Management of Bronchomalacia in Infants Post?Cardiac Surgery Using Synchronized Nasal DuoPAP: A Novel Technology

Background:Tracheo?bronchomalacia (TBM) is the weakness in the structural integrity of the cartilaginous ring and arch. It may occur in isolation with prematurity or secondarily in association with various congenital anomalies. Bronchomalacia is more commonly associated with congenital heart diseases. The conventional treatment options include positive pressure ventilation with or without tracheostomy, surgical correction of external compression and airway stenting. Aim: To use “synchronized” nasal Dual positive airway pressure (DuoPAP), a non?invasive mode of ventilation as an alternative treatment option for bronchomalacia to avoid complications associated with conventional treatment modalities. Study Design: Prospective observational study conducted in Army Hospital Research and Referral from Jul 2019 to Dec 2020. Material and Methods: We diagnosed seven cases of TBM post?cardiac surgery at our institute, incidence of 4.2%. Four infants were diagnosed with left sided bronchomalacia, 2 were diagnosed with right sided bronchomalacia and one with tracheomalacia. Those infants were managed by “synchronized” nasal DuoPAP, a first in ventilation technology by Fabian Therapy Evolution ventilator (Acutronic, Switzerland). Results: All seven infants showed significant improvement with synchronized nasal DuoPAP both clinically as well as radiologically. None of the infant required tracheostomy and discharged to home successfully. Conclusion: The synchronized nasal DuoPAP is a low cost and effective treatment option for infants with TBM. It could be attributed to synchronization of the breaths leading to better tolerance and compliance in paediatric age group

Assessment of zinc inadequacy among tribal adolescent population of central India - A cross-sectional study

Background & objectives: Zinc is a crucial micronutrient in adolescence, required for promoting growth and sexual maturation. Adolescents of some tribes may be at high risk of zinc deficiency due to dietary inadequacy and poor bioavailability of zinc from plant-based diets. This study aimed to evaluate the risk of zinc deficiency by estimating prevalence of inadequate zinc intake, prevalence of low serum zinc and stunting among tribal adolescents. Methods: A cross-sectional community-based survey was conducted among adolescents (10-19 yr) in three purposively selected districts where Bhil, Korku and Gond tribes were in majority. Structured data collection instrument comprising information about sociodemographic characteristics and dietary recall data was used. Anthropometric assessment was conducted by standardized weighing scales and anthropometry tapes, and blood sample was collected from antecubital vein into trace element-free vacutainers. Serum zinc was estimated using an atomic absorption spectrophotometer. Results: A total of 2310 households were approached for participation in the study, of which 2224 households having 5151 adolescents participated. Out of these enlisted adolescents, 4673 responded to dietary recall (90.7% response rate). Anthropometry of 2437 participants was carried out, and serum zinc was analyzed in 844 adolescents. The overall prevalence of dietary zinc inadequacy was 42.6 per cent [95% confidence interval (CI) 41.2 to 44.1] with reference to the estimated average requirement suggested by International Zinc Nutrition Consultative Group (IZiNCG) and 64.8 per cent (95% CI 63.4 to 66.2) with Indian Council of Medical Research-recommended requirements. Stunting was observed in 29 per cent (95% CI 27.2 to 30.8) participants. According to IZiNCG cut-offs, low serum zinc was detected in 57.5 per cent (95% CI 54.1 to 60.8) of adolescents, whereas it was 34.4 per cent (95% CI: 31.2-37.5) according to the national level cut-off. Interpretation & conclusions: Risk of dietary zinc inadequacy and low serum zinc concentration amongst adolescents of the Gond, Bhil and Korku tribes is a public health concern.

Neutrophil to Lymphocyte Ratio: Prognostic Marker for OSCC

Introduction: Tumor microenvironment is infiltrated by innateand adaptive immune system cells particularly T lymphocytesthat assist tumors to mimic inflammatory conditions seen innormal tissues. Tumor microenvironment plays an importantrole in determining the biological behavior of cancers likeproliferation, invasion, metastasis and therapeutic resistance.Study aimed to estimate and compare the neutrophil tolymphocyte ratio (NLR) in patients with oral squamous cellcarcinoma (OSCC) and in normal healthy individuals.Material and method: A case control study was conductedon 15 cases of oral squamous cell carcinoma (OSCC) and 15cases of normal healthy individuals. Neutrophil to lymphocyteratio (NLR) was determined by the examination of peripheralblood smear in each case.Results: In the present study, significant increased in theabsolute neutrophil count and decreased in the absolutelymphocyte count were observed along with high neutrophilto lymphocyte ratio in OSCC patients than that of healthycontrols.Conclusion: Neutrophil to lymphocyte ratio can be used asa feasible, cost‑effective, and potential marker for determingthe aggressive behavior of OSCC and may also benefit inprognostic prediction.

Does intravenous sildenafil clinically ameliorate pulmonary hypertension during perioperative management of congenital heart diseases in children? – A prospective randomized study.

Background: Pulmonary hypertension (PHT), if present, can be a significant cause of increased morbidity and mortality in children undergoing surgery for congenital heart diseases (CHD). Various techniques and drugs have been used perioperatively to alleviate the effects of PHT. Intravenous (IV) sildenafil is one of them and not many studies validate its clinical use. Aims and Objectives: To compare perioperative PaO2 – FiO2 ratio peak filling rate (PFR), systolic pulmonary artery pressure (PAP) – systolic aortic pressure (AoP) ratio, extubation time, and Intensive Care Unit (ICU) stay between two groups of children when one of them is administered IV sildenafil perioperatively during surgery for CHDs. Materials and Methods: Patients with ventricular septal defects and proven PHT, <14 years of age, all American Society of Anesthesiologists physical status III, undergoing cardiac surgery, were enrolled into two groups – Group S (IV sildenafil) and Group C (control) – over a period of 14 months, starting from October 2013. Independent t‑test and Mann–Whitney U‑test were used to compare the various parameters between two groups. Results: PFR was higher throughout, perioperatively, in Group S. PAP/AoP was 0.3 and 0.4 in Group S and Group C, respectively. In Group S, mean group extubation time was 7 ± 7.34 h, whereas in Group C it was 22.1 ± 10.6. Postoperative ICU stay in Group S and Group C were 42.3 ± 8.8 h and 64.4 ± 15.9 h, respectively. Conclusion: IV sildenafil, when used perioperatively, in children with CHD having PHT undergoing corrective surgery, improves not only PaO2 – FiO2 ratio and PAP – AoP ratio but also reduces extubation time and postoperative ICU stay.

Morbidity profile of preschool children in rural area of central Madhya Pradesh.

Background: The children of Preschool age are a vulnerable or special risk group in any population, deserving special health care. Major causes of death in the age group 0-5 years are preventable. Objective of this study was to study the morbidity profile of preschool children (0-5 years) in the rural areas and its association with some selected variables. Methods: A cross sectional study was conducted among preschool children of rural areas for a period of 4 months. A sample size of total 400 children was selected and the children were examined after interviewing mother. Results: Morbidity was found in 217 out of total 400 children. The male and female ratio of morbid children was 1.47:1. The respiratory infections and diarrheal diseases together accounted for 76.5% of children at least once in three month. Conclusions: Communicable diseases were the commonest cause of morbidity in the preschool children. A total of 164 children were found having one of the episodes of illness in last three month.

A Regression Model to Predict Diameter of Mitral Valve Prosthesis Preoperatively: An Aid to Clinical Decision Making.

Aim: Accurate estimation of the prosthetic valve size pre-operatively can aid to the efficiency and effectiveness to mitral valve surgery. Traditionally Two dimensional Echocardiography is being used for this purpose but cannot be claimed as optimum tool. This study computes and analyses several linear regression equations in order to obtain a best fit model for predicting mitral prosthesis size well before operation. Materials and Methods: This hospital based longitudinal study was conducted in a tertiary care Cardio Thoracic Vascular Department from August 2011 to August 2012. A total of 67 participants suffering from Rheumatic Heart Disease (with severe mitral valve disease) were recruited. Short and long axis of the mitral annulus were measured through 2-dimensional transthoracic echocardiography. Further three regression models were plots using short axis, long axis and area of the annulus as independent variables and diameter of prosthetic valve as dependent variable. Results: Among the three predictors namely the anterio-posterior axis (short axis), commissurecommissural axis (long axis) and area of mitral valve annulus; the regression equation with short axis predicted the diameter of prosthesis more accurately. The optimum regression model for short axis is calculated as -Diameter of prosthetic valve= -0.165 + 0.769X short axis of Ellipse. The coefficient of determination for this equation (R2) is 0.905. This equation offers the explanation for maximum observations in the model (F=609.48). Conclusion: The size of optimum prosthetic valve may be determined preoperatively as a function of anterio-posterior axis (short axis) of annulus through non invasive 2-D Echocardiography. However this finding is amenable for further multi-centric validation.