Comparison of sensitivity, specificity, and accuracy of Wilson's score and intubation prediction score for prediction of difficult airway in an eastern Indian population-A prospective single-blind study.

INTRODUCTION: Unidentified difficult airway leads to significant adverse events and therefore prediction of a difficult airway is of importance. Independent bedside tests for the prediction of a difficult airway have poor accuracy. The airway assessment scores have not gained popularity as they are cumbersome to perform at the bedside. They also have a varying degree of interobserver variability because of their subjective parameters. Therefore, there is a need to search for a simple score with objective parameters that can be performed at the bedside. AIM: To determine the diagnostic accuracy of the Wilson score andiIntubation prediction score for predicting difficult airway in the Eastern Indian population. MATERIAL AND METHOD: A prospective single-blind study was done including 150 consecutive patients, ASA grade I and II between the ages of 18 and 70 years, undergoing surgery requiring general anesthesia with endotracheal intubation. Preoperatively, the airway was assessed in all patients using Wilson Score and Intubation Prediction Score. General anesthesia with endotracheal intubation was done in all patients. The airway was assessed for ease laryngoscopy and intubation using the Intubation Difficulty Scale. An IDS >5 was taken as difficult airway. The sensitivity, specificity, PPV, NPV, and accuracy of the two predictive tests to predict a difficult was calculated. RESULTS: The sensitivity, positive predictive value and accuracy of Intubation Prediction Score was 77.8%, 58.3%and 90.7% respectively as compared to 38.9%, 25.95% and 78.33% respectively of Wilsons score. CONCLUSION: Intubation Prediction score with its objective parameters can be preferred as a simple and accurate bedside test to predict a difficult airway in an Eastern Indian population.

Arsenic load in rice ecosystem and its mitigation through deficit irrigation.

Rice the staple food is a notable intake source of arsenic to the rural population of eastern India through food-chain. A field survey was carried out to study the variation of arsenic load in different parts of rice genotype Shatabdi (most popular genotype of the region) exposed to varying level of arsenic present in the irrigation water and soil. As irrigation is the primary source of arsenic contamination, a study was conducted to assess arsenic load in rice ecosystem under deficit irrigation practices like intermittent ponding (IP), saturation (SAT) and aerobic (AER) imposed during stress allowable stage (16-40 days after transplanting) of the crop (genotype Shatabdi). Present survey showed that arsenic content in water and soil influenced the arsenic load of rice grain. Variation in arsenic among different water and soil samples influenced grain arsenic load to the maximum extent followed by straw. Deviation in root arsenic load due to variation in water and soil arsenic content was lowest. Arsenic concentration of grain is strongly related to the arsenic content of both irrigation water and soil. However, water has 10% higher impact on grain arsenic load over soil. Translocation of arsenic from root to shoot decreased with the increase in arsenic content of water. Imposition of saturated and aerobic environment reduced both yield and grain arsenic load. In contrast under IP a marked decrease in grain arsenic content recorded with insignificant reduction in yield. Deficit irrigation resulted in significant reduction (17.6-25%) in arsenic content of polished rice and the values were lower than that of the toxic level (<0.2 mg kg-1). In contrast the decrease in yield was to the tune of 0.9% under IP regime over CP.

Nutritional status of children in two districts of the mountain region of Nepal.

BACKGROUND: Nutritional status is a prime indicator of health. Generally, three anthropometric indicators are often used to assess nutritional status during childhood and adolescence: underweight (weight-for-age), stunting (height- for-age) and thinness (BMI-for-age). Malnutrition in children is a major public health problem in many developing countries. This study was conducted to assess nutritional status among children attending health camps in two mountainous districts in Nepal. METHODS: Five hundred and seventy five children below 15 years of age attending the medical camp in Humla and Mugu districts in October 2011 were assessed for nutritional status. For children less than five years, weight for age, weight for height and height for age as per WHO classification, and for children between five to 15 years age specific values of height, weight and Body Mass Index (BMI) were calculated. RESULTS: In Humla district, 28.2% children were undernourished, 8.8% wasted and 22.4% stunted in less than five years. In the same age group, 31.7% children were undernourished, 9.4% wasted and 29.4% stunted in Mugu district. In the age group five to 15 years, thinness was seen in 22.4% and 29.4% children in Humla and Mugu respectively. CONCLUSIONS: Malnutrition (underweight, stunting, wasting and thinness) still constitutes a major health problem among Nepalese children, particularly in mountainous regions.

Development and Validation of a RP-HPLC Method for Estimation of Prulifloxacin in Tablet Dosage Form.

A simple, precise, rapid, accurate and economic reverse phase high performance liquid chromatographic method has been developed for the estimation of prulifloxacin in tablet dosage form. The separation was achieved by using octadecylsilane column (C(18)) and KH(2)PO(4) buffer: acetonitrile adjusted to pH 7.3 with triethyl amine in proportion of 10:90 v/v as mobile phase, at a flow rate of 1.0 ml/min. The detection was carried out at 278 nm. The retention time of prulifloxacin was found to be 2.4 min. The limit of detection and limit of quantitation were found to be 0.14 µg/ml and 0.42 µg/ml respectively. The accuracy and reliability of the proposed method was ascertained by evaluating various validation parameters like linearity, precision, accuracy and specificity according to ICH guidelines. The proposed method provides an accurate and precise quality control tool for routine analysis of prulifloxacin in tablet dosage form.

Seasonal variations in isoprene emission from tropical deciduous tree species.

Isoprene is a dominant constituent of the global biogenic volatile organic compounds budget. It plays an important role in regulating the atmospheric trace gas composition including tropospheric ozone concentrations. In this study, monthly measurements of isoprene emission rates were carried out over a 1-year period (December 2002-November 2003) from four Indian deciduous tree species, namely Ficus relegiosa, Ficus infectoria, Pongamia pinnata, and Morus alba, using branch enclosure method. Significantly high monthly variations in isoprene emission rates were observed in all four-plant species. Also, each plant species exhibited pronounced seasonal variation in isoprene emission. Maximum isoprene emissions were observed during summer and minimum during the winter or spring months.

Geophysical expression of natural recharge in different geological terrains.

Behavior of the Dar-Zarrouk parameters--longitudinal unit conductance, transverse unit resistance, longitudinal resistivity, and transverse resistivity--has been compared with the behavior of the natural recharge in two geological terrains. Contour patterns of the geophysical parameters and those of natural recharge have been analyzed and a qualitative relation in their behavior was recognized. Graphical comparison of the geophysical and hydrogeological parameters clearly illustrates a qualitative relationship between the two parameters. Use of such qualitative relation in the field of ground water exploration and management studies is explained. A modest beginning is attempted to arrive at a quantitative relation between natural recharge and Dar-Zarrouk parameters.

Studies on essential oils: part 10; antibacterial activity of volatile oils of some spices.

The essential oils extracted from the seeds of seven spices, Anethum graveolens, Carum capticum, Coriandrum sativum, Cuminum cyminum, Foeniculum vulgare, Pimpinella anisum and Seseli indicum have been studied for antibacterial activity against eight pathogenic bacteria, causing infections in the human body. It has been found that the oil of C. capticum is very effective against all tested bacteria. The oil of C. cyminum and A. graveolens also gave similar results. These oils are equally or more effective when compared with standard antibiotics, at a very low concentration.

Successful management of infantile hypertrophic pyloric stenosis with atropine sulfate.

OBJECTIVE: To evaluate the effectiveness of atropine sulfate in management of infantile hypertrophic pyloric stenosis (IHPS). DESIGN: Prospective observational. SUBJECT: Patients attending the hospital with complaints of persistent vomiting and later clinically and sonographically diagnosed as cases of IHPS were selected for the trial. METHODS: Atropine was initially administered intravenously in a dose of 0.06 mg/kg/day in eight divided doses, increased by 0.15 mg/kg/day till vomiting ceased and remained so for a period of 24 hours at a stretch and ultrasonography showed a transit time (of gastric contents through pyloric canal) of less than 1 minute. Intravenous atropine was then substituted by oral atropine at double the effective IV dose for 3 weeks. Ultrasonographic evaluation of pyloric muscle thickness and length was done at the commencement of IV treatment, after completion of oral treatment and at 3,6,9,12 and 15 months follows up. Transit time of gastric contents was measured at the commencement of intravenous treatment and then daily after the vomiting stopped for more than 24 h at a stretch. RESULTS: Medical treatment of IHPS with atropine was successful in 50/52 (96.2%) cases. Vomiting ceased in 1-3 days in all patients with mild hypertrophy and in 4-7 days in all the cases with moderate hypertrophy. In all except 2 patients with severe hypertrophy, vomiting ceased in 8-12 days. These two cases continued to vomit at least once daily even after 2 weeks of IV treatment and ultimately opted out for pyloromyotomy. All the 50 medically treated children made uneventful recovery during oral therapy except 3 cases (6%) in whom vomiting recurred during the follow-up. These 3 children later responded by increasing the dose of oral atropine. All of them began to gain weight by the time oral therapy was commenced and ultrasonographic evidence of normalization of pylorus was observed in all these children 3-15 months after completion of oral therapy. CONCLUSION: Atropine sulfate proved to be an effective and safe treatment option for IHPS.

Ciprofloxacin in children: is arthropathy a limitation?

Two hundred and nineteen children treated with Ciprofloxacin were observed for drug related adverse reactions (ADR). ADR was observed in 35/219 (15.98%) children, arthropathy in 2/219 (0.9%) children only. All the ADR were reversible even on continuation of therapy except one child with arthropathy and no permanent sequele or death occurred as a drug related ADR.

Immunochemotherapy for Leishmania donovani infection in golden hamsters: combinatorial action of poly ICLC plus L-arginine and sodium stibogluconate (Stibanate).

We demonstrate that golden hamsters infected with Leishmania donovani amastigotes develop the capacity to eliminate intracellular pathogens on treatment with low-dose standard antileishmanial sodium stibogluconate (Stibanate) in combination with polyinosinic-polycytidilic acid stabilized with polylysine and carboxymethycellulose (poly ICLC), a potent inducer of interferon (IFN) and immune enhancer, plus L-arginine. Data suggest that low doses of both Stibanate and poly ICLC plus L-arginine provide marginal inhibition against L. donovani infection in golden hamsters. When given in combination, however, a significant inhibition was achieved without toxicity, as all the animals survived up to 45 or 60 days. These results suggest that combination therapy using Stibanate and poly ICLC plus L-arginine may be very effective in reducing the dose of Stibanate and, hence, its dose-dependent toxicity in clinical situations.

Prognostic value of serum C-reactive protein in kala-azar.

The currently recommended protocol for treatment of kala-azar (KA) necessitates repeated bone marrow/splenic aspiration to monitor the response and duration of therapy as well as to detect resistance and change to alternative drugs. These procedures being invasive, there is a pressing need for less invasive diagnostic tools for this purpose. We have evaluated the role of C-reactive protein (CRP) in 201 children with visceral leishmaniasis at different stages of the disease to work out the relationship, if any, between CRP levels and disease activity, including response to therapy. The subjects belonged to the 2-12 year age group in whom CRP estimation was done on admission, every 5th day during treatment, and repeated on follow-up at 2 and 6 months. The levels were compared with those of 50 randomly chosen age-matched healthy children who served as controls. The mean serum CRP value in the study group before the commencement of treatment was 62.96 +/- 1.03 mg/l, which was significantly higher (p < 0.001) in comparison to the control group. Commencement of treatment resulted in a simultaneous decline in serum CRP. Parasitic clearance from the spleen was faster in patients with an initial low serum CRP level (< 60 mg/l) in comparison to patients with high levels (> 60 mg/l). During treatment, mean serum CRP levels were significantly higher in late responders than in early responders (p < 0.001). Correlation of CRP levels to indicate the presence or absence of parasites suggested a cut-off level of 12 mg/l by day 10, with a sensitivity of 82.5 per cent, specificity of 78.5 per cent, positive predictive value of 92 per cent, and negative predictive value of 60.2 per cent. Our observations suggest a promising role for CRP estimation every 5-10 days during therapy in visceral leishmaniasis for monitoring the response to therapy and to detect possible resistance.