Background: Lead poisoning is very much common in India and has significant negative impact on general health of children. Lead inhibits necessary enzymes required for heme synthesis, this results in increased levels of delta aminolevulinic acid excretion through urine. Objective: To find out the prevalence of lead poisoning among the age group 1 to 5 years, in a suburban Mumbai, Maharashtra, India. Methods: This is cross-sectional pilot study in Mumbai suburban localities. The study was done on 60 randomly chosen children of age group 1 to 5 years with their brief history related with lead exposure. Their urine samples were analyzed for δ ALA by Ehrlich method. Results: According to our observation it was found that out of 60 urine samples 20 samples have urinary δ-ALA levels below 0.2 mg/dl, while 40 samples showed increased urinary δ-ALA levels. Prevalence of lead exposure among our study population is 66.66% hence lead exposure is a serious public health issue. Conclusion: we conclude that there is high prevalence of lead exposure in Mumbai and necessary precautions to be taken to avoid it.

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Blindness in infants due to congenital cataract is up to 5-20% of all the vision loss of which 25% is due to Congenital Rubella Syndrome (CRS). CRS is a constellation of multi-system abnormalities with each posing its own variant of anesthetic dilemmas. CRS affects all the structures with rubella cataract being the commonest in the early age. Anesthetic management becomes a challenge in these rubella infants in view of Low Birth Weight (LBW), small infants, PDA/PS (pulmonary stenosis), ASD, PHT (pulmonary hypertension). Here we discuss the anesthetic management of three CRS infants coming for cataract surgery presenting with unique problems of the syndrome such as congenital cardiac septal defects, PDA, pulmonary hypertension and unanticipated difficult airway. Knowledge of the disease, anticipation preparedness, extreme caution and multidisciplinary approach for management is required for a successful outcome.

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Background: Co-morbid depression may occur among diabetic patients, and may be associated with poor outcomes. However, despite large diabetic population, literature of depression in T2DM from India is scare. Objective: Our aim was to measure the proportion of depression and metabolic syndrome (Mets) in T2DM in rural population and to determine the association of depression with different demographic and clinical parameters. Methods: This cross-sectional study was done at the out-patient clinic of rural tertiary care hospital in central India. Cases were eligible patients with T2DM. Depression and Mets were assessed with patient health questionairre-9 (PHQ-9) and IDF criteria respectively and their relationship with sociodemographic and clinical profile including complications were analyzed. Results: Total 300 patients (58.67% females) were evaluated. The proportion of depression and Mets were 25.3%&45.3% respectively. Severe depression (PHQ score ≥15) was present in 13 (17.11%), moderate depression (PHQ score 10-14) in 28 (36.84%), and mild depression(PHQ score 5-9) in 35 (46.05%) of subjects. Depression and Mets were significantly more prevalent in females (33% vs 14.5%) and (53.4% vs. 33.9%) respectively. Patients having comorbid depression and Mets had significantly higher fasting plasma glucose, hypertension, TG, BMI, longer duration of diabetes and lower HDL-C while those with depresion also had significantly higher proportion of pill burden and various complication of T2DM (p<0.05). Conclusions: Our study demonstrates comparatively lower proportion of depression in T2DM patients from rural population. Variety of demographic and clinical parameters are associated with depression in T2DM and those patients should be routinely evaluated for depression.

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Background: The invention of McCoy blade in the early 1990s is a modification of the Macintosh blade with a hinged tip. The McCoy blade reduces the amount of force applied during laryngoscopy and endotracheal intubation, thus the increased reflex haemodynamic changes in response to tracheal intubation becomes less significant. Objective: To determine the advantages of McCoy blade laryngoscope in obtunding the pressor response, better glottic visualization and ease of intubation during laryngoscopy and endotracheal intubation as compared to Macintosh blade laryngoscope. Methods: The present study was done on 60 adult patients of ASA I and II, between the age group of 20 to 50 years. We observed the haemodynamic changes, glottic view and ease of intubation by using either Macintosh or McCoy blade laryngoscope during general anesthesia at laryngoscopy and endotracheal intubation. The changes in HR, SBP, DBP, and MAP were recorded before induction, at laryngoscopy and intubation and at 1 min, 3 min and 5 min after tracheal intubation. Glottic view obtained on laryngoscope was compared as per Cormack and Lehene grading. Tracheal intubation grading was also compared between the groups. Complications during the procedure like arrhythmias, injury, and bleeding were noted. Results: In our study, a significant haemodynamic changes were observed in both the groups following laryngoscopy and endotracheal intubation. The rise in HR, SBP, DBP and MAP were more significant with Macintosh blade laryngoscope, where as better visualization of the glottis, ease of intubation and less haemodynamic changes were noted with McCoy blade laryngoscope. Conclusion: McCoy blade laryngoscope produces significantly less marked haemodynamic changes, better glottic view and ease of intubation as compared to Macintosh blade laryngoscope during laryngoscopy and tracheal intubation.

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Background: Lens induced glaucoma are phacomorphic (closed angle) or phacolytic (open angle). Its definitive treatment after the control of the high intraocular pressure and inflammation is cataract extraction alone or combined with a filtration surgery. Objective: To evaluate the Visual outcome of Phacomorphic Glaucoma, a common cause of ocular morbidity. Methods: Participants were Seventy two patients in a tertiary care hospital for both urban and rural population. Seventy two eyes of patients clinically diagnosed as Phacomorphic Glaucoma were treated. Demographic data and the Duration of the symptoms before presenting to the hospital were noted. Intraocular pressure and Visual Acuity were recorded preoperatively and postoperatively. Small Incision cataract surgery with posterior chamber intraocular lens (PCIOL) implantation was done after the control of intraocular pressure. Postoperative complications were noted. The data was analyzed by simple statistical methods. Results: Mean age was 61.6 yrs. RE in 38 (52.7%) and LE in 34 (47.3%) were involved. 53 (73.6%) were Rural and 19 (26.4%) were Urban. Duration of the presenting symptoms before reporting of the patients to the hospital was < 1wk. in 44 (61.1%) with 6 (8.4%) within 48 hrs and 38 (52.7%) after 48 hrs - < 1 wk. and > 1 wk. in 28 (38.9%). The Mean IOP was 46.3 mmHg preoperatively and 13.5 mmHg postoperatively. Visual Acuity preoperatively was PL doubtful in 9 (12.5%), PL + ve in 46 (63.8%) and HM - < 3/60 in 17 (23.6%) and postoperatively was <6/60 in 17 (22.2%) and >6/60 in 56 (77.8%). Postoperative complications were Striate Keratopathy in 11 (15.3%), Anterior Uveitis with membrane on IOL in 5 (6.9%), posterior capsular tear in 5 (6.9%) and Zonular dialysis in 5 (6.9%). Conclusion: This study showed that the effective control of preoperative IOP and inflammation was important for a better visual outcome.

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Background: Direct laryngoscopy and tracheal intubation following induction of anesthesia is almost always associated with hemodynamic changes due to reflex sympatho-adrenal activity which may result in hypertension, tachycardia and arrhythmias. Various agents like lidocaine, opioids, esmolol, magnesium sulphate, alpha 2 agonists and propofol have been shown to attenuate these responses, but they have limitations and side effects. Recently several studies have shown that calcium channel antagonist Diltiazem with its direct vasodilation, direct negative chronotropic and dromotropic properties is effective. Our study was designed to determine the efficacy of diltiazem 0.3mg/kg in attenuating the hemodynamic response to laryngoscopy and intubation in ASA I & II patients. Objectives: The prospective randomized study was done to evaluate the efficacy of Diltiazem in attenuation of hemodynamic response to laryngoscopy and intubation. Methods: 50 patients aged between 22-55 yrs of either sex of ASA Grade I and II scheduled for elective surgeries were studied after randomization into two groups, Control and Study (Diltiazem) groups. The anesthesia technique was standardized for both the groups. All the patients were given either saline 2ml or diltiazem 0.3 mg/kg in 2ml 60 seconds before laryngoscopy and intubation. The parameters like HR, SBP, DBP, and MAP were recorded at pre-induction, at induction, during laryngoscopy and intubation and at 1min, 2min, 3min, and 5min after intubation. Patients were also observed for side effects like hypotension, bradycardia and bronchospasm. Results: There was increase in the HR, SBP, DBP and MAP after induction and immediately after laryngoscopy and intubation in the control group but there was a fall in SBP, DBP and MAP in study group. There was no significant change in HR in the study group. Conclusion: Our study concludes that diltiazem 0.3 mg/kg given IV 60 seconds before laryngoscopy and intubation can be safely employed to attenuate hemodynamic responses without any side effects.

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Background: The aim of the study was to identify the pattern of pathologies involving nasal mass lesions which were received for histopathological evaluation at a tertiary hospital in Hyderabad during the period January 2014 to December 2016. Methods: The data pertaining to samples of nasal mass lesions received for histopathological evaluation at the laboratory of a tertiary care hospital in Hyderabad from January 2014 to December 2016 were analyzed to determine the pattern of pathologies diagnosed during such evaluation and the age distribution of all lesions. Results: A total of 62 specimens labeled as nasal masses were received during the period studied. The majority of patients, whose samples were received, were in the age group of 21 – 30 years [35.48%], with very few patients from either extreme of age. Inflammatory nasal polyp was the most common histopathological diagnosis given [26 out of 62 cases, 41.93%] followed by allergic nasal polyp [19 out of 62 cases, 30.64%]. Only one lesion was diagnosed as malignant [squamous cell carcinoma] Conclusion: The majority of nasal mass lesions received for evaluation were inflammatory or else allergic nasal polyps. Most patients were in the third decade of life.

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Background: Acute preeclampsia is associated with significantly higher prevalence of asymptomatic global left ventricular (LV) abnormal function and myocardial injury than uneventful pregnancy. Objective: To evaluate the LV changes in pre-eclamptic women and to compare with normotensive women. Methods: This study was conducted in the Department of Obstetrics and Gynecology, Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar. Two hundred women were in each group: 200 patients with preeclampsia as cases and 200normotensive patients as controls. Results: The mean LV end-systolic volume (LV ESV) in pre-eclamptic women was 33.45 ± 2.8, LV end-diastolic volume (LV EDV) was 106 ± 3.01, and LV systolic mass (LV Ms) was 87.1 ± 1.65 when compared to normotensive women LV ESV 27 ± 0.74, (P < 0.0001) LV EDV 106.2 ± 0.43, (P -0.3528), and LV Ms 84 ± 0.56 (P < 0.0001). Conclusion: This study emphasizes the importance of identifying this subset of preeclamptic patients with echo changes who are at higher risk of developing cardiovascular complications later in life by undergoing echocardiography.

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Background: Gallstone disease is a common disease responsible for considerable morbidity in the society. Surgery is the definitive treatment and laparoscopic cholecystectomy has largely replaced conventional surgery. However, laparoscopic cholecystectomy carries a higher risk of injury to biliary tree than conventional surgery. Significant number of these injuries is caused by variations in the biliary tree anatomy. By precisely delineating the biliary tree anatomy, magnetic resonance imaging and magnetic resonance cholangiopancreatography can assist the surgeons in predicting difficult surgery. Objective: The present study attempts to determine the role of magnetic resonance imaging and magnetic resonance cholangiopancreatography prior to laparoscopic cholecystectomy in gallstone disease. Method: In the present study, 100 patients with gallstone disease, referred for magnetic resonance imaging and magnetic resonance cholangiopancreatography were evaluated Result: The most common age group to be involved was 4th and 5th decade. Females were almost twice commonly affected than males. The sensitivity of MRI was 95 -100%, specificity 97 – 100% and accuracy 96 - 98% for detecting gallstones. Similar sensitivity and specificity was found for CBD calculi.3. The sensitivity and specificity for delineation of biliary tree anatomy was 100% each. Type A IHBR pattern was seen in 42 %, Type B in 22%, Type C in 26%, Type D in 6% and Type E in 2%. The cystic duct anatomy was delineated with 100% sensitivity and specificity. Anomalous cystic duct insertion patterns were seen in 11%. The incidence of CBD calculus was 7%. The mean diameter of CBD was 5.73±2.65 mm. The gall bladder volume had no statistically significant correlation with difficult surgery. The patterns of IHBR did not have any impact of difficult surgery. However, the pattern of cystic duct insertion had a statistically significant correlation with difficult surgery with anomalous insertions leading to difficult surgery with a p value of 0.025. It was significant on multivariate analysis too with a p value of 0.034. The CBD diameter also had a statistically significant correlation with difficult surgery with a p value of 0.011 on Univariate analysis and 0.021 on multivariate analysis. There were no bile duct injuries or forced conversion to open surgery. The mean operation time was 54.13±33.73 min. Conclusion: MRI and MRCP can accurately detect gallstones and delineate biliary tree anatomy. They can also detect anomalous biliary tree and can predict difficult surgery thus helping the surgeon to be prepared for the eventualities during surgery.

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