Context: Direct laryngoscopy and endotracheal intubation are the most stressful periods during induction of anesthesia. These events can lead to hypertension, tachycardia, arrhythmias and myocardial ischaemia. Aims: (1) To evaluate the haemodynamic response to laryngoscopy and endotracheal intubation with a single preinduction infusion of dexmedetomidine (DEX) 1 μg/kg over a 10 min period, (2) To assess the incidence of side effects, that is, rebound hypertension, bradycardia and hypotension etc., associated with the use of DEX. Settings and Design: This was a prospective, double-blind, parallel group randomized clinical trial of DEX (1 μg/kg) before anesthetic induction to study the attenuation of hemodynamic response to endotracheal intubation in 60 adult patients undergoing elective off pump coronary arterial bypass grafting. Materials and Methods: Patients were randomly allocated to receive either DEX (DEX group, n = 30) or 0.9% normal saline (PLA group, n = 30). Hemodynamic variables were recorded at baseline (Abbreviated as TB), after completion of drug infusion (Abbreviated as TC), 3 min after induction and immediately before intubation (T0), at the 1 ^st (T1), 3 ^rd (T3) and 5 ^th (T5) min after intubation. Statistical Analysis Used: The data are presented as mean ± standard deviation. Demographic data were analysed by Student's t-test between the two groups. Analysis of variance for repeated measures f-test was used to analyze changes over time. A P < 0.05 was considered as significant and P < 0.01 or 0.001 was considered as highly significant. Results: All the hemodynamic variables were comparable in both groups at baseline. Heart rate values were statistically significantly lower in the DEX group at TC and highly statistically significantly lower at T1, T3 and T5 values. Systolic blood pressure values were statistically significantly lower in the DEX group at T0 and highly statistically significantly lower at T1, T3 and T5. Diastolic blood pressure and mean blood pressure values and systolic pulmonary artery pressure values were highly statistically significantly lower in the DEX group at T1, T3 and T5. Diastolic pulmonary artery pressure were statistically significantly lower in the DEX group at TC, T0 and T1 and highly statistically significantly lower at T3. Mean pulmonary artery pressure were statistically significantly lower in the DEX group at T0 and highly statistically significantly lower at TC, T1 and T3. Arterial oxygen saturation was statistically significantly lower in the DEX group at TC. There was no case of hypotension or bradycardia in our case series. Conclusions: Dexmedetomeditine (1 μg/kg) attenuates hemodynamic response to laryngoscopy and intubation in elective surgery for off pump coronary artery bypass grafting.

Background: Patients with schizophrenia often have social skills deficits. Social skill training (SST) is a structured learning oriented approach for patient with schizophrenia. Effectiveness of SST improves communication, which achieves patient's goals in social situations. Aim: The aim of this study is to assess the efficacy of SST in patient with schizophrenia. Materials and Methods: A total of 65 patients with chronic schizophrenia participated in the study, 34 in experimental and 31 as a control group. This was cross-sectional interventional study. The patients were diagnosed as having schizophrenia (all types) disorders using International Classification of Disease 10 (ICD-10), classification of mental and behavioral disorders, ICD-10 diagnostic criteria for research criteria. Patient with more than 2 years duration of illness were included in the study groups. Positive and Negative Syndrome Scale was used to rule out predominant positive symptoms. Scale for the Assessment of Negative Symptoms (SANS), and social adaptive functioning evaluation (SAFE) were used to measure the efficacy of SST in schizophrenia patient. All participants were examined on SANS, and SAFE on pre- and post-test design. Data were analyzed using Statistical pakage for social sciences SPSS 17 version. P < 0.005 was considered as statistically significance. Results: The pre-and post-intervention score of SAFE of the control group did not show significant differences (P = 0.053). There was a significant difference between the pre- and post-intervention SAFE scores in the experimental group were noted (P < 0.002). The result indicated no significant decrease in SANS score in the experimental group compared to the control group (P = 0.072). However, results indicated significant improvement in alogia, apathy, and anhedonia (P = 0.007, P = 0.030, P = 0.025. Conclusion: SST is effective in improving social skills of patients with schizophrenia. SST is effective in alogia, apathy and anhodonia, but not other domains of negative symptoms.

Background: Aerobic non-fermenting Gram-negative bacilli (NFGNB) once considered as contaminants now associated with life-threatening infections and emerging as multi drug resistant nosocomial pathogens. Aim: Isolation and identification of NFGNB in all the clinical samples and to determine antibiotic susceptibility pattern of the isolated NFGNB. Materials and Methods: This study has been conducted in the Department of Microbiology at a tertiary care teaching hospital over a period of 2 months from September to October 2013. NFGNB were isolated and identified from clinical specimens by standard procedure and antibiotic sensitivity test was performed. Results: NFGNB isolation rate in the present study was 3.58%. Male to female ratio was 2.125. Pus was the most common specimen (21%) followed by tracheal aspirate (17%). Pseudomonas aeruginosa was the most common isolate (60%) followed by Acinetobacter baumannii (22%) and Acinetobacter lwoffii (12%). P. aeruginosa has shown good sensitivity to amikacin (83.3%), imipenem (80%) and piperacillin-tazobactam (73.3%) whereas A. baumannii showed multidrug resistance. Conclusion: It is necessary to identify NFGNB and to monitor their susceptibility pattern to guide the clinician for better care and management of patients. NFGNB are now emerging as organisms of nosocomial infections. Hence, antibiotic sensitivity testing and infection control measures are needed to prevent the emergence and spread of multi drug resistant NFGNB in health care settings.

Background: The failure of the conventional nailing of both bone of the forearm poses a potential problem of nail migration and rotational instability, despite the best reduction. Objectives: Rush nail is a very handy, low cost easily available implant. In the present study, we have tried to find out its applicability if used in the closed manner under C-arm control without injurying soft tissues and preserving the periosteal vascularity. Materials and Methods: This prospective study was conducted on thirty adult subjects. Skeletally mature subjects with Gustilo type 1 open and closed fractures without the neurovascular deficit were included. Stainless steel rush nails were used for all patients for both radius and ulnar repair. Patients were followed-up for a minimum of 4 months and maximum of 1.5 years. Results: The mean age of study participants was 37.43 years. Mean time of the union was 14.32 weeks. Average operative time was 67.16 min. No intraoperative complication occurred nor was any nailing converted to some other form of fixation, except in three cases radial nail was introduced by open method through anterior Henry's approach. Cast support was maintained for a mean of 7.43 weeks, after that forearm brace was applied for a mean period of 6.26 weeks and continued until radiographic union was seen. Three patients showed non-union of radius mostly distal third. They were treated with open reduction and internal fixation with locking plate and bone grafting. One patient had extensor tendon injury. Two patients have superficial infection which cured with antibiotics. One case had delayed union of radius which required bone grafting. Two patients had gross restrictions of wrist movements and pronation-supination movement. Using Anderson criteria 22 patients had satisfactory results (71.33%), three patients had excellent result. Three patients had non-unions (10%). Implant removal was performed in two cases about 14 months post-operatively and no refracture has been reported until date (after 4 months). Conclusion: Use of rush nail continues to have predictable and good results. Complication rates are lower when compared to plate osteosynthesis and even in locked intramedullary nails although application of above elbow cast after nailing is a downside of this procedure. The rush nail has still a future in repair of forearm fractures considering its low complications rates, cost and acceptable results in a developing country where financial matters are to be considered.

Introduction and Objective: Chronic subdural hematoma is the most common traumatic intra-cranial hemorrhage in elderly. It has serious morbidity and mortality, but good surgical prognosis. Burr hole craniotomy is the most common form of treatment for chronic subdural hematoma. However, there have been very few studies to see the postoperative influence of head position (head low/supine) on recurrence of chronic subdural hematoma. The aim of this study is to compare recurrence rates between patients given head low position postoperatively versus supine position after burr hole craniotomy. Materials and Methods: During the period of months from August 2011 to August 2013, 78 patients of chronic subdural hematoma treated with burr hole craniotomy were included. Pre- and post-operative computed tomography scan\magnetic resonance imaging scan were used for radiological evaluation. After surgical intervention, the preference of head position (supine/head low) of the patient was decided by treating neurosurgeon. Head low position was kept for 3 days. Supine position was given for the rest of the patients. All patients were followed-up for at least 1 month after discharge. Results: Of the 78 patients, 16 patients were given head low position, whereas 62 were given supine position. The overall recurrence rate was 7.69% (6 out of 78) in our study. One of 16 patients (6.25%) given head low position recurred, whereas 5 of 62 patients (8.06%) who were given supine position recurred. Statistically (P > 0.05) postoperative recurrence rate in both groups were same. Conclusion: Results of our study indicate that patients who were given head low position had same recurrence rate as those who were given supine position. Hence, postoperatively position of the head does not influence the recurrence rates.

Background: Annual exposure of health care workers (HCWs) to hepatitis B virus infection was estimated world-wide as 5.9%. Hepatitis B though a preventable disease is one of the major causes of morbidity and mortality throughout the world. Objective: This study was carried out to find out the prevalence of hepatitis B surface antigen (HBsAg) among supportive HCWs. Materials and Methods: A total of 115 blood samples were collected from different categories of supportive HCWs, sera were separated, stored at −20°C and tested for HBsAg enzyme-linked immunosorbent assay. Results: Of the 115 HCWs, two were positive for HBsAg. One was female nursing assistant with >20 years experience and the other was male sanitary worker with <20 years experience. Both were above 40 years of age. Conclusion: Proper training of HCWs about universal work precautions, awareness about vaccination, reporting of occupational exposure to health authorities and post-exposure prophylaxis in all health care set ups can be pivotal in preventing health care associated infections.

Necrotizing fasciitis is a rapidly spreading infection involving the superficial fat, fascial layers with necrosis of skin and is a disfiguring condition that is fatal. Head and neck are an unusual site, which is rarely affected. It is characterized by its fulminating, devastating and rapid progressive course. It usually occurs in patients with systemic conditions such as diabetes mellitus, renal disease, cardiovascular disease, HIV infections, etc. A case of cervical necrotizing fasciitis of odontogenic origin occurring in a nonimmunocompromised patient is reported here who was treated successfully by surgical debridement and antibiotic therapy.

We present this unusual case of the clinical importance of a 50-year-old male patient who presented with foreign body sensation in the throat and halitosis of 20 days duration. On examination, there were no palpable lymph nodes and oral cavity revealed an ulcero proliferative growth over the right tonsil. Computed tomography of the paranasal sinuses and neck revealed a heterogeneously enhancing mass involving the right tonsil measuring 3.8 cm × 3 cm. Biopsy of the tonsillar mass was suggestive of anaplastic large cell lymphoma (ALCL) with neoplastic large cells positive for CD30, epithelial membrane antigen and CD3 and negative for Tdt, CD56, anaplastic lymphoma kinase (ALK) and cytokeratin. A diagnosis of ALK negative ALCL Stage IA was made and the patient was started on chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone every 3 weeks. He received six cycles of chemotherapy followed by 33 gray involved region radiotherapy and reassessment showed total regression of the tonsillar lesion. The patient is in complete remission and now under follow-up for the last 2 years

Urethrocutaneous fistula (UCF) are common after hypospadias repair, but occurrence of congenital UCF without hypospadias is extremely rare and only about 35 cases are reported in the literature. The etiology is not established yet. We report a rare case of isolated congenital UCF in 1 year child managed by Snodgrass technique and review of literature regarding the etiology and management.

The prognosis of maxillary sinus carcinomas is not very promising. Maxillary sinus carcinomas are usually diagnosed at advanced stages and the proximity of important organs such as the eyes and cranial nerves makes complete surgical resection difficult. We here present a case that presented late with squamous cell carcinoma and was treated by radiotherapy (RT) followed by radical maxillectomy with en-bloc orbital exenteration. Patients who undergo RT followed by en-bloc radical maxillectomy with orbital exenteration as salvage, in these cases may have promising results. We had raised forehead fascio cutaneous flap and translocated it deep to the upper eyelid to bridge the cutaneous defect. Forehead defect was covered with split-thickness skin taken from left thigh. No microvascular surgery was done, but cosmetic results were comparable. In rural setups of developing countries where facilities for microvascular surgery are lacking flap translocation may have a positive outcome.

The association of alcoholism with stroke is known. However, acute cerebral venous sinus thrombosis (CVST) presenting as a complication of binge drinking is rare. Two such rare cases are presented here. Since, there is an overlap of symptoms between veisalgia and CVST, the diagnosis of CVST may be missed or delayed in alcoholic patients. It is important to keep a rare possibility of acute CVST in mind while dealing with patients who present with neurological symptoms following binge drinking. Imaging plays a vital role in making an early and specific diagnosis, thus preventing complications.

Cardiofaciocutaneous syndrome is a rare dysmorphic syndrome. There are over 100 individuals reported in the literature. It is estimated that there are perhaps 200-300 individuals world-wide. The diagnosis can be suspected by constellation of cutaneous, cardiac and facial features. Recognition of this syndrome is important in view of the future risk of malignancy and for genetic counseling. Hereby we report a case of 30-year-old female who presented with history of desquamation of skin since birth and history of a congenital heart disease detected during the first pregnancy. Intelligence quotient assessment revealed mild mental retardation two-dimensional echo revealed septum secundum atrial septal defect. The diagnosis was made by the presence of the cardiac, cutaneous and neurological condition.

Placement of central venous catheter (CVC) can lead to complications such as, malposition of catheter and perforation and/or injury of nearby blood vessels and structures. We present a case about malposition of central venous catheter (CVC) from right internal jugular vein (IJV) into right intrapleural space. It is advisable to check free venous outflow in all the ports of CVC and following placement of CVC, chest radiograph should be taken to confirm the position.

Chilaiditi syndrome is a condition in which the colon or rarely the small bowel is interposed temporarily or permanently between the liver and the diaphragm. Usually it is an asymptomatic and incidental radiographic finding, but may present with a variety of symptoms. We report a case of Chilaiditi syndrome with small bowel interposition who presented with chest pain, initially suspected to be myocardial infarction. Further Investigations revealed normal cardiac functions and gas under the right hemidiaphragm suggestive of pneumoperitoneum. After careful inspection of radiograph it was found to be gas filled small bowel between liver and diaphragm, which was later confirmed by ultrasound examination. The patient was successfully managed conservatively.

Myoepithelial carcinomas (MCs) are rare neoplasm of salivary glands composed predominantly of cells with myoepithelial differentiation characterized by infiltrative growth, necrosis, multinodular architecture, and potential for metastasis. Majority are seen in major salivary glands like parotid. They can arise either de novo or within a preexisting pleomorphic adenoma or myoepithelioma, the latter being very uncommon. We report a rare case of malignant myoepithelioma arising from a pleomorphic adenoma of the soft palate. A 66-year-old male patient presented with recurrent soft palate mass, with history of a pleomorphic adenoma at the same location operated 2 years ago. The recurrent tumor showed histopathological features of MC, confirmed by immunohistochemistry.

Neural tube defects (NTDs) are the most common malformations accounting for 0.5-1.3 cases/1000 live births with multifactorial etiology. Anencephaly and craniospinal rachischisis are open NTDs. Associated malformations are noted in anencephaly, indicating some etiological heterogeneity. Here, we report an anencephalic fetus with craniospinal rachischisis and multiple other anomalies.

Colovesical fistulae are most commonly associated with diverticulitis. We report a case of colovesical fistula in a 55-year-old male patient presenting with pneumaturia and fecaluria. Patient was treated with single stage resection of fistula, colocolostomy and closure of bladder.

Celiac disease (CD) is an immune-mediated enteropathy triggered by the ingestion of gluten in genetically susceptible individuals. It has been identified as one of the most common lifelong disorders on a worldwide basis. Enteropathy in CD is thought to be the final consequence of an abnormal immune reaction, showing features of both an innate and adaptive response to gluten prolamins. The clinical spectrum is wide, including cases with either typical intestinal or atypical extra intestinal features, or silent forms. Anemia has frequently been reported as the only manifestation or the most frequent extra-intestinal symptom of CD. The only available treatment consists in dietary exclusion of grains containing gluten.

Atrial septal defect (ASD) with rheumatic mitral stenosis is popularly known as eponym of Lutembacher syndrome. Definitive treatment of Lutembacher syndrome has been under the purview of cardiothoracic surgeons but with changing times, transcatheter treatment has been possible. We present a case of 38-year-old female with Lutembacher syndrome treated transcatheterly. This case attests the feasibility of transcatheter treatment in selected group of patients of Lutembacher treatment.

Transfusion of blood and its components has undergone technological advancement, and its use is increasing both perioperatively as well as in the Intensive Care Unit. The separation of blood into its various components has made it very economical as blood donated from a single donor can be utilized for many recipients at the same time. However, the transfusion of blood and its components do carry the inherent risk of various transfusion reactions as well as transmission of infections. The indications for transfusion should be strictly adhered to for preventing nonjudicious use. The health care persons involved in transfusion should be well aware of implications of the mismatched transfusion and should be able to provide treatment if such mishaps do occur. A health care professional should carefully weigh the benefits of blood transfusion against the risks involved before subjecting the patients to the transfusion. This manuscript aims to comprehensively review the current evidence based approaches in blood and component transfusion which are being followed in anesthesiology and intensive care practice.

With an increasing demand for newer anti-epileptic agents having a better pharmacological profile, many newer agents are being investigated. Lacosamide is a newer functional amino acid being developed as an adjunctive therapy for resistant partial-onset seizures owing to its activity of enhancing the slow inactivation of voltage-gated sodium channels thereby reducing pathologic hyperactivity in neurons. It has also being investigated for its role as anti-nociceptive in variety of pain scenarios specifically in diabetic neuropathic pain. It is well-absorbed orally, metabolized in liver and excreted by the kidneys. It has a favorable pharmacologic profile in having minimal drug interactions. The adverse effects include mild dizziness, behavioral changes and dose dependent prolongation of PR interval. This review is directed toward the development of lacosamide and its potential usefulness as an anti-epileptic and an anti-nociceptive drug.

A large number of psychosocial factors are associated with cancer. Depression is one of these important associated factors. It is hypothesized that depression compromises the immune system and results in dysregulation of deoxyribonucleic acid repair enzymes, leading to subsequent development of cancers. The association between depression and cancer has always been debatable and controversial. We decided to conduct a new systematic review to investigate, if the conclusion, about depression being a risk factor for cancer development still holds true. We did extensive literature search at databases like PubMed, MedLine and EBSCO. Our review suggests the significantly increased association between depression and cancer, especially breast cancer.