Orotracheal intubation in infants performed with a stylet versus without a stylet

Background: Neonatal endotracheal intubation is a common and potentially life-saving intervention. It is a mandatory skill for neonatal trainees, but one that is difficult to master and maintain. Intubation opportunities for trainees are decreasing and success rates are subsequently falling. Use of a stylet may aid intubation and improve success. However, the potential for associated harm must be considered. Objectives To compare the benefits and harms of neonatal orotracheal intubation with a stylet versus neonatal orotracheal intubation without a stylet. Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library; MEDLINE; Embase; the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and previous reviews. We also searched cross-references, contacted expert informants, handsearched journals, and looked at conference proceedings. We searched clinical trials registries for current and recently completed trials. We conducted our most recent search in April 2017. Selection criteria All randomised, quasi–randomised, and cluster-randomised controlled trials comparing use versus non-use of a stylet in neonatal orotracheal intubation. Data collection and analysis: Two review authors independently assessed results of searches against predetermined criteria for inclusion, assessed risk of bias, and extracted data. We used the standard methods of the Cochrane Collaboration, as documented in the Cochrane Handbook for Systemic Reviews of Interventions, and of the Cochrane Neonatal Review Group. Main results: We included a single-centre non-blinded randomised controlled trial that reported a total of 302 intubation attempts in 232 infants. The median gestational age of enrolled infants was 29 weeks. Paediatric residents and fellows performed the intubations. We judged the study to be at low risk of bias overall. Investigators compared success rates of first-attempt intubation with and without use of a stylet and reported success rates as similar between stylet and no-stylet groups (57% and 53%) (P = 0.47). Success rates did not differ between groups in subgroup analyses by provider level of training and infant weight. Results showed no differences in secondary review outcomes, including duration of intubation, number of attempts, participant instability during the procedure, and local airway trauma. Only 25% of all intubations took less than 30 seconds to perform. Study authors did not report neonatal morbidity nor mortality. We considered the quality of evidence as low on GRADE analysis, given that we identified only one unblinded study. Authors' conclusions: Current available evidence suggests that use of a stylet during neonatal orotracheal intubation does not significantly improve the success rate among paediatric trainees. However, only one brand of stylet and one brand of endotracheal tube have been tested, and researchers performed all intubations on infants in a hospital setting. Therefore, our results cannot be generalised beyond these limitations

Trends in Intracranial Stenting Among Medicare Beneficiaries in the United States, 2006–2010

Background: It is uncertain how intracranial stenting (ICS) has been adopted nationally during a period characterized by a restrictive payment policy by the Centers for Medicare & Medicaid Services, humanitarian device exemption approval by the Food and Drug Administration, and insufficient evidence of effectiveness. We sought to determine the trends in rates of ICS use and associated outcomes in the United States. Methods and Results: From 65 211 328 Medicare Fee‐for‐Service beneficiaries hospitalized between 2006 and 2010 in acute care hospitals in the United States, we included patients with ICD‐9‐CM procedure codes for intracranial angioplasty and stenting, excluding those with a principal discharge diagnosis code of cerebral aneurysm or subarachnoid hemorrhage. We report operative rates per 1 000 000 person‐years and outcomes including 30‐day and 1‐year mortality rates. There were 838 ICS procedures performed among Fee‐for‐Service beneficiaries. The overall hospitalization rate for ICS increased significantly from ≈1 per 1 000 000 person‐years (n=35 procedures) in 2006 to 9 per 1 000 000 person‐years (n=258 procedures) in 2010 (P=0.0090 for trend). Procedure rates were higher in men than in women, and were highest among patients aged 75 to 84 years and lowest among those ≥85 years. The 30‐day mortality rate increased from 2.9% (95% CI, 0.1 to 15.3) to 12.9% (95% CI, 9.0 to 17.6), P=0.1294 for trend, and the 1‐year mortality rate increased from 14.7% (95% CI, 5.0 to 31.1) to 19.5% (95% CI, 14.9 to 24.9), P=0.0101; however, the annual changes were not significant after adjustment. Conclusions: ICS utilization in the United States has modestly increased during a period of inadequate supportive evidence. Humanitarian device exemption and a restrictive payment policy appear to have caused slow adoption of the technology

Trend in Infant and Young Child Feeding practices during 2005 – 2015 in India

Background: Optimal infant and young child feeding (IYCF) practices during first 2 years of life is the key to ensuring optimal growth and development of the infant. Improving IYCF practices have an important role in reducing morbidity and mortality amongst under 5 children in India. Material & Methods: The secondary data from National Family Health Survey (NFHS)-3 and NFHS- 4 was analyzed. Objective: To assess the trend in IYCF practices during 2005 – 2015 for 13 selected states of India. Results: It was found that over a decade, there has been an improvement in early initiation of breast feeding and exclusive breastfeeding for 6 months amongst infant in 11 out of 13 states. However, a reduction in the timely initiation of complementary feeding amongst children in the age group of 6-8 months has been observed in 9 out of 13 states. Conclusion: There is a need to strengthen the efforts to further improve the IYCF practices in India for reducing high rates of undernutrition in the country

Impact of cropping systems on physico-chemical characteristics of surface water during different seasons in Shimla region of Himachal Pradesh

The present investigations were carried out in the year 2014 with an objective to find out the impact of different cropping systems on nearby surface water resources in Shimla region of Himachal Pradesh. The aim of the study was to monitor the surface water bodies for pollution caused by nearby cropping systems in the Shimla area. In this study fruit, fruit + vegetable, vegetable and cereal based cropping systems were selected along with control (uncultivated land) and sampling was done during winter, summer and rainy seasons. The estimated water quality parameters revealed very less organic pollution and pH values were within the BIS prescribed limits of 6.5-8.5. Under vegetable based cropping system EC (500.23 µS cm?1), TDS (329.17 mg/l), BOD (1.48 mg/l), COD (31.09 mg/l), Cl- (25.66 mg/l), Ca (75.59 mg/l) and Mg (11.14 mg/l) were in high concentration, whereas No3- content were high under fruit + vegetable based cropping system. DO were maximum (8.61mg/l) under uncultivated land. Calcium and COD were high in some samples, which could be from anthropogenic sources, rest of the parameters were within the desirable limits prescribed by Bureau of Indian Standards (BIS). The experimental data were statistically analysed through Analysis of variance (two way classification of data) indicated positive correlation among most of the physical and chemical parameters. Study reveals that cropping systems as well as seasonal changes has affected the water quality. The study carried out for water quality parameters, revealed the correlation of each parameter with one another under different cropping systems

Placental abruption at 18 weeks of gestation: a rare case report

Placental abruption is one of several notable obstetrical entities that may be complicated by massive and sometimes torrential hemorrhage. Hypovolemic shock is caused by maternal blood loss. Delayed or incomplete treatment of hypovolemia with severe placental abruption can cause acute kidney injury, disseminated intravascular coagulation. Placental abruption is most commonly seen after 24 weeks of pregnancy and it is very rare before 20 weeks of pregnancy. Here, we report a case of life-threatening placental abruption at 18 weeks of gestation.

Comparative evaluation of laparoscopic hysterectomy and non-descent vaginal hysterectomy in women with benign gynaecological disease

Background: Hysterectomy is one of the most frequently performed gynaecological operative procedure all over world, second most to caesarean section in United States. The aim of study was to compare the intraoperative and postoperative complications in patients undergoing non-descent vaginal hysterectomy (NDVH) and Laparoscopic hysterectomy (LH) for benign gynaecological disease.Methods: The prospective one-year study was conducted on 156 patients who required hysterectomy for benign gynaecological conditions. After applying inclusion and exclusion criteria, 75 patients assigned to Group A (NDVH) and 75 to Group B (LH) and both groups were compared.Results: On comparing the two groups there was statistically significant decrease in the duration of surgery (p<0.01, t = 11.65), pain score (p<0.01, t = 2.75) and blood transfusion requirement (p = 0.03, χ2 = 4.80) in group A, while blood loss (p = 0.73, t = 0.33), uterine volume (p = 0.15, t = 1.43), time taken to ambulate (p = 0.06 , t = 0.21), duration of hospital stay (p = 0.07, t = 1.80), conversion to laparotomy (p = 0.13, χ2 = 2.56), febrile morbidity (p = 0.27, χ2 = 1.34), infection (p = 0.42, χ2 = 1.11) and visceral injury was found statistically insignificant.Conclusions: Vaginal hysterectomy is an easier technique with shorter duration of surgery and with minimal infrastructure required and for fixed uterus or huge adnexal mass laparoscopic hysterectomy (LH) should be preferred

Assessment of nutritional status of elderly population living at high altitude regions of India utilizing Mini Nutritional Assessment (MNA) methodology

Background: Malnutrition is associated with increased risk of morbidity and mortality amongst elderly population. There is lack of scientific evidence on the staus of malnutrition amongst elderly population residing at high altitude regions of Uttarakhand, India. Background: Malnutrition is associated with increased risk of morbidity and mortality amongst elderly population. Lack of scientific evidence exists on the status of malnutrition amongst elderly population residing at high altitude regions of Uttarakhand, India. Materials and methods: A community based cross-sectional study was conducted in high altitude regions of District Nainital. A total of 980 elderly subjects were selected from 30 clusters identified using population proportionate to size sampling method. Nutritional status of the elderly population was assessed using Mini Nutritional Assessment (MNA) tool. Data was entered in MS Excel 2007 and analyzed using SPSS version 20.0. Results: The results of MNA revealed that 14.3% of the elderly subjects were malnourished. High prevalence of malnutrition was found among subjects who were illiterate (74.5%), financially dependent (75.2%), belonged to low monthly income (43.3%) had poor appetite (71.6%) and chewing problems (63.1%); (p&lt;0.0001). Conclusions: High prevalence of malnutrition was present amongst the elderly population in India. There is a need for timely assessment of malnutrition for maintenance of nutritional status and prevention of chronic diseases. Materials and methods: A community based cross-sectional study was conducted in high altitude regions of District Nainital. A total of 980 elderly subjects were selected from 30 clusters identified using population proportionate to size sampling method. Nutritional status of the elderly population was assessed using Mini Nutritional Assessment (MNA) tool. Data was entered in MS Excel 2007 and analyzed using SPSS version 20.0.   Results: The results of MNA revealed that 14.3% of the elderly subjects were malnourished. High prevalence of malnutrition was found among subjects who were illiterate (74.5%), financially dependent (75.2%), belonged to low monthly income (43.3%) had poor appetite (71.6%) and chewing problems (63.1%); (p&lt;0.0001).   Conclusions: High prevalence of malnutrition was present amongst the elderly population in India. There is a need for timely assessment of malnutrition for maintenance of nutritional status and prevention of chronic diseases

Platelet count estimation: a prognostic index in pregnancy induced hypertension

Background: Hypertension in pregnancy is one of the serious complications of pregnancy with an incidence of 5% to 7% of all pregnancies, particularly in cases with preeclampsia and eclampsia. Though platelet count during pregnancy is within the normal non pregnant reference values, there is a tendency for the platelet count to fall in late pregnancy. The frequency and intensity of maternal thrombocytopenia varies and is dependent on the intensity of the disease process and duration of PIH syndrome.Methods: A prospective observational study was conducted on 200 pregnant women attending OPD Or Inpatients in the Department of Obstetrics and Gynecology, SMGS Hospital, GMC Jammu from November 2015 to October 2016. Pregnant women beyond 28 weeks gestation of pregnancy are included and divided into two groups i.e. the study and control group. Platelet counts will be done every 4 weeks in controls and weekly in subjects from 28 weeks till delivery.Results: The mean platelet count observed among cases of mild preecclampsia, severe preeclampsia and ecclampsia was 2.26, 1.63 and 0.99 lakh/mm3 respectively. The difference in mean platelet count among cases and controls was statistically significant. The association of platelet count with severity of different categories of PIH was analysed statistically and was highly significant.Conclusions: Platelet count is a very important investigation for the antenatal mother having PIH, as it is directly related to maternal and perinatal outcome. Routine and regular monitoring of platelet count can be included in the routine antenatal checkup among the pregnant women with PIH

Morphological changes in placenta in cases of oligohydramnios

Background: There are gross and microscopic changes in placenta and umbilical cord in complicated pregnancies. The objective of this study was to study pathological (gross and microscopic) changes in placenta, membrane and umbilical cord in cases with oligohydramnios and to study relationship between changes in placenta, membranes and umbilical cord with severity of oligohydramnios.Methods: A total of 50 patients were selected and their placentas were collected after delivery and sent to pathology department in 10 % formalin for histopathological examination. Patients were divided into three groups and the results were compared. Statistical calculations were performed using the SPSS 16.0. In order to detect differences between subjects students t-test was used for continuous variables, while, for categorical variables, the X2 test was used. A p-value of less than 0.05 was considered statistically significant.Results: Atotal of 50 patients were studied for a period of one year and following observations were made, discoid shape placenta in 45 (90.0%), oval in 5 (10.0%), central attachment of umbilical cord in 16 cases (32.0%), eccentric in 33 (66.0%), marginal in 1 (2.0%) case following variables were compared and p value detected, placental maximum diameter (p <0.0001),placental minimum diameters (p = 0.041), mean of cord length (p <0.0001) placental weight (p = 0.273), placental thickness (p = 0.253), acute chorioamnionitis (p <0.0001), chronic chorioamnionitis (p<0.0001), focal squamous metaplasia (p <0.0001), bacterial colonies in subamnion (p <0.0001), meconium staining (p <0.0001), amnion nodosum (p < 0.0001), intra amniotic haemorrhage (p = 0.090), membranous deciduitis with chorioamnionitis (p = 0.081), focal haematoma (p = 0.010), acute inflammatory infiltrate in Wharton’s jelly (p = 0.012), single umbilical artery (p =0.010), intervillous fibrin deposition (p <0.0001), calcification (p<0.0001), chorangiosis (p <0.0001), syncytial knots (p <0.0001), avascular villi (p = 0.011), villous edema (p = 0.090) and infarct (p = 0.090).Conclusions: There are alterations in placental morphology associated with oligohydramnios hence placenta should be examined, which may be useful in predicting perinatal morbidity and mortality