Updated current (2012) national guidelines for paediatric tuberculosis in India.

A national consultation was organised in January 2012, in order to reconcile between global and national guidelines, to review the evidence base and update the RNTCP guidelines in consensus with Indian Academy of Paediatrics. The consultation had come up with wider recommendations in diagnosing and treating paediatric tuberculosis patients which has been incorporated in the programme.

Role of multidetector computed tomography in evaluating complications following endovascular repair of aortic aneurysm.

OBJECTIVE: To study the role of multidetector computed tomography (MDCT) in evaluating various complications following endovascular stenting of aortic aneurysms. MATERIALS AND METHODS: Over a period of 2 years (June 2005 to June 2007), 50 patients with aortic aneurysm on computed tomography (CT) angiogram were prospectively studied. Images were acquired on a 64 slice multidetector row CT scanner (GE-LightSpeed VCT) after intravenous administration of nonionic iodinated contrast. Nineteen patients underwent endovascular stent-graft repair based on their medical and surgical risk factors. Stent-graft related complications were recorded by CT angiography and analyzed using descriptive statistics. RESULTS: Most common complication related to the endovascular stent-graft placement was endoleak (44.4%), followed by puncture site hematoma (27.8%), thrombotic occlusion of a limb of the bifurcated stent graft, kinking of the stent-graft, and difficult catheterization with intimal tear in the common iliac artery were 5.6% each. Poststent diameter of the aneurysm was an important predictor of endoleaks. All the patients with either increase or no change in the aneurysm size had endoleaks. CONCLUSION: MDCT angiography is an important modality in identifying, describing, and following up the various complications following endovascular repair of aortic aneurysms, endoleaks being the most common complication. Decrease in the poststent diameter of the aneurysm suggested a good outcome.

Severe pulmonary oedema following therapeutic embolization with Onyx for cerebral arteriovenous malformation.

Acute respiratory distress syndrome (ARDS) is characterized by sudden onset of respiratory distress, infiltrates on radiographs consistent with pulmonary oedema, hypoxaemia and increased work in breathing. Infiltrates on radiographs are bilateral, but may be patchy or diffuse and fluffy or dense. It is associated with absence of left heart failure and a PaO2/FiO2 ratio of < or =200. Ethylene vinyl alcohol copolymer dissolved in dimethyl sulfoxide (DMSO), which was approved by the US FDA in July 2005, is used as an embolic agent for cerebral arteriovenous malformation (AVM). It is a biocompatible liquid polymer that precipitates and solidifies on contact with blood, thus forming a soft and spongy embolus. We report a case of ARDS following therapeutic embolization with ethylene vinyl alcohol copolymer for cerebral AVM under general anaesthesia. Experienced perioperative physicians adopted standard anaesthetic technique and monitoring for this procedure. Acute respiratory distress and hypoxaemia developed in the patient following extubation of the trachea. Infiltrates seen on postprocedural chest radiographs were consistent with pulmonary oedema. DMSO, the solvent for the ethylene vinyl alcohol copolymer, is excreted via the lungs after administration and we postulate that DMSO was the possible cause of ARDS in this patient. Monitoring of haemodynamic parameters (invasive blood pressure, electrocardiography) and ventilatory parameters (ETCO2, SpO2, airway pressure monitoring) are important in the recognition of this possible event. One should be vigilant and anticipate this complication following therapeutic embolization with ethylene vinyl alcohol polymer for the treatment of cerebral AVM.

Radioprotective potential of an herbal extract of Tinospora cordifolia.

A preparation of Tinospora cordifolia (RTc) administered i.p. (200 mg/kg b.w.) to strain "A" male mice 1 h before whole body gamma-irradiation was evaluated for its radioprotective efficacy in terms of whole body survival, spleen colony forming units (CFU), hematological parameters, cell cycle progression, and micronuclei induction. Preirradiation treatment with RTc rendered 76.3% survival (30 days), compared to 100% mortality in irradiated control and prevented radiation induced weight loss. On 10th postirradiation day, the endogenous CFU counts in spleen were decreased with increasing radiation doses 12.0 (5 Gy), 2.16 (7.5 Gy) and 0.33 (10 Gy) but pre-irradiation administration of 200 mg/kg b.w. of RTc increased CFU counts to 31.16, 21.83 and 3.00 respectively. Pre-irradiation RTc treatment could restore total lymphocyte counts (TLC) by the 15th day to normal. It also increased the S-phase cell population that was reduced following 2 Gy irradiation in a time dependent manner. 2 Gy irradiation-induced micronuclei were also decreased by a pre-irradiation administration of RTc from 2.9 to 0.52%. Because the radioprotective manifestation of RTc observed in several systems in experimental animals can be exploited for human applications.