Foreign body aspiration masquerading respiratory tract infection

Foreign body (FB) aspiration is a potentially life threatening event where prompt and precise action can turn tears into smiles. We report a case of an eight-year school going boy, with one-month old history of foreign body aspiration. The boy was treated as a case of respiratory tract infection. It was due to reappearance of symptoms and signs of chest infection supported by chest radiography that prompted for the CT-chest. It was followed by rigid bronchoscopy to confirm the therapeutic diagnosis of FB aspiration. This case report highlights the importance of detailed thoughtful history in pediatrics particularly to FB aspiration

Population Dynamics of Genus Keratella in Dal Lake, Kashmir

Rotifera as a groups as well as a particular rotifer species are able to inhabit a variety of environments and are known to be mostly typically littoral forms. Rotifers are sensitive to changes in water quality through eutrophication process and play an important role in trophic dynamics of lake ecosystems. The community structure of rotifers within shallow and macrophyte dominated lakes is affected by a number of environmental factors. The valley of Kashmir is endowed with a unique geographical position. The valley is famous for its lakes, crystal clear tarns, mountains, snow and spring fed meadows and alpine forests. Kashmir is unique in India in having numerous lakes which grade from oligotrophic (Marsar, Vishensar, Sheshnag, Kishensar, Alpather, Kounsarnag etc), mesotrophic (Mansbal, Nilnag etc) and eutrophic (Dal, Anchar etc).The Dal lake is the second largest lake of Kashmir covering an area of about 11.56 sq km. The lake is surrounded by Zabarwan hills on three sides. It is a shallow open drainage type water body divided into five basins- Hazratbal basin, Gagribal basin, Nishat basin, Nigeen basin and Brarinambal basin. For the present study five sites were selected in different basin of the lake and each site represents ecologicaly different habitats in the lake. Site 1 was located near Telbal Nallah, Site 2 in Hazratbal basin, Site 3 in Nigeen basin, Site 4 near Centaur hotel in Nishat basin and Site 5 in Brarinambal basin. Water samples were collected for different physical, chemical and biological parameters on monthly basis form Jan. 2011 to Dec. 2011. Standard methods proposed by Welch (1984), APHA (1995), Mackereth et al. (1978) were employed for determination of physico-chemical parameters. Indentification of different zooplankton species was done with the help of standard taxonomic works by Edmondson (1959) and Pennak (1978).The Dal lake is in a state of stress and as a result ecological conditions have undergone tremendous changes. The present study was undertaken to study the population dynamics of rotifera with special reference to genus Keratella, other zooplankton associations and physic-chemical environment. Keratella is an important genus of eurotatorian rotifers. Different species of genus Keratella can be distinguished on the basis of spination and sculpture of dorsal plate. In the present study only two species of Keratella were recorded i.e. keratella cochlearis and Keratella quadrata. Keratella cochlearis was the dominant one among two species. Water temperature in the lake fluctuated from 3.5oC to 26oC and a close relationship was recorded between water temperature and air temperature. Transparency fluctuated form site to site and least transparency was found in Brarinambal. The lake was alkaline throughout the year as pH always remained above 7.0. Conductivity value ranged from 163μs/cm to 810μs/cm. Dissolved oxygen ranged from 0.8mg/l to 9.8m/l. Lower values were recorded during summer and higher during winter. Chloride concentration ranged from 11.9mg/l to 71.3mg/l. Total alkalinity ranged from 94.8mg/l to 360.9mg/l. No definite trend was recorded in ammonical nitrogen concentration throughout study period. The concentration of nitrate ranged from 72.1mg/l to 925.2mg/l. Nitrite nitrogen was present in low concentration. Increase in total phosphorous concentration indicates that lake is eutropic in nature and Brarinambal basin is in its advanced hypereutrophic stage. During present study a total of 42 other species of zooplankton were recorded of which 20 belonged to rotifera, 18 to cladocera and 4 to copepoda. On the basis of physico-chemical and biological features Brarinambal basin stands quite different from other basins in most of its limnolgical features

Gabapentin Toxicity and Role of Dialysis; Case Series and Literature Review

Gabapentin is frequently used as an analgesic in patients with chronic kidney disease (CKD). It is excreted exclusively through kidney, and therefore impairment in kidney function could lead to gabapentin accumulation and hence toxicity. We present our experience of 3 cases with Gabapentin toxicity who were managed according to the severity of symptoms. Case 1: A 32-year-old male was found lying unconscious after consuming around 12,000 mg of gabapentin and had respiratory depression, rhabdomyolysis, and acute kidney injury (AKI). Patient was managed with supportive care and hemodialysis (HD). Case 2: A 64-year-old male CKD Stage 5 (5D) patient with diabetic neuropathy was started on gabapentin 300 mg daily by his primary care physician 1 week back. Patient started to feel sleepy and developed altered sensorium and myoclonus. Discontinuation of gabapentin and a session of HD led to dramatic improvement in patient’s status. Case 3: A 70-year-old female diabetic patient with CKD Stage 3 and had diabetic neuropathy. Her neuropathic symptoms had improved with gabapentin 300 mg twice daily, but lately patient was feeling sleepy during the day and was confused. Discontinuation of the drug led to improvement in symptoms. Gabapentin is a relatively safe medication, but in certain clinical scenarios, particularly in impaired renal functions, can lead to severe complications. Moreover, it per se can rarely lead to rhabdomyolysis and AKI. Clinical suspicion and timely decontamination are needed, and sometimes dialytic therapy may be needed

Inflammatory Duodenal Polyposis Associated with Primary Immunodeficiency Disease: A Novel Case Report

Agammaglobulinemia is a rare form of B-cell primary immunodeficiency disease characterized by reduced levels of IgG, IgA, or IgM and recurrent bacterial infections. Agammaglobulinemia is most commonly associated with diffuse nodular lymphoid hyperplasia. Duodenal polyps are a rare entity; however, due to wide use of esophagogastroduodenoscopy, incidental diagnosis of duodenal polyps appears to be increasing. Although inflammatory duodenal polyposis has been reported in the literature, its association with common variable immunodeficiency has not been reported till date to the best of our knowledge. We report a case of a 59-year-old male with chronic symptoms of agammaglobulinemia associated with inflammatory duodenal polyposis

Genomic Determinants and Antimicrobial Resistance Pattern of Clinical Isolates of Extended Spectrum Beta Lactamase (ESBL) Producing Escherichia coli

The growing prevalence of antibiotic-resistant bacteria is a worldwide public health apprehension, and Escherichia coli (E. coli) is one of the most commonly implicated bacterial species. Among E. coli isolates, extended-spectrum β-lactamase (ESBL)-producing strains have been identified as a key contributor to antibiotic resistance. Penicillin’s, cephalosporins, and monobactams are only a few of the β-lactam antibiotics that can be rendered inactive by ESBLs. This investigation’s goals were to determine the prevalence of ESBL-producing E. coli isolates found in clinical samples and to analyze the distribution of the blaTEM, blaSHV, and blaCTX-M genes among them. Additionally, we aimed to determine the antibiotic susceptibility patterns of these isolates to other antibiotics. Clinical isolates from urine, ear swab, and wound/pus swabs were collected from patients with suspected E. coli bacterial infections from different regions of north India viz., SKIMS-JVC medical college and NABL accredited Dr. Qadri’s Lab both from Srinagar Kashmir valley region and SMSR, SU from Greater Noida UP. Standard laboratory techniques were used to identify E. coli isolates, and the combined disc method and other phenotypic confirmation techniques were used to confirm ESBL formation. PCR amplification and sequencing were used to find the blaTEM, blaSHV, and blaCTX-M genes. The Kirby-Bauer disc diffusion method was used to test the antimicrobial susceptibility of various bacteria to different antibiotics. A total of 210 E. coli isolates were collected from different clinical samples and only 158 isolates showed positive results for ESBL by DDST and phenotypic confirmatory tests. Of these, 124 (78.48%) were ESBL-producing isolates. We found that blaTEM was the most prevalent gene (45.16%), followed by blaCTX-M (34.16%) and blaSHV (12.09%). Antimicrobial resistance profiles were assessed for each of the 120 isolates. Ampicillin and Cefepime were the most resistant drugs to ESBL-producing isolates, followed by Gentamicin, Ceftriaxone, and Cefixime

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Data from: A new hybodont shark (Chondrichthyes, Elasmobranchii) from the Upper Triassic Tiki Formation of India with remarks on its dental histology and biostratigraphy

A new lonchidiid genus, Pristrisodus, from the Upper Triassic Tiki Formation of India is described based on multiple, well-preserved, isolated teeth. Comparative analysis resulted in synonymizing Parvodus tikiensis and Lissodus duffini, which are known from the same horizon and resulted in a new taxon, Pristrisodus tikiensis n. comb. These teeth are elongated with mesiodistal length greater than or equal to twice the labiolingual width and have a high principal cusp, lateral cusplets, a distinct ridge near the crown-root junction labially and higher up on the crown lingually, weak ornamentation, and linear depression along the crown-root junction. Five morphotypes based on overall shape, robustness and crown height are determined. The teeth show a gradual monognathic heterodonty. The anterolateral teeth (morphotypes I−II) have high, pyramidal principal cusp with two or three small but pointed cusplets, and triangular labial and lingual protuberance. The posterolateral teeth (morphotypes III−IV) have four incipient cusplets, relatively low principal cusp, bilobed/rounded, hanging labial and incipient lingual protuberances. Morphotype V comprises anterior teeth that are broad, triangular and robust, and have rounded/blunt principal cusp, one cusplet, and low, hanging labial peg. Multivariate analyses corroborate the qualitative assessment of the Indian hybodonts. Dental histology of Pristrisodus n. gen., shows that it is distinctly different from other lonchidiid genera. The assemblage of freshwater sharks, along with other vertebrate microfossils of the Tiki Formation, shows similarity with that of the lower Tecovas Formation of the Chinle Group, USA. The euryhaline nature resulted in the adaptation of the hybodonts to freshwater systems in India during the Carnian

Data from: A new hybodont shark (Chondrichthyes, Elasmobranchii) from the Upper Triassic Tiki Formation of India with remarks on its dental histology and biostratigraphy

A new lonchidiid genus, Pristrisodus, from the Upper Triassic Tiki Formation of India is described based on multiple, well-preserved, isolated teeth. Comparative analysis resulted in synonymizing Parvodus tikiensis and Lissodus duffini, which are known from the same horizon and resulted in a new taxon, Pristrisodus tikiensis n. comb. These teeth are elongated with mesiodistal length greater than or equal to twice the labiolingual width and have a high principal cusp, lateral cusplets, a distinct ridge near the crown-root junction labially and higher up on the crown lingually, weak ornamentation, and linear depression along the crown-root junction. Five morphotypes based on overall shape, robustness and crown height are determined. The teeth show a gradual monognathic heterodonty. The anterolateral teeth (morphotypes I−II) have high, pyramidal principal cusp with two or three small but pointed cusplets, and triangular labial and lingual protuberance. The posterolateral teeth (morphotypes III−IV) have four incipient cusplets, relatively low principal cusp, bilobed/rounded, hanging labial and incipient lingual protuberances. Morphotype V comprises anterior teeth that are broad, triangular and robust, and have rounded/blunt principal cusp, one cusplet, and low, hanging labial peg. Multivariate analyses corroborate the qualitative assessment of the Indian hybodonts. Dental histology of Pristrisodus n. gen., shows that it is distinctly different from other lonchidiid genera. The assemblage of freshwater sharks, along with other vertebrate microfossils of the Tiki Formation, shows similarity with that of the lower Tecovas Formation of the Chinle Group, USA. The euryhaline nature resulted in the adaptation of the hybodonts to freshwater systems in India during the Carnian

Rakshit et al._Appendix 1_R1

Appendix 1. Tikicopros triassicus igen et isp. nov. Details of the scroll coprolites collected from the Upper Triassic Tiki Formation of India. Colour code follows The Rock Color Chart Committee (1980). Abbreviations used: H, holotype; L, length measured along longitudinal axis; WL, maximum width measured along long axis in transverse section; WS, maximum width measured along short axis in transverse section. Explanation of abbreviations used given in Fig. 3A