Search

Convolutional neural networks have been utilised for medical disease detection. However, most of the work is completed on the feature maps of the final convolution layer and the benefits of additional layers are not considered. The extraction of effective features from a limited medical image dataset is key for improving disease classification. In this paper, we propose a novel deep learning-based multilayer multimodal fusion model that focuses on extracting the features of different layers of the model and their fusion. Our disease detection model considered discriminatory information from each layer. Furthermore, to fuse different-sized feature maps of layers, we propose a novel feature map transform module known as the fusion of differentsize feature maps (FDSFM). The proposed model has shown a significantly higher accuracy of 97.21% and 99.60% for both three-class classification and two-class classification, respectively. The proposed model can be extended to any disease classifications from chest X-Ray images.

Background Serum albumin is generally considered to be a predictor of patients' nutritional status. Previous studies have used serum albumin to assess postoperative morbidity, mortality, and various other surgical outcomes in cardiac surgeries and elective gastrointestinal surgeries. In this study, we used preoperative serum albumin levels to assess postoperative surgical site wound complications in patients who underwent emergency exploratory laparotomy. Methodology Preoperative serum albumin level was observed in 60 patients who underwent emergency exploratory laparotomy due to various pathological conditions and were divided into those with hypoalbuminemia (serum albumin level3.5 g/dl and3.5 g/dL). Postoperative surgical site infections, wound dehiscence, and various complications, such as duration of hospital stay, prolonged ileus, the incidence of enterocutaneous fistula, the incidence of anastomotic leak, and 30-day mortality, were assessed. Results In our study, about 65% of the patients had hypoalbuminemia. Among them, 56.4% of the patients had surgical site infections according to the Southampton grade, with a statistically significant p-value of0.001. Moreover, 87.2% of the patients had wound dehiscence according to the World Union Wound Healing Societies Surgical Wound Dehiscence wound grading, with a statistically significant p-value of0.001. In addition, statistical significance was noted between preoperative hypoalbuminemia and increased postoperative hospital stay, with a p-value of0.001. Conclusions Preoperative serum albumin value is a formidable predictor of postoperative surgical site infections, wound dehiscence, and duration of hospital stay in patients who underwent emergency exploratory laparotomy.

Introduction There was and still is much speculation about the COVID-19 pandemic impact on suicide rates. We aimed to assess the effect of the COVID-19 pandemic on suicide rates around the world. Methods We sourced real-time suicide data from countries or countries areas through a systematic internet search (official websites of Ministries of health, police agencies, and government-run statistics agencies or equivalents), recourse to our networks (e.g. ICSPRC) and the published literature (a living systematic review). We used an interrupted time-series analysis to model the trend in monthly suicides before COVID-19 in each country or country area, comparing the expected number of suicides derived from the model with the observed number of suicides in the early months of the pandemic (from April 1 to July 31, 2020, in the primary analysis). We have now updated this work to cover the first 15 months of the pandemic and stratified analyses by age and sex and method. We will present findings from the new updated data (35 countries) at the conference. Results Initially we sourced data from 21 countries (16 high-income and five upper-middle-income countries). Rate ratios (RRs) and 95% CIs based on the observed versus expected numbers of suicides showed no evidence of a significant increase in risk of suicide since the pandemic began in any country or area. There was statistical evidence of a decrease in suicide compared with the expected number in 12 countries or areas. Conclusions This was the first study to examine suicides occurring in the context of the COVID-19 pandemic in multiple countries. Early on high-income and upper-middle-income countries, suicide numbers remained largely unchanged or declined compared with the expected levels based on the pre-pandemic period. We need to remain vigilant and be poised to respond as the longer-term mental health and economic effects of the pandemic unfold. We will present updated findings with more recent data.

This study was conducted to microbiologically evaluate cotton, PTFE tape, and foam pellets as endodontic spacer in primary teeth.Thirty primary second molars indicated for pulpectomy were included in this study. Followed by the completion of pulpectomy in each teeth cotton, PTFE tape, and foam pellets were placed as endodontic spacers randomly in 10 teeth each. The samples were collected from the pulp chamber at baseline and after 7 days to evaluate for microbial contamination of the same. The data obtained was tabulated and subjected to appropriate statistical analysis.There was a statistically significant increase in the colony forming unit after 7 days in cotton and foam pellet group. But PTFE tape group showed very minimal contamination of the pulp chamber after 7 days.Within the limitations of this study, it can be concluded that PTFE tape found to be the best alternative to cotton as an endodontic spacer.In case of multiple visit pulpectomy procedure, the state of sterility must be maintained in between the appointments until a definitive coronal restoration is placed following root-canal obturation. So it is mandatory to place an endodontic spacer under a provisional restoration to maintain the patency of the root canals and prevention of the microbial growth. The PTFE tape is inorganic, nonfibrous material which can be tightly packed without any voids under the provisional restoration. So PTFE tape is the best material to maintain the root canal patency and to provide a sterile environment by preventing the microbial growth under the provisional restoration as an endodontic spacer material in between the appointments.Somani R, Arya MV, Singh DJ

Background: Agriculture plays a significant role in economic and social development in India. With the rapid development of Information and Communication Technologies, information and data can be effectively generated, stored and used by farmers to improve agricultural productivity. For this, smart farming technologies using mobile applications (apps) that help reduce costs, maximize yields and increase profits are being employed. Here, we present an overview of several mobile apps available for traceability in agricultural sectors, discuss their features, functions and how they are lacking in some domains.Methods: In this study during Aug 2019-Sep 2019, several online databases were used for the survey according to the guidelines for Transparent Reporting of Systematic Reviews and Meta-Analyses. 73 agriculture mobile apps were selected based upon the hits using keywords like “mobile apps, agriculture mobile app, animal husbandry, etc. and with the inclusion criteria of a good review and proper up to date information. These apps were found to be used in different agriculture allied sectors in India.Result: Among these 73 mobile apps used by Indian farmers in various agricultural sectors viz. farm management, fisheries, poultry, livestock and animal husbandry, food traceability and pure agriculture sectors; the respective availability percentage of apps were 12, 14, 14, 23, 23 and 14%. These apps are discussed here in detail along with their gap analysis and a new traceability mechanism has been proposed as well.

To perform a subjective and objective assessment of vocal complaints in patients of allergic rhinitis (AR) using voice handicap index and video-stroboscopy respectively and find the association of their parameters with severity of the disease. Cross-sectional-observational study design. Outpatient department of Otorhinolaryngology of a tertiary centre. Seventy-five adult patients diagnosed with AR and classified according to ‘Allergic Rhinitis and its Impact on Asthma’ guidelines were compared with same number of normal subjects as controls, with the same age and sex, to ensure uniformity. Both the groups were asked to fill a self-answered questionnaire called Voice Handicap Index (VHI) and underwent laryngeal examination with Video-Stroboscopy (VS). The mean VHI score of the AR group (29.45 ± 32.11) was significantly higher (p

Kuttanad, the rice bowl of Kerala is a unique agricultural tract lying 0.6 to 2.2 m below MSL. The soils of the area are highly acidic, saline and high in organic carbon content. Several parts of this delta have subsoil layers containing pyrites which on oxidation produce severe acidity. Hence, the present study was envisaged to characterize the acid sulphate wet land soils of Kuttanad. For the collection of soil samples, stratified random sampling technique was followed. Surface (0-15 cm) and sub surface (15-30 cm) soil samples were collected from the identified six soil series viz., Ambalapuzha, Kallara, Purakkad, Thakazhi, Vaikom and Thuravoor. From the study it is inferred that the pH of the samples varied between 3.0 -4.0 which is typical for acid sulphate soils. Lab incubation studies also revealed that there was a drastic decline in the pH of the soil with submergence while the EC ranged between 0.1 – 8 dS/m. With regard to the enzyme assay between the locations, subsurface soil samples collected from the wetlands of Thuravoor reported to have the highest value of 76.1 ppm of urea hydrolysed g-1 of soil hr- 1 for urease and surface samples of Thakazhi had the highest of 105.8 μg of p-nitrophenol released g-1 of soil hr-1 for phosphatase. In the case of respiratory activity, which is an indicator of soil microbial biomass, surface samples from Thuravoor recorded the highest followed by Vaikom.

Background: If properly used in appendicitis, antibiotics can reduce the rate of infection by 50%. The use of post-operative antibiotics for preventing infective complications in non-perforated cases is still controversial.Methods: A randomised prospective study was conducted in the Department of Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi with patients who presented acute appendicitis. A minimum number of 30 patients each in group A (pre-operative and post-operative antibiotics) and group B (only pre-operative antibiotics) were evaluated for 18 months, from January 2018 to June 2019.Results: The mean age of group A is 29.9±15.16 years and in group B is 25.97±9.470 years (p value=0.122, insignificant). There was male preponderance. The seroma formation in both the groups was 10.00% and no patients developed intra-abdominal abscess. The incidence of local site oedema was 10% in both the groups A and B and their p value is insignificant. In both the groups A and B, 10% of the people developed pus discharge from the stitch line and the p value is insignificant. In group A, 6.67% of the patients and in group B 10.00% of the patients developed stitch line inflammatory changes and the p value insignificant. In group A, 13.3% and in group B, 10.00% of the patients developed fever and their p value is 1. The mean length of hospital in case 1.23±0.5 days (group A) and is 1.17±0.45 days (group B) (p value=0.508).Conclusions: Hence we can conclude that a well-chosen and adequately-timed pre-operative antibiotics are adequate in preventing post-operative complications and post-operative antibiotics do not affect the same.

Summary Objectives Hypophosphataemic rickets (HR) is usually secondary to renal phosphate wasting but may occur secondary to reduced intake or absorption of phosphate. We describe a series of cases of HR associated with the use of Neocate®, an amino-acid based formula (AAF). Methods A retrospective review of cases with HR associated with AAF use presenting to centres across the United Kingdom. Results 10 cases were identified, over a 9 month period, all associated with Neocate® use. The age at presentation was 5 months to 3 years. The majority (8/10) were born prematurely. Gastro oesophageal reflux disease (6/10) was the most frequent indication for AAF use. Radiologically apparent rickets was observed after a median of 8 months (range 3–15 months) of exclusive Neocate® feed. The majority (7/10) were diagnosed on the basis of incidental findings on radiographs: rickets (6/10) or fracture with osteopenia (5/10). All patients had typical biochemical features of HR with low serum phosphate, high alkaline phosphatase, normal serum calcium and 25 hydroxyvitamin D. However, in all cases the tubular reabsorption of phosphate (TRP) was ≥96%. Phosphate supplementation resulted in normalisation of serum phosphate within 1–16 weeks, and levels remained normal only after Neocate® cessation. In patients with sufficient follow up duration (4/10), normalisation of phosphate and radiological healing of rickets was noted after 6 months (range: 6–8 months) following discontinuation of Neocate®. Conclusion The presence of a normal TRP and resolution of hypophosphataemia and rickets following discontinuation of Neocate® indicates this is a reversible cause likely mediated by poor phosphate absorption. Close biochemical surveillance is recommended for children on Neocate®, especially in those with gastrointestinal co-morbidities, with consideration of a change in feed or phosphate supplementation in affected children.

Removal of three pharmaceuticals, namely, atenolol, gemfibrozil and ciprofloxacin in three bioreactors namely, activated sludge process (ASP), submerged attached biofilter (SABF) and membrane bioreactor (MBR) was studied. Removal efficiencies at steady state for atenolol were found to be 93%, 82% and 95% in ASP, SABF and MBR, respectively. Removal efficiencies for gemfibrozil were 75%, 90% and 85%, while those for ciprofloxacin were 84%, 95% and 93% in ASP, SABF and MBR, respectively. Nearly 20% of the ciprofloxacin was found to be sorbed on the biomass in the reactors. Reduction in sludge residence time (SRT) decreased the removal of compounds in ASP and MBR, and reduction in hydraulic residence time (HRT) caused a negative impact on the performance of all the reactors. Considerable increase in easily available carbon source reduced the removal efficiency. Sorption coefficient (log K d ) of ciprofloxacin was found to be 3.86 and sorption was negligible in case of atenolol and gemfibrozil. Monod co-metabolic model could simulate biodegradation process satisfactorily. Inhibition concentrations ( K i ) of atenolol, ciprofloxacin and gemfibrozil were found to be 2.8 mg/L, 0.6 mg/L and 0.89 mg/L, respectively. Biokinetic parameters μ max , K s and Y X/S were 0.046 h −1 , 10 mg/L and 0.36, respectively. Efficiency factor ( η c ) was estimated to be 0.002, 0.0006 and 0.001 mg compound/gCOD for atenolol, ciprofloxacin and gemfibrozil, respectively.

Background: since perforation occurs in 2% of patients of peptic ulcer disease hence perforated peptic ulcer is one of the most common indications for emergency gastrointestinal surgery. Delayed treatment, older age, presence of shock on admission and American Society of Anesthetisiologist status (ASA) are the risk factors for prediction of complication and mortality. A delay of more than 24 hours increases the lethal status seven to eight fold and complications rate by three folds. Methods: A study was undertaken with 50 diagnosed patients of peptic ulcer disease to predict their morbidity and mortality using risk stratified Boey Score. Results: Perforated peptic ulcer is more common in males with younger age group and risk significantly increases with increase in Boey score. Pulmonary complications are commonest followed by surgical site infection. The accuracy in predicting morbidity and mortality with Boey score was 88.70%and 84.90% respectively. Conclusions: Boey score is a simple and precise predictor of post-operative status of the patients with perforated peptic ulcer patients. Pre-operative prediction with Boey score goes a long way in reducing mortality and morbidity and requires timely management with aggressive treatment in such stratified high risk patients.

A water treatment system was developed based on a photocatalytic process, employing immobilized N-doped TiO2, which worked under solar radiation. Batch reactor studies were conducted using an immobilized and suspended form of N-doped TiO2. Activities of Degussa P-25 and N-doped TiO2 were compared. Optimization of catalyst concentration was also carried out. Reaction rates under different working conditions were compared. The bacterial kill followed a pseudo first-order reaction. Continuous reactor studies were carried out using N-doped TiO2 coated glass plates. Three-log inactivation of bacteria was obtained after a contact time of 40 min. The effects of turbidity, bicarbonate ions and organic matter were studied. It was found that the efficiency of the system decreased due to these components. Comparison of the performance of solar water-disinfection (SODIS) and solar photocatalytic treatment for disinfection of water was also carried out. The results showed that the suspended catalyst achieved complete inactivation in 1 h compared to SODIS which took 6 h. Bacterial regrowth was observed in the case of SODIS treatment whereas no bacterial growth was observed after solar photocatalytic treatment.

Background: The pleomorphic adenoma comprises 45-60% of all salivary gland tumors most often in parotid gland up to 80%. The association between the facial nerve and the gland is responsible for most of the technical difficulties and complications of the surgical approaches.Methods: This is a retrospective observational study performed in a unit of General Surgery, Safdarjung Hospital, New Delhi from May 2011 to October 2019 of all patients who underwent superficial parotidectomy for pleomorphic adenoma of parotid gland. The data was tabulated and results made using SPSS 21.0 system. Results: Male:female ratios are 29:33. Average age was 47.1 years (31-61). Average duration of disease was 2.2 years (0.3-5). 4 were operated for recurrence. Facial paresis occurred in 7 out of 62 patients (11.3%), 4 females and 3 males. 11 patients have tumor greater than 4 cm, out of these 11 patients 2 patients had pre-op facial paresis. Out of 51 patients (size 4 cm), 5 suffered same. Out of 59 patients with depth of tumor 2 cm suffered post op facial paresis. Patients with pre-op facial nerve paresis had mean duration of tumor 3.35 year (±0.92) while with post-op facial nerve paresis had mean duration of tumor 2.99 year (±1.35).Conclusions: Meticulous separation of facial nerve from parotid tissue is key to preservation of the facial nerve. But factors like size of tumor, depth of invasion, previous surgery do affect the outcome in parotid surgery.

Background: The term ‘pilonidal sinus’ describes a condition found in the natal cleft overlying the coccyx which is treated by excision.Methods: This study is a prospective study held in Department of general surgery, Safdarjung Hospital, New Delhi from October 2014 to April 2016 on 60 patients out of which 30 were controls (excision with primary closure) and 30 were taken as case (Limberg flap). Post-operative follow up was done till 6 months and complications were noted. The data was tabulated and SPSS version 17 was used for statistics.Results: Pilonidal sinus disease is common in age group 20 years and above and twice more common in males than females. Although operating time in Limberg flap is little more as compared to primary closure but insignificant. The post-operative pain in the long term follow up is less in the Limberg flap procedure, although in the initial post-operative period it is slightly higher as compared to primary closure. In Limberg flap procedure, post-operative complications like stitch line infection, seroma formation, wound dehiscence are low as compared to primary closure. Limberg flap require 2.27±0.52 days hospital stay as compared to 3.57±1.43 days in primary closure due to less post-operative complications. Recurrence rate is 3.33% in Limberg flap as compared to 26.67% in primary closure group.Conclusions: We recommend the Limberg flap method for primary pilonidal disease with low morbidity rates over primary closure.

Background: Gall stone disease is the commonest hepatobiliary problem which is tackled by either laparoscopic or open technique. Since the advent of laparoscopic cholecystectomy by Eric Muhne in 1985, it has become gold standard for gall bladder removal. But a surgeon must be competent enough to convert it into open procedure, provided there are on table complications. Moreover, since laparoscopic surgery has a learning curve, open procedure for any surgery is must for safety of the patient as well as the surgeon.Methods: A retrospective study is done over a period of 4 years (January, 2015 to December, 2018) and data of 469 patients undergoing laparoscopic cholecystectomy in a single unit of Safdarjung Hospital, New Delhi, India has been collected and evaluated for conversion to open procedure on the basis of intraoperative findings. The complications noted and the intraoperative findings and the reasons of conversion to open cholecystectomy have been compared to the previous studies done.Results: Out of total 469 cases, M:F ratio was 1:3.51. Total 40 underwent conversion to open cholecystectomy (8.54%) with M:F ratio of 1:2.07. Most common cause of conversion was dense adhesions in Calot’s triangle along with omentum and bowel. Single patient had agenesis of gall bladder. There was no iatrogenic injury to common bile duct, common hepatic duct and there were no postoperative mortalities.Conclusions: Early conversion to open cholecystectomy is associated with lower intraoperative iatrogenic injuries and hence, lowers postoperative morbidity.

Exacerbations of Crohn’s disease are not infrequently associated with bacterial gastroenteritis. The recognition of synchronous infections in such patients is vital for the initiation of appropriate antimicrobial therapy. Furthermore, the detection of active bacterial infections may lead the clinician to delay starting biological therapy. We report here a man presenting with an exacerbation of his Crohn’s disease during a trip to Thailand. Stool cultures were positive for the unusual gut pathogen Edwardsiella tarda. The patient’s symptoms resolved with concurrent antibiotic and steroid therapy. This finding demonstrates the value of performing stool culture in all patients presenting with exacerbations of inflammatory bowel diseases.

484 cases of optic atrophy were studied for the distribution pattern and significance of various etiological factors in different age groups of both sexes. Bilateral optic atrophy was found to be two and a half times as common as unilateral optic atrophy. Intracranial neoplasm (29.5%) was the most frequent known cause of bilateral optic atrophy in either sex and the most common tumor was chromophobe adenoma (48% of intracranial tumors) with highest incidence over 20 years of age. Craniopharyngioma was the most frequent tumor responsible for bilateral optic atrophy before 20 years of age. Intracranial glioma also emerged as an important cause of bilateral optic atrophy. Head injury due to road accidents and periocular trauma were the most common causes of unilateral optic atrophy in males, whereas no definite factor could be elucidated in unilateral optic atrophy in females. Vascular factors were the usual cause of optic atrophy after 40 years of age, highlighting the significance of thorough systemic evaluation.

Background CDAI is a composite index for quantifying disease activity in RA. It utilises 4 clinical parameters namely, swollen and tender joints out of 28 (the set designated for DAS28) and global assessment of the patient and assessor on a visual analogue scale. No laboratory parameter is needed. Objective To determine cut-off values for CDAI (clinical disease activity index) in Indian patients with rheumatoid arthritis (RA) for classification into different grades of disease activity. Methods CDAI and DAS28 (disease activity score on 28 joints) were measured at the first and again at the last clinic visit on 100 adult patients with RA seen over a period of 1½ years. Using recommended DAS28 values as a comparator for classifying patients into the following 4 categories of disease activity namely ‘remission’, ‘low disease activity’, ‘moderate disease activity, and ‘high disease activity’, the corresponding CDAI cut-off values were derived statistically. Results Among Indian patients CDAI cut-off values for the classification of patients into 4 categories of disease activity were: remission ≤ 2.2, low disease activity > 2.2 to ≤ 5, moderate disease activity > 5 to ≤ 21 and high disease activity > 21. Conclusions CDAI, a simple tool that is based on clinical parameters alone, was applied to the Indian patients with RA. The cut-off values derived in this study by a standardised assessment methodology could be useful in routine monitoring and therapeutic decisions in RA.

Osteomalacia is a metabolic bone disease frequently seen by rheumatologists. The primary defect in this disorder lies in inadequate mineralization of normally formed osteoid leading to soft bones, which are easily deformed. The common cause is vitamin D deficiency due to inadequate exposure to sunlight, malabsorption, intake of drugs like phenytoin and chronic renal and hepatic disease. The exact prevalence of this disease is not known. However, vitamin D deficiency has been shown to be extremely common in Indians. Certain groups like adolescents, elderly, pregnant and lactating women and those confined indoors, are more prone to develop osteomalacia. Osteomalacia usually presents with generalized bone pain, proximal muscle weakness and non-specific constitutional features. It is often confused with hypothyroidism, inflammatory myopathies, multiple myeloma and even arthritis. The gold standard of diagnosis, bone biopsy, is rarely performed. Diagnosis rests on a combination of clinical, laboratory (elevated alkaline phosphatase, low serum calcium) and radiological findings (diffuse demineralization, Looser's zones). With early institution of treatment with vitamin D and calcium, most patients recover in 3–6 months. Diet is a very poor source of vitamin D. Increased exposure to sunlight and supplementation of vitamin D in susceptible populations are important measures to prevent osteomalacia.

Insulin secretion from pancreatic β-cells is tightly regulated to maintain fasting blood glucose level between 3.5-5.5 mmol/l. In hyperinsulinaemic hypoglycaemia (HH) insulin secretion becomes unregulated so that insulin secretion persists despite low blood glucose levels. HH can be due to a large number of causes and recent advances in genetics have begun to provide novel insights into the molecular mechanisms of HH. Defects in key genes involved in regulating insulin secretion have been linked to HH. The most severe forms of HH are clinically observed in the newborn period whereas in adults an insulinoma is the commonest cause of HH. This review provides an overview on the molecular mechanisms leading to HH in children and adults, it describes the clinical presentation and diagnosis, and finally the treatment options for the different forms of HH are discussed.

Growth of multicellular organisms depends on maintenance of proper balance between proliferation and differentiation. Any disturbance in this balance in animal cells can lead to cancer. Experimental evidence is provided to conclude with special reference to the action of follicle-stimulating hormone (FSH) on Sertoli cells, and luteinizing hormone (LH) on Leydig cells that these hormones exert a differential action on their target cells, i.e., stimulate proliferation when the cells are in an undifferentiated state which is the situation with cancer cells and promote only functional parameters when the cell are fully differentiated. Hormones and growth factors play a key role in cell proliferation, differentiation, and apoptosis. There is a growing body of evidence that various tumors express some hormones at high levels as well as their cognate receptors indicating the possibility of a role in progression of cancer. Hormones such as LH, FSH, and thyroid-stimulating hormone have been reported to stimulate cell proliferation and act as tumor promoter in a variety of hormone-dependent cancers including gonads, lung, thyroid, uterus, breast, prostate, etc. This review summarizes evidence to conclude that these hormones are produced by some cancer tissues to promote their own growth. Also an attempt is made to explain the significance of the differential action of hormones in progression of cancer with special reference to prostate cancer.

Floating macrophytes, including water hyacinth (Eichhornia crassipes), are dominant invasive organisms in tropical aquatic systems and they may play an important role in modifying the gas exchange between water and the atmosphere. However, these systems are underrepresented in global datasets of greenhouse gas (GHG) emissions. This study investigated the carbon (C) turnover and GHG emissions from a small (0.6 km2) water-harvesting lake in South India and analysed the effect of floating macrophytes on these emissions. We measured carbon dioxide (CO2) and methane (CH4) emissions with gas chambers in the field as well as water C mineralization rates and physicochemical variables in both the open water and in water within stands of water hyacinths. The CO2 and CH4 emissions from areas covered by water hyacinths were reduced by 57% compared with that of open water. However, the C mineralization rates were not significantly different in the water between the two areas. We conclude that the increased invasion of water hyacinths and other floating macrophytes has the potential to change GHG emissions, a process that might be relevant in regional C budgets.

Primary adenosquamous carcinoma of the colon is an aggressive entity. We report a 41-year-old man with a combination of adenocarcinoma and squamous cell carcinoma of the cecum, treated by right hemicolectomy and ileo-transverse anastomosis. Postoperatively he received adjuvant chemotherapy. However, the tumor recurred at the original site within two months and thereafter the patient was lost to follow up.

To determine efficacy of midazolam as a sedative in mechanically ventilated newborns.Double blind randomized placebo controlled trial.Neonatal Unit of Tertiary Hospital.Sedation over 48 h of observation.Neonates with birth weight less than 2000 g who were mechanically ventilated within 7 days of life were randomly assigned to midazolam and placebo group. Midazolam and placebo were administered as bolus (0.2 mg/kg) followed by continuous infusion (0.06 mg/kg/h). Both groups received morphine infusion (10 microg/kg/h). Sedation score was noted at 6 hourly intervals for 48 hours. Hemodynamic variables, ventilatory variables, complications and side effects of treatments were also recorded.Thirty-three neonates were enrolled (17 in midazolam, 16 in placebo group). The groups were comparable for birth weights and gestation. The midazolam group had significantly better sedation from 18-24 hours after enrollment compared to placebo group. At 48 h there were no significant differences in proportion of infants with adequate sedation between midazolam and placebo group. The two groups were comparable with respect to heart rate, perfusion, ventilatory indices and blood gas parameters. None of the infants were noted to have hypotension on loading with midazolam or placebo. Seizures were noted in 2 neonates in placebo group 24 hours after enrollment (insignificant statistically).Sedation provided by continuous infusion of midazolam and morphine appears to be comparable to morphine alone in newborn babies on mechanical ventilation, with no significant adverse effects. The course of mechanical ventilation is not influenced by use of midazolam.