Cooperative Distributed Uplink Cache over B5G small cell networks.

The emergence of content-centric network has resulted in a substantial increase in data transmission in both uplink and downlink directions. To tackle the ensuing challenges of network congestion and bottlenecks in backhaul links within Beyond Fifth Generation (B5G) networks, data caching has emerged as a popular solution. However, caching for uplink transmission in a distributed B5G scenario poses several challenges, including duplicate content matching and users' obliviousness about cached contents. Furthermore, it is important to maximize available space by caching the most popular contents in a distributed manner. In this paper, we propose two schemes for uplink transmission in distributed B5G SCNs. The first scheme focuses on content matching to eliminate duplicate contents among distributed caches, while the second scheme redistributes un-duplicated cached contents among distributed caches based on their available space and content's size. These approaches aim to enhance energy and spectral efficiency by reducing unnecessary uploads and optimizing distributed content caching, in addition to improve the content delivery. The analysis shows that the proposed schemes outperform the existing schemes by improving the cache hit ratio, cache hit probability, overall distributed cache efficiency, and diversity by 29.17%, 74.89%, 24.17%, and, 80%, respectively. Furthermore, the average throughput, Spectrum Efficiency (SE), and Energy Efficiency (EE) of the access network is improved by 17.78%, 18%, and 78%, respectively. Besides that, the EE and SE of both the sidehaul and backhaul links of the SBSs are also improved.

Mesenteric Parametrial Fat Pad Surgery for in vivo Implantation of Hepatocytes in Nude Mice.

Cell-based liver therapies utilizing functionally stabilized engineered hepatic tissue hold promise in improving host liver functions and are emerging as a potential alternative to whole-organ transplantation. Owing to the ability to accommodate a large ex vivo engineered hepatocyte mass and dense vascularization, the mesenteric parametrial fat pad in female nude mice forms an ideal anatomic microenvironment for ectopic hepatocyte transplantation. However, the lack of any reported protocol detailing the presurgical preparation and construction of the engineered hepatic hydrogel, fat pad surgery, and postsurgical care and bioluminescence imaging to confirm in vivo hepatocyte implantation makes it challenging to reliably perform and test engraftment and integration with the host. In this report, we provide a step-by-step protocol for in vivo hepatocyte implantation, including preparation of hepatic tissue for implantation, the surgery process, and bioluminescence imaging to assess survival of functional hepatocytes. This will be a valuable protocol for researchers in the fields of tissue engineering, transplantation, and regenerative medicine. Key features • Primary human hepatocytes transduced ex vivo with a lentiviral vector carrying firefly luciferase are surgically implanted onto the fat pad. • Bioluminescence helps monitor survival of transplanted hepatic tissue over time. • Applicable for assessment of graft survival, graft-host integration, and liver regeneration.

Availability of living donor optimizes timing of liver transplant in high-risk waitlisted cirrhosis patients.

Liver transplant (LT) candidates have become older and frailer, with growing Non-alcoholic steatohepatitis (NASH) and comorbid disease burden in recent years, predisposing them for poor waitlist outcomes. We aimed to evaluate the impact of access to living donor liver transplantation (LDLT) in waitlisted patients at highest risk of dropout. We reviewed all adult patients with decompensated cirrhosis listed for LT from November 2012 to December 2018. Patients with a potential living donor (pLD) available were identified. Survival analyses with Cox Proportional Hazards models and time to LT with Competing risk models were performed followed by prediction model development. Out of 860 patients who met inclusion criteria, 360 (41.8%) had a pLD identified and 496 (57.6%) underwent LT, out of which 170 (34.2%) were LDLT. The benefit of pLD was evident for all, but patients with moderate to severe frailty at listing (interaction p = 0.03), height <160 cm (interaction p = 0.03), and Model for end stage liver disease (MELD)-Na score <20 (interaction p < 0.0001) especially benefited. Our prediction model identified patients at highest risk of dropout while waiting for deceased donor and most benefiting of pLD (time-dependent area under the receiver operating characteristic curve 0.82). Access to LDLT in a transplant program can optimize the timing of transplant for the increasingly older, frail patient population with comorbidities who are at highest risk of dropout.

Intubation characteristics using modified USB videolaryngoscope: A prospective, randomised study.

Background and Aims: Videolaryngoscopes with varying characteristics with regard to angulation of blades and video configurations are now available. However, the contribution of each of these in improving ease of intubation is quite different. We evaluated the role of video camera in the performance of laryngoscopy by using the universal serial bus (USB) videolaryngoscope in patients with predicted difficult airway. Methods: Sixty patients in the age group of 25 to 65 years having Mallampati grade III or IV were randomly allocated to two groups. All patients were American Society of Anesthesiologists physical status grade I or II and planned for elective surgical procedure under general anesthesia. USB videolaryngoscope or Macintosh laryngoscope was used for intubation as per group allotted. Comparison of time of endotracheal intubation was our primary outcome measure and it was calculated from the time the laryngoscope tip passes the incisors to the initial appearance of capnography wave. Rate of successful intubation, number of attempts needed for successful tube placement, optimisation manoeuvres used, changes in haemodynamic parameters and airway injuries were evaluated as secondary outcomes. Results: Time for intubation was shorter in the Macintosh group than the USB group (P = 0.024). The incidence of successful intubation was similar in both groups (P = 0.079). USB group required lesser number of attempts for tube placement (P = 0.047). The incidence of airway injuries was similar in both the groups. Conclusion: USB videolaryngoscope reduces the number of attempts required for successful endotracheal intubation compared to Macintosh laryngoscope though it increases the time for intubation in patients with predicted difficult airway.

Predictors of patient survival following liver transplant in non-alcoholic steatohepatitis: A systematic review and meta-analysis.

Background: Non-alcoholic steatohepatitis (NASH) is the second-leading indication for liver transplantation (LT) worldwide and is projected to become the leading indication. Our study aimed to determine clinical variables that predict post-LT survival in NASH. Methods: A systematic review and meta-analysis was performed. On June 18, 2020 and April 28, 2022, Ovid MEDLINE ALL, Ovid Embase, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials were searched. No date limits were applied. Inclusion criteria specified the type of study and our study's population/comparison and outcome/timepoints. Pediatric, animal, retransplantation-only, and studies classifying cryptogenic cirrhosis patients with body mass index (BMI) <30 as NASH were excluded. Studies with duplicate cohorts and missing information were excluded from the meta-analysis. Studies were appraised using the Newcastle-Ottawa Scale. This study was preregistered in PROSPERO (CRD42020196915). Findings: Out of 8583 studies identified, 25 studies were included in the systematic review, while 5 studies were included in the meta-analysis. Our quantitative review suggested that the following variables were predictive of post-LT NASH patient survival: recipient age, functional status, pre-LT hepatoma, model for end-stage liver disease (MELD) score, diabetes mellitus (DM), pre-LT dialysis, hepatic encephalopathy, portal vein thrombosis, hospitalization/ICU at LT, and year of LT. Predictors of graft survival included recipient age, BMI, pre-LT dialysis, and DM. Our pooled meta-analyses included five predictors of patient survival. Increased patient mortality was associated with older recipient age (HR=2·07, 95%CI: 1·71-2·50, I2=0, τ2=0, p=0·40) and pretransplant DM (HR=1·18, 95%CI: 1·08-1·28, I2=0, τ2=0, p=0·76). Interpretation: Our systematic review and meta-analysis aimed to synthesise predictive variables of mortality in LT NASH patients. Clinically, this might help to identify modifiable risk factors that can be optimized in the post-transplant setting to improve patient outcomes and optimises decision making in the resource-limited LT setting. Funding: Toronto General and Western Hospital Foundation.

Distributed uplink cache for improved energy and spectral efficiency in B5G small cell network.

The advent of content-centric networks and Small Cell Networks (SCN) has resulted in the exponential growth of data for both uplink and downlink transmission. Data caching is considered one of the popular solutions to cater to the resultant challenges of network congestion and bottleneck of backhaul links in B5G networks. Caching for uplink transmission in distributed B5G scenarios has several challenges such as duplicate matching of contents, mobile station's unawareness about the cached contents, and the storage of large content size. This paper proposes a cache framework for uplink transmission in distributed B5G SCNs. Our proposed framework generates comprehensive lists of cache contents from all the Small Base Stations (SBSs) in the network to remove similar contents and assist uplink transmission. In addition, our framework also proposes content matching at a Mobile Station (MS) in contrast to an SBS, which effectively improves the energy and spectrum efficiency. Furthermore, large size contents are segmented and their fractions are stored in the distributed cache to improve the cache hit ratio. Our analysis shows that the proposed framework outperforms the existing schemes by improving the energy and spectrum efficiency of both access and core networks. Compared to the existing state of the art, our proposed framework improves the energy and spectrum efficiency of the access network by 41.28% and 15.58%, respectively. Furthermore, the cache hit ratio and throughput are improved by 9% and 40.00%, respectively.

Split Type Postman videolaryngoscope: The newer device versus the standard Macintosh laryngoscope in simulated difficult airway - A new hope for difficult intubation scenarios.

Background and Aims: Studies on simulated difficult airway provide an opportunity to evaluate the performance of intubation devices for use in limited neck mobility. We did a comparative study between Split Type Postman videolaryngoscope and Macintosh laryngoscope, evaluating their efficacy for tracheal intubation in a simulated difficult airway. Methods: Sixty American Society of Anesthesiologists (ASA) physical status I and II patients aged between 20 and 60 years, having body mass index <30 kg m-2, posted for elective surgery under general anaesthesia were allocated to two groups. Endotracheal intubation was done with either Split Type Postman videolaryngoscope or Macintosh laryngoscope after placing a rigid cervical collar around the neck to simulate a difficult airway. The primary outcome measure was time for tracheal intubation as assessed from the time of introduction of laryngoscope between incisors till visual confirmation of passage of endotracheal tube through the vocal cords by the anaesthesiologist. Success rate of intubation, number of attempts required for successful intubation, haemodynamic alterations and airway complications were measured as secondary outcomes. Results: Time taken for endotracheal intubation was significantly shorter in Postman group (26.23 ± 7.18 vs. 31.43 ± 9.83 s) (P = 0.012) compared to Macintosh group. The groups were comparable in terms of incidence (P = 0.491) of successful intubation, with significantly lesser number of attempts required for intubation in Postman group (P = 0.022). The incidence of airway trauma and postoperative sore throat was comparable between the groups. Conclusion: Split Type Postman videolaryngoscope was superior with respect to intubation characteristics when compared to conventional laryngoscope.

Greening the workforce in higher educational institutions: The pursuance of environmental performance.

The research aims to examine the role of green human resource management (GHRM) in the university's environmental performance. Furthermore, this research also focuses on the mediating effect of green commitment and pro-environmental behavior. It also aims to check how green self-efficacy moderates the relationship between green commitment and pro-environmental behavior. The paper opted for a quantitative design using the convenience sampling technique/approach by collecting the data through a structured questionnaire on 208 academic staff currently employed in the university. The data were collected from August until December 2021 on two campuses (Gujranwala, Jhelum) of the University of Punjab in Pakistan. The current study results give empirical insights that show how green human resource management practices lead to environmental performance at a greater level in a university setting. Study results proposed that change in behavior of employees through human resource management practices can ultimately affect the organization's environmental performance. Further results also demonstrate that green self-efficacy moderates the relationship between green commitment and pro-environmental behavior. This study highlights the role of the university staff's level of commitment and self-efficacy, which are beneficial for enhancing the university's environmental performance. The originality of this study fills the gap in how green commitment mediates the relationship of green human resource management and environmental performance further; it fulfills the gap of green self-efficacy that moderates the relationship of pro-environmental behavior and green commitment. The study sheds light on green human resource management practices in the higher education sector. It emphasizes the vital role of academic staff's environmentally conscious behavior in enhancing a university's environmental performance. The further study highlighted the increasing concept of green human resource management as a set of building the ability, enhancing motivation, and providing opportunities to influence workers' pro-environmental behaviors. The conclusion of the current research was capable of validating the positive concerns of green GHRM, behaviors, and commitments for environmental performance.

Distinctive clinical and genetic features of lean vs overweight fatty liver disease using the UK Biobank.

BACKGROUND: Lean NAFLD may differ from NAFLD found in overweight or obese patients. We used the UK biobank to conduct a cross-sectional study that examined features that distinguish lean NAFLD from overweight or obese NAFLD. METHODS: MRI-PDFF data were used to identify patients with NAFLD, with NAFLD defined as PDFF ≥ 5%. BMI patient cohorts were identified, with lean defined as a BMI < 25, and overweight or obese defined as a BMI ≥ 25. Variables of interest to fatty liver disease, including single nucleotide polymorphisms, were chosen from the UK biobank data portal. Logistic regression was used to generate models predictive of NAFLD in each cohort. RESULTS: 1007 patients had NAFLD, and of these, 871 had BMI ≥ 25, and 136 BMI < 25. Factors associated with NAFLD in patients with BMI < 25 included male sex, white blood cell count, red blood cell count, triglycerides, ALT, creatinine, visceral adipose tissue, rs58542926 T, and rs738409 G. In contrast, factors associated with NAFLD in patients with BMI ≥ 25 included male sex, waist circumference, HDL cholesterol, triglycerides, serum glucose, ALT, creatinine, urate, visceral adipose tissue, rs1260326 T, rs1044498 C, rs58542926 T, and rs738409 G. For lean patients, our generated prediction score had an AUC of 0.92, sensitivity of 0.90 and specificity of 0.81. For overweight or obese patients, the prediction score had an AUC of 0.86, sensitivity of 0.87 and specificity of 0.70. CONCLUSIONS: Our analysis suggests that lean and overweight or obese NAFLD are distinct entities. We have developed a risk score incorporating both clinical and genetic factors that accurately classify lean patients with NAFLD, with the potential to serve as a tool for screening purposes.

Soft tissue reconstruction of thumb: Classification of defects and standardization of treatment.

OBJECTIVE: The aim of this article is to share our experience of thumb defects based on the defect irrespective of the etiology of the defect and to work towards standardizing the treatment for thumb defects. METHODOLOGY: This study was conducted at the Burns and plastic surgery center at Hayatabad Medical complex from 2018 to 2021. Thumb defects were divided into small (< 3 cm), medium (4-8cm) and large defects (> 9cm). Post-operatively, patients were evaluated for complications. The type of flaps were stratified for size and site of the soft tissue defects to generate a standardized algorithm for thumb soft tissue reconstruction. RESULTS: After scrutinizing the data, 35 patients qualified for the study, including 71.4% (25) males and 28.6% (10) females. The mean age was 31.17+15.8SD. Right thumb was affected in majority of the study population (57.1%). Majority of the study population was affected by machine injury and post-traumatic contractures, affecting 25.7% (n=9) and 22.9% (n=8) respectively. First web-space and injuries distal to IPJ of thumb were the most common areas affected, accounting for 28.6% (n=10) each. First dorsal metacarpal artery flap was the most common flap followed by retrograde posterior interosseous artery flap, observed in 11 (31.4%) and 6 (17.1%) cases. The most common complication observed in the study population was flap congestion (n=2, 5.7%) with a complete flap loss in 1 patient (2.9%) cases. Based on the cross tabulation of flaps against the size and location of defects, an algorithm was developed to help standardize reconstruction of thumb defects. CONCLUSION: Thumb reconstruction is critical in restoring hand function of the patient. The structured approach towards these defects make their assessment and reconstruction easy especially for novice surgeons. This algorithm can further be extended to include defects of the hand irrespective of etiology. Most of these defects can be covered with local easy to do flaps without the need for a microvascular reconstruction.

ASPA: Advanced Strong Pseudonym based Authentication in Intelligent Transport System.

Intelligent Transport System (ITS) uses the IEEE 802.11P standard for the wireless communication among vehicles. A wireless ad hoc network of vehicles is established to improve road safety, comfort, security, and traffic efficiency. Wireless communication in ITS leads to many security and privacy challenges. Security and privacy of ITS are important issues that demand incorporation of confidentiality, privacy, authentication, integrity, non-repudiation, and restrictive obscurity. In order to ensure the privacy of vehicles during communication, it is required that the real identity of vehicles should not be revealed. There must be robust and efficient security and privacy mechanisms for the establishment of a reliable and trustworthy network. Therefore, we propose Advanced Strong Pseudonym based Authentication (ASPA), which is a distributed framework to handle the security and privacy issues of vehicle communications in ITS. ASPA only allows vehicles with valid pseudonyms to communicate in ITS. Pseudonyms are assigned to vehicles in a secure manner. The pseudonym mappings of vehicles are stored at different locations to avoid any chance of vehicle pseudonyms certificates linkability. In addition, the most recent communication pseudonyms of a malicious vehicle are revoked and are stored in the Certificate Revocation List (CRL) that results in small size of the CRL. Therefore, the CRL size does not increase exponentially. The distributed framework of ASPA guarantees, the vehicles privacy preservation in the real identities mapping and revocation phase. The empirical results prove that ASPA is robust and efficient with low computational cost, overhead ratio, average latency, and an increased delivery ratio.

Findings from a large Asian chronic hepatitis C real-life study.

There is a paucity of information on chronic hepatitis C (CHC) patients treated with direct antiviral agents (DAAs) in Asia. We invited Asia-Pacific physicians to collate databases of patients enrolled for CHC treatment, recording baseline clinical, virologic and biochemical characteristics, sustained virologic response at week 12 (SVR12) and virologic failure. SVR12 outcome was based on intention to treat (ITT). Multivariate analysis was used to assess independent risk factors for SVR12 using SPSS version 20. A total of 2171 patients from India (n = 977), Myanmar (n = 552), Pakistan (n = 406), Thailand (n = 139), Singapore (n = 72) and Malaysia (n = 25) were collected. At baseline, mean age was 49 years, 50.2% were males, and 41.8% had cirrhosis. Overall, SVR12 was 89.5% and by genotype (GT) based on ITT and treatment completion, respectively, was 91% and 92% for GT1, 100% and 100% for GT2, 91% and 97% for GT3, 64% and 95% for GT4, 87% and 87% for GT6 and 79% and 91% for GT untested. Patients with cirrhosis had SVR12 of 85% vs 93% for noncirrhosis (P < 0.001) (RR 2.1, 95% CI 1.4-3.1, P = 0.0002). Patients with GT1 and GT3 treated with sofosbuvir/ribavirin (SR) had 88% and 89% SVR12, respectively, but those GT6 treated with sofosbuvir/ledipasvir (SL) had only 77.6% SVR12. Multivariate analysis showed absence of cirrhosis was associated with higher SVR12 (OR 2.0, 95% CI 1.3-3.1, P = 0.002). In conclusion, patients with GT1 and GT3 with/without cirrhosis had surprisingly high efficacy using SR, suggesting that Asians may respond better to some DAAs. However, poor GT6 response to SL suggests this regimen is suboptimal for this genotype.

Acute Hepatitis in Infections Caused by Dengue Virus in Southern Punjab, Pakistan.

Background Dengue is the most common vector-borne disease worldwide. It poses a significant health burden in tropical and subtropical countries. Common clinical presentations include retro-orbital pain, fever, headache, nausea, vomiting and aches and pains in the body. A severe form of dengue fever is known as dengue hemorrhagic fever (DHF) that includes signs of hemorrhage. Besides the typical signs and symptoms, atypical presentations of dengue include myositis, hepatitis and encephalitis. Hepatic involvement in dengue has varied presentations. This study aims to highlight the importance of acute hepatitis, an atypical presentation in dengue patients. Methods  We conducted a descriptive, cross-sectional study in the Medical Unit-1 of Bahawal Victoria Hospital, Bahawalpur, a tertiary-care hospital serving the area of Southern Punjab, Pakistan. The relevant medical records of 63 patients admitted with dengue-associated hepatitis to the Medical Unit-1 of Bahawal Victoria Hospital, Bahawalpur, between January 1, 2015 and December 1, 2016, were reviewed. Informed consent was given. Information regarding demographic variables and disease course was collected and analyzed. Results  This study included 55 men (87.3%) and eight (12.7%) women. Fifty (79.3%) patients were diagnosed with dengue fever (DF). Thirteen patients were managed on the lines of DHF. Out of the total 63 patients, only six were locals. The common clinical presentations in these patients included high fever, retro-orbital pain, severe headache, rash, dark-colored urine, bleeding problems and hepatomegaly. Higher levels of aspartate aminotransferase (AST) were noted in comparison to alanine transferase (ALT). Despite the complicated clinical course in some patients, all patients were managed successfully and discharged, except one. Conclusion The frequency of acute hepatitis in dengue patients is high, especially in young men. Early diagnosis and prompt treatment are necessary for better prognosis. Although no specific treatment guidelines are available, supportive treatment in a timely fashion can prevent complications. Transfusion with packed cell volume (PCV) and N-acetyl cysteine (NAC) has produced promising results.

King Vision video laryngoscope for severe post burn contracture neck: an encouraging experience / Videolaringoscópio King Vision para contratura grave do pescoço após queimadura: uma experiência encorajadora

Abstract Background and objectives Managing the airway of post burn contracture of the neck has always been challenging to anesthesiologists as it limits the alignment of oro-pharyngo-laryngeal axes because of functional and anatomical deformities that occur as a result of long standing contractures. Here the role of the King Vision video laryngoscope which is the latest in the series of video laryngoscope has been evaluated for such patients. Case report A 35 year old male patient with post burn contracture of neck was scheduled for release of the contracture. As the patient had had fixed flexion deformity of the neck we did not attempt the conventional laryngoscopy. Instead we opted for King Vision video laryngoscope. Conclusion We therefore conclude that King Vision videolaryngoscope can be used for difficult airway situations like post burn contracture of neck.

Resumo Justificativa e objetivos O manejo de vias aéreas em contratura de pescoço após queimadura sempre foi um desafio para os anestesiologistas, pois a contratura limita o alinhamento do eixo orofaringolaríngeo devido às deformidades funcionais e anatômicas que ocorrem como resultado de contraturas de longa duração. Relato de caso Paciente do sexo masculino, 35 anos de idade, com contratura do pescoço após queimadura foi programado para liberação da contratura. Como estava com deformidade fixa em flexão no pescoço, não tentamos a laringoscopia convencional e optamos por usar o videolaringoscópio King Vision. Conclusão O videolaringoscópio King Vision pode ser usado em situações de via aérea difícil como a contratura de pescoço após queimadura.

A comparative evaluation of Video Stylet and flexible fibre-optic bronchoscope in the performance of intubation in adult patients.

BACKGROUND AND AIMS: Video Stylet (VS) is a new intubating modality that provides real-time video of endotracheal intubation (ETI). This device does not need alignment of the oral, pharyngeal and tracheal axes to view glottis and can be used in patients with limited mouth opening. The aim of this study was to compare flexible fibre-optic (FO) bronchoscope with VS in elective surgical patients in apparently normal airway patients requiring oral ETI. METHODS: Sixty patients undergoing elective surgery under general anaesthesia of age group 20-60 years, weight 40-70 kg, American Society of Anesthesiologist 1 and 2 and modified Mallampatti I and II were included in the study. Patients in group FO (n = 30) were intubated by flexible FO bronchoscope, whereas patients in group VS (n = 30) were intubated by VS. Primary outcome measure was time taken for intubation (TTI). Secondary outcome measures were successful intubation, haemodynamic response and post-operative complications if any. RESULTS: Average TTI in cases of FO group was 38.2 s (95% confidence interval [CI] 36-41) and in VS group was 19.7 s (95% CI 19-21; P = 0.0001). Three patients required a second attempt for successful intubation in FO group compared to eight in VS group (P = 0.2), with no failures in any group. Haemodynamic response and complications rate were greater in VS group; however, the differences were not statistically significant. CONCLUSION: VS takes lesser time to intubate than flexible FO bronchoscope.

Frequency of Acute Hepatitis Following Acute Paraphenylene Diamine Intoxication.

INTRODUCTION: Paraphenylene diamine (PPD) ingestion is manifesting as one of the more common ways of committing suicide in Southern Punjab, Pakistan, especially Bahawalpur. PPD is an ingredient of a compound commonly known "Kala Pathar" which means "Black Stone" in Urdu. It is readily available in the market at low cost and is used to dye hair and fur. Its intoxication inhibits cellular oxidation and affects the muscles causing rhabdomyolysis. This leads to myoglobinuria followed by renal failure and edema of face and throat resulting in respiratory difficulty. Very little is known about the impact of PPD intoxication on liver tissue. OBJECTIVE: The purpose of the study was to find out the frequency of acute hepatitis following PPD intoxication. METHODS: We reviewed the medical records of 109 patients with PPD intoxication admitted to Medical Unit-2, Bahawalpur Victoria Hospital from January 1, 2015, to June 30, 2015, in a descriptive, cross-sectional study. We noted the frequency of acute hepatitis and other complications, and we recorded the demographic features, clinical features, and outcomes of these patients. RESULTS: Our study included 32 men (29%) and 77 women (71%). The mean age was 22 ± 3.4 years, and most patients were young women aged 15 to 24 years. Suicidal ingestion was the leading cause of admission for 101 patients (93%). The most common clinical presentation was cervicofacial edema (95%), throat pain (88%), dysphonia (95%), cola-colored urine (100%), and oliguria (95%). Rhabdomyolysis (86%), acute hepatitis (51%), and acute renal failure (63%) were the most common clinical conditions following poisoning. Overall mortality was noted in 39 patients (36%) while all other patients achieved complete clinical recovery (64%). In patients with mortality, 20 of 39 (51%) developed acute hepatitis. Most patients (95%) in our study underwent tracheostomy. CONCLUSION: The frequency of acute hepatitis in PPD intoxication is high in this population, especially in young women. Measures need to be instituted regarding the management of acute hepatitis in PPD intoxication to improve patient outcomes. Workups in patients with PPD poisoning should include regular monitoring of aspartate aminotransferase and alanine aminotransferase to observe any damages to the liver so that acute hepatitis can be managed in a timely fashion.

[King Vision video laryngoscope for severe post burn contracture neck: an encouraging experience]. / Videolaringoscópio King Vision para contratura grave do pescoço após queimadura: uma experiência encorajadora.

BACKGROUND AND OBJECTIVES: Managing the airway of post burn contracture of the neck has always been challenging to anesthesiologists as it limits the alignment of oro-pharyngo-laryngeal axes because of functional and anatomical deformities that occur as a result of long standing contractures. Here the role of the King Vision video laryngoscope which is the latest in the series of video laryngoscope has been evaluated for such patients. CASE REPORT: A 35 year old male patient with post burn contracture of neck was scheduled for release of the contracture. As the patient had had fixed flexion deformity of the neck we did not attempt the conventional laryngoscopy. Instead we opted for King Vision video laryngoscope. CONCLUSION: We therefore conclude that King Vision videolaryngoscope can be used for difficult airway situations like post burn contracture of neck.

King Vision video laryngoscope versus Lightwand as an intubating device in adult patients with Mallampatti grade III and IV patients.

STUDY OBJECTIVE: Anticipated and unanticipated difficult airways are often encountered by anesthesiologists in their clinical practice. There are various devices available in such situations. We aim to compare King Vision video laryngoscope and Lightwand for their performance as an intubating device in predicted difficult intubation. DESIGN: Prospective, randomized, single blind study. SETTING: Jawaharlal Nehru Medical College. PATIENTS: Sixty ASA 1 and 2 with Mallampati grade III and IV. INTERVENTIONS: Patients were divided into 2 groups of 30 patients each. Patients of King Vision group [n=30] and Lightwand group [n=30] were intubated using respective devices. Primary outcome measure was time taken to intubate whereas secondary outcome measure ware number of attempts for intubation, no of adjustment maneuvers, changes in heart rate and mean arterial pressure and airway trauma. MEASUREMENTS AND MAIN RESULTS: Mean intubation time using King Vision video laryngoscope (19.50±6.73 seconds was lower than the intubation time using Lightwand 25.40±7.42 s, P=.00). The difference between number of attempts, success of intubation, numbers of adjustment maneuvers were comparable. There was a significant rise in heart rate within the groups from the pre-induction values. However inter group variations were similar. In addition, there was a significant rise in mean arterial pressure within the groups from the pre-induction values. Inter group variations show less increase in mean arterial pressure with Lightwand at immediate post intubation (P=.0234) and at 3 min and 5 min post intubation anesthesia.

Management of accidental extubation during oral surgery by nasotracheal intubation using the King vision video laryngoscope and a gum elastic bougie - a case report.

Accidental extubation during intra operative period especially during oral surgery is challenging for any anaesthesiologist. Securing the definitive airway during this period is not only crucial and life saving but also challenging to the anaesthesia provider. Here we report a case which got extubated during hemimandibulectomy and was successfully reintubated using King Vision video laryngoscope. This videolaryngoscope proved to be a good rescue device in managing an accidental extubation during oral surgery and could represent a useful tool for the management of such unfamiliar situations.