The Effects of Superior Laryngeal Nerve lesion on Swallowing Kinematics and Airway Protection

The superior laryngeal nerve (SLN) carries sensory information from the mucosal tissues of the pharynx superior to the vocal folds, and carries motor signals to the cricothyroid muscles. It also provides partial innervation to the thyroarytenoid and posterior cricoarytenoid muscles. Finally, the SLN initiates the swallow. When a food or liquid bolus is swallowed, the epiglottis and the false and true vocal folds work together to seal off the airway and allow the bolus to pass through the esophagus. If the SLN is damaged, it usually leads to dysphasia in which food or liquid enters the airway. We hypothesized that a lesion in the SLN would (1) cause an increase in liquid bolus entering the airway, and (2) the coordination between the soft palate, hyoid bone, thyroid cartilage, and epiglottis would be decreased. We surgically transected the right SLN in four 2- 3 week old infant pigs. Under anesthesia, radio-opaque markers were injected into the soft palate, or sutured into the tissues superficial to the hyoid bone and thyroid cartilage. A metal clip was placed onto the tip of the epiglottis to facilitate visualization. Videofluoroscopy was used to assess the airway protection. We digitized the markers to assess movement of the pharynx and larynx during swallows. We found that the unilateral lesion of the SLN did not significantly affect the airway safety. However, it appears that sensory deficits have a considerable impact on neuromuscular coordination. Without the sensory information, the brainstem sends poor, uncoordinated instructions to the muscles controlling the soft tissues of the pharynx.https://engagedscholarship.csuohio.edu/u_poster_2016/1020/thumbnail.jp

Supervised training of practical procedures in the internal medicine residency

In order to get feedback whether the medical residents are getting adequate supervised training to perform practical procedures, a questionnaire was distributed among the residents asking their involvement in sixteen frequently performed procedures in the medical unit of the Aga Khan University Medical Centre. Though the residents were satisfied about their training in doing lumbar punctures, pleural and peritoneal aspirations, bone marrow aspiration and trephine and chest tubes placement, they showed their concern about training in putting central lines, venous cut downs, cardiac pacing and biopsies. A better schedule training programme, organized subspecialty rotation, continuous evaluation of resident\u27s skill, credentialing procedures and willingness on the part of faculty to teach and residents to learn may improve the training

Cholera admissions in adults 1989-1994: a hospital based study

In order to gain insight into the distribution of cholera over the years and proportion of monthly admissions under our adult medical services, we scrutinized our records of hospital discharges between 1989 and 1994. Only culture positive cases were included. Each year most of the cases of cholera are admitted between May and November with almost disease free interval from December to April. In 1992 admission rate was 4.24/1000 medical admissions which increased to 12.65 in 1993 and 13.73 in 1994. Though the Vibrio cholerae 01 Ogawa was the major isolate upto May, 1993, Vibrio cholerae non-01 serogroup 0139 dominated between June and August, 1993. Ogawa strain re-established itself in October, 1993. In August, 1994, non-01 strain reappeared and became the major isolate in September. Cholera has caused multiple epidemics throughout the Indian subcontinent. Since 1800, there have been seven pandemics of cholera. The seventh pandemic originated in Indonesia and continues today

Antibiotic susceptibility patterns of Helicobacter pylori and triple therapy in a high-prevalence area

This study aims to determine primary Helicobacter pylori resistance and its effect on eradication of the organism. Ninety-two Patients with dyspeptic symptoms were enrolled. H. pylori was cultured and antibiotic sensitivity was determined by the Epsilometer test (Etest) for clarithromycin (CLR), amoxicillin (AMX) and metronidazole (MTR). 23S ribosomal RNA (rRNA) point mutations associated with clarithromycin resistance were also detected. Patients were treated with omeprazole (40 mg daily), CLR (500 mg) and AMX (1g twice a day) for 14 days. A (14)C-urea breath test ((14)C-UBT) was repeated four weeks after completion of treatment to confirm eradication. Triple therapy failure was seen in 30(33%) Patients. The resistance rates were: CLR 33% (30/92), MTR 48% (44192) and AMX (2/92). Clarithromycin resistance (CLR-R) was present in the 16-39 age group in 21 (47%) (P=0.007) compared to nine (19%)in the 40-79 age group. CLR resistance was seen in 30 H. pylori isolates, 20 (67%) from Patients with non-ulcer dyspepsia (NUD), six (20%) with gastric ulcer (GU) and four (13%) with duodenal ulcer (DU). Triple therapy failure was associated with CLR-R in 28 (93%) (

Hydrogen adsorption on sub-bituminous coal: Implications for hydrogen geo-storage

Hydrogen is a clean fuel that can potentially revolutionize the energy supply chain and decarbonize fuel consumption. However, a key hurdle that needs to be overcome before a full-scale hydrogen economy can be established is hydrogen storage which is currently the main limitation. Here, we propose that hydrogen gas can be stored in underground coal seams, where it adsorbs on the coal surface. However, currently, no hard data related to such a procedure exists. We, therefore, demonstrate experimentally that significant amounts of hydrogen gas can be stored via this route. Hydrogen adsorption capacities reached 0.6 moles H2/kg of coal at 14.3 MPa, and adsorption capacity initially increased strongly with pressure (up to ∼4 MPa) and then plateaued out, while temperature only had a very minor influence. This study provides fundamental data for hydrogen storage in coal seams, and thus aids in the industrial implementation of a hydrogen supply chain