Foreign body inhalation in children: A mixed bag of experiences over two years in a tertiary care center of Eastern India

Background: Foreign body aspiration (FBA) is a common medical emergency in childhood. It may have serious and lethal outcomes if not managed promptly. The clinician must suspect FBA on the grounds of history, even if clinical and radiological findings are not supportive. Objective: The objective of this study was to study the clinicoepidemiological profile of FBA in children. Materials and Methods: This hospital-based retrospective study was carried out in the Department of Pediatric Surgery between October 2017 and November 2019. A total of 15 cases of FBA reported in children were analyzed. All these cases presented in amedical emergency. History taking and clinical examination were followed by radiological evaluation and bronchoscopy in all the cases. Results: We reported 15 cases of FBA in children in our setting for 2 years. There were 11 boys (73%) and four girls (27%). Most of the cases reported within 3 days of aspiration, but the time of presentation was as long as 6 months. Rigid bronchoscopy was performed in all cases, and Magill forceps were used in two cases. Spontaneous expulsion of the FB occurred in two cases. All cases were subjected to check bronchoscopy. Conclusion: The age group <3 years have the highest risk for FBA. ronchoscopy is a skilled procedure and requires the utmost care to avoid lethal complications. The clinician must not get hesitant in doing repeat bronchoscopy in multiple settings to ensure successful retrieval of the FB

An Inquiry into the Scope of MFN Provisions in Bilateral Investment Treaties

This article inquires into the scope of MFN treatment in Bilateral Investment Treaties. The article primarily analyzes the ways in which MFN treatment may be extended to foreign investors; this includes extending favorable treatment to a foreign investor in cases of internal/domestic measures and borrowing more favorable provisions from third-party BITs. This article attempts to shed light on the interpretation and dynamics of the use of MFN provisions for internal measures. It also delves into the rationale for borrowing provisions from third-party BITs. It further presents a critique of various tribunals’ decisions and scholarly discussions and writings that deal with the use of MFN clauses to borrow provisions from third-party BITs. Ultimately, the article suggests suitable approaches to interpret MFN provisions in BITs as per the interpretative methodologies provided under the VCLT. It argues that allowing MFN clauses to borrow provisions from third-party BITs may lead to treaty shopping, create jurisdictional problems, and promote free-ridership, which goes against the objective of any multilateral or bilateral system

Effects of part-to-part gap and the variation of weld seam on the laser welding quality

Human and Systems EngineeringLaser welding is an emerging joining technique for automotive industry. Due to the complex process, the control of laser welding quality problem such as spatter, porosity, and undercut is not easy. Traditional mechanical testing of weld is time consuming, costly, and inefficient for on-line monitoring of laser welding quality. In this regards, this thesis aims to estimate the laser welding quality in a non-destructive way by using the geometry of top weld seam of weldment. The most challenging task which is covered in this thesis is the estimation of the tensile shear strength in a non-destructive way. Experimental analysis reveals that the existence of two types of correlation in the variation of weld seam and tensile shear strength in the laser welding of galvanized steel: (1) positive correlation exists between the log-transformed average width of the top weld seam and maximum tensile shear strength, and (2) negative correlation exists between the variation of the width of top weld seam and maximum tensile shear strength. These correlations exist only when top weld seam having non uniform seam boundary. However, weld seam having uniform seam boundary do not have sufficient evidence of the correlation between the variation of weld seam and tensile shear strength. The reason for this is due to the high value of standard deviation of the average width of the top weld seam. Width of weld seam is more responsible for tensile strength rather than variation of weld seam.ope

A rare self-mutilating post-operative behavioral change in a 3-year-old child

General anesthesia or sedation is mandatory even for minor surgery in children especially if they are below 5 years of age for oblivion. It’s mandatory not only for intraoperative period but also to omit the psychological impact that may adversely affect the children postoperatively. We report a case of post-operative behavioral change where a 3-year-old child applied a straight incision over his forehead to mimic the surgery that he learnt intraoperatively while drainage of small abscess of his own great toe carried out on him without anesthesia or sedation

Individualized dosing of oral propranolol for treatment of infantile hemangioma: a prospective study

Introduction: infantile hemangioma is the most common benign tumor in infancy. Currently, oral propranolol is the treatment of choice for infantile hemangioma, but there is no consensus when it comes to its recommended dosage for this condition. Hence this study was conducted to find out the appropriate dosage of oral propranolol for treatment of infantile hemangioma. Methods: a prospective study was conducted on 25 patients with infantile hemangioma, who were treated with gradually increasing dose of propranolol starting from a lower dose of 1mg/kg/day. Results: 17/22(76%) patients showed regression of the tumor at the dose of 1- 1.5 mg/kg/d. 5/22(24%) patients were unresponsive to the treatment with the lower dose and they did not respond even with the gradually escalated dose of 3-4 mg/kg/day. Conclusion: propranolol in a lower dose of 1-1.5 mg/kg/day is safe and efficacious in the treatment of infantile hemangioma and the lesions which do not show initial response to the lower dose are unlikely to respond to the higher dose of 3-4 mg/kg/day

Recent status on carbohydrate metabolizing enzyme inhibitors in regulation of diabetes: a mechanism based review

The important therapeutic approach for treating type 2 diabetes mellitus is to decrease the post-prandial glucose levels which could be done by decreasing the absorption of glucose through the inhibition of the carbohydrates-hydrolyzing enzymes such as α-amylase and α-glucosidase present in the small intestinal brush border that are responsible for the breakdown of oligosaccharides and disaccharides into monosaccharide’s and suitable for absorption. Inhibition of α-amylase generally considered as strategy for the treatment of disorders in carbohydrate uptake, such as diabetes and obesity. Among the marketed allopathic preparations carbohydrates-hydrolyzing enzymes Inhibitors like acarbose, voglibose etc delay carbohydrate digestion and prolong overall carbohydrate digestion time, causing a reduction in the rate of glucose absorption and consequently blunting the postprandial plasma glucose rise. Some of the plants are also considered as an important source of chemical constituent with potential for inhibition of α-amylase and can be used as therapeutic purposes. In this review our efforts have been devoted to explore the mechanism based carbohydrates-hydrolyzing enzymes Inhibitors for the regulation of diabetes

Ectopic thoracic kidney in a child presenting with recurrent cough: a case report and review of literature

Ectopic thoracic kidney is a rare clinical entity in pediatric patients. It is usually an incidental finding on evaluation of patients with recurrent cough or mediastinal mass. Its clinical course is benign. We are presenting a case of right ectopic intrathoracic kidney diagnosed incidentally on contrast-enhanced computed tomography chest during evaluation of a child with recurrent cough.Keywords: mediastinal mass, recurrent cough, thoracic kidne

Olbrzymi tętniak obejmujący kilka tętnic wieńcowych, w tym pień tętnicy wieńcowej lewej, powodujący objawy ostrego zespołu wieńcowego u 23-letniego chorego: nietypowe powikłanie choroby Kawasaki

The reported incidence of coronary artery aneurysms (CAA) on angiography varies between 0.3 to 5.3%. Right coronary artery is the most commonly affected followed by left circumflex or left anterior descending artery. Three-vessel or left main involvement is exceedingly rare. Atherosclerosis accounts for the vast majority of CAAs in adults, whereas Kawasaki disease is responsible for most cases in children. We report a rare case of Kawasaki disease associated with giant aneurysms ( > 8 mm) in coronary circulation, including left main coronary artery in 23-year-old male having maturity onset diabetes (MODY), who presented with acute coronary syndrome.The reported incidence of coronary artery aneurysms (CAA) on angiography varies between 0.3 to 5.3%. Right coronary artery is the most commonly affected followed by left circumflex or left anterior descending artery. Three-vessel or left main involvement is exceedingly rare. Atherosclerosis accounts for the vast majority of CAAs in adults, whereas Kawasaki disease is responsible for most cases in children. We report a rare case of Kawasaki disease associated with giant aneurysms ( > 8 mm) in coronary circulation, including left main coronary artery in 23-year-old male having maturity onset diabetes (MODY), who presented with acute coronary syndrome