Human otoacariasis: a common outbreak in rubber growing belt of Karnataka.

Background/Objective: Soft tick in the ear is a very common acute painful and distressing condition in the flowering months of October to March. It’s a common condition in the rubber growing belt of Sullia.The mouthparts of the tick grips firmly the skin of the external auditory canal or the tympanic membrane and sucks blood and swells up. Otoscopy and removal of the tick from the ear can be done in outpatients in adults and difficult in a frightened irritable child.Materials and methods: 312 cases of intra-aural ticks presenting to the opd and casualty which included 131 males and 181 females were included in the study.Results: Out of the 312 cases of intra-aural ticks, 170 cases were treated in the outpatient and 140 cases under short general anesthesia with oto-microscopy.Conclusion: Intra-aural tick infestation is an acute painful condition which needs prompt management by an experienced otolaryngologist. Proper visualization and instrumentation is necessary to avoid complications.

Life-Cycle Assessment of Buildings

The chapter presents a complete overview of LCA applied to buildings. After a brief introduction on the origin and developments of the LCA, it describes four steps of the LCA methodology, according to the framework of the International standards of ISO 14040 series. Then, the authors focus on the LCA applied to the building sector and on the standard EN 15978. They identify the main issues related to the application of the methodology to buildings, such as the selection of the functional unit, the systems boundaries,the environmental indicators, etc. In the context of the sustainability, a brief overview on the economic and social aspects of buildings and on the available building life-cycle evaluation tools is given. The authors also discuss simplified approaches for LCA in construction and different relevant parameters of LCA of buildings, which can affect the final results. At the end, some examples of the sustainability assessment of new and retrofitted buildings are presente

Timing of Cholecystectomy After Moderate and Severe Acute Biliary Pancreatitis

IMPORTANCE Considering the lack of equipoise regarding the timing of cholecystectomy in patients with moderately severe and severe acute biliary pancreatitis (ABP), it is critical to assess this issue.OBJECTIVE To assess the outcomes of early cholecystectomy (EC) in patients with moderately severe and severe ABP.DESIGN, SETTINGS, AND PARTICIPANTS This cohort study retrospectively analyzed real-life data from the MANCTRA-1 (Compliance With Evidence-Based Clinical Guidelines in the Management of Acute Biliary Pancreatitis) data set, assessing 5304 consecutive patients hospitalized between January 1, 2019, and December 31, 2020, for ABP from 42 countries. A total of 3696 patients who were hospitalized for ABP and underwent cholecystectomy were included in the analysis; of these, 1202 underwent EC, defined as a cholecystectomy performed within 14 days of admission. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality and morbidity. Data analysis was performed from January to February 2023.MAIN OUTCOMES Mortality and morbidity after EC.RESULTS Of the 3696 patients (mean [SD] age, 58.5 [17.8] years; 1907 [51.5%] female) included in the analysis, 1202 (32.5%) underwent EC and 2494 (67.5%) underwent delayed cholecystectomy (DC). Overall, EC presented an increased risk of postoperative mortality (1.4% vs 0.1%, P <.001) and morbidity (7.7% vs 3.7%, P < .001) compared with DC. On the multivariable analysis, moderately severe and severe ABP were associated with increased mortality (odds ratio [OR], 361.46; 95% CI, 2.28-57 212.31; P = .02) and morbidity (OR, 2.64; 95% CI, 1.35-5.19; P = .005). In patients with moderately severe and severe ABP (n = 108), EC was associated with an increased risk of mortality (16 [15.6%] vs 0 [0%], P < .001), morbidity (30 [30.3%] vs 57 [5.5%], P < .001), bile leakage (2 [2.4%] vs 4 [0.4%], P = .02), and infections (12 [14.6%] vs 4 [0.4%], P < .001) compared with patients with mild ABP who underwent EC. In patients with moderately severe and severe ABP (n = 108), EC was associated with higher mortality (16 [15.6%] vs 2 [1.2%], P < .001), morbidity (30 [30.3%] vs 17 [10.3%], P < .001), and infections (12 [14.6%] vs 2 [1.3%], P < .001) compared with patients with moderately severe and severe ABP who underwent DC. On the multivariable analysis, the patient's age (OR, 1.12; 95% CI, 1.02-1.36; P = .03) and American Society of Anesthesiologists score (OR, 5.91; 95% CI, 1.06-32.78; P = .04) were associated with mortality; severe complications of ABP were associated with increased mortality (OR, 50.04; 95% CI, 2.37-1058.01; P = .01) and morbidity (OR, 33.64; 95% CI, 3.19-354.73; P = .003).CONCLUSIONS AND RELEVANCE This cohort study's findings suggest that EC should be considered carefully in patients with moderately severe and severe ABP, as it was associated with increased postoperative mortality and morbidity. However, older and more fragile patients manifesting severe complications related to ABP should most likely not be considered for EC