood pressure, diastolic blood pressure, waist circumference and fasting insulin levels. Conclusions: Serum magnesium levels were significantly lower in overweight children compared to those with normal weight in spite of a higher dietary intake.

Spectrum of primary immune deficiency at a tertiary care hospital.

OBJECTIVE: To report various primary immune deficiencies diagnosed in children at a tertiary care hospital, their clinical manifestations and laboratory profile. METHODS: Case records of children diagnosed to have primary immunodeficiency disorders over a period of 24 months at a tertiary care hospital in northern India were evaluated. RESULTS: Twenty-seven children (M: F=3.5: 1) with mean age of 5.4 +/- 4.6 yrs (2 mo-16 yr) were diagnosed to have primary immunodeficiency. Thirteen children had chronic granulomatous disease (CGD), 4 had severe combined immunodeficiency (SCID), 4 had hypogammaglobulinemia, 2 had Ataxia telangiectasia, and one each had DiGeorge syndrome, Wiskott Aldrich syndrome, hyper IgM syndrome and leukocyte adhesion defect. Common mode of presentation were recurrent/ persistent pneumonia in 19, recurrent/ persistent diarrhea in 10, deep seated abscesses in 8, allergy in 3, disseminated tuberculosis infection in 2, extensive fungal infections in 2 and 1 each of disseminated cytomegalovirus (CMV) infection, disseminated BCG disease, otitis media and meningitis. Family history of sibling deaths was elicited in 2 families. Infectious agents were isolated in 16 cases. CONCLUSION: From a single center 27 patients with primary immune deficiency could be identified by chart review, suggesting need for high index of suspicion for diagnosis of primary immune deficiency in India. Though the exact prevalence is not known there is need to make a registry to document the magnitude of problem of these disorders.

The study of bacterial flora of different types in hospital waste: evaluation of waste treatment at Aiims Hospital, New Delhi.

Bio-medical waste management rules were formulated in response to the worldwide public concern over medical waste. The practice of separation into different types of waste in health care institutes should be evaluated more scientifically. Due to a lack of data from the Indian sub-continent, this study was initiated at a tertiary care hospital. Samples were collected from different types of waste at the hospital, at different time intervals, for microbiological evaluation. The results reveal that the microbial flora isolated from infectious waste and general waste from the hospital are similar. The samples from general waste in this study reveal many types of pathogens. The bacteria present in the waste initially was low in quantity, but they replicated rapidly over time so that significant numbers were detected by 24 hours, due to environmental factors which were favorable for growth during this period. This study strongly suggests that waste should be removed from the hospital within 24 hours of its generation to prevent environmental contamination caused by any accidental spillage of waste. General waste generated in the hospital should be treated similar to infectious waste, as it can be equally hazardous.