Inhaled budesonide versus oral prednisolone in the treatment of acute exacerbation of moderate bronchial asthma: an open label randomized clinical trial

Background: Recently published studies have suggested that inhaled corticosteroids may offer benefit over systemic steroids in bronchial asthma. This research was carried out to study the efficacy of inhaled budesonide and to compare the efficacy of inhaled budesonide with oral prednisolone in the treatment of acute moderate asthma in children.Methods: This was an open label randomized clinical trial. Children in the age group of 1-12 years with acute exacerbation of asthma presenting to pediatric emergency from November 1, 2015 to October 31, 2016 who fail to show prompt improvement after initial treatment with oxygenand three doses of inhaled salbutamol, were enrolled. Children in group B (n=35) and group P (n=35) received inhaled budesonide and oral prednisolone, respectively, in addition to oxygen inhalation and salbutamol as per the study protocol. Outcome was measured in terms of pulmonary score at the beginning, at 6 hours, and at 24 hours of starting the treatment. The analysis was undertaken according to intent to treat principle.Results: Baseline characteristics (sex, age, weight, height, body mass index) were comparable in the 2 groups. Mean heart rate, respiratory rate, pulmonary score at 6 and 24 hours, mean SpO2 at 24 hours were significantly showing normalizing trend (p<0.05) and mean hospital stay was significantly reduced [2.60 (±0.60) vs 3.11 (±0.80); p<0.05] in group B as compared to group P.Conclusions: Outcome measures of clinical improvement were better in inhaled budesonide group than oral prednisolone group in acute moderate exacerbation of bronchial asthma.

Risk factors for extrauterine growth restriction in preterm neonates: a prospective analytical cohort study

Background: Objective of the study was to determine the incidence and risk factors for extrauterine growth restriction (EUGR) at discharge in preterm neonates.Methods: This prospective analytical cohort study included 107 preterm neonates between 30-35 weeks of gestational age who were admitted to a tertiary neonatal intensive care unit from January 2016 to December 2016. These preterm neonates were classified into EUGR group (n=93) and non-EUGR group (n=14) based on the body weight at discharge. The risk factors for EUGR were analyzed statistically.Results: The incidence of EUGR at discharge was 87.4% in the cohort. Delay in initiation of parenteral nutrition (p=0.04), longer time to reach full enteral feeds (p=0.03), very low birth weight (p=0.01), small for gestational age (p=0.01), intrauterine growth restriction (p=0.01), necrotizing enterocolitis (p=0.03), late-onset sepsis (p=0.03) and bronchopulmonary dysplasia (p=0.04) were significant risk factors for extra-uterine growth restriction at discharge in preterm neonates.Conclusions: The incidence of EUGR can be decreased by improving perinatal care, minimizing preterm deliveries, early initiation of parenteral nutrition and enteral feeding and reducing immediate postnatal complications

A review of the blood transfusion practices in neuroanesthesia in the perioperative period in a tertiary care hospital

Background: Blood transfusion involves the administration of blood and blood components. Neurosurgical procedures are associated with significant blood loss with the need for blood transfusion in the preoperative, intraoperative and postoperative period to maintain optimal hemodynamic and cerebral oxygenation. Various neurosurgical procedures as traumatic brain injury, complex spinal surgeries, and endovascular neurosurgical procedures may need blood transfusions to maintain the optimal physiology.Methods: This study was performed prospectively at a tertiary care hospital in northern India with about a work load of 800 to 1000 elective neurosurgical surgical procedures being done per year. This data was collected prospectively over a period of one year from the patients being operated for elective neurosurgical procedures and later on shifted to the neurosurgical intensive care unit and the neurosurgical wards. The patients operated for emergency procedures for traumatic brain surgery were not included in the study.Results: A total of 455 elective neurosurgical procedures were done during the study period. Out of these 455 patients there were 95 patients who were in the paediatric age group with age less than 12 years. Out of 360 adult patients 85 patients were in need of blood transfusion which constituted 23.6 percent of the operated patients.   Out of these 85 patients 45 patients needed two transfusions in the form of whole blood or packed cells, 40 patients needed a single transfusion.42 units of fresh frozen plasma were transfused to 17 patients with 15 patients receiving platelet transfusions.Conclusions: In conclusion, neurosurgical population is associated with significant blood loss and a requirement of blood transfusion. About 47 percent of paediatric population needed blood transfusion in our study with around 24 percent of adult population. The transfusion requirement was mainly seen in patients with craniostenosis, meningiomas, cerebello pontine tumours and meningiomas

Breast Gangrene

<p>Abstract</p> <p>Background</p> <p>Breast gangrene is rare in surgical practice. Gangrene of breast can be idiopathic or secondary to some causative factor. Antibiotics and debridement are used for management. Acute inflammatory infiltrate, severe necrosis of breast tissue, necrotizing arteritis, and venous thrombosis is observed on histopathology. The aim of was to study patients who had breast gangrene.</p> <p>Methods</p> <p>A prospective study of 10 patients who had breast gangrene over a period of 6 years were analyzed</p> <p>Results</p> <p>All the patients in the study group were female. Total of 10 patients were encountered who had breast gangrene. Six patients presented with breast gangrene on the right breast whereas four had on left breast. Out of 10 patients, three had breast abscess after teeth bite followed by gangrene, one had iatrogenic trauma by needle aspiration of erythematous area of breast under septic conditions. Four had history of application of belladonna on cutaneous breast abscess and had then gangrene. All were lactating female. Amongst the rest two were elderly, one of which was a diabetic who had gangrene of breast and had no application of belladonna. All except one had debridement under cover of broad spectrum antibiotics. Three patients had grafting to cover the raw area.</p> <p>Conclusion</p> <p>Breast gangrene occurs rarely. Etiology is variable and mutifactorial. Teeth bite while lactation and the iatrogenic trauma by needle aspiration of breast abscess under unsterlised conditions could be causative. Uncontrolled diabetes can be one more causative factor for the breast gangrene. Belladonna application as a topical agent could be inciting factor. Sometimes gangrene of breast can be idiopathic. Treatment is antibiotics and debridement.</p

Effect of foliar application of nano-nutrients solution on growth and biochemical attributes of tomato (Solanum lycopersicum) under drought stress

IntroductionDrought stress has drastically hampered the growth and yield of many crops. Therefore, environmentally safe agricultural techniques are needed to mitigate drought stress impact. To this end, foliar spray of nano-nutrients solution to (NNS) alleviate harmful aspects of drought stress.MethodsIn a completely randomized design (CRD) experiment, seedlings were transplanted into pots at 2-3 leaf stage, each filled with loam-compost- organic manure soil (3:1:1). Plants were divided into two groups. (a) control group (b) applied stress group. Plants at vegetative stage were treated with 100% FC for control group and 60% FC for drought group, and these levels were maintained until harvesting. Three treatments of NNS with four levels i.e., 0%, 1%, 3% and 5% were given to all the pots after two weeks of drought stress treatment with a gap of 5 days at vegetative stage.Results and discussionApplication of 1% of nano-nutrient solution displayed an improvement in shoot length, shoot fresh and dry weight, number of leaves and flowers. Leaf chlorophylls and carotenoids and total phenolics contents were found maximum while minimum electrolyte leakage was observed at 3% application compared to control. Further, 1% application of NNS increased the Leaf RWC%, total soluble sugars, flavonoids contents. 5% NNS application exhibited higher total free amino acids with minimum lipid peroxidation rate in leaves of tomato under drought. Antioxidant enzyme activities increased in a concentration dependent manner as gradual increase was observed at 1%, 3% and 5%, respectively. Overall, this study introduced a new insights on using nano-nutrient solutions to maintain natural resources and ensure agricultural sustainabilit

Remaining idle time aware intelligent channel bonding schemes for cognitive radio sensor networks

Channel bonding (CB) is a technique used to provide larger bandwidth to users. It has been applied to various networks such as wireless local area networks, wireless sensor networks, cognitive radio networks, and cognitive radio sensor networks (CRSNs). The implementation of CB in CRSNs needs special attention as primary radio (PR) nodes traffic must be protected from any harmful interference by cognitive radio (CR) sensor nodes. On the other hand, CR sensor nodes need to communicate without interruption to meet their data rate requirements and conserve energy. If CR nodes perform frequent channel switching due to PR traffic then it will be difficult to meet their quality of service and data rate requirements. So, CR nodes need to select those channels which are stable. By stable, we mean those channels which having less PR activity or long remaining idle time and cause less harmful interference to PR nodes. In this paper, we propose two approaches remaining idle time aware intelligent channel bonding (RITCB) and remaining idle time aware intelligent channel bonding with interference prevention (RITCB-IP) for cognitive radio sensor networks which select stable channels for CB which have longest remaining idle time. We compare our approaches with four schemes such as primary radio user activity aware channel bonding scheme, sample width algorithm, cognitive radio network over white spaces and AGILE. Simulation results show that our proposed approaches RITCB and RITCB-IP decrease harmful interference and increases the life time of cognitive radio sensor nodes

Endoscopic ultrasound-guided fine-needle aspiration and Trucut biopsy in thoracic lesions: when tissue is the issue

Endoscopic ultrasound-guided fine-needle aspiration (EUS FNA) has a high accuracy in the evaluation of mediastinal lesions. The use of a core biopsy needle for EUS guided biopsy (EUS TCB) may further improve the yield of EUS. The aims of this study are to evaluate the safety of EUS TCB in thoracic lesions and to compare the diagnostic accuracy of TCB with FNA and FNA + TCB. A single-center retrospective study. All patients underwent EUS-FNA and TCB. A cytopathologist was not present during the procedure. EUS FNA, TCB and FNA + TCB diagnostic accuracy were compared. A total of 48 patients were included. The lesions sampled included 41 lymph nodes (six aorto-pulmonary window, 32 subcarinal, two right paratracheal, one paraesophageal ATS station 8), five lung masses, and two esophageal masses. Twenty-nine patients had malignant disease and 19 had benign disorders. The overall diagnostic accuracy of FNA, TCB and FNA + TCB was 79%, 79% and 98% respectively (p = 0.007). TCB changed the diagnosis in nine cases missed by FNA. EUS TCB was better than FNA for benign diseases (89% vs. 63%, p = 0.04). All eight patients with a prior failed biopsy had a correct diagnosis established by EUS. No patient required mediastinoscopy or thoracoscopy after EUS. The combination of TCB and FNA is superior to FNA alone. EUS-guided TCB should be considered in patients with benign disorders of the mediastinum when other modalities fail to yield a diagnosis