Laryngeal mask cuff damage during interscalene block.
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Brachial Plexus↗
Biomedical subjects
S Ahuja
Publications and source records attributed to S Ahuja.
Trypsin activity in stool and duodenal aspirate of neonates for differential diagnosis of intestinal obstruction.
The diagnosis of a non-surgical cause of delayed passage of meconium in a neonate may be challenging to the pediatric surgeon. The usefulness of determining trypsin activity (TA) in stool and duodenal aspirate for the diagnosis of cystic fibrosis (CF) and the existence of an entity called transient deficiency of trypsin (TTD) was assessed in 49 neonates over a 14-month period. TA was determined by a gelatin liquefaction technique. An absence of TA was considered if gelatin liquefaction was seen at a dilution of less than 1:100. Neonates with negative activity in both samples were started on supplementary pancreatic enzymes (pancreatin) for 1 month. TA was retested in the stool after stopping pancreatin for 1 week. Neonates with a return of TA were considered to have TTD; those who showed persistent TA deficiency at re-evaluation were investigated for CF by sweat iontophoresis. Twenty-one neonates had negative TA (in 1 only stool was tested); 13 could be re-evaluated (4 died, 4 were lost to follow-up). Nine were found to have TTD as a stool or duodenal sample showed the presence of TA; 3 of 4 patients with persistent negative TA were confirmed to have CF. One patient with normal sweat chloride is awaiting genetic studies. Determination of TA by gelatin liquefaction is a simple, rapid, inexpensive, and reliable (sensitivity 100%, negative predictive value 100%) means to differentiate non-surgical causes of intestinal obstruction such as neonatal and postoperative TTD and CF.
Clinical Enzyme Tests↗
Approach to learning disability.
Learning disabilities (LD) is one of the important causes of poor academic performance in school going children. Learning disabilities are developmental disorders that usually manifest during the period of normal education. These disabilities create a significant gap between the true potential and day to day performance of an individual. Dyslexia, dysgraphia and dyscalculia denote the problem related to reading, writing and mathematics. Perinatal problems are certain neurological conditions, known to be associated with LD; however, genetic predisposition seems to be the most probable etiological factors. Evaluation of a child suspected to be having LD consists of medical examination, vision and hearing test analysis of school performance. The psycho-behaviour assessment and education testing are essential in the process of diagnosis. The experienced persons in the field of LD should interpret the results of such tests. With Individualized Remedial Education Plan (IEP) most children learn to cope up with disability and may get integrated in a regular steam.
Adolescent↗
PPD-tuberculin skin testing and TB prophylaxis of children, The Bronx, New York.
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Adolescent↗
Noise pollution: a study of noise levels in the operation theatres of a general hospital during various surgical procedures.
Noise, defined as any unwanted or undesirable sound, is a known environmental pollutant and health hazard. Sound levels during the entire surgical procedures were measured in the operation theatres (OTs) of a general hospital in Delhi, using a sound level meter, B & K 2209, on the dB(A) scale. The sound levels were found to be higher as compared to the recommended international standands. The noise was contributed mainly by doors, trolleys, equipment and alarms and the incessant conversation among the operation theatre (OT) staff. It is well documented that noise is stressful eliciting changes in the autonomic nervous system, impairing mental faculties and producing masking that could affect the staff and the conscious patient alike, leading to decreased work performance and increased anxiety respectively. Better acoustic designing and maintenance of equipment together with an increased awareness of the OT staff towards this vital factor of work environment may effectively reduce the noise pollution in OTs.
Humans↗
An unusual presentation of orbital cysticercosis.
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Adolescent↗
Undernutrition in children--effect on vecuronium induced neuromuscular blockade.
Sixty children aged one to 12 years requiring anaesthesia including a muscle relaxant were assessed for their nutritional status based on simple anthropometric and biochemical parameters. They were allocated to one of four groups: normal nutrition, mild, moderate or severe malnutrition. The neuromuscular effects of vecuronium bromide 0.1 mg/kg were studied by recording evoked responses to train of four (TOF) nerve stimulation using an accelerograph. In the above nutritional groups, time to onset of 25% depression of T1 was 0.8, 1.4, 1.3 and 2.1 minutes respectively. Maximal depression of TOF response was seen at 2.2, 3.2, 3.7 and 8.4 minutes. The duration of action of the initial dose was 26.5, 24.0, 17.7 and 13.3 minutes and the mean duration of action of top-up doses was 16.2, 14.9, 11.2 and 8.9 minutes respectively. Reversal time with neostigmine 0.05 mg/kg was not significantly different in the four groups. These results demonstrate a statistically significant delay in onset and shortening of the duration of action of vecuronium in the undernourished groups compared with the normal nutrition group when vecuronium is administered to children on a milligram per kilogram basis.
Body Mass Index↗
Carbon Monoxide, Nitric Oxide, and Nitrogen Dioxide Levels in Gas Ovens Related to Surface Pinking of Cooked Beef and Turkey.
Carbon monoxide (CO) and total nitrogen oxide (NO(x)()) levels were monitored during meat cookery with a standard Ovenpak and a new ultralow-NO(x)() (ULN) cyclonic gas burner. With the standard burner, CO varied from 103 to 152 ppm, NO(x)() was 1.3-10.7 ppm, and surface pinking was observed on both beef and turkey. The ULN burner at optimal efficiency produced only 6.7 ppm of CO and 1 ppm of NO(x)(), insufficient to cause surface pinking. To determine the relative contribution of CO and NO(x)() to pinking, trials were also conducted in an electric oven with various pure gases. Pinking was not observed with up to 149 ppm of CO or 5 ppm of NO. However, as little as 0.4 ppm of nitrogen dioxide (NO(2)) caused pinking of turkey rolls. Beef roasts were pink at >2.5 ppm of NO(2). Thus, pinking previously attributed to CO and NO in gas ovens is instead due to NO(2), which has much greater reactivity than NO with moisture at meat surfaces.
Journal Article↗
Loss of fimbrial adhesion with the addition of Vaccinum macrocarpon to the growth medium of P-fimbriated Escherichia coli.
PURPOSE: Vaccinium macrocarpon--the American cranberry--irreversibly inhibits the expression of P-fimbriae of E. coli. Further effects on the function and expression of P-fimbriae were studied by growing P-fimbriated E. coli in solid media laced with cranberry juice. METHODS: Cranberry concentrate at pH 7.0 was added to CFA medium to a final concentration of 25%. E. coli strains JR1 and DS17 were plated on this medium with a plain CFA control and incubated at 37C. Cultures were tested for ability to agglutinate P-receptor specific beads. Bacteria were washed in PBS and agglutination retested. Cultures were also replated on plain CFA agar and rechecked for their ability to agglutinate. Transmission electron micrographs were performed on positive control and test bacteria. RESULTS: For E. coli strain JR1, P-fimbrial agglutination was inhibited after the third plating. DS17 was fully inhibited after the second plating. Washing in PBS did not affect agglutination, but replating on CFA agar allowed agglutination to recur. Electron micrographic study of control populations confirmed fimbriae. Fully inhibited bacteria had a 100% reduction in expression of fimbriae. Additionally, inhibited bacteria showed cellular elongation. CONCLUSIONS: Cranberry juice irreversibly inhibits P-fimbriae. Electron micrographic evidence suggests that cranberry juice acts on the cell wall preventing proper attachment of the fimbrial subunits or as a genetic control preventing the expression of normal fimbrial subunits or both.
Bacterial Adhesion↗
Evidence of enhanced kindling and hippocampal neuronal injury in immature rats with neuronal migration disorders.
PURPOSE: Neuronal migration disorders (NMD) are often found in patients with epilepsy. However, the mechanisms linking these two pathologies are not yet fully understood. In this study, we evaluated whether NMD increased kindling seizure susceptibility and seizure-induced acute neuronal damage in the immature brain. METHODS: Experimental NMD were produced by exposing pregnant rats (gestation day 15) to methylazoxymethanol acetate (MAM, 25 mg/kg, ip). Seizures were induced in rat pups (postnatal day 15) transplacentally exposed to MAM and controls by hippocampal kindling. Afterdischarge (AD) threshold and duration, seizure stage, and number of stimulations required to reach each seizure stage were recorded. Acute seizure-induced damage was histologically assessed in Nissl-stained and silver-impregnated hippocampal tissue 24 h after kindling. RESULTS: Rat pups with NMD had a significantly lower AD threshold than controls (91+/-18 vs. 163+/-23 microA; p < 0.05). Furthermore, rats with NMD required fewer stimulations to reach seizure stage 3.5 and 4 than did controls. Additionally, rats with NMD had longer AD the second day of stimulation (2,094+/-416 s vs. 1,755+/-353 s; p < 0.05). Histologic examination revealed that in rats with NMD, acute seizure-induced neuronal hippocampal damage occurred bilaterally in CA3 hippocampal neurons. CONCLUSIONS: The lowered AD threshold and more rapid kindling to stages 3.5 and 4 indicate that in the presence of severe NMD, hippocampal kindling is facilitated. Furthermore, this study suggests that in the immature brain, seizure-induced hippocampal neuronal damage occurs if there is an underlying pre-existing pathology.
Animals↗
Patients with type 2 diabetes have a high frequency of the C282Y mutation of the hemochromatosis gene.
OBJECTIVE: To determine whether a specific mutation (C282Y) associated with primary hemochromatosis (PHC) is more common in patients with type 2 diabetes than in a control group of patients with type 1 diabetes. Patients with type 2 diabetes have a two- to threefold higher rate of PHC than the general population. Recent identification of a genetic mutation in patients with PHC raises the possibility that the mutation is related to type 2 diabetes. DESIGN: Cross-sectional study. SUBJECTS: One hundred and five patients with type 2 diabetes and 103 control patients with type 1 diabetes, who attended the same tertiary care diabetes clinic, who were of European origin, and in whom there was no clinical suspicion of hemochromatosis. INTERVENTIONS: Patients completed a brief clinical assessment and provided a blood sample. Iron studies were measured in serum, and DNA was assayed for the presence of the C282Y and H63D mutations of the HFE gene. RESULTS: Twenty-three of 105 patients (21.9%, 95% confidence interval [CI] 14.0, 29.8) with type 2 diabetes (1 homozygote) and 12 of 103 patients (11.7%; 95% CI 5.5, 17.9) with type 1 diabetes (all heterozygotes) had at least 1 copy of the C282Y mutation (odds ratio [OR] = 2.1; 95% CI 1.0, 4.5; p = 0.048). Neither serum ferritin nor transferrin saturation level identified patients with a C282Y mutation. CONCLUSION: The C282Y gene mutation is a potential genetic marker for type 2 diabetes. It, or a closely linked gene, may be associated with greater than 20% of cases of type 2 diabetes.
Adolescent↗
Complications of urological laparoscopy: a standardized 1 institution experience.
PURPOSE: Urological laparoscopy has a significant and steep learning curve plus its own unique set of complications. Our retrospective study documents the success at 1 institution of maintaining a low number of complications during urological laparoscopy using a standardized approach plus clinicians with significant laparoscopic experience. MATERIALS AND METHODS: We evaluated 282 consecutive adults who underwent urological laparoscopic procedures at our institution. Of the procedures 241 (85%) were performed for pelvic lymph node dissection, and 41 (15%) for renal and other miscellaneous conditions. The common factor in all of these laparoscopic procedures was a single team approach, thus standardization for the entire series of procedures. RESULTS: Of 12 complications (4.2%) 5 were noted intraoperatively and 7 were discovered in the postoperative period. Five patients (1.8%) required open surgical intervention, including 3 intraoperative repairs of vascular (1), ureteral (1) and bladder (1) injuries. Procedures were aborted because of technical difficulties in 7 patients (2.8%) and because of hemorrhage during adrenalectomy in 1. Delayed complications included ureteral injury in 1 patient, seroma at the trocar site in 2, exacerbation of bowel diverticulitis requiring surgical intervention in 1, prolonged endotracheal intubation for hypercapnia in 1 and transient brachial nerve palsy in 2. CONCLUSIONS: Along with appropriate patient selection and adequate instrumentation, the benefit of significant laparoscopic experience and standardization cannot be overemphasized. The success of this combined approach is reflected in the low rate of major (2%) and minor (2.5%) complications experienced at 1 institution.
Adult↗
Infra-orbital nerve block for relief of postoperative pain following cleft lip surgery in infants.
The study was conducted on 20 infants scheduled for cleft lip repair surgery. Ten were randomly allocated to receive bilateral infra-orbital local anaesthetic nerve blocks at the conclusion of surgery with the other 10 receiving bilateral 'sham' blocks as controls. Postoperative pain relief was assessed using a pain assessment scoring system and by monitoring arterial blood pressure, heart rate and respiratory rate. The mean pain assessment score was significantly higher (i.e. better) (p < 0.05) in the infants receiving the local anaesthetic block. There were no significant statistical or clinical differences in the physiological measurements between the two groups. The infants receiving the block required less analgesia in the postoperative period. The results suggest that infra-orbital nerve block is a simple and effective means of achieving postoperative analgesia after cleft lip repair surgery in infants.
Blood Pressure↗
Evaluation of an innovative school eye health educational mode.
An innovative mode of using school children as health educators for transmitting messages on eye health care in the school environment was evaluated. Fifty children were evaluated at baseline and immediately after the educational session. A significant change in cognitive aspects of eye care was demonstrated (p < 0.001). Knowledge on vitamin A related aspects and childhood ocular trauma improved substantially compared to all other aspects of eye care.
Child↗
Factors influencing survival in esophageal atresia.
There is little published literature from the third World countries that described the factors influencing survival of babies with esophageal atresia. We analysed 25 consecutive neonates treated for esophageal atresia. The overall survival rate was 36%. All 4 babies in Waterston Group A, 37.5% in Group B, and 15.4% in Group C survived. All 9 preterm babies died. Only 2 of the 16 babies who had pre-operative chest infection survived. The mean delay in diagnosis was 54 h in outborn babies and 20 h in hospital-born babies. We believe that a survival rate of 40% is easily achieved with minimum infrastructural inputs. Simple methods and practices that would vastly improve operative results have been suggested.
Developing Countries↗
Neodymium: YAG laser iridolenticular synechiolysis in uveitis.
Fifteen patients with "bound down" pupil or ring synechiae associated with chronic granulomatous uveitis in whom dilatation could not be obtained pharmacologically underwent iris-lens synechiolysis using relatively low energies from a Q-switched Nd:YAG laser. Pupil size increased significantly in all of the treated eyes; visual acuity improved in 40%. Postlaser elevated intraocular pressure developed in a significant number, but there were no serious long-term complications associated with the procedure. Although acuity improved in less than half of the patients, because this laser treatment is relatively safe and offers some possibility of visual improvement, we recommend it for routine use, but only if performed by an experienced laser microsurgeon.
Adult↗
Resuscitation of asphyxic newborn infants with room air or 100% oxygen.
To test the hypothesis that room air is superior to 100% oxygen when asphyxiated newborns are resuscitated, 84 neonates (birth weight > 999 g) with heart rate < 80 and/or apnea at birth were allocated to be resuscitated with either room air (n = 42) or 100% oxygen (n = 42). Serial, unblinded observations of heart rates at 1, 3, 5, and 10 min and Apgar scores at 1 min revealed no significant differences between the two groups. At 5 min, median (25th and 75th percentile) Apgar scores were higher in the room air than in the oxygen group [8 (7-9) versus 7 (6-8), p = 0.03]. After the initial resuscitation, arterial partial pressure of oxygen, pH, and base excess were comparable in the two groups. Assisted ventilation was necessary for 2.4 (1.5-3.4) min in the room air group and 3.0 (2.0-4.0) min in the oxygen group (p = 0.14). The median time to first breath was 1.5 (1.0-2.0) min in both the room air and oxygen groups (p = 0.59), and the time to first cry was 3.0 (2.0-4.0) min and 3.5 (2.5-5.5) min in the room air and oxygen groups, respectively (p = 0.19). Three neonates in the room air group and four in the oxygen group died in the neonatal period. At 28 d, 72 of the 77 surviving neonates were available for follow-up (36 in each group), and none had any neurologic sequelae.(ABSTRACT TRUNCATED AT 250 WORDS)
Acid-Base Equilibrium↗
Macular infarction after intravitreal amikacin.
A case of macular infarction after intravitreal amikacin was observed in a patient with postoperative endophthalmitis. A review of the literature revealed no previously documented case occurring after intravitreal amikacin. Suggestions to avoid such a complication in an otherwise recovered patient are discussed. Also, better alternatives to intravitreal aminoglycosides should be sought.
Amikacin↗