Characteristics of Auditory Brainstem Response in Night-shift Health Workers.

With technological advancement and economic competitiveness there is an exponential rise in the number of shift workers. Worldwide, healthcare workers constitute the single largest proportion of workers who work on shift duty in order to provide round-the-clock healthcare services to patients. Various studies have demonstrated an association between circadian cycle disturbance due to shift work and adverse health impacts.

Assessing the Brainstem Auditory Evoked Potentials in Subjects with Family History of Hypertension.

Background: Hypertension (HTN) has a genetic predisposition and it also impairs microcirculation, thereby, affecting the well vascularized structures like the brainstem and causing changes in Brainstem Auditory Evoked Potentials (BAEPs).

Purpose: To find out the usefulness of BAEPs as a screening tool in apparently healthy individuals with a family history of HTN.

Methods: One hundred and ten volunteers, aged 17 to 23 years, were enrolled in the study as participants with proper consent.

Efficacy of Chronomodulated Chemotherapy for Palliation of Hematemesis in Inoperable Gastric Cancer: A Single-Institutional Retrospective Study.

Context: Aside abdominal discomfort and pain, upper gastrointestinal bleeding (UGIB) significantly disgraces the quality of life (QoL), especially in inoperable gastric cancer patients. Although, in early stages, it is infrequent and often ignored, but in advanced stages, its aggressiveness often deteriorates patient's hemoglobin (Hb) level and performing status.

Aim: The aim of this study is to correlate the change in (1) the frequency of episodes of UGIB, (2) its severity in terms of Common Terminology Criteria for Adverse Events (CTCAE) grade for UGIB, and (3) Hb level with the successful completion of successive cycles of palliative chemotherapy where it becomes invariably the only modality to palliate the cancer disease.

Perception of Oncology Evaluated by Medical Students (P.O.E.M.S)-a Single Institutional Study.

Rising incidence of cancer coupled with lack of structured oncology teaching in the undergraduate (UG) medical curriculum could be detrimental by generating unmet needs in the proper care of cancer patients in the future. To determine the orientation amongst undergraduate medical students regarding Oncology as a specialization and future career option, a cross-sectional, single institutional study was conducted amongst 950 undergraduate students by using an online survey over 2 months. The perception of the subject of Oncology as a career option and the opinion regarding the need for inclusion in the undergraduate curriculum were assessed.

Expression of P53 Protein and Ki-67 Antigen in Oral Leukoplakia with Different Histopathological Grades of Epithelial Dysplasia.

Aims And Objective: The aim of this study is to investigate the expression of p53 protein and Ki-67 antigen in normal oral mucosa and oral leukoplakia with different grades of dysplasia using immunohistochemistry and to clarify the correlation of the expression of these cell cycle regulatory proteins.

Materials And Methods: A total of 20 archival tissue blocks obtained from our department which were diagnosed as mild ( = 5), moderate ( = 5), and severe dysplasia ( = 5) with normal mucosa ( = 5) as a control. Positivity of Ki-67 and p53 was analyzed using Statistical Package for the Social Sciences (IBM Corp.

Migrating foreign body in an adult bronchus: An aspirated denture.

As a safety measure, dentures are routinely removed before surgery. Aspiration of a denture could be catastrophic, with medicolegal implications. Foreign body aspiration is uncommon in adults; however, aspirations may remain asymptomatic and undiagnosed for long periods of time.

Adjuvants to local anesthetics: Current understanding and future trends.

Although beneficial in acute and chronic pain management, the use of local anaesthetics is limited by its duration of action and the dose dependent adverse effects on the cardiac and central nervous system. Adjuvants or additives are often used with local anaesthetics for its synergistic effect by prolonging the duration of sensory-motor block and limiting the cumulative dose requirement of local anaesthetics. The armamentarium of local anesthetic adjuvants have evolved over time from classical opioids to a wide array of drugs spanning several groups and varying mechanisms of action.

Computer-assisted morphometric image analysis of cells of normal oral epithelium and oral squamous cell carcinoma.

Context: Oral squamous cell carcinoma (OSCC) is a malignant neoplasm of epithelial tissue origin. OSCC is traditionally graded into well, moderate and poorly differentiated. The assessment of cellular and nuclear features is very important in the histological grading of OSCC.

Biochemical changes in the injured brain.

Brain metabolism is an energy intensive phenomenon involving a wide spectrum of chemical intermediaries. Various injury states have a detrimental effect on the biochemical processes involved in the homeostatic and electrophysiological properties of the brain. The biochemical markers of brain injury are a recent addition in the armamentarium of neuro-clinicians and are being increasingly used in the routine management of neuro-pathological entities such as traumatic brain injury, stroke, subarachnoid haemorrhage and intracranial space occupying lesions.

Perianesthetic refractory anaphylactic shock with cefuroxime in a patient with history of penicillin allergy on multiple antihypertensive medications.

We report a case of perianesthetic refractory anaphylactic shock with cefuroxime in a patient with history of penicillin allergy on regular therapy with atenolol, losartan, prazosin and nicardipine. Severe anaphylactic shock was only transiently responsive to 10mL of (1:10,000) epinephrine and needed norepinephrine and dopamine infusion. Supportive therapy with vasopressors and inotropes along with mechanical ventilation for the next 24hours resulted in complete recovery.

[Perioperative stroke following transurethral resection of prostate: high index of suspicion and stabilization of physiological parameters can save lives].

We report a case of a 72 year old hypertensive male who developed severe hypertension followed by neurological deterioration in the immediate postoperative period after transurethral resection of prostate. While arterial blood gas and laboratory tests excluded transurethral resection of prostate syndrome or any other metabolic cause, reduction of blood pressure failed to ameliorate the symptoms. A cranial CT done 4 hours after the onset of neurological symptoms revealed bilateral gangliocapsular and right thalamic infarcts.

Inappropriate fixation of an endotracheal tube causing cuff malfunction resulting in difficult extubation.

We discuss a case of difficult extubation, due to inadequate deflation of the tracheal tube cuff, despite collapse of the pilot balloon, on its aspiration. This was caused by inadvertent kinking of the pilot balloon tubing due to inappropriate tape fixation of the endotracheal tube.

Intensive Care in India: The Indian Intensive Care Case Mix and Practice Patterns Study.

Aims: To obtain information on organizational aspects, case mix and practices in Indian Intensive Care Units (ICUs).

Patients And Methods: An observational, 4-day point prevalence study was performed between 2010 and 2011 in 4209 patients from 124 ICUs. ICU and patient characteristics, and interventions were recorded for 24 h of the study day, and outcomes till 30 days after the study day.

Sepsis associated delirium mimicking postoperative delirium as the initial presenting symptom of urosepsis in a patient who underwent nephrolithotomy.

We report a case of 70 years old male who underwent percutaneous nephrolithotomy for renal calculi. After an uneventful recovery from anaesthesia, the patient developed delirium which manifested as restlessness, agitation, irritability and combative behavior. All other clinical parameters including arterial blood gas, chest X-ray and core temperature were normal and the patient remained haemodynamically stable.

Inadvertent migration of guidewire into Murphy's eye of endotracheal tube during percutaneous dilatational tracheostomy.

Percutaneous dilatational tracheostomy is a commonly performed bedside procedure in the Intensive Care Unit. Although serious and fatal complications have been reported, the procedure is by and large safe to perform in experienced hands. We report here an innocuous problem encountered twice.

[Perianesthetic refractory anaphylactic shock with cefuroxime in a patient with history of penicillin allergy on multiple antihypertensive medications].

We report a case of perianesthetic refractory anaphylactic shock with cefuroxime in a patient with history of penicillin allergy on regular therapy with atenolol, losartan, prazosin and nicardipine. Severe anaphylactic shock was only transiently responsive to 10mL of (1:10000) epinephrine and needed norepinephrine and dopamine infusion. Supportive therapy with vasopressors and inotropes along with mechanical ventilation for the next 24hours resulted in complete recovery.

Cardiac arrest following acute puerperal uterine inversion.

Although uterine inversion is a potentially life-threatening complication of childbirth, there are only six case reports of cardiac arrest due to acute inversion to date. We report a successful outcome in a patient with sickle cell disease who had a witnessed cardiac arrest due to acute puerperal uterine inversion. Revival from cardiac arrest and resuscitation was followed by manual repositioning of the uterus.

Vasopressors in obstetric anesthesia: A current perspective.

Vasopressors are routinely used to counteract hypotension after neuraxial anesthesia in Obstetrics. The understanding of the mechanism of hypotension and the choice of vasopressor has evolved over the years to a point where phenylephrine has become the preferred vasopressor. Due to the absence of definitive evidence showing absolute clinical benefit of one over the other, especially in emergency and high-risk Cesarean sections, our choice of phenylephrine over the other vasopressors like mephentermine, metaraminol, and ephedrine is guided by indirect evidence on fetal acid-base status.

Guidelines for prevention of hospital acquired infections.

These guidelines, written for clinicians, contains evidence-based recommendations for the prevention of hospital acquired infections Hospital acquired infections are a major cause of mortality and morbidity and provide challenge to clinicians. Measures of infection control include identifying patients at risk of nosocomial infections, observing hand hygiene, following standard precautions to reduce transmission and strategies to reduce VAP, CR-BSI, CAUTI. Environmental factors and architectural lay out also need to be emphasized upon.

Necrotizing fasciitis caused by Aeromonas caviae.

Aeromonads are rarely associated with human intestinal and extra-intestinal diseases and syndromes, ranging from relatively mild illnesses such as acute gastroenteritis to life-threatening conditions, including septicemia, necrotizing fasciitis, and myonecrosis. Among the aeromonas species known to cause human infection, Aeromonas caviae has been associated with septicemia and only one reported case of human soft tissue infection. Most of the infections due to aeromonas occur in immunocompromised patients.

Delayed onset seizures after inguinal herniotomy in a premature infant: a case report.

We report a case of a premature neonate born at 34 weeks and operated at 6 weeks of age developing unexplained seizures 10 hours after the end of surgery under single shot caudal epidural analgesia with bupivacaine and lidocaine combined with general anesthesia.

General anesthesia in a patient with Gilbert's syndrome.

Gilbert's syndrome, caused by relative deficiency of glucuronyl transferase is the commonest cause of congenital hyperbilirubinemia. We report anesthetic management in a case of Gilbert's syndrome for laparoscopic cholecystectomy under general anesthesia. Avoiding drugs which use this enzyme for its metabolisim or excretion, and minimizing the stress during the perioperative period allows safe conduct of anesthesia for these patients.