Evaluation of four supraglottic devices used by paramedical staff for securing airway in simulated emergency airway management

Background

Prehospital emergency airway management challenges every paramedic. Emergencies evacuated from difficult areas by armed forces need airway maintenance throughout evacuation. Effective use of supraglottic airway (SGA) devices during prehospital transfer is life saving. This study compared use of four commonly available SGAs by Armed Forces paramedics in simulated emergency situations.

Methods

This prospective observational study conducted in a tertiary care institution, included 58 volunteer paramedics. They were trained on manikins before the study in basic airway skills and insertion of the four SGA devices under study viz. Classic laryngeal mask airway (cLMA), laryngeal tube (LT), I-gel, and Combitube. SGA device insertions were performed on 474 patients scheduled for short elective surgical procedures under general anesthesia. All volunteers inserted and assessed the four SGA devices equal number of times in different patients. Overall success rate, time for successful insertion, first attempt success rate, number of attempts for successful insertion, oro-pharyngeal leak pressures, ease of insertion, durability of device, and complications were recorded.

Results

Differences among the four groups were statistically significant in all parameters. Intergroup comparison revealed that both I-gel and LT were comparable to each other, however superior to cLMA and Combitube in all outcome measures except ease of insertion and durability of device where I-gel was better and oro-pharyngeal seal pressures where Combitube was better.

Conclusion

Considering all parameters, I-gel proved superior with minimal complications compared with other SGA devices tested. I-gel may be recommended for emergency airway rescue use in patients by military paramedics.

Extended Total Mesorectal Excision (e-TME) for Locally Advanced Rectal Cancer

BACKGROUND

Locally advanced rectal cancer (LARC) can involve surrounding pelvic organs requiring multivisceral resection. Extended total mesorectal excision (e-TME) or multivisceral resection is a complex procedure associated with high morbidity, mortality, and R1 resection rates. However, e-TME in LARC with surrounding organ involvement is the only potential option for cure. The study aims to assess the clinical outcome of patients requiring e-TME for LARC.

METHODS

The study is a retrospective review of all patients with LARC requiring multivisceral resection (2013 to 2019). The database includes clinic-demographic profile, pelvic organ involved, operative details, resection margin status, morbidity, mortality, and survival.

RESULTS

Seven consecutive patients (9.2%) out of 76 LARC (median age 46 years; 5 females) required multivisceral resection. The organs involved were bladder (4); posterior wall of vagina (2); and uterus (1). The en bloc resection included total cystoprostatectomy - 1; partial cystectomy - 3; posterior vaginectomy - 2; and hysterectomy - 1. Additionally, four required abdominoperineal resection. All were adenocarcinoma: stage III, with R0 resection - 76%. The overall complications were seen in 60% of patients, majority being wound related. There was no operative mortality. The median survival was 32.2 months in the entire series, while one died with the disease at a 28-month follow-up.

CONCLUSION

e-TME with curative intent, though a complex procedure, is associated with high wound-related morbidity, R1 resection, but improved median survival benefit.

Inequality in child undernutrition among urban population in India: a decomposition analysis

Background

With increasing urbanization in India, child growth among urban poor has emerged as a paramount public health concern amidst the continuously growing slum population and deteriorating quality of life. This study analyses child undernutrition among urban poor and non-poor and decomposes the contribution of various factors influencing socio-economic inequality. This paper uses data from two recent rounds of National Family Health Survey (NFHS-3&4) conducted during 2005–06 and 2015–16.

Methods

The concentration index (CI) and the concentration curve (CC) measure socio-economic inequality in child growth in terms of stunting, wasting, and underweight. Wagstaff decomposition further analyses key contributors in CI by segregating significant covariates into five groups-mother’s factor, health-seeking factors, environmental factors, child factors, and socio-economic factors.

Results

The prevalence of child undernutrition was more pronounced among children from poor socio-economic strata. The concentration index decreased for stunting (− 0.186 to − 0.156), underweight (− 0.213 to − 0.162) and wasting (− 0.116 to − 0.045) from 2005 to 06 to 2015–16 respectively. The steepness in growth was more among urban poor than among urban non-poor in every age interval. Maternal education contributed about 19%, 29%, and 33% to the inequality in stunting, underweight and wasting, respectively during 2005–06. During 2005–06 as well as 2015–16, maternal factors (specifically mother’s education) were the highest contributory factors in explaining rich-poor inequality in stunting as well as underweight. More than 85% of the economic inequality in stunting, underweight, and wasting among urban children were explained by maternal factors, environmental factors, and health-seeking factors.

Conclusion

All the nutrition-specific and nutrition-sensitive interventions in urban areas should be prioritized, focusing on urban poor, who are often clustered in low-income slums. Rich-poor inequality in child growth calls out for integration and convergence of nutrition interventions with policy interventions aimed at poverty reduction. There is also a need to expand the scope of the Integrated Child Development Services (ICDS) program to provide mass education regarding nutrition and health by making provisions of home visits of workers primarily focusing on pregnant and lactating mothers.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-020-09864-2.

Emergence of Primary Teeth in Children of Sunsari District of Eastern Nepal

ABSTRACT: This study assessed the timing and eruption sequence of primary teeth in children of Sunsari district of Eastern Nepal and compared the eruption pattern of males & females between various, ethnic groups. Method: This cross-sectional study, included 501 subjects, aged 3 months to 60 months selected by simple random sampling method. The determinant variables such as age, gender, ethnicity, and eruption of teeth were recorded. Results: This study provides a model data on emergence of primary teeth and number of deciduous teeth in these children. This is a first study of its kind in Nepal. The findings of this study will help as a reference data for optimal use in clinical, academic, and research activities, especially for children of Eastern Nepal.

Early warning systems development for agricultural drought assessment in Nigeria

The existing drought monitoring mechanisms in the sub-Saharan Africa region mostly depend on the conventional methods of drought monitoring. These methods have limitations based on timeliness, objectivity, reliability, and adequacy. This study aims to identify the spread and frequency of drought in Nigeria using Remote Sensing/Geographic Information Systems techniques to determine the areas that are at risk of drought events within the country. The study further develops a web-GIS application platform that provides drought early warning signals. Monthly NOAA-AVHRR Pathfinder NDVI images of 1 km by 1 km spatial resolution and MODIS with a spatial resolution of 500 m by 500 m were used in this study together with rainfall data from 25 synoptic stations covering 32 years. The spatio-temporal variation of drought showed that drought occurred at different times of the year in all parts of the country with the highest drought risk in the north-eastern parts. The map view showed that the high drought risk covered 5.98% (55,312 km²) of the country's landmass, while low drought risk covered 42.4% (391,881 km²) and very low drought risk areas 51.5% (476,578 km²). Results revealed that a strong relationship exists between annual rainfall and season-integrated NDVI (r² = 0.6). Based on the spatio-temporal distribution and frequency of droughts in Nigeria, drought monitoring using remote sensing techniques of VCI and NDVI could play an invaluable role in food security and drought preparedness. The map view from the web-based drought monitoring system, developed in this study, is accessible through localhost.

Klotho gene polymorphism in renal stone formers from Northwestern India

Klotho gene is an important gene involved in calcium homeostasis, and polymorphisms of this gene may render the individual prone to renal stone formation. We evaluated G395A single nucleotide polymorphisms (SNPs) of Klotho gene at rs1207568 in renal stone patients of North India. This was a prospective study involving 150 patients of renal stone disease (aged 15-60 years) and 100 age- and sex-matched controls. The DNA was isolated and subjected to polymerase chain reaction (PCR) for identifying the G395A Klotho SNPs at rs1207568. Confronting two pair primers were used, and gel electrophoresis showing two bands at 175,252 bp was considered as GG genotype, three bands at 121,175 and 252 bp as GA and two bands at 121 and 252 bp as AA genotype. The association between genotype and cases was evaluated by using Chi-square test and logistic regression analysis. Cases and controls were well matched for age (40.65 vs 42.06, p = 0.063) and sex (p = 0.420). Significantly high proportion of patients with renal stones had GG genotype as compared to controls (odds ratio (OR) 2.37(1.39,4.03), p = 0.001). None of the participants (cases and controls) had homozygous recessive AA genotype. The risk of stone formation was significantly higher in the population carrying G allele {OR 1.94 (1.225-3.073), p 0.004}. Mean serum calcium was higher in stone formers with GG genotype as compared to those with GA genotype (9.16 mg/dl vs 8.91 mg/dl; p = 0.06). GG genotype of G396A Klotho gene SNPs is associated with renal stone formation. The G allele carrier is twice at risk of renal stone formation. The absence of AA genotype in north-western Indian population remains a curiosity.

Idiopathic Hypoparathyroidism: Still a Diagnostic Conundrum - A Tertiary Centre Experience

Idiopathic hypoparathyroidism leads to hypocalcemia and hyperphosphatasemia and usually has a genetic aetiology. The variable but often subtle signs and symptoms usually lead to a misdiagnosis of hypoparathyroidism. Case records of 32 patients of idiopathic hypoparathyroidism admitted over a period of five years were analysed. There was a lag period of 5.94 years from the onset of symptoms to the diagnosis. Carpopedal spasm was the most common indication for admission to the hospital. Trivial symptoms such as fatigue (84%) and paresthesia (62.5%) were the most common reported symptoms. A sum of 46.5% of the patients were on antiepileptic drugs before the correct diagnosis of hypoparathyroidism was made. This observation emphasized that Calcium profile should be obtained in patients with history of paresthesia and seizure to avoid the long delay in diagnosis of hypoparathyroidism.

Disease surveillance during a large religious mass gathering in India: The Prayagraj Kumbh 2019 experience

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At Kumbh Mela 2019, disease surveillance was established for 22 acute diseases and syndromes.

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Among the reported illnesses, 95% were communicable diseases such as acute respiratory illness (35%), acute fever (28%), and skin infections (18%).

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The incident command centre generated 12 early warning signals from indicator-based and event-based surveillance: acute diarrheal diseases (n = 8, 66%), vector-borne diseases (n = 2, 16%), vaccine-preventable disease (n = 1, 8%), and thermal event (n = 1, 8%).

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There were two outbreaks (acute gastroenteritis and chickenpox) that were investigated and controlled.

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Implementation of disease surveillance facilitated early outbreak detection and response.

Background

Mass gathering (MG) events are associated with public health risks. During the period January 14 to March 4, 2019, Kumbh Mela in Prayagraj, India was attended by an estimated 120 million visitors. An onsite disease surveillance was established to identify and respond to disease outbreaks.

Methods

A health coordination committee was established for planning. Disease surveillance was prioritized and risk assessment was done to identify diseases/conditions based on epidemic potential, severity of illness, and reporting requirement under the International Health Regulations (IHR) of 2005. A daily indicator and event-based disease surveillance was planned. The indicator-based surveillance (IBS) manually and electronically recorded data from patient hospital visits and collected MG area water testing data to assess trends. The event-based surveillance (EBS) helped identify outbreak signals based on pre-identified event triggers from the media, private health facilities, and the food safety department. Epidemic intelligence was used to analyse the data and events to detect signals, verify alerts, and initiate the response.

Results

At Kumbh Mela, disease surveillance was established for 22 acute diseases/syndromes. Sixty-five health facilities reported 156 154 illnesses (21% of a total 738 526 hospital encounters). Among the reported illnesses, 95% (n = 148 834) were communicable diseases such as acute respiratory illness (n = 52 504, 5%), acute fever (n = 41 957, 28%), and skin infections (n = 27 094, 18%). The remaining 5% (n = 7300) were non-communicable diseases (injuries n = 6601, 90%; hypothermia n = 224, 3%; burns n = 210, 3%). Water samples tested inadequate for residual chlorine in 20% of samples (102/521). The incident command centre generated 12 early warning signals from IBS and EBS: acute diarrheal disease (n = 8, 66%), vector-borne disease (n = 2, 16%), vaccine-preventable disease (n = 1, 8%), and thermal event (n = 1, 8%). There were two outbreaks (acute gastroenteritis and chickenpox) that were investigated and controlled.

Conclusions

This onsite disease surveillance imparted a public health legacy by successfully implementing an epidemic intelligence enabled system for early disease detection and response to monitor public health risks. Acute respiratory illnesses emerged as a leading cause of morbidity among visitors. Future MG events should include disease surveillance as part of planning and augment capacity for acute respiratory illness diagnosis and management.

Development of hierarchical magnesium oxide anchored cerium oxide nanocomposites with improved magnetic properties and photocatalytic performance

A facile strategy was introduced for the development of pure MgO and its nanocomposites using different CeO₂ contents (3%-7%) to enhance their magnetic properties and photocatalytic performance. Different morphologies (namely nanoflowers and rhombohedral type nanostructures) were obtained using an in situ hydrothermal method at different concentrations of CeO₂. X-ray diffraction results revealed that peaks of CeO₂ were observed along with peaks of MgO, which confirms the presence of both phases. The crystallite size and particle size were found to increase with changing CeO₂ content in the host matrix of MgO. Moreover, the band gap reduces while the magnetic character increases with CeO₂ content. The magnetic behaviour of the nanocomposites was elucidated on the basis of oxygen intrinsic defects, which are shown through XPS. EPR measurements were carried out to understand the valence electrons and establish the defects present in the material, which are related to the size of the nanostructures. The degradation of Rose Bengal dye was performed to probe the photocatalytic activity of the MgO@CeO₂ nanocomposites. Hence the facile synthesis of these nanostructures conveyed good magnetic properties along with its application towards dye degradation.

Hepatitis-B virus infection in India: Findings from a nationally representative serosurvey, 2017-18

INTRODUCTION

India introduced a hepatitis-B (HB) vaccine in the Universal Immunization Program in 2002-2003 on a pilot basis, expanded to ten states in 2007-2008 (phase-1), and the entire country in 2011-2012 (phase-2). We tested sera from a nationally representative serosurvey conducted duing 2017, to estimate the seroprevalence of different markers of HB infection among children aged 5-17 years in India and to assess the impact of vaccination.

METHODS

We tested sera from 8273 children for different markers of HB infection and estimated weighted age-group specific seroprevalence of children who were chronically infected (HBsAg and anti-HBc positive), and immune due to past infection (anti-HBc positive and HBsAg negative), and having serological evidence of HB vaccination (only anti-HBs positive). We compared the prevalence of serological markers among children born before (aged 11-17 years) and after (aged 5-10 years) introduction of HB-vaccine from phase-1 states.

RESULTS

Among children aged 5-8 years, 1.1% were chronic carriers, 5.3% immune due to past infection, and 23.2% vaccinated. The corresponding proportions among children aged 9-17 years were 1.1%, 8.0%, and 12.0%, respectively. In phase-1 states, children aged 5-10 years had a significantly lower prevalence of anti-HBc (4.9% vs. 7.6%, p<0.001) and higher prevalence of anti-HBs (37.7% vs. 14.7%, p<0.001) compared to children aged 11-17 years. HBsAg positivity, however, was not different in the two age groups.

CONCLUSIONS

Children born after the introduction of HB vaccination had a lower prevalence of past HBV infection and a higher prevalence of anti-HBs. The findings of our study could be considered as an interim assessment of the impact of the hepatitis B vaccine introduction in India.

Vitamin D deficiency in patients with diabetes and COVID- 19 infection

BACKGROUND AND AIMS

Data show that vitamin D deficiency may play a role in patients with diabetes mellitus and COVID-19 infection. In this article, we review evidence of vitamin D deficiency and COVID-19 infection in context of diabetes mellitus.

METHODS

A literature search was carried out by using the key term 'COVID 19' combined with 'Diabetes', 'Vitamin D', 'Extra skeletal effects', 'immunity', 'infection', 'India' from Pub Med (National Library of Medicine, Bethesda, MD and Google Scholar from December 2019 to May 2020. A manual search of the references was also carried out.

RESULTS

Vitamin D deficiency has been linked to increased morbidity and mortality in COVID -19 infections but convincing data on diabetic subgroup of patients in particular is still awaited.

CONCLUSION

Robust studies are required to ascertain if Vitamin D supplementation could be beneficial in patients with diabetes and COVID-19.

Prognostic evaluation of metastasizing ameloblastoma: A systematic review of reported cases in literature

Ameloblastoma is a benign odontogenic tumor which undergoes malignant transformation to ameloblastic carcinoma. However, rarely it metastasizes without undergoing cytological malignant changes, an entity referred to as Metastasizing Ameloblastoma (MA). Through this study, we aimed to review cases of MA reported since 2000 to explore the impact of clinico-demographic variables on its prognosis. Based on PRISMA guidelines, a review of relevant literature from PubMed/Medline, Science Direct and Cochrane database was performed from January 2000 to March 2019. A total of 65 cases were considered for further evaluation as per predefined inclusion and exclusion criteria. Results showed that lungs followed by lymph nodes were the most common sites for benign metastatic deposits. Multiple recurrences and inadequate surgical removal increase the probability of distant metastatic spread. Despite having benign cytological features, tumor recurrence and metastasis were associated with an unfavorable clinical outcome in MA.

Public Health in Political Dilemma - A Case for Covid-19 Control

COVID 19 has been declared a Public Health Emergency of International Concern by the WHO (1). The management of COVID 19 pandemic by Govt. of India has been applauded by the WHO for its timely and strict actions. No doubt we have borrowed time from the lockdown but it could have been utilized in a much better way to control. The epidemiological opinion is that the harshest lockdown was acceptable but its extension was not required as we have not been able to sustain the benefits of lockdown gained in the beginning. The gain of lockdown could have been better had it been coupled with meticulous contact tracing and containment measures during the early period of pandemic. A subsequent failure to ensure all these together resulted in spread of virus everywhere in spite of lockdown. It has also given a false feeling to the public that lockdown will prevent infection.

The National Mental Health Survey of India (2016): Prevalence, socio-demographic correlates and treatment gap of mental morbidity

BACKGROUND

Recognizing the need for good quality, scientific and reliable information for strengthening mental health policies and programmes, the National Mental Health Survey (NMHS) of India was implemented by National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, in the year 2015-2016.

AIM

To estimate the prevalence, socio-demographic correlates and treatment gap of mental morbidity in a representative population of India.

METHODS

NMHS was conducted across 12 Indian states where trained field investigators completed 34,802 interviews using tablet-assisted personal interviews. Eligible study subjects (18+ years) in households were selected by a multi-stage, stratified, random cluster sampling technique. Mental morbidity was assessed using MINI 6. Three-tier data monitoring system was adopted for quality assurance. Weighted and specific prevalence estimates were derived (current and lifetime) for different mental disorders. Mental morbidity was defined as those disorders as per the International Statistical Classification of Diseases, Tenth Revision Diagnostic Criteria for Research (ICD-10 DCR). Multivariate logistic regression was conducted to examine risk for mental morbidity by different socio-demographic factors. Survey was approved by central and state-level institutional ethical committees.

RESULTS

The weighted lifetime prevalence of 'any mental morbidity' was estimated at 13.67% (95% confidence interval (CI) = 13.61, 13.73) and current prevalence was 10.56% (95% CI = 10.51, 10.61). Mental and behavioural problems due to psychoactive substance use (F10-F19; 22.44%), mood disorders (F30-F39; 5.61%) and neurotic and stress-related disorders (F40-F48; 3.70%) were the most commonly prevalent mental morbidity in India. The overall prevalence was estimated to be higher among males, middle-aged individuals, in urban-metros, among less educated and in households with lower income. Treatment gap for overall mental morbidity was 84.5%.

CONCLUSION

NMHS is the largest reported survey of mental morbidity in India. Survey estimated that nearly 150 million individuals suffer from one or the other mental morbidity in India. This information is to be used for planning, delivery and evaluating mental health programming in the country.

Development of ultrasensitive and As(iii)-selective upconverting (NaYF4:Yb3+,Er3+) platform

Solid-phase, LRET-based NaYF₄:Yb³⁺,Er³⁺ platform for the ultrasensitive (1 nM) detection of arsenic.

Vocal Fold Insufficiency: How Effective is Injection Laryngoplasty? Short Term Clinical Outcomes

Office based Injection Laryngoplasty has become a common and feasible method of addressing vocal fold insufficiency (VFI) resulting from a plethora of aetiologies. Contemporary to various injectates, Calcium Hydroxylapatite has met with great success across usage with various techniques. But, irrespective of the technique and injectate material, the burning question in mind of "realistic" clientele remains, "How soon will I have by voice back?". Aim of this study is to evaluate the short term (3 months postoperative) effects of Injection Laryngoplasty in cases of VFI using Calcium Hydroxylapatite via trans cricothyroid route, in terms of both objective and subjective parameters. 12 patients with mean age of 35.67 years underwent vocal fold injections (via transnasal flexible fibreoptic laryngoscopic guided trans-cricothyroid membrane approach using CaHA) for VFI. The pre injection and 1, 2- and 3-months post injection scores' changes in outcome measures in form of videostroboscopic parameters, Voice Handicap Index scores and acoustic analysis were compiled and analysed. 91.6% of patients showed statistically significant benefit after 3 months post injection. 0.1% patients showed loss of benefit of the CaHA material even 3 months post injection. Average length of benefit was 1-month post injection. No significant complication was observed in any patient. We conclude that the objective evidence of structural and functional improvement may be seen immediately post injection laryngoplasty, minimum of 3 months is required for evident improvement in patient's perception of his own voice in terms of Quality of Life parameters.

Positron emission tomography/computed tomography guided percutaneous biopsies of Ga-68 avid lesions using an automated robotic arm

PURPOSE

The purpose of this prospective study was to evaluate the feasibility of positron emission tomography/computed tomography (PET/CT)-guided biopsy of Ga-68 avid lesions using an automated robotic arm and determine the diagnostic yield of this technique.

MATERIAL AND METHODS

Patients who underwent Ga-68 labelled tracers imaging followed by PET/CT-guided biopsies of tracer-avid lesions were prospectively included. Biopsies were performed using a dedicated automated-robotic-arm assisted PET/CT-guided biopsy device on the same-day of diagnostic PET/CT-imaging. The tissue samples were retrieved after confirming the position of needle-tip in the target lesion. Procedure-related complications and radiation exposure of the interventionist were recorded. Histopathological reports were reviewed for diagnostic yield.

RESULTS

A total of 25 patients (19 men, six women) with a mean age of 50.8±17.3 (SD) years (range: 17-83 years) were included. The biopsies were performed after PET/CT using Ga-68 DOTANOC (n=16) or Ga-68 PSMA (n=8) and Ga-68 chemokine-analogue (n=1). The biopsy samples were obtained from the liver (n=9), bone (n=8), lymph-nodes (n=3), lung (n=1), pancreas (n=1), anterior mediastinal lesion (n=1), peritoneal-deposit (n=1) and thigh-lesion (n=1). No immediate or delayed procedure-related complications were documented in any patient. PET/CT-guided molecular sampling was technically successful in all the patients. Histopathology revealed malignancies in all the biopsied specimens without the need for repeat sampling or further invasive-diagnostic workup, with a diagnostic yield of 100%. The estimated absorbed-radiation dose was 566.7μSv/year for the interventionist.

CONCLUSION

PET/CT-guided molecular biopsy using Ga-68 labelled radiotracers is feasible and can be performed safely and accurately with a high-diagnostic yield. It is helpful in accurately staging the disease when tracer-avid isolated distant lesion evident on imaging and highly practical in patients with previous inconclusive sampling.