Social-emotional issues among children with strabismus higher than among non-strabismus children in Western India

Purpose: Data on social?emotional aspects among children with strabismus in India are scanty. We compared the emotional symptoms (ES), loneliness and social dissatisfaction (LSD), and self?esteem (SE) and their associated risk factors among children with and without strabismus in India. Methods: A cross?sectional case–control study design was used to recruit 101 children with strabismus aged 8 to 18 years and a control group of 101 children that were age? and gender?matched. Interviews were performed using standardized scales to assess ES, LSD, and SE. Variations in the intensity of ES, LSD, and SE were assessed using multiple classification analysis (MCA). Results: A total of 202 children participated in the study. The mean ES, LSD, and SE scores were 3.4 (standard deviation [SD] 1.9), 48.4 (SD 3.2), and 22.1 (SD 3.8) for the strabismus group and 1.8 (SD 1.5), 33.3 (SD 3), and 31.3 (SD 2) for the non?strabismus group, respectively. Among the strabismus group, the highest levels of mean ES, LSD, and SE scores were observed among children facing problems in performing daily tasks. Amongst the non?strabismus group, children studying at the primary level and those facing neglect had the highest mean scores. In MCA, being affected with strabismus had the highest effect on the intensity of ES, LSD, and SE with a beta (?) value of 0.223 (P = 0.016), 0.922 (P < 0.001), and 0.853 (P < 0.001). Conclusion: A significantly high proportion of children with strabismus deal with elevated levels of ES, LSD problems, and low SE as compared with non?strabismus children, highlighting the need to address the poor social?emotional health of children

Effectiveness of Lactobacillus rhamnosusGG as an Adjunct in the Treatment of Enteric Fever in Children: A Double‑Blinded Randomized Controlled Trial in Southern India

Introduction:Aprobiotic used as an adjunct in Salmonella typhi infection along with antibiotic is postulated to interfere with the virulence and growth of Salmonella. To determine the effectiveness of Lactobacillus rhamnosusGG (LGG), as an adjunct with intravenous ceftriaxone, compared with a placebo in defervescence and toxemia resolution in children with enteric fever. Settings and Design: This hospital‑based randomized double‑blinded controlled trial was conducted among 56 study participants who were children below the age of 12 years, admitted as inpatients with fever and whose blood culture grew S. typhi. Materials and Methods: Study participants were equally allocated into intervention or control group by simple randomization. The intervention group received injection ceftriaxone and oral LGG (probiotic) for 7 days while the control group received an injection ceftriaxone and oral placebo for 7 days. Statistical Analysis: Kaplan–Meier curves and mantel cox log‑rank test were used to compare the duration for defervescence and toxemia resolution after treatment initiation. Results: Mean duration for defervescence in the intervention and control groups was 3.87 (1.57) days and 3.35 (1.19) days, respectively. The mean time taken for the resolution of toxemia was 3.00 (1.15) days in the intervention group and 2.64 (0.87) days in the control group. Conclusions:The addition of oral LGG at a dose of 3 × 109 colony‑forming units for 7 days to the standard antibiotic therapy for enteric fever did not show a significant reduction in the time taken for defervescence (P = 0.099) or resolution of toxemia (P = 0.148)

Challenges for Primary Caregivers during the COVID‑19 Pandemic in Accessing Health Care of Children with Chronic Diseases under Periodic Follow‑up at a Tertiary Care Hospital in South India

Introduction: Challenges faced by the primary caregivers during the COVID‑19 pandemic help to identify their needs and health seeking behavior during pandemic. Objectives: (1) To describe the factors associated with periodic follow‑up at the hospital which posed as difficulties to their primary caregivers during the COVID‑19 pandemic. (2) To identify the measures adopted by these primary caregivers to overcome those difficulties. MaterialsandMethods: This hospital‑based cross‑sectional observational study was conducted from May to August 2021 among 57 primary caregivers of children with chronic diseases registered before March 1, 2020, who were under periodic follow‑up in our pediatrics department. Data were collected by direct or telephonic interview using a predesigned semi‑structured questionnaire and analyzed using descriptive and inferential statistics like mean, standard deviation, proportions and paired “t”‑test using Epi info and IBM SPSS trial version 28.0. Results: Frequency of hospital visits of 14 (24.6%) subjects were reduced during the COVID pandemic compared to the prepandemic period. During the COVID pandemic, 42 (73.7%) subjects had faced transportation difficulties, 23 (40.3%) had faced financial difficulties, 22 (38.6%) had skipped their scheduled follow‑up visits and around 31.6% of them have feared of contracting COVID. None had availed telemedicine consultation for their children either before or during the pandemic. Conclusions: Difficulties faced in transportation, fear of contracting COVID, financial difficulties, and lack of awareness of teleconsultation services were identified as their major obstacles.

Depressive and generalized anxiety symptoms in adults awaiting cataract surgery in India

BACKGROUND Systematic data on mental health issues among adults awaiting cataract treatment are not readily available in India. We explored the prevalence and predictors of depressive and generalized anxiety (GA) symptoms in a cohort of adults awaiting cataract surgery. METHODS Our study is based on data from baseline assessments which were conducted as part of a multicentre prospective, longitudinal cohort study. Subjects were recruited from four eye hospitals to assess depression and GA and associated risk factors using standardized scales, i.e. Center for Epidemiologic Studies–Depression Scale (CES-D) and Generalised Anxiety Disorder (GAD-7). Variation in the intensity of depression and GA was assessed using multiple classification analysis (MCA). RESULTS A total of 813 adults awaiting cataract surgery participated, of whom 456 (56.1%) were men. The mean (SD) CES-D and GAD-7 scores were 24.6 (7.8) and 6.3 (SD 4.2) for men and 25.8 (8.9) and 6.9 (4.4) for women, respectively. The overall prevalence of depression score of >16 was 87.4% (95% confidence interval [CI] 84.7%– 89.6%), and GA score of >10 was 57.1% (95% CI 53.5%–60.7%). The prevalence of comorbid depressive and anxiety symptoms was 56.6% (95% CI 52.9%– 60.2%). MCA showed that being neglected and mistreated by family/friends because of vision condition and facing difficulty and requiring help with daily tasks had the highest effect on the intensity of both depression (beta=0.254 and 0.238, respectively) and GA (beta=0.219 and 0.211, respectively). CONCLUSION The majority of adults with untreated cataract had both depressive and GA symptoms. These findings could be used for planning mental health interventions for adults awaiting cataract surgery.

Right ventricular systolic pressure – Non-invasive bedside predictor of mortality and readmission in heart failure with reduced and preserved ejection fraction hospitalization

Objective: To study the prognostic role of right ventricular systolic pressure (RVSP) in patients with heart failure (HF). Background: Although RVSP is a readily available echocardiographic parameter, it is often underused. Its prognostic role in patients with heart failure is not well established compared with pulmonary artery pressure measured by right heart catheterization. Methods: This single-center retrospective cohort study included patients with acute heart failure hospitalization admitted to the hospital from January 2005 to December 2018. The primary predictor was right ventricular systolic pressure (RVSP) obtained from bedside transthoracic echocardiography at admission. We divided RVSP into two groups, RVSP <40 mm Hg (reference group) and RVSP 40 mm Hg. Primary outcome was all-cause mortality. Secondary outcomes were all-cause readmission and cardiac readmission. We conducted propensity-score matching and applied cox-proportional hazard model to compute hazard ratio (HR) with 95% confidence interval (CI). Results: Out of 972 HF patients, 534 patients had RVSP <40 mm Hg and 438 patients had RVSP 40 mm Hg. Patients with RVSP 40 mm Hg compared with RVSP <40 mm Hg were associated with higher rates of death [HR: 1.60, 95% CI: 1.22e2.09, P-value ¼ 0.001], all-cause readmissions [HR: 1.37, 95% CI: 1.09 e1.73, P-value ¼ 0.008] and cardiac readmissions [HR: 1.41, 95% CI: 1.07e1.85, P-value ¼ 0.014]. Conclusion: Higher RVSP (40 mm Hg) in HF patients was associated with higher rates of death, allcause readmissions, and cardiac readmissions. RVSP can be considered as a prognostic marker for mortality and readmission.P

AYURNUTRIGENOMICS - A STEP TOWARDS PERSONALIZED NUTRITION

Ahara is one of the three pillars of life according to Ayurveda. Along with medicine, food plays a role in the prevention and mitigation of diseases. Compared to any drug, food is consumed in large quantity. Hence, research on its effect and interaction with the genome is highly relevant towards understanding diseases and their management. The epistemic perspective on health and nutrition in Ayurveda is different from that of biomedicine and modern nutrition. However, contemporary knowledge is reinventing and advancing several of these concepts in an era of systems biology and personalized medicine. Ayurgenomics presents a personalized approach in the predictive, preventive, and curative aspects of medicine. It is the study of interindividual variability due to genetic variability in humans for assessing diagnosis and prognosis of diseases, mainly based on the Prakriti (constitution type of person). In the emerging field of Ayurnutrigenomics, based on the clinical assessment of an individual’s Prakriti the selection of suitable ahara, oushadha, and vihara are made. This Ayurveda-inspired concept of personalized nutrition is an innovative perception of nutrigenomic research for developing personalized functional foods and nutraceuticals suitable for one's genetic makeup with the help of Ayurveda. Trans-disciplinary research could be important for pushing the boundaries of food and health sciences and also for providing practical solutions for contemporary health conditions. Hence this novel concept of Ayurnutrigenomics and its emerging areas of research, may unfold future possibilities towards smart yet safe therapeutics

A Comparative Study Of Topical Betaxalol And Timolol For Their Efficacy And Side Effects

Purpose:Primary open angle glaucoma (POAG) is one such field in Ophthalmology where ophthalmologists have failed to stop blindness due to it. All the available treatment modalities are directed towards the reduction of intra-ocular pressure (IOP) but without interfering the basic aetiopathogenesis. In this study we propose to study efficacy, potency and adverse effects of topical Timolol and Betaxalol in primary open angle glaucoma. Methodology:A com-parative study of topical Betaxalol 0.5% and Timolol 0.5% in the management of POAG was conducted at Tertiary care hospital. Fifty patients of newly diagnosed POAG of different age, sex, religion from both urban and rural popu-lation attending eye OPD were included in this study.25 patients were treated with topical Timolol maleate 0.5% ophthalmic solution BD and 25 patients were treated with topical 0.5% Betaxalol hydrochloride phthalmic solution BD. At 20 weeks follow up IOP levels n both the groups measured by applanation tonometer were compare to each other. Results:In this study a total of 50 patients with POAG were studied. 25 patients were treated with Timolol maleate 0.5% ophthalmic solution and 25 patients were treated with 0.5% Betaxalol hydrochloride ophthalmic solu-tion. Out of 50 patients, 29 (58%) were male and 21(42%) were female patients. POAG was most common in the age group of 51-60 years with average age 51.50 (S.D. 9.8) years. Average age in males was 54.50 years, while in female it was 49.31 years. Conclusion: both Timolol and Betaxalol are effective in decreasing IOP in POAG patients. The mag-nitude of Timolol in decreasing IOP is more as compared to Betaxalol. The selective beta 1 adrenergic inhibition of Betaxalol provides an added benefit for those patients in whom beta 2 blockade could be harmful.

Applicability of the Cleveland clinic scoring system for the risk prediction of acute kidney injury after cardiac surgery in a South Asian cohort

Background Acute kidney injury (AKI) after cardiac surgery is a frequent post-operative complication associated with an increased risk of mortality, morbidity and hospital costs. Preoperative risk scores such as the Cleveland Clinic Scoring Tool (CCST) have been validated in Western population group to identify patients at higher risk of AKI and may facilitate preventive strategies. However, the scoring tool has not been validated systematically in a South Asian cohort. We aimed to evaluate the applicability of the CCST in prediction of AKI after open cardiac surgery in a South–Indian tertiary care center. Materials and methods A retrospective study of all patients who underwent elective open cardiac surgery over a 4 year period from Jan 2012 to Dec 2015 at a single centre were included and relevant details extracted from a comprehensive chart review. The primary outcome was AKI as defined by the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Patients were risk stratified as per the CCST to assess for prediction of AKI into low risk (0–2), intermediate risk (3–5) and high risk (>6) groups. Results A total of 276 patients underwent open cardiac surgery with mean age of 51.5 ± 13.06 yrs. This included 177 (64.1%) males and 99 females (35.8%). Overall incidence of AKI was 6.88%. Mean age, gender, BMI, preoperative serum creatinine, diabetes mellitus, chronic obstructive pulmonary disease, cardiopulmonary bypass time was similar in patients who developed AKI vs those who did not have AKI postoperatively. The mean CCST scores were 1.6 in those without AKI, 1.5 in stage 1, 3.0 in stage 2 and 3.4 in stage 3 AKI. Higher risk scores predicted greater risk of AKI. A total of 106 patients (38.4%) were on ACE/ARB, 119 patients (43.1%) received beta-blockers, 110 (39.8%) received diuretics while 144(52.1%) had received preoperative statins. Comparison of drug use between the two groups revealed that preoperative use of ACEI/ARB was associated with highest risk of AKI (p = 0.006). Mortality rate was also high at 15.7% in those with AKI compared to 3.1% in non-AKI group (p = 0.04). Conclusion The modified CCST was valid in risk identification of patients with severe stage of AKI but did not have strong discrimination for early AKI stages. Preoperative statin use did not protect against AKI in our study, however preoperative ARB/ACEI use was significantly associated with occurrence of postoperative AKI.

Role of butorphanol in preemptive analgesia: a comparison with pentazocine

Background: Preemptive analgesia establishes effective antinociception before surgery and continuation of this effective analgesic level well into the postoperative period. Butorphanol tartrate and pentazocine lactate are opioid analgesics with mixed agonist-antagonist properties

Aim: The aim of the present study was to compare the preemptive analgesic effect of butorphanol and pentazocine given by intramuscular [IM] route as a primary outcome. Secondary outcome was to compare hemodynamic parameters and the side effects profile

Methodology: A comparative randomized, single blind, and prospective clinical study in sixty patients ASA physical status I and II was carried out. Patients were demographically similar. Patients were randomized to receive either a butorphanol injection [Group B] 2 mg [n=30] or pentazocine injection [Group P] 60 mg [n=30] both IM 60 min before surgery. Lower abdominal surgeries under spinal anesthesia were selected. Duration of pain relief was recorded by visual analogue scale [VAS] postoperatively up to 24 h. Sedation was measured with Cook's sedation score system. Patients were observed for any change in vital signs and any other side effect for 24 h. Rescue analgesia in the form of IM diclofenac sodium 75 mg was given when VAS>3

Results: Duration of analgesia was up to 18 h in Group P while it was extended in Group B, but this was statistically not significant. Requirements of rescue analgesia were higher and occurred earlier in Group P, although not statistically significant. Sedation score was also comparable. Hemodynamic changes were not significant with the exception of an increase in mean arterial pressure in Group P. No severe side effects were observed in any patient of either group

Conclusion: Butorphanol a mixed agonist-antagonist opioid in the dose of 2 mg IM is an acceptable alternative to pentazocine as a pre-emptive analgesic due to longer duration of analgesia and greater analgesic efficacy with low incidence of side effects

To study the pattern, efficacy and tolerability of analgesic self‑medication among undergraduate medical students: a questionnaire based survey.

Background: Self-medication is widely prevalent among medical students. Sufficient data is still lacking in India. The present study was aimed to determine the pattern, efficacy and, tolerability of analgesic self-medication among undergraduate medical students. Methods: This was a cross-sectional questionnaire-based study. A structured questionnaire was given to medical students aged 18-24 years. Results were expressed in numbers and percentage. Results: In the present study, 130 students filled the questionnaires completely and were assessed for study. The principal morbidity for seeking self-medication was moderate intensity headache which is completely relieved by analgesics in most of the cases. Pain affected the quality of life of students by decrease in concentration in studies, decrease in energy level, and affecting their daily activity. Analgesics which were commonly used for self-medication included paracetamol (64%), diclofenac (7.6%), aceclofenac (5.3%), paracetamol plus ibuprofen combination (4.6%), mefenamic acid plus dicyclomine combination (7.7%) ibuprofen (5.3%), and others (5%). Gastrointestinal side effects were also observed (29%). Reasons for seeking selfmedication were mild nature of the illness (39%), saves time and money (27%), self confidence in treatment (19%), easy and effective (15%). Among the source of information of self-medication includes the use of previous prescriptions (50%), advertisement (9%), textbooks (23%), and others (18%). Conclusions: Our study showed a high prevalence (77.8%) of analgesic self‑medication among medical students. Paracetamol was the most common drug consumed, followed by other non-steroidal anti-inflammatory drugs. A high incidence of side effects observed. It is necessary to create more awareness regarding possible harmful effects of self-medication and ways to minimize them.

Hemophagocytic lymphohistiocytosis with a leukemoid reaction in an infant with scrub typhus

A two-month-old male infant presented with a clinical picture suggestive of fever without focus. Treatment was initiated with broad spectrum intravenous antibiotics. The infant subsequently developed septic shock, hepatosplenomegaly and tachypnoea with oxygen dependency. There was laboratory evidence of anemia, thrombocytopenia and a leukemoid reaction. Infection induced hemophagocytic lymphohistiocytosis with a leukemoid reaction was suspected because of fever, splenomegaly and bicytopenia in conjunction with elevated serum triglycerides and ferritin. Empiric therapy with doxycycline caused a rapid resolution of the fever, and the diagnosis of scrub typhus was confirmed by a positive scrub IgM ELISA. HLH with a leukemoid reaction secondary to scrub typhus has not previously been reported in early infancy

comparative study between ropivacaine 30 ml [0.75%] and ropivacaine 30 ml [0.75%] with clonidine 150 microg as an adjuvant in brachial plexus block through supraclavicular approach

Ropivacaine is a novel alternative to bupivacaine with the less cardiovascular system and central nervous system toxicity. Clonidine, an alpha 2 agonist, may have benefited patients when it is injected at peripheral nerve sites with local anesthetic ropivacaine. Clonidine is second only to epinephrine as a useful adjuvant for brachial plexus blockade. A clinical study was carried out to compare the anesthetic effects of ropivacaine alone and clonidine as an adjuvant to ropivacaine in brachial plexus block for upper limb surgeries. A comparative, double-blind, prospective, randomized, clinical study was carried out on 60 patients of either sex of American Society of Anesthesiologist physical status I and II, with age group 25-65 years undergoing various orthopedic surgeries of upper limb under supraclavicular brachial plexus block. Patients were randomly allocated to either of the two groups of 30 each. Group-R: Injection ropivacaine 30 ml [0.75%] with 1 ml normal saline. Group-ropivacaine clonidine [RC]: linjection ropivacaine 30 ml [0.75%] with injection clonidine 1 ml [150 microg]. Heart rate, mean arterial pressure, onset and duration of motor and sensory blockade were observed during preoperative, intraoperative and postoperative period. At the end of the study, the data were analyzed using Chi-square test for qualitative data and Student t-test. P < 0.05 was considered significant and P < 0.01 was considered as highly significant. Demographic and hemodynamic data were comparable. Onset of sensory and motor block was significantly earlier in Group-R. Duration of analgesia and motor blockade was prolonged in the RC group. Both groups were observed for the side-effects, which were not significant. Addition of clonidine 150 microm to ropivacaine 0.75% 30 ml delays the onset of sensory and motor blockade while prolongs the postoperative motor blockade and analgesia significantly without producing any clinical significant side-effects in brachial plexus block through supraclavicular approach

Time dependent enhanced resistance against antibiotics & metal salts by planktonic & biofilm form of Acinetobacter haemolyticus MMC 8 clinical isolate.

Background & objectives: Available literature shows paucity of reports describing antibiotic and metal resistance profile of biofilm forming clinical isolates of Acinetobacter haemolyticus. The present study was undertaken to evaluate the antibiotic and metal resistance profile of Indian clinical isolate of A. haemolyticus MMC 8 isolated from human pus sample in planktonic and biofilm form. Methods: Antibiotic susceptibility and minimum inhibitory concentration were determined employing broth and agar dilution techniques. Biofilm formation was evaluated quantitatively by microtiter plate method and variation in complex architecture was determined by scanning electron microscopy. Minimum biofilm inhibiting concentration was checked by Calgary biofilm device. Results: Planktonic A. haemolyticus MMC 8 was sensitive to 14 antibiotics, AgNO3 and HgC12 resistant to streptomycin and intermediately resistant to netilmycin and kanamycin. MMC 8 exhibited temporal variation in amount and structure of biofilm. There was 32 – 4000 and 4 – 256 fold increase in antibiotic and metal salt concentration, respectively to inhibit biofilm over a period of 72 h as against susceptible planktonic counterparts. Total viable count in the range of 105 -106cfu / ml was observed on plating minimum biofilm inhibiting concentration on Muller-Hinton Agar plate without antimicrobial agents. Biofilm forming cells were several folds more resistant to antibiotics and metal salts in comparison to planktonic cells. Presence of unaffected residual cell population indicated presence of persister cells. Interpretation & conclusions: The results indicate that biofilm formation causes enhanced resistance against antibiotics and metal salts in otherwise susceptible planktonic A. haemolyticus MMC 8.

Chronic hepatitis B in Nepal: An Asian country with low prevalence of HBV Infection.

Sandwiched between China, a country with high prevalence of hepatitis B surface antigen (HBsAg) and 30% of the world’s HBsAg carriers, and India which has intermediate HBsAg prevalence and 10% of the world’s carriers, Nepal has the lowest prevalence of hepatitis B virus (HBV) infection in Asia, with an HBsAg carrier rate of 0.9%. This treatise discusses the probable causes of this low prevalence based on published literature on the subject. The HBsAg prevalence among pregnant women in Nepal is low (0.5%) and none of those examined were HBeAg positive. The highest prevalence of HBsAg was found in the 6-15 years age group. The low prevalence of this infection in the country was due to an absence of significant vertical transmission and its predominant spread by horizontal transmission among the adolescent age group.

Religiosity as Related to Women’s Health.

Background:.A number of well-conducted clinical and epidemiological studies have shown that religiosity can under some circumstances can help prevent depression and anxiety. Thus, given the prevalence and importance of religiosity, it is reasonable to consider the impact of religiosity on mental well-being such that to clarify its position in the existing literature. Aims of the study: The aims of the present study were (i) To examine the relationship between religiosity and anxiety (ii) To examine the relationship between religiosity and depression. Method: The sample of the study consisted of one hundred and fifty women aged 20-30 which were taken from B.H.U., Varanasi. The various measures used were Religiosity scale by Bhusan (1971), State, Trait and Free Floating Anxiety Scale (Hindi version) by Rastogi and Tripathi (1986), Epidemiological Studies Scale (CES-D) by Radloff (1972)along with personal data schedule respectively. This is a correlational study and it employed Mean, S.D, Range,‘t’ test and correlation for the interpretation of the results. Results: The results indicated that mean sores of depression and anxiety were comparatively higher in low level of religiosity as compared with high level of religiosity. Result of the correlation tests also indicated that religiosity is significantly negatively correlated with anxiety and depression. Conclusion: This study confirms the positive links between religiosity and mental health. This shows that high religious women would have good mental health as compared to less religious women.

Lymphangioleiomyomatosis - Retroperitoneum.

Lymphangioleiomyomatosis (LAM) is a progressive disease affecting women of childbearing age. It is microscopically characterized by abnormal smooth muscle proliferation in the walls of lymphatics and lymph nodes. A 52-year old female presented with pain in left leg and bilateral pedal oedema. USG and CT abdomen revealed a retroperitoneal cystic mass suspicious of malignancy. Retroperitoneal exploration was done and the mass was excised which revealed milky contents within. On gross examination of the specimen, a spongy mass was noted . Histopathological examination led to a diagnosis of lymphangioleiomyomatosis. LAM is a rare disease unfamiliar to many physicians and may pose a diagnostic dilemma to the physician, possibly resulting in delayed or missed diagnosis . Many treatment modalities including corticosteroids, cytotoxic drugs, chemotherapy, radiation and hormonal therapy are suggested. The prognosis of LAM varies with the individual, but many patients respond well to intramuscular medroxyprogesterone injections.

comparative study of efficacy of esmolol and fentanyl for pressure attenuation during laryngoscopy and endotracheal intubation

To compare the effectiveness of single bolus dose of esmolol or fentanyl in attenuating the hemodynamic responses during laryngoscopy and endotracheal intubation. Ninety adult ASA I and ASA II patients were included in the study who underwent elective surgical procedures. Patients were divided into three groups. Group C [control] receiving 10 ml normal saline, group E [esmolol] receiving bolus dose of esmolol 2 mg/kg and group F [fentanyl] receiving bolus dose of fentanyl 2microg/kg intravenously slowly. Study drug was injected 3 min before induction of anesthesia. Heart rate, systemic arterial pressure and ECG were recorded as baseline and after administration of study drug at intubation and 15 min thereafter. Reading of heart rate, blood pressure and rate pressure product were compared with baseline and among each group. The rise in heart rate was minimal in esmolol group and was highly significant. Also the rate pressure product at the time of intubation was minimal and was statistically significant rate 15 min thereafter in group E. Esmolol 2 mg/kg as a bolus done proved to be effective in attenuating rises in heart rate following laryngoscopy and intubation while the rise in blood pressure was suppressed but not abolished by bolus dose of esmolol

Necrotizing adenoviral pneumonia: manifestation of nosocomial infection in pediatric intensive care unit.

A 5-year-old child admitted in the pediatric intensive care unit developed fever and crepitations in the chest on 6(th) day of admission. She succumbed to her illness depite administration of adequate supportive and ventilatory care and anti-microbial therapy. At autopsy, she was diagnosed to have chronic ligneous type of tuberculous meningitis and necrotizing adnoviral pneumonia. There are hardly any reports of nosocomial adenoviral pneumonia from Indian centers. The case serves to remind intensivists to consider this diagnosis so that appropriate therapeutic adjustments and measures to prevent the spread of infection to other critically ill subjects are initiated.

Pathology of pulmonary aspergillomas.

Aspergilloma refers to a fungal ball formed by saprophytic overgrowth of Aspergillus species and is seen secondary to cavitatory/cystic respiratory diseases. Paucity of clinical and pathological data of aspergilloma in India prompted us to analyze cases of aspergilloma over 15 years. The clinical features were recorded in all and correlated with detailed pathological examination. Aspergillomas were identified in 41 surgical excisions or at autopsy. There was male predominance; half the patients were in their fourth decade. Episodic hemoptysis was the commonest mode of presentation (85.4%). Forty aspergillomas were complex, occurring in cavitatory lesions (82.9%) or in bronchiectasis (14.6%). Simple aspergilloma was seen as an incidental finding in only one. Tuberculosis was the etiological factor in 31 patients, producing cavitatory or bronchiectatic lesions; other causes were chronic lung abscess and bronchiectasis (unrelated to tuberculosis). Surgical resections are endorsed in view of high risk of unpredictable, life-threatening hemoptysis.