Correlation between correctly sized uncuffed endotracheal tube and ultrasonographically determined subglottic diameter in pediatric population

Background: The size of the airway varies greatly in pediatric patients, making it difficult to predict an appropriate size Endotracheal tube (ETT) for securing the airway. Several formulae are used to predict approximate ETT size. With the wider availability of ultrasonography (USG), many clinicians have suggested it as a useful tool for airway management and have used USG to measure tracheal dimensions in adults and children. Aims and Objectives: The primary aim of this study was to evaluate the usefulness of USG for the selection of correct sized uncuffed ETT in pediatric patients and the secondary aim was to correlate the age-based formula with ultrasound measured subglottic diameter for predicting the size of ETT. Materials and Methods: A total of 64 patients of either gender in the age group of 2–6 years were enrolled in the study. Standard anesthetic induction was done and transverse subglottic diameter was measured using USG. The minimal transverse subglottic diameter was measured and noted and the patient was intubated with the tube size as determined by modified Cole’s age-based formula. Results: Out of 64 patients, 33 were male and 31 female. Average age was 3.9 (±1.47) years, 42.2% belonged to the age group of (2–3) years, average weight of the patients was 20.3 (±10.45) kg. The mean ETT outer diameters (OD) based on age-based formula was 6.81 mm compared to 6.91 mm and 6.78 mm by USG based and actual ETT OD, respectively. Both the age based ETT OD and USG-based ETT OD showed good correlation with actual ETT OD used with r-value of 0.891 and 0.876, respectively. Conclusion: Although USG is a non-invasive, cost-effective, and reproducible technique its routine use for estimating ETT size in pediatric patients could not be justified over age-based formula as both of them have comparable results (statistically insignificant). The success rate of age-based formula and USG in precisely predicting ETT outer diameter is comparable with the size of actual ETT outer diameter (78% vs. 75%, P=0.86)

Tanqiya wa Tadeel (Evacuation and Rejuvenation): The Unani Concept as Evolutionary Basis for Conventional Stroke Management

The treatment of stroke has always been a challenge for all systems of medicine. The modern medicine has substantially been capable to treat and control both, the haemorrhagic and ischemic strokes in emergency situations. The current approach of modern medicine relies on thrombolysis, antithrombosis, neuroprotection and rehabilitation. While the former two approaches yield significant mortality and morbidity reduction with available thrombolytic and antithrombotic agents but the latter two approaches have limited success with prevalent neuroprotective agents and physical therapy. While the Unani medicine approach in treatment of stroke strongly resemble to that of modern medicine, the action of thrombolysis and antithrombosis exerted by Unani drugs; however, remains undesirably slow in acute stroke and may lead to relatively extended damage to brain tissues in comparison to significantly effective control achieved by modern medicine. The latter part of stroke recovery in the form of rehabilitation remains tardy with available modern approaches, however, several studies done in stroke rehabilitation, following the principle of Tanqia and Tadeel of Unani medicine, have shown promising results in relatively rapid recovery from various post stroke disabilities. Unani drugs used in various dosage forms under the rubric of tanqia and tadeel possess antioxidant, anti-inflammatory, analgesic and neuroprotective properties represented by Muhallil (Resolvent), Mulattif (Demulcent), Munaqqie Dimagh (Brain Cleanser), Mufatteh Sudad (Deobstruent), Muhallile Auram (Anti-inflammatory) and Jali (Cleanser) terminologies, used for drug actions in Unani medicine. The explicable reason of early recovery during rehabilitation appears to be the rapid improvement in neuroplasticity of brain exerted by various active constituents of Unani drugs used in various combinations and permutations in different dosage forms. The term tanqia stands for evacuation of morbid material and tadeel for rejuvenation. The principle of tanqia and tadeel of Unani medicine offers all therapeutic approaches for various forms and stages of stroke and therefore provides theoretical and practical bases for the evolution of modern medical approaches in stroke management. Keywords: Falij; Istefragh; Munzij; Mushil; Nuz

Understanding the concept of Purgation (Ishal) in Unani Medicine: A Review

The theory of humours (akhlat) is one of the fundamental pillars of the Unani System of Medicine (USM). The concept of health and disease depends on the quality (kaifiyat) and quantity (kammiyat) of humour (khilt). Health (sehat) lasts when humours remain in equilibrium and the main determinant of health is the balance in six essential factors (asbab-e-sittah zarooriya). These factors are highly modifiable and deviation in any of them leads to disequilibrium in humours either qualitatively or quantitatively which ultimately manifests in the form of the disease. Elimination (istifragh) of these morbid humours from the body becomes mandatory to treat the diseases or to restore health. One of the effective methods of elimination is purgation (ishal). It is a method by which morbid humours from the body are eliminated through the anal route. Before the elimination of any pathological humour especially in chronic diseases, it is mandatory to make the humour easily eliminable. This process of making the pathological humour eliminable is known as concoction (nuzj). The process of concoction is a regular and continuous process of the tabiyat (mediatrix naturae) of the body. In case of a minor deviation in humour, tabiyat itself eliminates it from the body after concoction. When the causative pathological humours are in abundance or grossly deviated from normalcy, tabiyat needs help from outside the body. This help of tabiyat can be done with some humour specific drugs which are known as concoctive medicines (munzij advia). Once, the humours become eliminable, the process of evacuation can be started. Classical Unani literature and published papers were explored to find the rationale of purgation therapy. Purgation is found to be advisable in the treatment of many chronic diseases. Tabiyat is the ultimate healer in the body and purgation helps it to overcome the diseases. Keywords: Istifragh; Munzij; Nuzj; Akhlat; Humours; Concoctio

The role of social networks in an imperfect market for agricultural technology products: Evidence on Bt cotton adoption in Pakistan

Social networks play an important role in generating learning externalities that can drive the diffusion of innovative, and potentially poverty-reducing, technologies. This is particularly the case in developing countries where rural education, extension, and agricultural information services are underprovided. The recent introduction of genetically modified insect-resistant Bt (Bacillus thuringiensis) cotton in Pakistan represents an example where imperfect markets, weak extension services, and information asymmetries limit the ability of farmers to make informed decisions on how to take best advantage of the technology. This study explores the role of social networks and learning externalities in the adoption of Bt cotton in Pakistan. We model how information from social network members influences farmers’ adoption decisions, controlling for farmers’ characteristics, cotton growing conditions, and other possible information sources. We apply our model to a representative sample of 728 cotton-growing households randomly selected in 2012-13 from 52 villages across Punjab and Sindh. We also assess the role of input dealers, progressive farmers, public extension agents, and farmers’ individual characteristics in the uptake of the technology. Results suggest that communication within social networks helps disseminate information about Bt cotton cultivation and has encouraged its adoption

Information efficiency in a lemons market: Evidence from Bt cotton seed market in Pakistan

Efficient information exchanges between sellers and buyers are essential if prices are to act as a signal for resource allocation in an economy. In the case of seed and planting materials, information on quality traits are often difficult for consumers (farmers) to obtain prior to purchase, resulting in failures in the market for seed-based technologies. While regulations on seed certification, labeling and packaging seek to remedy this problem, such regulations are often difficult to enforce where markets are large and diverse, or where the government’s regulatory infrastructure is limited. The market for genetically modified insect-resistant Bt (bacillus thuringiensis) cotton seed in Pakistan appears to be one of these markets. In this paper, we test for the presence of asymmetric information in the seed market by comparing the quality of seed purchased across a representative sample of cotton farmers in Pakistan’s two main cotton-growing provinces. We also test for the extent to which seed prices reflect the efficacy of the insect-resistance traits—a quality trait that is generally unobservable by the farmer—as measured by ELISA (enzyme-linked immunosorbent assay) readings of the Bt toxin expression levels. Drawing on initial results from these tests, we then explore the various regulatory mechanisms and market instruments that can be used to help farmers to better infer Bt seed quality

Evidence-Based Therapeutic Benefits of Cupping Therapy (Ḥijāma): A Comprehensive Review

Ilaj bi’l tadbeer (regimenal therapy) is one of the preferred treatment methods used in Unani system of medicine since ancient times. Ḥijāma is one of the effective modalities of treatment in Ilaj bi’l tadbeer. It is a unique therapeutic procedure in which cup like vessels are placed on the body surface by creating a vacuum to either let out blood from below the skin surface or just plain suction without bloodletting. The objective of this comprehensive review paper is to address the claims of Unāni physicians and clinical studies conducted on the efficacy of Ḥijāma. Various published clinical trials showed the efficacy of Ḥijāma in the management of a number of diseases. Though, the effect showed by some clinical trials was short term. Hence, it is suggested that rigorous, well-designed, controlled, randomized and long duration follow up clinical trials on large sample size are to be conducted by trained clinicians or researchers to establish the efficacy of Ḥijāma in the management of various diseases. Keywords: Ilaj bi’l tadbeer, Ḥijāma, Therapeutic Benefit

<i>Aloe barbadensis</i> Based Bioactive Edible Film Improved Lipid Stability and Microbial Quality of the Cheese

An attempt was made to develop a bioactive edible film using carrageenan and A. vera gel for enhancing the storage quality of cheese using kalari, a popular Himalayan cheese, as a food-model system. The film was evaluated for various physicomechanical and oxidative properties (ABTS (2,2-azino-bis (3-ethylbenzothiazoline-6-sulfonate)) and DPPH (1,1-diphenyl-2-picrylhydrazyl) radical scavenging activities, total flavonoid and phenolic contents). Based on preliminary trials, 1% A. vera gel was found to be optimum. The addition of the gel resulted in a significant decrease in moisture content, transparency, solubility, and water-vapor transmission rate and increased the thickness and density of the film. The film showed antimicrobial properties against E. coli and significantly (p < 0.05) decreased the lipid-oxidation (thiobarbituric acid reactive substances, free-fatty acids, and peroxide values) and increased microbial-quality (total-plate, psychrophilic, and yeast/molds) of the samples during 4-week refrigerated storage (4 ± 1 °C). The film also exhibited a significant positive impact on the sensory quality of the cheese, indicating the potential for commercial applications for quality control of cheese during storage

Effectiveness of Terminalia bellerica based bioactive edible film in controlling the microbial growth and lipid oxidation of cheese during storage

A novel bioactive film was developed using Terminalia bellerica as a bioactive ingredient for improved lipid-oxidative stability and microbial quality of cheese using kalari, a Himalayan cheese, as a food-model system. The carrageenan-based film with optimum characteristics was developed using 0.5% T. bellerica extract and characterized for various physicochemical and oxidative properties. The cheese samples were packaged within the films (T1 = control film, T2 = film containing 0.5% T. bellerica) and stored for four weeks at 4±1°C along with control samples. The addition of T. bellerica significantly increased the thickness and density and decreased the moisture content, transparency, solubility and water-vapour transmission rate of the film. It also increased (P<0.05) the antioxidant potential (total-phenolic and flavonoid contents, DPPH and ABTS radical scavenging activities) of the film. A significant impact of the film was observed on lipid stability and microbiological quality and the samples stored within the T2 film showed significantly lower values for thiobarbituric acid reactive substances, free-fatty acids, peroxide values and microbial counts on days 14 and 28. The T2 film showed a significant positive effect on the sensory quality of the stored product indicating the potential of the film for controlling the quality loss during storage