Colorectal Foreign Body: A Case Report

Background:Emergency surgeons seldom encounter cases of foreign body ingestion/insertion. Both children and adults may present with ingestion or insertion of foreign body inside body cavitiesCase presentation: Two foreign nationals were brought by customs officer to emergency department with alleged history of insertion of cocaine packets through anus.Any subjects that caused omission from patients were admitted and rectal examinations were carried out. Rectum was filled with cocaine capsules which were retrieved manually as far as we could reach.Conclusion: It is likely that the use of various objects for anal eroticism is increasing, resulting in an increased incidence of retained rectal foreign bodies.Copyright©2012 Department of Forensic Medicine and Toxicology. Allrights reserved.

Tea Cup in the brain, a rare case of penetrating brain injury in pediatric patient

Head injuries are very common in children. All over the world, the most common mechanism is fall. These injuries are more prevalent in developing countries due to lack of education, poverty, lack of standard and scientific ways to child upbringing. Penetrating injuries in pediatric patients is extremely uncommon and usually occur due to sharp objects like knife, screw driver, drills, nails. We are reporting a rare case of a child with penetrating head injury due to tea cup, very commonly used crockery in every house hold. To the best of our knowledge, no similar case has ever been reported in world literature. Our case also emphasized the need for educating people about child care

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

Evaluation of antidepressant and analgesic activity of tapentadol with mirtazapine: an experimental study

Background: Data comparing tapentadol with an antidepressant is limited. A comparison of tapentadol with mirtazapine at different dose has not been performed, the other antidepressant in the same therapeutic class with a significant market share, has been undertaken. In the absence of relevant data to assess the place that tapentadol should occupy in the therapeutic arsenal, indirect comparisons are the most rigorous way to go. We conducted a study evaluate antidepressant and analgesic activity of tapentadol with mirtazapine at different doses in Swiss albino mice.Methods: Tapentadol was administered at 10, 20 and 40 mg/kg (i.p) once daily for 14 days to swiss albino mice of either sex. The immobility period for antidepressant activity of mice were recorded in forced swim test and reaction time for analgesic activity of mice were recorded in tail flick test of the control and drug treated group. The antidepressant and analgesic activity of tapentadol (10, 20, 40 mg/kg i.p) was compared with that of mirtazapine (3, 5, 7 mg/kg i.p), administered for 14 days.Results: Tapentadol produced better antidepressant at (20, 40 mg/kg), but less at 10 mg/kg and significant analgesic activity at all the three doses, as indicated by reduction in immobility times and increase in reaction time as compared to control. Mirtazapine produced no antinociceptive activity at 3 mg/kg, but significant at 5, 7 mg/kg and showed better antidepressant activity at all the three doses in mice. The result of this study indicates the better analgesic activity of tapentadol at all the doses and least antidepressant activity at 10 mg/kg, as compared to mirtazapine which has shown better antidepressant activity at all the three doses but no analgesic activity at 3 mg/kg.Conclusion: It can be concluded that tapentadol is a better drug in case of depression associated with pain compared to mirtazapine in mice

Dating protracted fault activities: microstructures, microchemistry and geochronology of the Vaikrita Thrust, Main Central Thrust zone, Garhwal Himalaya, NW India

The timing of shearing along the Vaikrita Thrust, the structurally upper boundary of the Main Central Thrust zone (MCTz), was constrained by combined microstructural, microchemical and geochronological investigations. Three different biotite-muscovite growth and recrystallisation episodes were observed: a relict mica-1; mica-2 along the main mylonitic foliation; mica-3 in coronitic structures around garnet during its breakdown. Analyses of biotite by electron microprobe show chloritization, and bimodal composition of biotite- 2 in one sample. Muscovite-2 and muscovite-3 differ in composition from each other. Biotite and muscovite 39Ar-40Ar age spectra from all samples give both inter-sample and intra- sample discrepancies. Biotite step ages range between 8.6 and 16 Ma, muscovite step ages between 3.6 and 7.8 Ma. These ages cannot be interpreted as "cooling ages", as samples from the same outcrop cooled simultaneously. Instead, Ar systematics reflect sample-specific recrystallisation markers. Intergrown impurities were diagnosed by Ca/K ratios. Age data of biotite were interpreted as a mixture of true biotite-2 (9.00±0.10 Ma) and two alteration products. The negative Cl/K-age correlation identifies a Cl-poor muscovite-2 (>7 Ma) and a Cl-rich, post-deformational, coronitic muscovite-3 grown at ≤5.88±0.03 Ma. The Vaikrita Thrust was active at least from 9 to 6 Ma around 600 °C; its movement ceased by 6 Ma

Why does currency denomination in external liabilities of small island developing states matter? Evidence from Fiji

The valuation effects on international investment position induced by the exchange rate volatility are not uniform or easily manageable in small and vulnerable economies when compared with larger developing or developed countries. To investigate the underlying dynamics, we developed a foreign currency exposure index over the period 2006–2019. The positive reading of the index suggests that though Fiji has a high net negative international investment position (90% of its GDP), it does not pose any serious risk. To ascertain determinants of Fijiʼs exposure index, we applied fully modified ordinary least square and autoregressive distributed lag bounds test. We have compared both estimates for consistency. Our findings suggest that the underlying determinants of Fijiʼs currency exposure are foreign debt, trade openness and exchange rate. This article bridges the gap in the literature on currency exposure risks in small island developing states and is the first study of its kind for the Pacific region

Early detection of influenza outbreaks using the DC Department of Health's syndromic surveillance system

<p>Abstract</p> <p>Background</p> <p>Since 2001, the District of Columbia Department of Health has been using an emergency room syndromic surveillance system to identify possible disease outbreaks. Data are received from a number of local hospital emergency rooms and analyzed daily using a variety of statistical detection algorithms. The aims of this paper are to characterize the performance of these statistical detection algorithms in rigorous yet practical terms in order to identify the optimal parameters for each and to compare the ability of two syndrome definition criteria and data from a children's hospital versus vs. other hospitals to determine the onset of seasonal influenza.</p> <p>Methods</p> <p>We first used a fine-tuning approach to improve the sensitivity of each algorithm to detecting simulated outbreaks and to identifying previously known outbreaks. Subsequently, using the fine-tuned algorithms, we examined (i) the ability of unspecified infection and respiratory syndrome categories to detect the start of the flu season and (ii) how well data from Children's National Medical Center (CNMC) did versus all the other hospitals when using unspecified infection, respiratory, and both categories together.</p> <p>Results</p> <p>Simulation studies using the data showed that over a range of situations, the multivariate CUSUM algorithm performed more effectively than the other algorithms tested. In addition, the parameters that yielded optimal performance varied for each algorithm, especially with the number of cases in the data stream. In terms of detecting the onset of seasonal influenza, only "unspecified infection," especially the counts from CNMC, clearly delineated influenza outbreaks out of the eight available syndromic classifications. In three of five years, CNMC consistently flags earlier (from 2 days up to 2 weeks earlier) than a multivariate analysis of all other DC hospitals.</p> <p>Conclusions</p> <p>When practitioners apply statistical detection algorithms to their own data, fine tuning of parameters is necessary to improve overall sensitivity. With fined tuned algorithms, our results suggest that emergency room based syndromic surveillance focusing on unspecified infection cases in children is an effective way to determine the beginning of the influenza outbreak and could serve as a trigger for more intensive surveillance efforts and initiate infection control measures in the community.</p