Descriptions of three new species of Strattis Pascoe, 1883 (Coleoptera: Curculionidae: Cryptorhynchinae) from the Indian subcontinent.

The cryptorhynchine genus Strattis Pascoe originally described from Sri Lanka is recorded from India with the descriptions of three new species: S. pascoei sp. nov., S. maculatus sp. nov., and S. srilankaiensis sp. nov. from the Indian subcontinent. Strattis biguttatus is designated as type species for the genus. A key to species is provided. The character of a presumable stridulatory structure between the meta-femur and the first abdominal ventrite is discussed.

Effect of no-tillage and tillage on the ecology of mite, Acarina (Oribatida) in two different farming systems of paddy field in Cachar district of Assam.

The present investigation was carried out in Cachar district of Assam over a period of one year (January 2011 - December 2011) to understand the seasonal ecology of Acarina (Oribatida) in rice (Oryza sativa L.) cultivated fields. Population of Oribatida was found to be maximum during August 2011, both in no-tillage (6.32 ± 0.66 No./m2 x 100(2)) and tillage (5.30 ± 0.71 No./M2 x 100(2)) sites in Dorgakona area whereas the peak was recorded during August 2011, both in no-tillage (5.38 ± 0.75 No./m(2) x 100(2)) and tillage (4.69 ± 0.77 No./m2 x 100(2)) in Durby area of study sites. Least population was encountered during January 2011, in both no-tillage (0.98 ± 0.28 ± No./m2 x 100(2)) and tillage (0.98 ± 0.30 No/m2 x 100(2)) sites in Dorgakona area whereas the same was found during November 2011 in no-tillage (0.57 ± 0.31 No.m/2 x 100(2)) and in February 2011 in tillage (0.45 ± 0.21 No./m2 x 100(2)) sites of Durby area. Linear regression analysis with all the environmental variables showed positive and significant influence on the population dynamics whereas relative humidity (R2 = 0.26 p > 0.05) in Dorgakona no-tillage and tillage (R2 = 0.19 P > 0.05) sites and relative humidity in tillage site (R2 = 0.27 P > 0.05) in Durby area showed no influence. Multiple regression analysis showed that the combined effect of climatic variables having a significant influence (p < 0.05) on the oribatid mite population in no-tillage and tillage systems in both the study sites. Rainfall, relative humidity and temperature facilitated the soil moisture, microbial activity and litter decomposition, which in turn may favour the reproduction and growth rate of the species. Among microclimatic conditions all the parameters showed positive and significant influence (P < 0.05) on the population in no-tillage and tillage system on both the sites except pH which showed negative correlation with the population. One way ANOVA revealed significant difference (F = 6.53, P < 0.01) of the Oribatid population between the systems.

Seasonal distribution of Isotomina thermophilan in a secondary succession and a homegarden in Cachar, Assam.

Present investigation was carried out in Cachar district of Assam over a period of two years (May 2007-April 2009) to understand the seasonal ecology of Isotomina thermophila (Axelson, 1900) in secondary succession and homegarden ecosystems. Population was found to be maximum during July 2008 (7949.05 No. m(-2)) and September 2008 (7949.05 No. m(-2)) in homegarden whereas the peak was recorded in secondary succession during September 2008 (13656.05 No. m(-2)). Least population was encountered during March 2008 (1222.93 No. m(-2)) and April 2008 (1630.57 No. m(-2)) in homegarden and secondary succession, respectively. It may be due to the fact that, vital activity of this species effected in the dry period or migrate towards lower soil profile in search of food and moisture. Linear regression analysis established the hypothesis that all the environmental variables showed positive and significant influence on the population dynamics whereas in homegarden, rainfall (r = 0.36, p > 0.05) did not show any influence. In multiple regression analysis positive and significant influences (p < 0.05) were recorded for both the investigated sites. Rainfall, relative humidity and temperature facilitated the soil moisture, microbial activity, litter decomposition may favour the reproduction and growth rate of the species. Among microclimatic conditions except soil pH all other parameters exhibited significant correlations (p < 0.05) with population. Based on the present investigation, it can be concluded that I. thermophilia does not differ much with the general ecology of collembolans in this sub humid climate.

Tracheal intubation in the critically ill: a multi-centre national study of practice and complications.

BACKGROUND: Complications associated with tracheal intubation may occur in up to 40% of critically ill patients. Since practice in emergency airway management varies between intensive care units (ICUs) and countries, complication rates may also differ. We undertook a prospective, observational study of tracheal intubation performed by critical care doctors in Scotland to identify practice, complications, and training. METHODS: For 4 months, we collected data on any intubation performed by doctors working in critical care throughout Scotland except those in patients having elective surgery and those carried out before admission to hospital. We used a standardized data form to collect information on pre-induction physical state and organ support, the doctor carrying out the intubation, the techniques and drugs used, and complications noted. RESULTS: Data from 794 intubations were analysed. Seventy per cent occurred in ICU and 18% occurred in emergency departments. The first-time intubation success rate was 91%, no patient required more than three attempts at intubation, and one patient required surgical tracheostomy. Severe hypoxaemia ( <80%) occurred in 22%, severe hypotension (systolic arterial pressure <80 mm Hg) in 20%, and oesophageal intubation in 2%. Three-quarters of intubations were performed by doctors with more than 24 months formal anaesthetic training and all but one doctor with <6 months training had senior supervision. CONCLUSIONS: Tracheal intubation by critical care doctors in Scotland has a higher first-time success rate than described in previous reports of critical care intubation, and technical complications are few. Doctors carrying out intubation had undergone longer formal training in anaesthesia than described previously, and junior trainees are routinely supervised. Despite these good results, further work is necessary to reduce physiological complications and patient morbidity.

A comparison of McGrath and Macintosh laryngoscopes in novice users: a manikin study.

Direct laryngoscopy using the Macintosh laryngoscope is a difficult skill to acquire. Videolaryngoscopy is a widely accepted airway management technique that may be easier for novices to learn. We compared the McGrath videolaryngoscope and Macintosh laryngoscope by studying the performance of 25 medical students with no previous experience of performing tracheal intubation using an easy intubation scenario in a manikin. The order of device use was randomised for each student. After brief instruction each participant performed eight tracheal intubations with one device and then eight tracheal intubations with the other laryngoscope. Novices achieved a higher overall rate of successful tracheal intubation, avoided oesophageal intubation and produced less dental trauma when using the McGrath. The view at laryngoscopy was significantly better with the McGrath. Intubation times were similar for both laryngoscopes and became shorter with practice. There was no difference in participants' rating of overall ease of use for each laryngoscope.

Rapid sequence induction in the emergency department: induction drug and outcome of patients admitted to the intensive care unit.

OBJECTIVES: Etomidate is used widely for rapid sequence induction (RSI) of anaesthesia in the emergency department (ED) as a result of its relative cardiovascular stability. There is concern over possible adrenal suppression and also that outcomes could be worse than in patients given other induction drugs. This possible association has not been studied in ED patients undergoing RSI. METHODS: 525 consecutive patients who underwent RSI in the ED and were subsequently admitted to an intensive care unit (ICU) were reviewed. The following information was retrieved from the records: induction drug use; incidence of hypotension and vasopressor administration at induction; acute physiology and chronic health evaluation (APACHE) II severity of illness and predicted mortality; and ICU and hospital outcome. The choice of induction drug was not controlled but was at the discretion of the attending clinicians. RESULTS: The numbers of patients given an induction drug were 184 etomidate, 306 thiopental and 35 propofol. Patients given etomidate were older and sicker than those given thiopental or propofol. Mortality appeared greater with etomidate but there was no difference when outcome was related to pre-existing risk. Age, APACHE II score and presenting diagnosis were independent predictors of hospital mortality, but etomidate use was not. CONCLUSION: Induction drug was not related to patient outcome in this cohort of patients. The risks of developing hypotension and receiving a vasopressor at induction were greatest with propofol. Emergency physicians should choose an induction drug based on individual patient circumstances, rather than being solely concerned about adrenal suppression.

Effect of spinal anaesthesia on plasma concentrations of glutathione S-transferase.

BACKGROUND: Plasma glutathione S-transferase (GST) concentration measurement is a sensitive and specific index of hepatocellular injury. GST concentration increases after anaesthesia with most volatile anaesthetic agents, but not after propofol. Such increases are thought to result from reduced liver blood flow. The effect on GST concentration of spinal (subarachnoid) anaesthesia, which might also reduce liver blood flow, is not known. METHODS: We studied the effects of spinal anaesthesia on GST concentrations measured by specific radioimmunoassay in 33 patients undergoing intermediate orthopaedic, general or gynaecological surgery. GST concentrations were measured before anaesthesia and 3, 6 and 24 h after induction of anaesthesia. Hypotension (systolic blood pressure <70% of pre-induction value) was rapidly corrected with i.v. ephedrine. RESULTS: Mean duration of surgery was 41 min (range 11-80). No increase in GST concentration was observed at any time, but at 24 h GST concentration was significantly reduced (P<0.05). One patient in whom hypotension was not treated developed a greatly increased GST concentration at 3 h. CONCLUSION: We found no association between spinal anaesthesia and disturbance of hepatocellular integrity when hypotension does not occur or is rapidly corrected.

The coagulative and cardiorespiratory responses to reamed intramedullary nailing of isolated fractures.

We measured the changes during operation in seven markers of coagulation in a prospective series of 84 patients with fractures of the tibia or femur who were undergoing reamed intramedullary nailing. All patients were also continually monitored using transoesophageal echocardiography to assess marrow embolism. In a subset of 40 patients, intraoperative cardiopulmonary function was monitored, using pulmonary and systemic arterial catheterisation. The procedure produced a significant increase in prothrombin time, activated partial thromboplastin time, the level of prothrombin fragments F1+2 and D-dimers, and a decrease in the fibrinogen level, suggesting activation of both the coagulation and fibrinolytic pathways. There was evidence of both platelet hyper-reactivity and depletion, as estimated by an increase in beta-thromboglobulin levels and a decrease in the platelet count. In the patients who had invasive monitoring there was an incremental increase in mean pulmonary arterial pressure, with the changes being greatest during insertion of the guide-wire and reaming. The change in markers of coagulation, pulmonary artery pressure and arterial oxygen partial pressures correlated with the intraoperative embolic response. Greater changes in these parameters were observed during stabilisation of pathological fractures and in those patients in whom surgery had been delayed for more than 48 hours. Seven patients with pathological fractures developed more severe hypoxic episodes during reaming, which were associated with significantly greater arterial hypoxaemia, a fall in the right ventricular ejection fraction and an increase in the mean pulmonary artery pressure, pulmonary capillary wedge pressure, central venous pressure and the pulmonary vascular resistance index. These changes suggested that the patients had transient intraoperative right heart strain. Eight patients developed significant postoperative respiratory compromise. They all had severe intraoperative embolic responses and, in the three who had invasive monitoring, there was a significantly greater increase in pulmonary artery pressure and alveolar-arterial oxygen gradient, and a fall in the ratio of arterial partial pressure of oxygen to the inspired oxygen concentration. Operative delay, intraoperative paradoxical embolisation and the scores for the severity of the coagulative and embolic responses were predictive of the development of postoperative respiratory complications on univariate logistic regression analysis. On multivariate analysis, however, only the embolic and coagulative scores were significant independent predictors of respiratory complications.

Serum thyroxine binding capacity-dependent bias in an automated free thyroxine assay.

The magnitude of serum thyroxine (T4) binding capacity (sBC) dependent bias in the AXSYM free thyroxine (FT4) assay was assessed using two recently described tests. One of the tests uses a direct equilibrium dialysis (ED) FT4 assay as the reference method. The results obtained with the AXSYM method were compared with those obtained by the ED FT4 method in patient sera having a wide range of sBC. The other test involves comparison of the FT4 results obtained following dilution of sera by an inert buffer, to theoretically derived FT4 results. As serum dilution causes a predictable decrease in sBC, the demonstration of a negative bias whose magnitude increases in parallel to the dilution, is indicative of an sBC-dependent bias. The AXSYM FT4 assay exhibited a significant sBC-dependent bias. This sBC-dependent bias is likely to have been caused by the presence of significant amounts of T4 binding proteins in the assay reagents.

Assessment of serum thyroxine binding capacity-dependent biases in free thyroxine assays.

BACKGROUND: Free thyroxine (FT4) assays may exhibit biases that are related to serum T4 binding capacity (sBC). We describe two tests that can be used to assess the presence and magnitude of sBC-dependent biases in FT4 assays. METHODS: We used a direct equilibrium dialysis FT4 assay as the reference method and compared the results obtained with those of the FT4 assays under investigation, in patient sera having a wide range of sBC. We then compared the expected and observed FT4 results for sera diluted with an inert buffer. Because serum dilution causes a predictable decrease in sBC, an increasingly negative bias on progressive dilution is indicative of a sBC-dependent bias. RESULTS: The automated FT4 assay investigated (Vitros FT4) showed no demonstrable sBC-dependent bias by either test. CONCLUSION: These two tests can be used to screen for sBC-dependent biases in FT4 assays.

Effect of sevoflurane anaesthesia on plasma concentrations of glutathione S-transferase.

To assess the effect of sevoflurane anaesthesia on hepatocellular integrity, we measured plasma concentrations of glutathione S-transferase (GST) before anaesthesia and 1, 3, 6 and 24 h after the end of anaesthesia in 41 healthy, Japanese patients undergoing elective, body surface surgery. Sevoflurane (approximately 1.0 MAC) was delivered in 50-66% nitrous oxide in oxygen via a circle system, with a fresh gas flow of 6 litre min-1. Ventilation was spontaneous in all patients. Mean duration of anaesthesia was 101 min. Concentrations of GST increased significantly 1 h after the end of anaesthesia (P = 0.0075), but this was not significantly different from preoperative concentrations at 3, 6 and 24 h. Three patients developed a large secondary increase in GST concentrations at 24 h. The increase observed at 1 h was probably a result of reduced total liver blood flow; the mechanism for the secondary increase at 24 h is unclear but the possibility that products of sevoflurane biotransformation are responsible cannot be excluded.

Relationship of admission thyroid function tests to outcome in critical illness.

One hundred and eighty patients had serum thyrotropin, total triiodothyronine and free thyroxine concentrations measured within 3 h of admission to the Intensive Therapy Unit to assess whether thyroid function tests could predict outcome in critical illness. Overall mortality was 30.6%. Nonsurvivors were older (p = 0.001), and had higher APACHE II scores (p < 0.001) and predicted mortalities (p < 0.001). There was no difference in the median values of thyrotropin, total triiodothyronine and free thyroxine concentrations between survivors and nonsurvivors. Thyrotropin concentration was subnormal in 15 patients, normal in 152 and elevated in 13 patients. In contrast, 80 patients had subnormal triiodothyronine concentration. Free thyroxine was subnormal in five patients. Thyrotropin, total triiodothyronine and free thyroxine concentrations were not related to outcome (p = 0.360, p = 0.622, p = 0.726, respectively). No variable independently predicted death. Total triiodothyronine concentrations were lower in patients who received dopamine before admission to the intensive therapy unit than those who did not (p = 0.008); thyrotropin and free thyroxine concentrations were not influenced by dopamine administration. Serum concentrations of thyrotropin, total triiodothyronine and free thyroxine measured within 3 h of admission to the intensive therapy unit are not predictive of outcome.

Biological variation and the effect of fasting and halothane anesthesia on plasma glutathione S-transferase concentrations.

Using a specific RIA, we have investigated in patients and volunteers whether fasting, diminished hepatic clearance, hemoconcentration, or within-day biological variation might be responsible for the transient increases in plasma glutathione S-transferase (GST) concentration observed after anesthesia. GST concentration was measured in 44 healthy volunteers after an overnight fast and at 3, 6, and 24 h after the fasting sample. The concentration was significantly lower at 3 and 6 h after than in the fasting sample (P = 0.0019 and P = 0.015, respectively). The change in GST concentration caused by fasting was examined in 30 subjects by comparing pre- and postfasting values. Fasting had no significant effect on GST concentration overall (P = 0.4721), but two individuals showed a marked increase in GST concentration after fasting overnight. In a separate study of 10 patients, plasma amylase activity and plasma concentrations of GST and albumin were measured immediately before and 3 h after induction of halothane anesthesia. Although GST concentration was increased at 3 h in each of the 10 patients, plasma amylase activity and plasma albumin concentration were significantly decreased in all patients (P = 0.002). Apparently, increases in GST concentration after anesthesia do not result from incidental factors.

Medullary lavage reduces embolic phenomena and cardiopulmonary changes during cemented hemiarthroplasty.

We randomised 24 patients before they had a cemented hemiarthroplasty for hip fracture to receive either thorough or minimal saline lavage of the femoral canal. We then determined the effect in each group on the thromboembolic and cardiopulmonary responses to the pressurised insertion of cement, using transoesophageal echocardiography to show the echogenic embolic response. We found a statistically significant reduction in both the duration of the response and the number of large emboli in patients who had had thorough lavage as compared with the control group with minimal lavage. There was also less disturbance of pulmonary function, as assessed by the change in end-tidal CO2 levels and oxygen saturation, in patients who had thorough lavage. Three patients had a significant fall in blood pressure during cement insertion; all had only minimal lavage. We consider that thorough lavage should be an essential part of the preparation of the proximal femur before cement insertion.

Effects of perceived responsibility on help-seeking decisions among elderly persons.

This study sought to clarify why elderly adults underutilize mental health services. One hundred ten elderly individuals were asked to imagine experiencing symptoms described in a vignette and to appraise their responsibility for the problem and for its solution, their willingness to seek help, and their preference among sources of help. Results indicated that perception of problems as either medical or psychological significantly affected how elders appraised responsibility. Although attributions were unrelated to help-seeking for medical problems, elderly persons feeling responsible for psychological problems were more likely to seek help for them. Perceived responsibility predicted the sources of help (e.g., social network, physicians, mental health workers) selected by elders who believed that their problems were medical, but not for problems thought to be psychological. A discussion of the reasons for their underutilization of mental health services is presented, with an emphasis on the practical implications of the results.

Halothane hepatitis.

The historical background, clinical features, morphology, epidemiology and aetiology of halothane hepatitis have been presented. Animal models of halothane hepatotoxicity have been described, although their application to humans is of doubtful significance. Two, probably distinct, forms of liver damage associated with halothane have been identified. The much more common mild form may result from reductive biotransformation of halothane, possibly influenced by genetic factors, or reduced liver oxygenation, whereas the rare fulminant form is most likely to be immune-mediated. The role of altered calcium homeostasis has not yet been established. In addition, a common mechanism for liver dysfunction associated with halogenated volatile anaesthetic agents has been proposed. The hepatotoxicity of enflurane cannot be excluded; while hepatic dysfunction after isoflurane or nitrous oxide is considered unlikely, further attention is necessary. It is too soon to comment on the hepatotoxic potential of sevoflurane or desflurane.

Effect of adrenaline on plasma concentrations of bupivacaine following lower limb nerve block.

Twenty-two patients undergoing total knee arthroplasty received combined sciatic plus femoral "3 in 1" blocks as adjuncts to general anaesthesia. Eleven patients received 0.375% bupivacaine 45 ml (168.75 mg) with adrenaline 1 in 200,000 and the remaining 11 received plain solution according to a previously prepared, randomized list. The mean maximum plasma bupivacaine concentration was significantly greater with plain solution than when adrenaline was added (1.66 micrograms ml-1 compared with 0.98 micrograms ml-1) (P less than 0.05). Bupivacaine concentrations were greater at all times in the plain group compared with the group receiving adrenaline. These differences were statistically significant at 10, 15 and 20 min (P less than 0.05). The greatest peak concentration recorded was 3.13 micrograms ml-1 in one patient receiving plain bupivacaine. No patient developed signs of systemic toxic effects. Peak plasma concentrations were related inversely to body weight in patients receiving solution containing adrenaline (P less than 0.005), but no relationship existed in patients who received plain solution.

A disposable blood pressure cuff. An assessment of its accuracy.

An empty 500-ml infusion bag was used as the cuff for a Lifestat 100 oscillotonometer. The systolic and mean blood pressures obtained in 40 subjects were not significantly different from those measured with a standard cuff. The diastolic pressure was unrelated between the two cuffs. The empty bag is a cheap and hygienic option in patients who present a high infection risk.