Management of a case of laryngotracheal esophageal cleft type III with review of literature

Badole et al. Laryngotracheal esophageal cleft 80 Key points Laryngotracheal esophageal cleft (LTEC) is a rare developmental disorder of upper airway which accounts for 0.3% to 0.5% of all congenital anomalies of the larynx. It demands high clinical judgment to diagnose the case as most of the times patient is erroneously diagnosed as tracheoesophageal fistula and recurrent esophageal intubation or slipping of endotacheal tube in the esophagus should arise suspicion of LTEC. It has ben divided into four types by Benjamin and Inglis and severity depends upon type. Type III and IV present with severe symptoms in the neonatal period. Knowledge of different approaches to secure and maintain airway and preparedness for the same in such a case is most important to prevent catastrophic events

Silicon alleviates PEG-induced osmotic stress in finger millet by regulating membrane damage, osmolytes, and antioxidant defense

Drought restricts plant growth and productivity. Silicon has beneficial effects on imparting drought tolerance in plants. Present work was intended to evaluate the effect of Si on polyethylene glycol-6000 (PEG) induced osmotic stress in local landraces of finger millet. The seeds of stress-tolerant and stress-sensitive landraces of finger millet were treated with distilled water, 15% PEG, and PEG+Si (5-25 ppm). The ameliorative effect of Si was evaluated in terms of percentage seed germination, seedling growth, accumulation of osmolyte and activity of antioxidative enzymes. PEG-induced osmotic stress reduced seed germination, seedling growth, and augmented osmolyte accumulation. It also elevated the levels of antioxidant enzymes. The exogenous supplementation of silicon significantly improved seed germination as well as early seeding growth. Positive effects of Si were reflected in decline in malondialdehyde (MDA) content and improved glycine betaine content and antioxidant enzymes in PEG-induced stress tolerant as well as susceptible landraces. The Si-induced ameliorated effects on all the parameters studied were more pronounced in the stress-tolerant landrace (FM/ST/01) than the stress-sensitive landrace (FM/RT/01). These results clearly indicate advantageous effects of Si in relieving PEG-induced stress during seed germination and early seeding growth and suggest a possibility of better stand establishment by application of silicon containing fertilizer during seed sowing

Longitudinal clinical, cognitive and biomarker profiles in dominantly inherited versus sporadic early-onset Alzheimer's disease

Approximately 5% of Alzheimer's disease cases have an early age at onset (<65 years), with 5-10% of these cases attributed to dominantly inherited mutations and the remainder considered as sporadic. The extent to which dominantly inherited and sporadic early-onset Alzheimer's disease overlap is unknown. In this study, we explored the clinical, cognitive and biomarker profiles of early-onset Alzheimer's disease, focusing on commonalities and distinctions between dominantly inherited and sporadic cases. Our analysis included 117 participants with dominantly inherited Alzheimer's disease enrolled in the Dominantly Inherited Alzheimer Network and 118 individuals with sporadic early-onset Alzheimer's disease enrolled at the University of California San Francisco Alzheimer's Disease Research Center. Baseline differences in clinical and biomarker profiles between both groups were compared using t-tests. Differences in the rates of decline were compared using linear mixed-effects models. Individuals with dominantly inherited Alzheimer's disease exhibited an earlier age-at-symptom onset compared with the sporadic group [43.4 (SD +/- 8.5) years versus 54.8 (SD +/- 5.0) years, respectively, P < 0.001]. Sporadic cases showed a higher frequency of atypical clinical presentations relative to dominantly inherited (56.8% versus 8.5%, respectively) and a higher frequency of APOE-epsilon 4 (50.0% versus 28.2%, P = 0.001). Compared with sporadic early onset, motor manifestations were higher in the dominantly inherited cohort [32.5% versus 16.9% at baseline (P = 0.006) and 46.1% versus 25.4% at last visit (P = 0.001)]. At baseline, the sporadic early-onset group performed worse on category fluency (P < 0.001), Trail Making Test Part B (P < 0.001) and digit span (P < 0.001). Longitudinally, both groups demonstrated similar rates of cognitive and functional decline in the early stages. After 10 years from symptom onset, dominantly inherited participants experienced a greater decline as measured by Clinical Dementia Rating Sum of Boxes [3.63 versus 1.82 points (P = 0.035)]. CSF amyloid beta-42 levels were comparable [244 (SD +/- 39.3) pg/ml dominantly inherited versus 296 (SD +/- 24.8) pg/ml sporadic early onset, P = 0.06]. CSF phosphorylated tau at threonine 181 levels were higher in the dominantly inherited Alzheimer's disease cohort (87.3 versus 59.7 pg/ml, P = 0.005), but no significant differences were found for t-tau levels (P = 0.35). In summary, sporadic and inherited Alzheimer's disease differed in baseline profiles;sporadic early onset is best distinguished from dominantly inherited by later age at onset, high frequency of atypical clinical presentations and worse executive performance at baseline. Despite these differences, shared pathways in longitudinal clinical decline and CSF biomarkers suggest potential common therapeutic targets for both populations, offering valuable insights for future research and clinical trial design

Anaesthetic management in Gorlin-Goltz syndrome

Gorlin-Goltz syndrome is a rare autosomal-dominant syndrome related to mutation in " Patched" tumour suppressor gene on chromosome 9. Basocellular carcinomas, odontogenic keratocysts, palmar and/or plantar pits and ectopic calcifications of the falx cerebri are its major features, along with more than 100 minor features. Odontogenic cysts, notorious for recurrence, can make endotracheal intubation difficult, requiring modification of the standard intubation technique. We report such a case managed successfully by awake fibreoptic intubation. Direct laryngoscopy under anaesthesia later confirmed that it was a good decision

Use of ultrasound to diagnose pneumothorax after video assisted thoracic surgery: Do we need to acquire a new skill?

Diagnosis of a pneumothorax in the immediate post-operative area can be difficult. Traditional gold-standard modalities may not be available or feasible to institute. Ultrasound (US) guidance allows the anesthesia provider a method of quickly detecting this potentially life-threatening complication especially when it′s least expected. We encountered such a case when a 40 years male patient posted for video assisted thoracic surgery for drainage of empyema on left side of chest developed pneumothorax on right side post-operatively. Timely diagnosis with the help of US saved time and his life. We thus want to emphasize the importance of this simple but useful skill to the anesthesiologist