Bedaquiline-Loaded Solid Lipid Nanoparticles Drug Delivery in the Management of Non-Small-Cell Lung Cancer (NSCLC).

Non-small-cell lung cancer (NSCLC) mortality and new case rates are both on the rise. Most patients have fewer treatment options accessible due to side effects from drugs and the emergence of drug resistance. Bedaquiline (BQ), a drug licensed by the FDA to treat tuberculosis (TB), has demonstrated highly effective anti-cancer properties in the past. However, it is difficult to transport the biological barriers because of their limited solubility in water. Our study developed a UPLC method whose calibration curves showed linearity in the range of 5 ng/mL to 500 ng/mL. The UPLC method was developed with a retention time of 1.42 and high accuracy and precision. Its LOQ and LOD were observed to be 10 ng/mL and 5 ng/mL, respectively, whereas in the formulation, capmul MCM C10, Poloxamer 188, and PL90G were selected as solid lipids, surfactants, and co-surfactants, respectively, in the development of SLN. To combat NSCLC, we developed solid lipid nanoparticles (SLNs) loaded with BQ, whereas BQ suspension is prepared by the trituration method using acacia powder, hydroxypropyl methylcellulose, polyvinyl acrylic acid, and BQ. The developed and optimized BQ-SLN3 has a particle size of 144 nm and a zeta potential of (-) 16.3 mV. whereas BQ-loaded SLN3 has observed entrapment efficiency (EE) and loading capacity (LC) of 92.05% and 13.33%, respectively. Further, BQ-loaded suspension revealed a particle size of 1180 nm, a PDI of 0.25, and a zeta potential of -0.0668. whereas the EE and LC of BQ-loaded suspension were revealed to be 88.89% and 11.43%, respectively. The BQ-SLN3 exhibited insignificant variation in particle size, homogeneous dispersion, zeta potential, EE, and LC and remained stable over 90 days of storage at 25 °C/60% RH, whereas at 40 °C/75% RH, BQ-SLN3 observed significant variation in the above-mentioned parameters and remained unstable over 90 days of storage. Meanwhile, the BQ suspension at both 25 °C (60% RH) and 40 °C (75% RH) was found to be stable up to 90 days. The optimized BQ-SLN3 and BQ-suspension were in vitro gastrointestinally stable at pH 1.2 and 6.8, respectively. The in vitro drug release of BQ-SLN3 showed 98.19% up to 12 h at pH 7.2 whereas BQ suspensions observed only 40% drug release up to 4 h at pH 7.2 and maximum drug release of >99% within 4 h at pH 4.0. The mathematical modeling of BQ-SLN3 followed first-order release kinetics followed by a non-Fickian diffusion mechanism. After 24 to 72 h, the IC50 value of BQ-SLN3 was 3.46-fold lower than that of the BQ suspension, whereas the blank SLN observed cell viability of 98.01% and an IC50 of 120 g/mL at the end of 72 h. The bioavailability and higher biodistribution of BQ-SLN3 in the lung tumor were also shown to be greater than those of the BQ suspension. The effects of BQ-SLN3 on antioxidant enzymes, including MDA, SOD, CAT, GSH, and GR, in the treated group were significantly improved and reached the level nearest to that of the control group of rats over the cancer group of rats and the BQ suspension-treated group of rats. Moreover, the pharmacodynamic activity resulted in greater tumor volume and tumor weight reduction by BQ-SLN3 over the BQ suspension-treated group. As far as we are aware, this is the first research to look at the potential of SLN as a repurposed oral drug delivery, and the results suggest that BQ-loaded SLN3 is a better approach for NSCLC due to its better action potential.

Prostaglandin-endoperoxide synthase (PTGS2) and Defensin beta 1 (DEFB1) gene polymorphisms are not associated with periodontitis in Malays.

INTRODUCTION: In line with the association of prostaglandin-endoperoxide synthase 2 (PTGS2) and defensin beta 1 (DEFB1) single nucleotide polymorphisms (SNPs) with periodontitis among the Chinese and European populations, the current study was aimed to assess the same association among the Malays in Malaysia. METHODS: Blood samples of individuals with periodontitis (PD) (n=72) and periodontally healthy (PH) (n=62) donors were obtained from Malaysian Periodontal Database and Biobanking system (MPDBS). Genomic DNA samples were analyzed for three PTGS2 SNPs (rs5275, rs20417, rs689466,) and one DEFB1 SNP (rs1047031) using Taqman SNP genotyping assays. Notably, rs20417 and rs689466 were located in the promoter region while rs5275 and rs1047031 were located in the 3' untranslated region of the transcript. Association between the SNPs and PD were then analyzed using genotypic association analysis (additive, dominant and recessive models). RESULTS: The allelic frequency for the rs689466-G was higher in PD group (35.2%) compared that in PH group (29.0%). However, the association of rs689466-G and other SNPs with PD was not statistically significant (at 95% CI). No associations were observed for genotypic associations between the PTGS2 and DEFB1 SNPs with PD susceptibility. CONCLUSIONS: PTGS2 (rs5275, rs20417, and rs689466) and DEFB1 (rs1047031) polymorphism was not associated with PD in Malays, unlike the Chinese, Taiwanese & European population. This suggests that other causal variants might be involved in the development and progression of PD among Malays.

The NeST (Neoadjuvant systemic therapy in breast cancer) study: National Practice Questionnaire of United Kingdom multi-disciplinary decision making.

BACKGROUND: Neoadjuvant systemic therapy (NST) is increasingly used in the treatment of breast cancer, yet it is clear that there is significant geographical variation in its use in the UK. This study aimed to examine stated practice across UK breast units, in terms of indications for use, radiological monitoring, pathological reporting of treatment response, and post-treatment surgical management. METHODS: Multidisciplinary teams (MDTs) from all UK breast units were invited to participate in the NeST study. A detailed questionnaire assessing current stated practice was distributed to all participating units in December 2017 and data collated securely usingREDCap. Descriptive statistics were calculated for each questionnaire item. RESULTS: Thirty-nine MDTs from a diverse range of hospitals responded. All MDTs routinely offered neoadjuvant chemotherapy (NACT) to a median of 10% (range 5-60%) of patients. Neoadjuvant endocrine therapy (NET) was offered to a median of 4% (range 0-25%) of patients by 66% of MDTs. The principal indication given for use of neoadjuvant therapy was for surgical downstaging. There was no consensus on methods of radiological monitoring of response, and a wide variety of pathological reporting systems were used to assess tumour response. Twenty-five percent of centres reported resecting the original tumour footprint, irrespective of clinical/radiological response. Radiologically negative axillae at diagnosis routinely had post-NACT or post-NET sentinel lymph node biopsy (SLNB) in 73.0 and 84% of centres respectively, whereas 16% performed SLNB pre-NACT. Positive axillae at diagnosis would receive axillary node clearance at 60% of centres, regardless of response to NACT. DISCUSSION: There is wide variation in the stated use of neoadjuvant systemic therapy across the UK, with general low usage of NET. Surgical downstaging remains the most common indication of the use of NAC, although not all centres leverage the benefits of NAC for de-escalating surgery to the breast and/or axilla. There is a need for agreed multidisciplinary guidance for optimising selection and management of patients for NST. These findings will be corroborated in phase II of the NeST study which is a national collaborative prospective audit of NST utilisation and clinical outcomes.

Optimization of USSP duration for enhanced corrosion resistance of AA7075.

This investigation was carried out following our earlier work on the effect of ultrasonic shot peening (USSP) on corrosion resistance of the 7075 aluminium alloy in 3.5 wt% NaCl solution to optimize the duration of USSP. The samples not treated with USSP and different samples treated with USSP were subjected to potentiodynamic polarization and electrochemical impedance spectroscopy. Among the specimens USSP treated from 5 to 30 s, the one USSP treated for 15 s (USSP 15) was found to exhibit highest corrosion potential (Ecorr) and lowest corrosion current density (icorr). Corrosion products were characterized by Scanning Electron Microscopy (SEM) and X-ray Photoelectron Spectroscopy (XPS). Scanning Kelvin Probe Force Microscopy (SKPFM) was used to measure the surface free potential. The enhanced corrosion resistance of the USSP 15 sample was found to be due to combined effect of surface nanostructure of the matrix, homogeneity and refinement of second phase precipitates. There was enhancement in formation of adherent passive layer in the USSP15 specimen.

Impact of specialist management on survival from radiation-associated angiosarcoma of the breast.

BACKGROUND: Radiation-associated angiosarcoma of the breast (RAAS) is a rare complication of adjuvant radiotherapy associated with poor survival. The British Sarcoma Group guidelines recommend that all angiosarcomas are referred to a sarcoma multidisciplinary team, although there is no recommendation that patients are managed within a sarcoma service. The aims of this study were to compare survival, complete excision rates and local recurrence rates of patients managed within a sarcoma service and those managed within local hospitals. METHODS: All patients with RAAS referred to a regional sarcoma service between 1998 and 2015 were identified from prospective databases. Patient records, and radiology, pathology and operation notes were reviewed retrospectively. RESULTS: Thirty-six patients were operated on with curative intent; 26 were managed by the sarcoma service (of whom 21 underwent radical excision of the irradiated field followed by chest wall reconstruction) and ten were managed locally. Median age was 69·5 (range 43-85) years. Disease-specific survival was significantly longer in patients managed by the sarcoma service than in those managed locally: median 91·1 (range 69·2-113·0) versus 48·8 (18·6-79·1) months respectively (P = 0·012). Overall survival rates were similar (P = 0·112). There was no difference in complete excision rate (18 of 26 in sarcoma service versus 5 of 10 in local services; P = 0·456), although the local recurrence rate was significantly lower among patients managed by the sarcoma service (9 of 26 versus 8 of 10; P = 0·015). CONCLUSION: Specialist management of RAAS leads to fewer local recurrences and improved disease-specific survival. Early referral and management within specialist units is recommended.

Factors Associated with Smokeless Tobacco Use among Pregnant Women in Rural Areas of the Southern Terai, Nepal.

BACKGROUND: Tobacco use among women during pregnancy leading to poor maternal and child health outcomes has been well documented. However, factors influencing use of smokeless tobacco in Nepal has not yet been well established. This study aims at exploring the factors related to smokeless tobacco use among pregnant women in rural southern Terai of Nepal. METHODS: A community-based cross-sectional study was performed at 52 wards within 6 Village Development Committee in Dhanusha district of Nepal. A total of 426 expectant mothers in their second trimester were selected using a multistage cluster sampling method. Descriptive and regression analyses were done to explore the factors that influence smokeless tobacco use. RESULTS: In a total of 426 pregnant mothers, one in five used tobacco in any form. Among the users, 13.4% used smokeless tobacco. Pregnant mothers who were smoking tobacco (AOR 6.01; 95% CI (1.88-19.23), having alcohol consumption (AOR 3.86; 95% CI (1.23-12.08), stressed (AOR 5.04; 95% CI (1.81-14.03), non-vegetarian (AOR 3.31;(1.84-13.03), not attending regular mothers' group meetings (AOR 4.63; (1.41-15.19), and not-exposed to mass media (AOR 5.02; (1.89-13.33) were significantly associated with smokeless tobacco use. Similarly, mothers of age group 20-34 years, dalit, aadibasi and janajati, hill origin, no education and primary education were more likely to use smokeless tobacco than their counterparts. CONCLUSIONS: Factors such as smoking tobacco, alcohol consumption, stress, and poor education were found to be significantly associated with smokeless tobacco use among pregnant women in southern Terai of Nepal. This requires an immediate attention develop an effective strategy to prevent and control smokeless tobacco use among pregnant women in southern Terai of Nepal.

Effect of Maternal Socio-demographic Factors and Child Feeding Practice on Wasting Among Under Five Years Children in Slum Area of Rupandehi District in Nepal.

INTRODUCTION: Childhood wasting although well studied elsewhere, it has not been well understood about in slum area of Nepal. This study aimed to assess effect of socio-demographic factors and child feeding practice in the determination of wasting among the children under five years of age in slum area of Nepal. METHODS: A community based cross-sectional study was performed among 150 children under five years of age from the slum area of Nepal between 1st January and 28th February 2013 using simple random sampling techniques. Multivariate analyses were performed to determine factors associated with wasting controlling the potential confounders. RESULTS: In a total of 150 under five years children, the prevalence of wasting was 56 (37.33%). The current study demonstrated that children of mothers from dalit Adjusted Odds Ratio (OR) 11.5; 95% CI: 03.1 - 41.3), aadibasi/janajati (AOR 4.6; 95% CI: 1.2 - 17.0), illiterate mothers (AOR 3.6; 95% CI: 1.1 - 13.6), laborer mothers (AOR 2.1; 95% CI: 1.1-9.4), child age group 25-36 months (AOR 2.8; 95% CI: 1.5-5.3), multiple child birth order (AOR 10.0; 95% CI: 2.5-25.0), children who were not fed colostrums (AOR 15.0; 95% CI: 1.25-10.0) were more likely to develop wasting compared to their counterparts. CONCLUSIONS: As incremental childhood wasting is associated with maternal socio-demographic factors and child feeding practice, health promotion strategies should focus maternal socio-demographic factors, age of children and early initiation of breast feeding for the improved child nutrition in slum area of Nepal.

Relationship of prepartum udder and teat measurements with subsequent milk production traits in primiparous Nili-Ravi buffaloes.

AIM: This study was conducted to find out the relationship of prepartum udder and teat measurements with subsequent milk production traits in primiparous Nili-Ravi buffaloes. MATERIALS AND METHODS: A total of 12 Nili-Ravi buffalo heifers were selected from Buffalo Farm, Central Institute for Research on Buffaloes, Regional Station- Bir Dosanjh, Nabha, Patiala, Punjab. The udder length (UL), udder width (UW), udder depth, teat length (TL), teat diameter (TD), and teat distances were measured at fortnightly interval from 60 days prepartum until calving. After calving, 60 days total milk yield (TDMY), peak yield (PY), and days taken to attain PY (DPY) were also recorded. The correlation coefficients of various prepartum udder and teat measurements since 60 days prepartum to calving with 60 days TDMY, PY, and DPY were calculated to find out the relationship between the traits in primiparous Nili-Ravi buffaloes. RESULTS: The result envisaged that all udder and teat measurements were increased gradually toward the date of calving in primiparous buffaloes. The UL, UW, left fore (LF) and right rear (RR)TL, RRTD, and the distance between LF to left rear (LR) teat were positively correlated with 60 days TDMY. The UL and UW depicted positive but nonsignificant correlation with PY. Fore TLs showed positive correlation where as TDs and teat distances had a negative correlation with the DPY in primiparous Nili-Ravi buffaloes. CONCLUSION: It was concluded that milk production performance could be assessed on the basis of prepartum udder and teat measurements in primiparous Nili-Ravi buffaloes.

Oral Health of New Zealand Service Personnel in WW1.

BACKGROUND AND OBJECTIVES: During the First World War, 10% of New Zealand's population served in the armed forces, and around one in five of those were killed. In commemoration of 100 years since WW1, this study uses retrospective data to report on the oral health of NZ service personnel. METHODS: 325 Pakeha, 165 Maori and 150 Samoan male recruits who served in the NZ Expeditionary Force between 1914 and 1918 were randomly selected and their personnel files accessed through Archives New Zealand. RESULTS: The oral health of recruits was described as 'good' for 44%, 'pass' for 38%, 'pass with false teeth' for 5% and 'poor' for 13%. Dental health was documented at enlistment for a decreasing proportion of soldiers as the war progressed, dropping from 96% during 1914-15, to 54% in 1916 and 22% in 1917-18 (p < 0.001). Significantly more soldiers who enlisted in 1917-18 had poor dental health (44%) than those who enlisted during 1916 (20%) and 1914-15 (8%) (p < 0.001). By ethnicity, Maori had the best dental health, followed by Samoan and Pakeha recruits (p < 0.001). On average, dental health was poorer among the lower ranks and among recruits of low socio-economic status; and soldiers from major cities had better oral health than those from rural areas; however, these differences were not statistically significant in this sample. CONCLUSIONS: Enlistment criteria appear to have been loosened as the war progressed, perhaps to accept more soldiers into service. Poor oral health was reported for approximately 1 in 7 accepted recruits. Maori appear to have had better oral health.

Management of Locally Advanced Cancer Cervix an Indian Perspective.

Cervical cancer has a major impact on the lives of Indian women with an estimated 122, 844 new cases of cervical cancer in the year 2012. About 80% of these cases present in a locally advanced stage leading to high morbidity and mortality. Because of lack of public awareness and infrastructure for screening and early detection in developing countries, this late presentation is likely to continue in the coming years. Radiation therapy has been the treatment of choice for patients with locally advanced cancer cervix. Many clinical trials and meta-analyses have shown a significant improvement in overall and progression-free survival with decreased local and distant recurrences with the use of concurrent chemotherapy with radiation. Most of these trials have been done in women from developed countries where the patient and disease profile are entirely different from ours. Recently, few trials from India have also shown promising results in locally advanced cancer cervix with concurrent chemoradiotherapy but toxicities remain a major concern. Further exploration is required for the use of concurrent chemo radiation prior to incorporating it into routine clinical practice.

Efficient anti-corrosive coating of cold-rolled steel in a seawater environment using an oil-based graphene oxide ink.

We report the production of an efficient anti-corrosive coating of cold-rolled (CR) steel in a seawater environment (∼3.5 wt% NaCl aqueous solution) using an oil-based graphene oxide ink. The graphene oxide was produced by heating Aeschynomene aspera plant as a carbon source at 1600 °C in an argon atmosphere. The ink was prepared by cup-milling the mixture of graphene oxide and sunflower oil for 10 min. The coating of ink on the CR steel was made using the dip-coating method, followed by curing at 350 °C for 10 min in air atmosphere. The results of the potentiodynamic polarization show that the corrosion rate of bare CR steel decreases nearly 10,000-fold by the ink coating. Furthermore, the salt spray test results show that the red rusting in the ink-coated CR steel is initiated after 100 h, in contrast to 24 h and 6 h in the case of oil-coated and bare CR steel, respectively. The significant decrease in the corrosion rate by the ink-coating is discussed based on the impermeability of graphene oxide to the corrosive ions.

Prevention of chaff cutter injuries in rural India.

Chaff cutter is an extensively used machine in Indian rural households to chop fodder for feeding draft and mulch to animals. A survey was conducted in five villages of Ghaziabad district of Uttar Pradesh (a northern state of India) to determine the causal factors responsible for chaff cutter injuries. It was observed that major injuries were caused during children playing with the machine and workers feeding the fodder in to the chute. Further, a survey of chaff cutter manufacturers was conducted to determine the critical dimensions of the machine so that safety interventions could be developed. Based on the survey results and mechanism of injuries, three safety interventions were developed to prevent the injuries. These interventions can be retrofitted on old machines and can be incorporated in new machines as well. Experiments were conducted using different fodder crops to observe difficulty in chaff cutting with the safety interventions. It was observed that incorporation of the interventions had no effect on performance of chaff cutting operation. These were retrofitted on existing machines at different locations and the response was very positive.

Ovarian response of prepubertal Murrah heifers to exogenous GnRH.

The aim of the current study was to evaluate the ovarian follicular response to GnRH at two dose levels in prepubertal Murrah buffalo heifers during hot-humid months. Heifers received 10 µg (Group A, n=7) or 20 µg (Group B, n=6) of GnRH during the growing phase of the dominant follicle (DF>6mm), as identified by pretreatment regular ultrasound scanning. A similar dose was repeated approximately 30 days later, again coinciding with another growing DF. Post-treatment ovarian activity was studied by alternate day transrectal ultrasonography until 25 days post-second GnRH. In both groups, three types of response were recorded: formation of a corpus luteum (CL), luteinization of the follicle wall, i.e. luteinized follicle (LF) or no response (NR). Pooled data at GnRH injections revealed that the DF diameter in relation to the type of response in Group A heifers was, NR: 6.83 ± 0.17 (n=3), LF: 8.10 ± 0.67 (n=6) and CL: 8.88 ± 0.96 mm (n=5), while respective values in Group B heifers were 8.68 ± 0.44 mm (n=4), 9.37 ± 0.46 (n=6) and 8.95 ± 0.55 mm (n=2). The pattern of response was more evident in Group A but unpredictable in Group B. Corpora lutea developed in response to both the GnRH injections were short-lived. Mean maximum diameter of LFs in Groups A and B were 16.07 ± 0.99 and 16.58 ± 1.20 mm respectively and wave duration of these follicles in both groups was 23.33 ± 1.67 and 25.33 ± 1.12 days, respectively. None of the heifers commenced cyclicity following regression of the CL or LF.

Elevated level of prostate specific antigen among prostate cancer patients and high prevalence in the Gangetic zone of Bihar, India.

Prostate cancer (CaP) is a common reproductive cancer among men. This study was conducted to correlate the cancer incidence with Gangetic zone and to correlate the tumor marker prostate specific antigen (PSA) level in serum with different age groups and stage of malignancy. Patients suffering from CaP in the pathology unit of Mahavir Cancer Sansthan (Hospital and Research Centre), Patna, Bihar, India were studied from June 2009 to May 2010. PSA level in the serum of CaP patients was estimated by ELISA method. CaP incidence was highly recorded in Gangetic zone than the non-Gangetic zone. Maximum patients were in the 56 - 75 years age group with a marked predominance. Results of PSA examination showed that serum PSA level was not correlating with the age of patient and stage of malignancy. Significantly, elevated level of more than 10 ng/ml of PSA was recorded among the studied cancer patients. In this study, it is concluded that Gangetic zone habitat have high risk of CaP and elevated level of PSA was marked in Bihar, India.

Power tiller: vibration magnitudes and intervention development for vibration reduction.

The operators of power tiller are exposed to a high level of vibration originating from the dynamic interaction between the soil and the machine. The vibration from the power tiller is transmitted from the handle to hands, arms and shoulders. In the present study, experiments were conducted in three operational conditions i.e. transportation on farm roads, tilling with cultivator and rota-tilling with rota-vator. The highest vibration values were observed in x-direction in all the experiments. The maximum vibration rms values for x-direction were 5.96, 6.81 and 8.00 ms(-2) in tilling with cultivator, transportation and rota-tilling respectively. Three materials were used for intervention development to reduce vibration magnitude. The maximum reduction of 25.30, 31.21 and 30.45% in transportation; 23.50, 30.64 and 20.86% in tilling with cultivator and 24.03, 29.18 and 25.52% in rota-tilling were achieved with polyurethane (PU), rubber and combination of PU and rubber intervention. It was found that the maximum vibration reductions were achieved with the rubber in all three operational conditions. The average exposure time for occurrence of white finger syndrome increased by 28-50% with incorporation of intervention in different operations. Physiological and postural parameters also improved with incorporation of interventions.

Diffusion tensor MR imaging in children with pantothenate kinase-associated neurodegeneration with brain iron accumulation and their siblings.

BACKGROUND AND PURPOSE: It has been reported that iron concentration influences DTI metrics in deep gray matter nuclei. We hypothesized that increased FA in the deep gray nuclei may indicate abnormal iron accumulation in patients with PKAN and their siblings. MATERIALS AND METHODS: Seven patients with the characteristic "eye-of-the-tiger sign," their 5 siblings, and 5 age-matched controls were prospectively studied. One-way ANOVA with Bonferroni post hoc multiple comparisons was used to compare DTI metrics (FA and MD) among subject groups in the putamen, CN, GP, SN, and ALIC. In addition, hypointense and hyperintense regions of the eye-of-the-tiger sign were segmented, and their DTI metrics were compared. In the patient group, the values of DTI metrics in hypointense regions were also compared with those of the ALIC. RESULTS: A significant increase in FA values of the GP and SN from controls to the patient group to siblings was observed. In the GP, MD values were significantly higher in patients compared with controls and siblings. The patients showed significantly increased FA with decreased MD in hypointense compared with hyperintense regions of the eye-of-the-tiger sign. No difference in FA values were observed between the ALIC and hypointense regions of the eye-of-the-tiger sign in patients. CONCLUSIONS: High FA values in siblings of patients with PKAN suggest the presence of abnormal iron in deep gray matter nuclei, even in the absence of its demonstration on T2*-weighted GRE.

Role of tracheostomy in the management of foreign body airway obstruction in children.

INTRODUCTION: Foreign body aspiration in the airway of children is a life-threatening clinical situation. Endoscopic retrieval alone is successful in the majority of patients. Occasionally, open surgical intervention in the form of tracheostomy, thoracotomy and bronchotomy and/or pulmonary resection is needed. We analysed the specific indications for tracheostomy during the removal of airway foreign bodies in our study. METHODS: The records of four patients who needed tracheostomy, out of 342 cases of foreign body airway obstruction managed by the senior author, were analysed. These patients underwent an additional tracheostomy for open removal of the foreign body and/or to secure the airway to facilitate the foreign body removal. RESULTS: Rigid bronchoscopy was successful in retrieving the foreign bodies in 338 (98.8 percent) cases, while four (1.2 percent) cases required additional tracheostomy, either to protect the airway during the procedure or to assist in removing the foreign body. The indications for tracheostomy were subglottic foreign bodies of long duration, sharp subglottic foreign bodies and foreign bodies that were larger than the glottic chink. There was no mortality or long-term complication because of the tracheostomies. CONCLUSION: Tracheostomy is occasionally indicated in foreign body extraction, when they are subglottic in location and impacted, or are large foreign bodies that get obstructed at the glottic chink during removal.