All India Difficult Airway Association guidelines in practice-A survey.

BACKGROUND AND AIMS: The All India Difficult Airway Association (AIDAA) has come up with difficult airway (DA) guidelines to suit the Indian context. We conducted an online survey with the primary aim to find out the awareness about AIDAA guidelines and adherence to them in clinical practice. The secondary aims were to explore variations in practice with respect to experience or the type of the institute. METHODS: An online web-based questionnaire survey was sent to all practising anaesthesiologists who attended an airway workshop. The validated and piloted questionnaire consisted of 23 questions and the practice patterns were asked to be graded on a Likert scale of four. RESULTS: The response rate was 66%. Awareness about AIDAA guidelines was high (81%) but adherence varied. Apnoeic nasal oxygen insufflation was always practised by only 19.59%.Only 79.7%of the respondents always used capnography to confirm intubation. While 23.64% did not ensure a safe peripheral oxygen saturation (SpO2) level of 95% to do repeat laryngoscopy, 64% chose supraglottic devices after three failed laryngoscopic attempts. A departmental debriefing of a DA event and issuing an alert card to the patient was practised by 58.78% and 52.7%, respectively. Although 50% had training to do cricothyrotomy, only 41% had ready access to a cricothyrotomy set in their workplace. The use of capnography was more prevalent in private institutions. The survey revealed a safety gap with some recommendations like debriefing of a DA event, alert card, nasal oxygenation etc. CONCLUSION: Awareness about AIDAA guidelines is high among our practising anaesthesiologists, but adherence to the recommendations varied and there is room for improvement, especially for debriefing a DA event, issuing an alert card, the use of capnography and nasal oxygenation.

Barriers in Utilization of Maternal Health Care Services: Perceptions of Rural Women in Eastern Nepal.

BACKGROUND: Nepal is promoting safe motherhood through maternity incentives schemes. Still about two-thirds of births take place at home. Inadequate access to health care and under utilization of services is the major reasons for poor health of women and children. OBJECTIVES: The study aim to explore the barriers in utilization of maternal health care services in eastern Nepal specifically to explore the reasons for not availing the services and to assess the indigenous practices regarding maternal health. METHODS: An exploratory study design was adopted to elicit the information from the selected respondents from different villages. Focus group discussions and in-depth interviews were conducted. Data was transcribed and analyzed manually to identify themes. RESULTS: The barriers to maternal health care service utilization were identified as social factors like family pressure, superstition, shyness, misconception, negligence, illiteracy, alcoholism. Likewise, large family size, jobless, unnecessary expenditure on health services was identified as economic barrier. Some cultural practices were also found as barrier for not availing the health services. CONCLUSION: The study explored factors that are contributing in not availing the maternal health care services. The elimination of these barriers will facilitate quality of care and health outcomes. Therefore, the interventions should be developed and implemented to improve the health status of women and children. The result of this study can be utilized to draw the attention of local government, in strategic planning related to maternal health interventions.

Soil contamination of heavy metals in the Katedan Industrial Development Area, Hyderabad, India.

Studies on quantitative soil contamination due to heavy metals were carried out in Katedan Industrial Development Area (KIDA), south of Hyderabad, Andhra Pradesh, India under the Indo-Norwegian Institutional Cooperation Programme. The study area falls under a semi-arid type of climate and consists of granites and pegmatite of igneous origin belonging to the Archaean age. There are about 300 industries dealing with dyeing, edible oil production, battery manufacturing, metal plating, chemicals, etc. Most of the industries discharge their untreated effluents either on open land or into ditches. Solid waste from industries is randomly dumped along roads and open grounds. Soil samples were collected throughout the industrial area and from downstream residential areas and were analysed by X-ray Fluorescence Spectrometer for fourteen trace metals and ten major oxides. The analytical data shows very high concentrations of lead, chromium, nickel, zinc, arsenic and cadmium through out the industrial area. The random dumping of hazardous waste in the industrial area could be the main cause of the soil contamination spreading by rainwater and wind. In the residential areas the local dumping is expected to be the main source as it is difficult to foresee that rain and wind can transport the contaminants from the industrial area. If emission to air by the smokestacks is significant, this may contribute to considerable spreading of contaminants like As, Cd and Pb throughout the area. A comparison of the results with the Canadian Soil Quality Guidelines (SQGL) show that most of the industrial area is heavily contaminated by As, Pb and Zn and local areas by Cr, Cu and Ni. The residential area is also contaminated by As and some small areas by Cr, Cu, Pb and Zn. The Cd contamination is detected over large area but it is not exceeding the SQGL value. Natural background values of As and Cr exceed the SQGL values and contribute significantly to the contamination in the residential area. However, the availability is considerably less than anthropogenic contaminants and must therefore be assessed differently. The pre- and post-monsoon sampling over two hydrological cycles in 2002 and 2003 indicate that the As, Cd and Pb contaminants are more mobile and may expect to reach the groundwater. The other contaminants seem to be much more stable. The contamination is especially serious in the industrial area as it is housing a large permanent residing population. The study not only aims at determining the natural background levels of trace elements as a guide for future pollution monitoring but also focuses on the pollution vulnerability of the watershed. A plan of action for remediation is recommended.

Soil contamination due to heavy metals from an industrial area of Surat, Gujarat, Western India.

The pollution of soil is a source of danger to the health of people, even to those living in cities. The anthropogenic pollution caused by heavy industries enters plants then goes through the food chain and ultimately endangers human health. In the context, the knowledge of the regional variability, the background values and anthropogenic vs. natural origin of potentially harmful elements in soils is of critical importance to assess human impact. The present study was undertaken on soil contamination in Surat, Gujarat (India). The aims of the study were: i) to determine extent and distribution of heavy metals (Ba, Cu, Cr, Co, Ni, Sr, V and Zn) ii) to find out the large scale variability, iii) to delineate the source as geogenic or anthropogenic based on the distribution maps and correlation of metals in soils. Soil samples were collected from the industrial area of Surat from top 10 cm layer of the soil. These samples were analysed for heavy metals by using Philips PW 2440 X-ray fluorescence spectrometer. The data reveal that soils in the area are significantly contaminated, showing higher levels of toxic elements than normal distribution. The heavy metal loads of the soils in the study area are 471.7 mg/kg for Ba, 137.5 mg/kg for Cu, 305.2 mg/kg for Cr, 51.3 mg/kg for Co, 79.0 mg/kg for Ni, 317.9 mg/kg for Sr, 380.6 mg/kg for V and 139.0 mg/kg for Zn. The higher concentrations of these toxic metals in soils need to be monitored regularly for heavy metal enrichment.

Dengue fever presenting with acute colitis.

Gastrointestinal manifestations of dengue fever are mainly in the form of bleeding or liver function abnormalities. Dengue fever presenting as acute colitis-like picture is not reported to date. We report a 50-year-old man with dengue fever presenting with lower gastrointestinal bleeding and colonoscopic features of acute inflammatory colitis.

Effects of formulation variables and post-compression curing on drug release from a new sustained-release matrix material: polyvinylacetate-povidone.

A new commercially available sustained-release matrix material, Kollidon SR, composed of polyvinylacetate and povidone, was evaluated with respect to its ability to modulate the in vitro release of a highly water-soluble model compound, diphenhydramine HCl. Kollidon SR was found to provide a sustained-release effect for the model compound, with certain formulation and processing variables playing an important role in controlling its release kinetics. Formulation variables affecting the release include the level of the polymeric material in the matrix, excipient level, as well as the nature of the excipients (water soluble vs. water insoluble). Increasing the ratio of a water-insoluble excipient, Emcompress, to Kollidon SR enhanced drug release. The incorporation of a water-soluble excipient, lactose, accelerated its release rate in a more pronounced manner. Stability studies conducted at 40 degrees C/75% RH revealed a slow-down in dissolution rate for the drug-Kollidon SR formulation, as a result of polyvinylacetate relaxation. Further studies demonstrated that a post-compression curing step effectively stabilized the release pattern of formulations containing > or = 47% Kollidon SR. The release mechanism of Kollidon-drug and drug-Kollidon-Emcompress formulations appears to be diffusion controlled, while that of the drug-Kollidon-lactose formulation appears to be controlled predominantly by diffusion along with erosion.

Isolation technology for research and development applications: from concept to production.

A prototype parenteral manufacturing facility based on isolation technology was designed, constructed, and commissioned at Warner-Lambert Co., Morris Plains, NJ, with emphasis on its application to research and development (R&D) settings. The facility contains closed isolators for holding, transferring, and manufacturing sterile products. Vaporized hydrogen peroxide (VHP) was used for sanitization of the isolators. Various factors were evaluated to ensure complete distribution of VHP inside the isolators. VHP sanitization validation of the isolators was performed using chemical and biological indicators, and by swab testing the inside surfaces of the isolators. On the basis of these studies, operating conditions for routine VHP sanitization of the various isolators were established. Performance qualification of the manufacturing facility was conducted via media fills, which demonstrated sterile integrity of the manufacturing process. The media fills revealed certain deficiencies in handling procedures of filled product, which were subsequently corrected. The Warner-Lambert isolation technology-based parenteral facility proved to be a reliable and cost-effective alternative to standard clean room technology. The facility is ideally suited for manufacturing small batches. Closed isolator technology has its limitations when used for production-size batches involving automated processing.

Micellar solubilization of a new antimalarial drug, beta-arteether.

beta-Arteether (1) is a new antimalarial drug derived from artemisinin (2, quinghaosu). Compound 1 is quite water insoluble, but very soluble in a variety of organic solvents. Solubilization in a variety of surfactants was investigated to obtain higher concentrations of 1 in aqueous solutions. Anionic and cationic surfactants exhibited dramatic solubilizing ability for 1, while nonionic surfactants showed significantly lower solubilizing ability. The solubilization data are analyzed on the basis of a pseudo-phase model with 1 exhibiting a high partition coefficient into the micellar phase. An empirical model is presented to identify the possible sites of solubilization of 1 in the micelle.