Histopathological changes in the arrector pili muscle of normal appearing skin in leprosy patients

AbstractBackgroundLeprosy is a chronic inflammatory disease caused by Mycobacterium leprae, which affects not only the peripheral nerves and skin, but also various internal viscera through hematogenous spread, especially in lepromatous cases. Histology in its own way plays a vital role, not only in classifying the established lesion, but also in confirming the clinical diagnosis. During the latent period of subclinical involvement, the apparently normal looking skin might also be undergoing some pathological changes.MethodsWe investigated skin biopsy material taken from 60 patients with clinically diagnosed leprosy at Subharti Hospital, Subharti Medical College, Meerut, India. Hematoxylin and eosin staining and Harada's modified allochrome method for acid-fast bacilli were applied for histological investigations.ResultsThe pattern of leprosy among the patients was indeterminate in 25 cases (41.7%), tuberculoid in 14 (23.3%), borderline tuberculoid in six (10%), borderline leprosy in four (6.7%), borderline lepromatous in four (6.7%), and lepromatous leprosy in seven (11.7%). Changes were seen in the arrector pili muscle of normal appearing skin in all types of leprosy, but involvement was greater at the lepromatous end of the spectrum compared to the tuberculoid end.ConclusionsResults of this study revealed definitive histological changes in the arrector pili muscle in normal appearing skin. The presence of AFB is significant as far as dissemination and transmission of the disease is concerned

Anaesthetic management in a case of large plunging ranula with difficult airway: A case report

AbstractPlunging ranula is a mucous retention cyst found on the floor of mouth which arises from the submandibular and sublingual salivary glands extending to lateral aspect of neck, which may often cause potential airway obstruction leading to difficulty in airway management. A forty year old female patient was admitted to our hospital with large, painless swelling in the floor of mouth extending to the lateral part of body of mandible and neck. This intraoral swelling distorted the normal airway anatomy thus making airway management difficult as the patient was planned for excision of swelling under general anaesthesia. So we present a case of successful management of a difficult airway by using awake fibre optic intubation in a patient posted for excision of a large plunging ranula under general anaesthesia

A randomised clinical study to compare the haemodynamic effects of etomidate with propofol during induction of general anaesthesia

Background: Induction agents are frequently associated with changes in heart rate and blood pressure and various adverse effects. Since the introduction of general anaesthesia, no ideal induction agent has yet been discovered in term of providing a stable hemodynamic with fewer adverse effects. This prospective randomized clinical study was conducted to compare propofol and etomidate for their effect on hemodynamic and various adverse effects on patients scheduled for elective surgeries during the induction of general anesthesia.Methods: 50 patients of ASA I and II of age group 18-60 years scheduled for elective surgeries under general anaesthesia were randomly assigned in two groups (n=25) receiving etomidate (0.3 mg/kg) in group E and propofol (2.5 mg/kg) in group P as an induction agent. Hemodynamic parameters were recorded at various time intervals. Any adverse effect pain on injection and myoclonus was carefully watched. VAS score was recorded for pain on injection. Statistical analysis was done using software (SPSS IBM version 20). P value was considered significant if (p0.05). Patients in propofol group showed significant fall of  systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MAP) and compared to etomidate (P<0.05).) Pain on injection was more in propofol group (P=0.021), While incidence of myoclonus activity was higher in etomidate group (P=0.0027).Conclusions: Etomidate is a better induction agent over propofol as it provides more hemodynamic stability and less pain on injection as compared to propofol

A comparative study of propofol and N2O versus sevoflurane and N2O with respect to haemodynamic response and ease of laryngeal mask airway insertion: a prospective randomized double blinded study

Background: Laryngeal mask airway (LMA) is an accepted airway device for spontaneous and modest positive pressure ventilation. Propofol is widely used Induction agent. Sevoflurane is a newer pleasant volatile anaesthetic with rapid induction and recovery with stable haemodynamics. The aim of this study was to compare propofol and sevoflurane with respect of haemodynamic changes and conditions for LMA insertion.Methods: This study was done on 60 female patients of ASA I, II grade between 20-60 years of age. Patients were randomized into two groups (n=30). All patients were preoxygenated and received inj. fentanyl 2µg/kg. Induction agent was propofol 2.5mg/kg (group P) or sevoflurane 8% with vital capacity breath (group S). Loss of eyelash reflex was the end point of induction. Induction time, conditions for LMA insertion, number of attempts, time of successful LMA insertion and haemodynamic parameters were noted.Results: time for induction and LMA insertion was significantly faster in propofol group than group S (p<0.05). Successful LMA insertion in first attempt was 100% in group P with excellent conditions (score 18) while in group S, it was 86.7% with excellent to satisfactory conditions (score 16-17). A significant fall in mean arterial pressure (p<0.05) was noted in group P while pulse rates were comparable in both groups.  Conclusions: Sevoflurane vital capacity breath inhalational induction can be used as an effective alternative to propofol though it requires greater time for LMA insertion but with better haemodynamic stability.

A prospective randomized study for comparison of haemodynamic changes and recovery characteristics with propofol and sevoflurane anaesthesia during laparoscopic cholecystectomies

Background: Day care laparoscopic surgical procedures are rapidly increasing nowadays. Rapid emergence and early recovery from anaesthesia with minimal complications are desired. Both propofol and sevoflurane meet above criteria and established as agents of choice in laparoscopic surgeries for induction and maintenance of anaesthesia. So this study aimed to compare sevoflurane with propofol for intraoperative haemodynamic changes with postoperative recovery profile in patient’s undergone laparoscopic cholecystectomies under general anaesthesia.Methods: In this prospective randomized study, sixty patients of either sex, 18-60 years with ASA grade 1 and 2 scheduled for laparoscopic cholecystectomies under general anaesthesia were randomly allocated into two groups. In Group S, patients were maintained on sevoflurane anaesthesia (0.5-2.5%) while in Group P, patients were maintained with propofol infusion (75-125 µg/kg/min) along with O2 (50%) and N2O (50%).The intraoperative haemodynamic parameters, recovery characteristics and postoperative nausea and vomiting (PONV) were observed in both groups.Results: The mean baseline haemodynamic parameters (HR, SBP, DBP, MBP, SpO2 and EtCO2) were comparable in both groups, (P>0.05). No significant difference in HR was at observed any time interval, P>0.05, however, SBP, DBP and MBP were significantly lower in propofol group at different time intervals, P<0.05, but clinically not significant and patients remained haemodynamically stable in both groups. The mean time for all recovery characteristics were significantly shorter in sevoflurane group as compared to propofol group, (P<0.01). However the incidence of PONV was significantly more in sevoflurane group.Conclusions: Sevoflurane can be used as an effective alternative to propofol for maintenance of anaesthesia in day care laparoscopic procedures as it has better recovery profile with stable haemodynamic parameters

Appearance of L90I and N205S Mutations in Effector Domain of NS1 Gene of pdm (09) H1N1 Virus from India during 2009–2013

In the present study, full length sequencing of NS gene was done in 91 samples which were obtained from patients over the time period of five years from 2009 to 2013. The sequencing of NS gene was undertaken in order to determine the changes/mutations taking place in the NS gene of A H1N1 pdm (09) since its emergence in 2009. Analysis has shown that the majority of samples belong to New York (G1 type) strain with valine at position 123. Effector domain of NS1 protein displays the appearance of three mutations L90I, I123V, and N205S in almost all the samples from 2010 onwards. Phylogenetic analysis of available NS1 sequences from India has grouped all the sequences into four clusters with mean genetic distance ranging from 12% to 24% between the clusters. Variability in length of NS1 protein was seen in sequences from these clusters, 230-amino-acid-residue NS1 for all strains from year 2007 to 2008 and for 21 strains from year 2009 and 219-residue products for 37 strains from year 2009 and all strains from year 2010 to 2013. Mutations like K62R, K131Q, L147R, and A202P were observed for the first time in NS1 protein and their function remains to be determined

A randomised clinical study to compare the haemodynamic effects of etomidate with propofol during induction of general anaesthesia

Background: Induction agents are frequently associated with changes in heart rate and blood pressure and various adverse effects. Since the introduction of general anaesthesia, no ideal induction agent has yet been discovered in term of providing a stable hemodynamic with fewer adverse effects. This prospective randomized clinical study was conducted to compare propofol and etomidate for their effect on hemodynamic and various adverse effects on patients scheduled for elective surgeries during the induction of general anesthesia.Methods: 50 patients of ASA I and II of age group 18-60 years scheduled for elective surgeries under general anaesthesia were randomly assigned in two groups (n=25) receiving etomidate (0.3 mg/kg) in group E and propofol (2.5 mg/kg) in group P as an induction agent. Hemodynamic parameters were recorded at various time intervals. Any adverse effect pain on injection and myoclonus was carefully watched. VAS score was recorded for pain on injection. Statistical analysis was done using software (SPSS IBM version 20). P value was considered significant if (p&lt;0.05).Results: Demographic variables were comparable in both the groups. Hemodynamic parameters at baseline were comparable. There were no statistically significant differences among groups E and P in terms of heart rate (HR) (P&gt;0.05). Patients in propofol group showed significant fall of  systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MAP) and compared to etomidate (P&lt;0.05).) Pain on injection was more in propofol group (P=0.021), While incidence of myoclonus activity was higher in etomidate group (P=0.0027).Conclusions: Etomidate is a better induction agent over propofol as it provides more hemodynamic stability and less pain on injection as compared to propofol