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Context: Vitiligo is an autoimmune depigmentary disorder characterized by loss of epidermal melanocytes. It can be diagnosed clinically, however, dermoscopy aids in its differentiation from other hypopigmentary and depigmentary conditions and also helps in evaluating disease activity. Aims: To study the dermoscopic patterns of vitiligo and evaluate their correlation with disease activity. Settings and Design: This is a cross-sectional and observational study conducted in the outpatient department of dermatology of a tertiary care hospital at Sri Amritsar. Methods and Materials: Fifty patients complaining of depigmented lesions were diagnosed clinically for vitiligo. Histopathological confirmation was done in difficult to diagnose cases. Patients with clinically stable vitiligo, unstable vitiligo, and vitiligo under treatment were included. A dermoscopic examination was done with a Dermlite DL4 dermoscope. The photographs were taken using a standard phone and the dermoscopic findings were documented. Statistical Analysis Used: The results were tabulated and expressed as percentages. The Pearson correlation coefficient was calculated between dermoscopic patterns of vitiligo and disease activity. Results: On examination with the dermoscope, pigmentary patterns observed were marginal hyperpigmentation, perifollicular pigmentation, reticulate hyperpigmentation, and altered pigment network. Morphological patterns seen on dermoscopy included leukotrichia, micro-Koebner phenomena, polka dots, and starburst appearance. Conclusions: Marginal hyperpigmentation, perifollicular pigmentation, and reticulate pigmentation were the markers of disease stability. Leukotrichia was seen in patients of stable vitiligo majority being treatment refractory. Altered pigment network, micro-Koebner phenomena, starburst appearance, and polka dots indicated unstable vitiligo. Presence of erythema and telangiectasias indicated response to treatment. Hence, dermoscopy can be used as an effective tool for the diagnosis of vitiligo and evaluation of disease activity. [ABSTRACT FROM AUTHOR]

Context: Though many treatment options are available for treating post-acne scars, optimized treatment still does not exist. Till date, comparative split-face studies, analyzing the efficacy of combined treatment modalities for acne scars with adequate sample size and with statistically significant results, are still lacking. Aim: The aim of this study was to compare the effectiveness of the combined use of platelet-rich plasma (PRP) and fractional ablative CO2 laser (FACL) versus FACL in the management of acne scars and to study the safety of autologous PRP and FACL in the treatment of post-acne scars. Settings and Design: This was a randomized split-face trial study. Materials and Methods: This study was conducted in 30 patients having Goodman and Baron's grade 3 and 4 acne scars. The efficacy of PRP in combination with FACL was compared to FACL alone in the treatment of post-acne scars. Right half of the patient's face was taken as the study side where FACL was performed followed by PRP injections. The left half of the same patient's face was taken as the control side where FACL was performed followed by normal saline injections. Statistical Analysis: Results were analyzed using Statistical Package for the Social Sciences (SPSS, Chicago). Results: At the time of enrollment, mean Goodman and Baron Acne Qualitative Grading Scale on study and control side was 3.80 with standard deviation (SD) of 0.40 at baseline. After completion of four treatment sessions, it was reduced to 2.43 (SD = 0.76) and 2.76 (SD = 0.49) on the study and control side, respectively. Improvement on both sides was statistically significant (P = 0.000). Conclusion: There is no single proven modality for the effective treatment of post-acne scars. Combination of FACL with newer adjuvants such as PRP has definitive role in managing post-acne scars with better safety profile than FACL alone. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular disease is the leading cause of mortality worldwide, including in low- and middle-income countries. Cardiovascular risk assessment is essential to prevent the mortality caused by diabetes. Aim: The current study was conducted to assess the prevalence of cardiovascular risk factors in type 2 diabetes and to compare the United Kingdom Prospective Diabetes Study (UKPDS) and World Health Organization (WHO)/International Society of Hypertension (ISH) chart in assessing cardiovascular risk score. Materials and Methods: Cardiac risk assessments were done in fifty patients attending the medicine outpatient department in an institutional hospital after ethical clearance and taking informed consent from patients. Two assessment tools were applied on the same patient. Results: Overall, 10% of people were obese (body mass index >30). Smoking was prevalent in 20% (10/50) of patients. Hypertension was observed in 60% (30/50) of patients. Raised total cholesterol (TC) was the most common lipid abnormality affecting 94% of patients. The WHO/ISH prediction charts identified 14% and 10% of patients with cardiovascular risk category <10 and 10–20, whereas the UKPDS engine predicted 24% and 38% in the same category. In high-risk categories 30–40 and >40, the WHO/ISH score predicted a higher proportion of patients (18% and 32%) than the UKPDS engine (8% and 4%, respectively). Kappa value was calculated to calculate the degree of agreement between two tools, and it was found to be 0.781 (P < 0.01). Conclusion: Raised TC and hypertension were the most prevalent risk factors. There was no significant discrepancy between two assessment tools in predicting cardiovascular risk score among type 2 diabetes mellitus patients in our study. [ABSTRACT FROM AUTHOR]

Background and Aims: Labor pain is one of the most severe pain that a woman experiences in her lifetime. Various methods are being used to relieve this pain and to achieve higher maternal satisfaction. One such technique is transcutaneous electrical nerve stimulation (TENS) that uses low-frequency electrotherapy. The aim of our study was to evaluate TENS by comparing it to an established labor analgesia technique, i.e., epidural analgesia in terms of maternal satisfaction. Material and Methods: This prospective study was conducted on 60 parturients in active stage of labor. The choice of analgesia was made by the parturient after informed consent. In group A (n = 30) TENS was used, while in group B (n = 30) epidural ropivacaine 0.125% + 2 μg/ml fentanyl was given. Continuous monitoring of maternal vitals, visual analogue score, and fetal heart rate (FHR) was done. Maternal satisfaction was scored considering pain relief, ability to move and experience of labor at the end of delivery and outcome was labeled as favorable and unfavorable. Results: TENS was found to be favorable in 90% of parturients as compared to 96.6% in epidural (P 0.301). The number of highly satisfied parturients was 4 (13.3%) in TENS group and 17 (56.6%) in the epidural group (P= 0.000). Three patients in the epidural group had assisted delivery and two had cesarean section whereas all patients in TENS group delivered normally (P= 0.065). No significant difference was found in the fetal outcome. Conclusions: TENS is a good alternate choice for providing labor analgesia and may have a major role in future. [ABSTRACT FROM AUTHOR]

Background: Breast cancer is one of the malignant diseases where early diagnosis and treatment leads to a good prognosis. Breast self-examination (BSE) is the most cost-effective screening technique. Objective: The objective of the study is to assess the effect of training on awareness and behavior of BSE among the community health workers (CHWs). Methodology: A community-based interventional study was conducted among 148 Accredited Social Health Activist and Anganwadi Workers of the selected wards of South Delhi district in the year 2018. The study was done in three phases: baseline survey followed by intervention in the form of training session, which involved the use of nursing manikins for the demonstration of BSE technique and video demonstration, depicting proper performance of BSE. After a period of 2 weeks, the same questionnaire and training models were used on the same CHWs to assess the effect of the intervention on their awareness and behavior. Results: Although most of the CHWs were in the age group of 20–40 years and educated till higher secondary and above, only 40% had ever heard of self-breast examination and an even lesser number had ever performed self-breast examination before. The intervention helped in the increase of knowledge about the symptoms of breast cancer considerably. The confidence levels among CHWs and barriers seeking help in CHWs also improved and more people approached their doctors regarding changes seen in the breast, mainly lumps on self-examination. Conclusion: It was determined that the awareness and behavior change after training was positive. There is also effective improvement seen in confidence level and health-seeking behavior. [ABSTRACT FROM AUTHOR]

Background: Autism spectrum disorder (ASD) is a developmental disability and is of public health importance. It affects not only the child and the family. It also has direct and indirect cost implications on the nation that are incurred in providing health care, support for education, and rehabilitative services. There is a lack of evidence-based estimate of the population prevalence of ASD in India. Therefore, this systematic review was aimed at determining the prevalence of ASD in the Indian population.Materials and Methods: We conducted a systematic review and meta-analysis of the published studies evaluating the prevalence of ASD in the community setting. A search within the published literature was conducted from different databases (PubMed, OvidSP, and EMBASE). The analysis of data was done using STATA MP12 (StataCorp, College Station, TX, USA).Results: Four studies were included in this systematic review. Of the four included studies, one had studied both urban and rural populations, and the other three had studied the urban populations only. The study from the rural setting showed a pooled percentage prevalence of 0.11 [95% confidence interval (CI) 0.01-0.20] in children aged 1-18 years; and, four studies conducted in the urban setting showed a pooled percentage prevalence of 0.09 (95% CI 0.02-0.16) in children aged 0-15 years.Conclusion: The scarcity of high-quality population-based epidemiological studies on ASD in India highlights an urgent need to study the burden of ASD in India. The proper acquisition of data related to the prevailing burden of ASD in India would lead to a better development of rehabilitative services in our country. [ABSTRACT FROM AUTHOR]

Background and Aims: Ambulatory surgery is continually evolving specialty in the majority of surgical procedures. Dexmedetomidine and midazolam are newer adjuvants for sedation and reducing the dose of anesthetic agents. The aim of this study was to compare the sedative and propofol-sparing effect of dexmedetomidine and midazolam in minor gynecological day care surgeries. Observer's Assessment of Activity and Sedation, dose of additional propofol, Aldrete and street fitness score were studied as primary outcomes. Hemodynamic parameters and side effects were evaluated as secondary outcomes. Materials and Methods: A prospective randomized placebo-controlled study was conducted on 150 American Society of Anesthesiologists ASA physical status Classes I and II gynecological patients between 18 and 50 years and were allocated into three groups of fifty each. Group A received intravenous (i.v.) dexmedetomidine 0.1 μg/kg, Group B received i.v. midazolam 0.04 mg/kg, and Group C received normal saline 10 min before induction. Results: Sedation score was statistically highly significant between Group A and B (P < 0.001). Between Group A and C, it was statistically significant (P < 0.05); however, score was nonsignificant between Groups B and C (P > 0.05). During recovery at 120 min after surgery, score 5 was achieved equally by all three groups which was found to be statistically insignificant (P > 0.05). Mean dose of additional propofol used was less in Group A (14 ± 9.25) than B (25 ± 5.40) and C (53 ± 10.96). On intergroup comparison between all three groups, it was found to be statistically highly significant (P < 0.001). Comparison of bispectral index (BIS) values between Groups A and C and Groups B and C were highly significant (P < 0.001). However, it was statistically significant between Groups A and B (P < 0.05). Aldrete scoring and street fitness scores were highly significant between Groups A and B, B and C, and also between Groups A and C (P < 0.001). No significant hemodynamic derangements and side effects were noted in any of three groups. Conclusion: Dexmedetomidine had good sedation and better recovery characteristics than midazolam. BIS monitoring was helpful in maintaining the depth of anesthesia. [ABSTRACT FROM AUTHOR]

Background and Aims: The external jugular vein (EJV), often used for resuscitation, has been underutilised for central venous catheterisation (CVC) in view of an unpredictable success rate. There is an encouraging literature on the improved success rate of CVC through EJV with the inclusion of certain body manoeuvres. This prospective randomised controlled study was conducted with the aim of evaluating the efficacy of body manoeuvres in improving the success rate of CVC through EJV. Methods: One hundred patients aged 18-50 years, scheduled for elective surgery requiring CVC, were randomly assigned to either undergo CVC using Seldinger technique with body manoeuvres or a control group undergoing CVC without body manoeuvres. The primary outcome was the success rate of CVC, as observed in the post-procedure chest radiograph. Secondary outcomes included quality of central venous pressure waveform, catheterisation attempts, total time for CVC, complications. Results: CVC was achieved in 98% (49/50) of patients in study group and 80% (40/50) of patients in control group (P = 0.008). Mean catheterisation time was significantly lower in the study group (151.06 ± 40.50 s) compared to control group (173.50 ± 50.66 s) (P = 0.023). The incidence of catheter misplacement and failure to cannulate were lower in the study group (0%, 2% vs. 20%, 12.5%, respectively). Groups did not differ in a number of catheterisation attempts and incidence of haematoma. Conclusion: Inclusion of various body manoeuvres to Seldinger technique significantly improves the success rate of CVC through EJV. [ABSTRACT FROM AUTHOR]

Background and Aim: Induced hypotension limits intra-operative blood loss to provide better visibility of the surgical field and diminishes the incidence of major complications during functional endoscopic sinus surgery (FESS). We aimed at comparing nitroglycerine, esmolol and dexmedetomidine for inducing controlled hypotension in patients undergoing FESS. Material and Methods: One hundred and fifty American Society of Anesthesiologists physical status I or II adult patients undergoing FESS under general anesthesia were randomly allocated to three groups of 50 patients each. Group E received esmolol in a loading and maintenance dose of 1 mg/kg over 1 min and 0.5-1.0 mg/kg/h, respectively. Group D received a loading dose of dexmedetomidine 1 µg/kg over 10 min followed by an infusion 0.5-1.0 µg/kg/h, and group N received nitroglycerine infusion at a dose of 0.5-2 µg/kg/min so as to maintain mean arterial pressure (MAP) between 60 and 70 mmHg in all the groups. The visibility of the surgical field was assessed by surgeon using Fromme and Boezaart scoring system. Hemodynamic variables, total intra-operative fentanyl consumption, emergence time and time to first analgesic request were recorded. Any side-effects were noted. The postoperative sedation was assessed using Ramsay Sedation Score. Result: The desired MAP (60-70 mmHg) could be achieved in all the three study groups albeit with titration of study drugs during intra-operative period. No significant intergroup difference was observed in Fromme's score during the intra-operative period. The mean total dose of fentanyl (µg/kg) used was found to be significantly lower in group D compared to groups E and N (1.2 ± 0.75 vs. 3.6 ± 1.3 and 2.9 ± 1.1 respectively). The mean heart rate was significantly lower in group D compared to groups E and N at all times of measurement (P < 0.05). The MAP was found to be significantly lower in group D compared to groups E and N after infusion of study drugs, after induction, just after intubation and 5 min after intubation (P < 0.05). The Ramsay Sedation Scores were significantly higher in group D (score 3 in 46%) when compared to group E (score 2 in 50%) and group N (score 2 in 54%) (P < 0.001). The emergence time was significantly lower in group E and group N compared to group D. Time to first analgesic request was significantly longer in group D. Conclusion: Dexmedetomidine and esmolol provided better hemodynamic stability and operative field visibility compared to nitroglycerin during FESS. Dexmedetomidine provides an additional benefit of reducing the analgesic requirements and providing postoperative sedation. [ABSTRACT FROM AUTHOR]

Trichothiodystrophy (TTD) is characterized by the common feature of sulfur-deficient brittle hair associated with a constellation of neuroectodermal symptoms. There is a wide phenotypic variation in the severity; ranging from isolated hair defect to multiple neuroectodermal symptoms such as photosensitivity, ichthyosis, intellectual impairment, decreased fertility, and short stature. This case report describes TTD in two sisters with only hair fragility and no other associated feature. This case highlights the variable clinical presentation of TTD and the need for regular follow-up in such patients for an early detection of any neurological, physical, and sexual impairment. [ABSTRACT FROM AUTHOR]

Background: The combinations of topical keratolytics with anti-microbials and topical retinoids with antimicrobials are commonly prescribed in the treatment of acne. Aim: The present study was undertaken with the aim of comparing the efficacy and safety of topical benzoyl peroxide and clindamycin versus topical benzoyl peroxide and nadifloxacin versus topical tretinoin and clindamycin in patients of acne vulgaris. Materials and Methods: 100 patients between 15 and 35 years having =2 and =30 inflammatory and/or noninflammatory lesions with Investigator's Global Assessment (IGA) score 2/3 were randomly divided into 3 groups. Group A was prescribed benzoyl peroxide 2.5% gel and clindamycin 1% gel, Group B was prescribed benzoyl peroxide 2.5% gel and nadifloxacin 1% cream and Group C was prescribed tretinoin 0.025% and clindamycin 1% gel. Total number of lesions and adverse effects during the treatment were assessed at 0, 4, 8, 12 weeks with IGA score. Results: There was statistically significant reduction in total number of lesions with better improvement in Group A. Adverse drug reactions during the study showed a better safety profile of Group B which is found to be statistically significant also. Conclusion: These findings confirm that Group A is more efficacious and Group B is safest among the other two groups. [ABSTRACT FROM AUTHOR]

Xylometazoline nasal drops used for nasal decongestion can have side-effect in the form of palpitation, hypertension, headache, and tremors. Anaphylaxis to xylometazoline nasal drops is a relatively unrecognized complication. We encountered a patient posted for tonsillectomy who developed serious anaphylaxis upon administration of a commercially available preparation of xylometazoline nasal drops and required aggressive management for stabilization. Further evaluation and literature search indicated toward the preservative (benzylalkonium chloride) as the cause of this adverse event. [ABSTRACT FROM AUTHOR]

The article discusses the etiology and risk factors associated with Stevens-Johnsons syndrome(SJS) and toxic epidermal necrolysis. Topics discussed include symptoms of SJS such as fever, sore throat and fatigue oftenly treated with antibiotics, variations in HLA-B gene associated with SJS and risk of death and prognosis of the SJS.

Background and Aims: Neuraxial anaesthesia has become popular for the renal surgeries during the last few years. This study was aimed at comparing general anaesthesia (GA) with epidural anaesthesia in patients undergoing renal surgeries. Methods: One hundred American Society of Anaesthesiologists (ASA) physical status-I and II adult consenting patients of both gender in the age group of 25-55 years undergoing renal surgeries were randomly assigned to two groups of 50 patients each: Group G and Group E. Group G patients were administered conventional GA while Group E received epidural anaesthesia (EA) with 3 mg/kg of ropivacaine and 1 µg/kg of dexmedetomidine. Besides cardio-respiratory parameters, surgeon's satisfaction, patient's satisfaction and side effects were observed. Parametric data were analysed by ANOVA while non-parametric data were compared with Mann--Whitney U-test and Wilcoxon test. Value of P < 0.05 was considered statistically significant. Results: The demographic profile, total anaesthesia time, surgical time and haemodynamic parameters and surgeon's satisfaction scores were comparable in both groups. Patient's satisfaction scores were better in Group E during the post-operative period. Incidence of side-effects such as nausea and vomiting and shivering were higher in Group G (P < 0.001) while the incidence of dry mouth was higher in Group E (P < 0.001). Conclusion: Epidural anaesthesia with ropivacaine and dexmedetomidine can be safely and effectively used in patients undergoing renal surgeries. [ABSTRACT FROM AUTHOR]

Background: Epidural opioids acting through the spinal cord receptors improve the quality and duration of analgesia along with dose-sparing effect with the local anesthetics. The present study compared the efficacy and safety profile of epidurally administered butorphanol and fentanyl combined with bupivacaine (B). Materials and Methods: A total of 75 adult patients of either sex of American Society of Anesthesiologist physical status I and II, aged 20-60 years, undergoing lower abdominal under epidural anesthesia were enrolled into the study. Patients were randomly divided into three groups of 25 each: B, bupivacaine and butorphanol (BB) and bupivacaine + fentanyl (BF). B (0.5%) 20 ml was administered epidurally in all the three groups with the addition of 1 mg butorphanol in BB group and 100 μg fentanyl in the BF group. The hemodynamic parameters as well as various block characteristics including onset, completion, level and duration of sensory analgesia as well as onset, completion and regression of motor block were observed and compared. Adverse events and post-operative visual analgesia scale scores were also noted and compared. Data was analyzed using ANOVA with post-hoc significance, Chi-square test and Fisher's exact test. Value of P < 0.05 was considered significant and P < 0.001 as highly significant. Results: The demographic profile of patients was comparable in all the three groups. Onset and completion of sensory analgesia was earliest in BF group, followed by BB and B group. The duration of analgesia was significantly prolonged in BB group followed by BF as compared with group B. Addition of butorphanol and fentanyl to B had no effect on the time of onset, completion and regression of motor block. No serious cardio-respiratory side effects were observed in any group. Conclusions: Butorphanol and fentanyl as epidural adjuvants are equally safe and provide comparable stable hemodynamics, early onset and establishment of sensory anesthesia. Butorphanol provides a significantly prolonged post-operative analgesia. [ABSTRACT FROM AUTHOR]

The quest for searching newer and safer anesthetic agents has always been one of the primary needs in anesthesiology practice. Levobupivacaine, the pure S (--)-enantiomer of bupivacaine, has strongly emerged as a safer alternative for regional anesthesia than its racemic sibling, bupivacaine. Levobupivacaine has been found to be equally efficacious as bupivacaine, but with a superior pharmacokinetic profile. Clinically, levobupivacaine has been observed to be well-tolerated in regional anesthesia techniques both after bolus administration and continuous post-operative infusion. The incidence of adverse drug reactions (ADRs) is rare when it is administered correctly. Most ADRs are related to faulty administration technique (resulting in systemic exposure) or pharmacological effects of anesthesia; however, allergic reactions can also occur rarely. The available literary evidence in anesthesia practice indicates that levobupivacaine and bupivacaine produce comparable surgical sensory block, similar adverse side effects and provision of similar labor analgesia with good comparable maternal and fetal outcome. The present review aims to discuss the pharmacokinetic and pharmacological essentials of the safer profile of levobupivacaine as well as to discuss the scope and indications of levobupivacaine based on current clinical evidence. [ABSTRACT FROM AUTHOR]

Metastasis in cases of glioblastoma multiforme are extremely rare, having an incidence of 0.2%-2% in the literature.[[1]],[[2]] These are generally seen post-surgery or when there is a breach of the blood - brain barrier due to local extradural spread. If anything related to the patient's identity is shown, adequate consent has been taken from the patient/relative/guardian. Extraneural metastasis of glioblastoma multiforme presenting as an unusual neck mass. [Extracted from the article]

Background: The induction dose of propofol is reduced with concomitant use of opioids as a result of a possible synergistic action. Aim and Objectives: The present study compared the effect of fentanyl and two doses of butorphanol pre-treatment on the induction dose of propofol, with specific emphasis on entropy. Methods: Three groups of 40 patients each, of the American Society of Anaesthesiologistsphysical status I and II, were randomized to receive fentanyl 2 μg/kg (Group F), butorphanol 20 μg/kg (Group B 20) or 40 μg/kg (Group B 40) as pre-treatment. Five minutes later, the degree of sedation was assessed by the observer's assessment of alertness scale (OAA/S). Induction of anesthesia was done with propofol (30 mg/10 s) till the loss of response to verbal commands. Thereafter, rocuronium 1 mg/kg was administered and endotracheal intubation was performed 2 min later. OAA/S, propofol induction dose, heart rate, blood pressure, oxygen saturation and entropy (response and state) were compared in the three groups. Statistical Analysis: Data was analyzed using ANOVA test with posthoc significance, Kruskal-Wallis test, Chi-square test and Fischer exact test. A P<0.05 was considered as significant. Results: The induction dose of propofol (mg/kg) was observed to be 1.1±0.50 in Group F, 1.05±0.35 in Group B 20 and 1.18±0.41 in Group B40. Induction with propofol occurred at higher entropy values on pre-treatment with both fentanyl as well as butorphanol. Hemodynamic variables were comparable in all the three groups. Conclusion: Butorphanol 20 μg/kg and 40 μg/kg reduce the induction requirement of propofol, comparable to that of fentanyl 2 μg/kg, and confer hemodynamic stability at induction and intubation. [ABSTRACT FROM AUTHOR]

Background: It is difficult to visualise the larynx using conventional laryngoscopy in the presence of cervical spine immobilisation. Airtraq® provides for easy and successful intubation in the neutral neck position. Objective: To evaluate the effectiveness of Airtraq in comparison with the Mc Coy laryngoscope, when performing tracheal intubation in patients with neck immobilisation using hard cervical collar and manual in-line axial cervical spine stabilisation. Methods: A randomised, cross-over, open-labelled study was undertaken in 60 ASA I and II patients aged between 20 and 50 years, belonging to either gender, scheduled to undergo elective surgical procedures. Following induction and adequate muscle relaxation, they were intubated using either of the techniques first, followed by the other. Intubation time and Intubation Difficulty Score (IDS) were noted using Mc Coy laryngoscope and Airtraq. The anaesthesiologist was asked to grade the ease of intubation on a Visual Analogue Scale (VAS) of 1-10. Chi-square test was used for comparison of categorical data between the groups and paired sample t-test for comparison of continuous data. IDS score and VAS were compared using Wilcoxon Signed ranked test. Results: The mean intubation time was 33.27 sec (13.25) for laryngoscopy and 28.95 sec (18.53) for Airtraq (P=0.32). The median IDS values were 4 (interquartile range (IQR) 1-6) and 0 (IQR 0-1) for laryngoscopy and Airtraq, respectively (P=0.007). The median Cormack Lehane glottic view grade was 3 (IQR 2-4) and 1 (IQR 1-1) for laryngoscopy and Airtraq, respectively (P=0.003). The ease of intubation on VAS was graded as 4 (IQR 3-5) for laryngoscopy and 2 (IQR 2-2) for Airtraq (P=0.033). There were two failures to intubate with the Airtraq. Conclusion: Airtraq improves the ease of intubation significantly when compared to Mc Coy blade in patients immobilised with cervical collar and manual in-line stabilisation simulating cervical spine injury. [ABSTRACT FROM AUTHOR]

Background: Management of high risk obstetric patients. Aim: The present study was conducted to evaluate the primary causes of the admission of obstetric patients to Intensive Care Unit (ICU), the presence of co-morbid diseases, outcome of such patients, their survival rate as well as the factors which contribute to the maternal mortality. Settings and Design: A retrospective study was conducted in the Department of Obstetrics and Gynaecology and Anaesthesiology/ICU of our Institute. Materials and Methods: Sixty-one obstetric patients, who were admitted to ICU between 20 December 2006 and 31 January 2010, were evaluated for various factors responsible for their admission as well as their outcome. Statistical Analysis: At the end of study, the data were arranged systematically and subjected to statistical analysis using nonparametric tests and P value <0.05 was considered significant. Results: Majority of the 61 patients admitted in ICU were referred from the peripheral health centers, smaller nursing homes/hospitals and some even without proper primary care and mainly comprising uneducated and rural population. Hemorrhage, pregnancy induced hypertension, cardiac diseases, respiratory insufficiency and sepsis were the main causes for admission. A total of 18 patients among 61 died during their ICU stay in the hospital. Conclusions: In the developing countries, high risk pregnancy should be managed at peripheral centers with proper facilities, antenatal visits and timely referral. The intensive care help should be reserved for very high risk pregnancies with co-morbid diseases. [ABSTRACT FROM AUTHOR]

Monoclonal antibodies (MAbs), a new class of biological agents, are used these days in therapeutics and diagnosis. MAbs also labeled as 'magic bullets', are highly specific antibodies produced by a clone of single hybrid cells formed in the laboratory by fusion of B cell with the tumor cell. The hybridoma formed yields higher amount of MAbs. MAbs can be produced in vitro and in vivo. Animals are utilized to produce MAbs, but these antibodies are associated with immunogenic and ethical problems. Of late, recombinant DNA technology, genetic engineering,phage display and transgenic animals are used to produce humanized MAbs or pure human MAbs, which have fewer adverse effects. MAbs alone or conjugated with drugs, toxins, or radioactive atoms are used for treatment of cancer, autoimmune disorders, graft rejections, infectious diseases, asthma, and various cardiovascular disorders. New MAbs are being developed which are more specific and less toxic. [ABSTRACT FROM AUTHOR]

The article deals with the role of the medical emergency team (MET), led by a maternal fetal medicine specialist or obstetrician and intensivists, in the management of obstetric patients admitted in intensive care units (ICU). Topics discussed include ICU admission for obstetric patients in developed and developing countries, complications arising from delivery and the gap between critical care services and outcome. The role of invasive monitoring in ICU patients is also discussed.

A letter to the editor about the use of subcision and trichloreoacetic acid peels (TCA) chemical reconstruction of skin scars (CROSS) in the treatment of atrophic acne scars is presented.

Multiple squamous cell carcinoma (SCC) of the skin is an exceedingly rare entity. It has been reported in a few patients of psoriasis treated with oral psoralen therapy and UV radiation, immunodeficiency states, local intramuscular metastasis and cutaneous metastasis from vulvar SCC. We report the case of a 55-year-old man who reported with a painless non-healing warty growth on the lower back persisting for the last 2 years which was excised. Its histopathology proved it to be SCC with HPV changes. On examination, 4 similar lesions were found on the upper back; out of which 1 lesion exhibited marked dysplastic changes on histopathology, but without HPV changes. This case could be either multicentrically developed SCC due to HPV infection or cutaneous metastasis as carcinoma of unknown primary site i.e. metastasis occurring before primary tumor diagnosis. [ABSTRACT FROM AUTHOR]

Achondroplasia, a common cause of short limbed type of dwarfism is due to quantitative decrease in rate of endochondral ossification. This abnormal bone growth leads to disproportionate body and head structure, thus placing them under high risk for anaesthetic management. There is paucity in literatures, regarding appropriate drug dosage selection in these patients. Use of drugs as per standard dosage recommendations based on body weight or body surface area, may not be adequate in these patients owing to discrepancies in overall body weight and lean body weight, especially during rapid sequence induction. Here, we report a case of failed rapid sequence induction due to abnormal response to administered drugs in an adult achondroplastic dwarf. Standard doses of thiopentone and rocuronium had to be repeated thrice to achieve adequate conditions for intubation. [ABSTRACT FROM AUTHOR]

The article presents a case study of 52-year-old male patient with laryngeal carcinoma who was posted for total laryngectomy and hemithyroidectomy. It mentions his tracheostomy tube was replaced with flexo-metallic tube and fixed over the chest with sutures. Deflation of tube was done post-surgery using bore needle and replaced with a tracheostomy tube.

A letter to the editor is presented which discusses the case report of a 60-year-old male patient with history of fall leading to posttraumatic loss of soft tissue and underwent forehead flap rhinoplasty, wherein, a modified mask ventilation (MV) was carried out.

The article describes a case of a female patient who complained about sinus discharge on her face. The authors explained their diagnosis as verrucous trichoadenoma after histopathological examination showing the presence of epidermis with hyperplasia and keratotic plugging. They mentioned that trichoadenoma features multiple horn cysts throughout dermis and solid epithelial islands of eosinophilic epithelial cells.