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Introduction: Direct laryngoscopy is most widely used method of oro-tracheal intubation but at times it could be difficult, and may lead to adverse effect on cardiovascular system. Video laryngoscopy in contrast provides better visualisation of airway making oro-tracheal intubation easy. The aim of this study was to prospectively compare the use of Video laryngoscope (Glidescope) versus the direct (Macintosch) laryngoscope blade for routine airway management Materials and Methods: A prospective randomised comparative study was done by randomly allocating patients undergoing elective surgery to one of two Groups comprising 50 patients in each as: Group Iindirect laryngoscope (Video) and Group D-Direct (Macintosh) laryngoscope. After induction patients were intubated according to group allotted. Ease of intubation and other haemodynamic parameters were recorded at numerous intervals as follow: baseline, after induction of anaesthesia, one and five minutes after intubation. Results: Time required for the laryngoscopy and tracheal intubation in Group I i.e. indirect (18.50 seconds) was more as compared to Group D direct (11.76 seconds) with statistical significance. The Group I procedure significantly reduced tracheal intubation difficulty score and the ease of intubation was statistically insignificant as compared to that of Group D. It was found that there was a significantly better Modified Cormack Lehane Grade in Group I(100%) as compared to Group D(65%). Conclusion: Video laryngoscopy (Glidescope) is considered advantageous over conventional direct laryngoscope (Macintosh) in terms of lower intubation difficulty score (IDS), better ease of intubation and lower grades of Modified Cormack Lehane Grade with indirect laryngoscopy). It can be used as a teaching tool for novice intubators and offers a new approach to tracheal intubation. Keywords: Video laryngoscopy, Glidescope, Airway management, Laryngoscopes.

Introduction: During the past decades, practice of routine investigations prior to surgery has been challenged as it has little impact on perioperative management but increases cost, causes delay and increases laboratory load. We aimed to prospectively assess the influence of pre-operative investigations on resource utilisation and peri-operative management in elective surgeries. Materials and Methods: Prospective observational study was done in 500 Patients, who attended preanaesthetic check-up (PAC) for elective surgeries. Number of investigation already performed before arriving in PAC and their results in terms of normal and abnormal tests were noted. Based on National Institute for Health and Care Excellence (NICE) guideline, the test was considered as indicated or unindicated. These patients were then followed up till the post-operative period and any referral, further investigation or delay done during pre-operative was noted. An abnormal test result was said to be impactful if it resulted in referral, delay or further investigations. Cost analysis was done for every test that was considered not necessary based on NICE guidelines. Results: Majority (60.6%) of the patients had at least one abnormal test results on routine pre-operative tests, but only 6.93% of all tests performed had any impact in terms of referral, further testing or delay. Only 5 (0.14%) of all 3462 abnormal test had significant impact which it lead to change in perioperative management. Conclusion: The practice of prescribing large number of routine pre-operative investigations is prevalent in the institution. Most of the investigations are done without following any guidelines, which leads to wastage of resources. Keywords: Routine laboratory testing, Preoperative investigations, NICE guidelines, Peri Operative anesthesia management.

Cancer is one of the most lethal disease that affects humans. Many anticancer agents have been developed but have downsides such as toxicity, affordability and limits of the administered dose. Alternatively, natural anticancer products are promising due to their non-toxic nature. Indeed, natural anticancer products have doubled the human life span in twentieth century. Moreover, over 60% of approved drugs and drug candidates against cancer are of natural origin. Yet, natural drugs have limitations such as non-specific action, low aqueous solubility and reduced bioavailability. These limitations can be circumvented by delivering drugs using polymeric nanocarriers. For instance, polylactic acid and polylactic-co-glycolic acid have been used as carriers in the medical field for a very long time. About 20 products based on these polymers have been approved by the Food and Drug Administration and European Medicine. Polymeric nanocarriers are versatile and have potential to meet actual challenges in the delivery of natural products for cancer treatment. Here we review natural products in treating cancer with focus on polymeric nanocarriers.

Phyllodes tumor is a rare neoplasm of female breast have its origin from the broepithelial cells of breast. It predominantly occur in females (0.3- 0.5%). Phyllodes in pregnancy are larger in size and rapidly growing may be because of the inuence of pregnancy hormones on the female breast tissues. A 22 year old female with six months of pregnancy with phyllodes tumor of right breast was posted for wide local excision and reconstruction of defect using latissimus dorsi myocutaneous ap. She had presented with swelling of approximately 24cm X10cm X 6cm in her right breast which developed pain since last eight days. She was maintained on the intravenous injection duvadilan (isoxsuprine) 80 mg 8 hourly for three days perioperatively for tocolysis. The case was done using thoracic epidural catheterization at T6-T7 interspace using 0.75% ropivacaine with no perioperative complications. The choice of anesthetic technique for the emergency procedures in pregnancy will depend on the trimester and the type and duration of surgical procedure. Whenever possible, a regional anesthetic technique should be used.

Cancer is a major cause of deaths throughout the world. According to World Health Organization, cancer lead to the loss of about 9.6 million lives in the year 2018 with low and middle income countries accounting for 70% of these deaths. With its ability to grow in an uncontrolled manner and spreading out to different sites in the body, cancer is seen as that dreaded disease with no cure or treatment. Several promising cancer chemotherapeutic advancements have emerged but these came along with unavoidable limitations like toxicity, limits on the administered dosage as well as affordability for the people who most need them. Natural products with anticancer potential have also emerged as an immensely attractive option to treat cancer. The use of natural products has been credited to doubling of human life span in twentieth century. Furthermore, of all the anti-cancer agents approved and pre-new drug application candidates till date, more than 60% are of natural origin or a derivative thereof. However, an estimated 4 in 10 of the new chemical entity proposed against cancer turns out to be lipophilic. Problems of low aqueous solubility, low bioavailability and non-specific action still pose as major stumbling blocks in their advancement. Recently, polymeric nanocarriers have been used to deliver cancer chemotherapeutics to circumvent the associated limitations and improve their efficacy. Polymers like polylactic acid/poly lactic-co-glycolic acid are have a long history of use in medical field. These are safe and biodegradable with about 20 products approved by the Food and Drug Administration and European Medicine Agency for use in humans. The polymeric nanocarriers with their versatility offer solution to many of the hurdles of natural product delivery for cancer chemotherapy.

Cancer is a well-known disease that leads to death of human beings and breast cancer (BC) is one of the types of cancer diagnosed in women. About one of eight women is diagnosed with BC during her life time. Treatment for BC can be easy if it is diagnosed early. The approach of this study is to identify a patient having BC or not by different Machine Learning (ML) Techniques. In this study Wisconsin Diagnostic Breast Cancer (WDBC) dataset is going to classify with Support Vector Machine (SVM), k-Nearest Neighbours (k-NN), Naive Bayes (NB), Decision-Tree (DT) and Logistic Regression (LR). There is pre-processing stage prior to classification in which five different classifiers applied with 5-fold cross-validation method. Classification performance is measured by performance measuring parameters i.e.accuracy, sensitivity, and specificity with the use of confusion metrics. The best performance found by SVM with an accuracy of 99.12% after normalization process in this study.

Background: Post-partum haemorrhage (PPH), an obstetric emergency that can complicate vaginal or cesarean deliveries and associated with serious complications. Guidelines for the management of PPH involve a stepwise escalation of pharmacological and eventual surgical approaches. In women who do not respond to uterotonics or medical treatment, a variety of procedures, such as arterial embolization, surgical ligation of the uterine arteries or obstetric hysterectomy, may be used. The Bakri balloon is an intrauterine device indicated to reduce or control PPH temporarily when conservative treatment is warranted. Here, we are presenting case series of primary atonic PPH and which were managed by Bakri Balloon Tamponade (BBT).Methods: This case series included five women with PPH managed by Bakri balloon as a conservative therapeutic option.Results: All five women were in age group between 23 years to 34 years. The causes of PPH were uterine atony, retained placenta and central placenta previa. The Bakri balloon was successful in controlling hemorrhage in all women (five of five) who did not respond to medical uterotonic treatment.Conclusions: Bakri balloon is a simple, easy to use and effective method for conservative management of acute PPH. This device reduces bleeding, shortens the hospital stay and avoids the need for more aggressive procedures.