Appearance of a double bubble in achalasia cardia: a case report

<p>Abstract</p> <p>Introduction</p> <p>Achalasia cardia is characterized by failure of the lower esophageal sphincter to relax in response to swallowing and by an absence of peristalsis in the esophageal body. Absence of a gastric air bubble is a well known radiological finding. Pneumatic balloon dilatation results in reappearance of the gastric bubble.</p> <p>Case presentation</p> <p>We report the case of a 43-year-old Indian man with achalasia cardia whose chest X-ray at the time of presentation showed an air bubble in the gastric region causing a diagnostic quandary. Successful dilatation of the lower esophageal sphincter resulted in the appearance of another air bubble in the gastric region. Proper analysis showed that the first bubble was actually a colonic air bubble of the splenic flexure and the appearance of the second bubble was the anticipated gastric air bubble.</p> <p>Conclusion</p> <p>In patients presenting with achalasia cardia, a colonic air bubble may be seen in the gastric region causing diagnostic difficulty. In these patients, a gastric air bubble may appear after pneumatic dilatation. At the end of the procedure, there will be two air bubbles ("double bubble"): a colonic and a gastric air bubble. To our knowledge, this finding has not been reported in the literature thus far.</p

Synthesis, C-13 NMR and anticonvulsant activity of new isatin-based spiroazetidinones

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Improving lentil (Lens culinaris) productivity and profitability through farmer participatory action research in India

Application of technology for on-farm productivity enhancement is the major intervention besides meeting the other requirements like input supply, marketing, biotic and abiotic stresses. Further, to what extent farmers are involved in technology delivery process is another dimension of technology application. Farmers may be either the passive receiver of any technology of information, or they be be the active partners in planning, implementing and evaluating the interventions. In the first phase of the study, documentation and characterization of lentil based cropping systems, variety use pattern and existing yield level; comparison of lentil (Lens culinaris Medik.) and non-lentil based cropping systems, constraint analysis and identification of need based and situation specific potential solutions were done. In the second phase of the study, the suggested solutions were translated and prioritized into meaningful interventions in the form of lentil variety demonstration; assessment of different technological components like weed management,fertilizer  management, irrigation management and disease management in integrated crop management (ICM) mode and implemented for two cropping seasons of 2010-11 to 2011-12. Action research was, therefore, conducted among 965 lentil growers (389 ha area) selected from 35 districts across four states of India during 2010-11 to 2011-12. Yield gap II (37.65 - 54.39%) was found more prominent than the research gap or yield gap I (15.0 - 22.5 %) in selected states. The states of Uttar Pradesh (716 kg/ha), Bihar (629 kg/ha), Madhya Pradesh (619 kg/ha) and West Bengal (604 kg/ha) showed higher yield gap in lentil. Distinct lentil based existing cropping system and very poor level of yields was observed (as low as 300 kg/ha in Madhya Pradesh to 932 kg/ha in some parts of Uttar Pradesh). Lentil based cropping systems (B: C ratio - 3.11-3.77) was economically efficient than non-lentil based cropping system (B:C ratio - 1.17 to 1.72). Assessment of improved lentil varieties and integrated crop management technologies resulted in higher gain both in yield (57.8%) and net return (87.8%), followed by improved variety (50.4% increase in yield and 82.2% higher net return) over the farmers' practices. Other technological components like weed management, fertilizer management, irrigation management and disease management contributed increase in yield (20-29%) and net returns (17-37%) over farmers' practices

Diversification of U.S. medical schools via affirmative action implementation

BACKGROUND: The diversification of medical school student and faculty bodies via race-conscious affirmative action policy is a societal and legal option for the U.S. Supreme Court has recently ruled its use constitutional. This paper investigates the implications of affirmative action, particularly race-conscious compared to race-blind admissions policy; explains how alternative programs are generally impractical; and provides a brief review of the history and legality of affirmative action in the United States. DISCUSSION: Selection based solely on academic qualifications such as GPA and MCAT scores does not achieve racial and ethnic diversity in medical school, nor does it adequately predict success as practicing physicians. However, race-conscious preference yields greater practice in underserved and often minority populations, furthers our biomedical research progression, augments health care for minority patients, and fosters an exceptional medical school environment where students are better able to serve an increasingly multicultural society. SUMMARY: The implementation of race-conscious affirmative action results in diversity in medicine. Such diversity has shown increased medical practice in underserved areas, thereby providing better health care for the American people