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Background: Endotracheal intubation is an essential resuscitative procedure in the emergency setting. Airway assessment parameters such as the Mallampati classification are difficult to perform in an emergency setting. As point-of-care ultrasound (POCUS) assessment of airway parameters does not require patients to perform any mandatory action, ultrasound may become the potential first-line noninvasive airway assessment tool in the emergency department (ED). The use of POCUS in the ED has not been sufficiently studied. Using POCUS in airway assessment for predicting difficult intubation may be the next step in successful airway management. Methodology: The study was an observational study conducted at the ED of the All India Institute of Medical Sciences (Rishikesh). The treating emergency physician recorded the patient history and systemic examination along with an indication for intubation. The POCUS assessment of airway parameters pre-epiglottis to epiglottic vocal cord ratio (Pre-E/E-VC), tongue thickness, hyomental distance, and distance from skin to the hyoid bone was performed by the study investigator. During laryngoscopy, Cormack-Lehane (CL) grading was assessed. The data was entered and analyzed. Results: Seventy patients who required intubation in the ED were enrolled in the study. Among the study population, 48.6%, 28.6%, 14.3%, 1.4%, and 7.1% were classified with the following CL grading: 1, 2a, 2b, 3a, and 3b, respectively. At a cutoff of ≥ 1.86, Pre-E/E-VC predicts difficult laryngoscopy (AUC 0.835) with a sensitivity of 83% and a specificity of 94%. At a cutoff of ≥ 5.98 cm, tongue thickness predicts difficult laryngoscopy (AUC 0.78) with a sensitivity of 83% and a specificity of 88%. At a cutoff of hyomental distance ≤ 6 cm, it predicts difficult laryngoscopy with a sensitivity of 83% and a specificity of 88%. All parameters can act as a promising tool for predicting difficult laryngoscopy, with the single best parameter being Pre-E/E-VC. Conclusion: Assessment of the airway with POCUS may be helpful to the emergency physician when the clinical airway assessment parameters fail to predict difficult laryngoscopy as most patients requiring intubation are uncooperative. Assessment of the parameters in our study Pre-E/E-VC, tongue thickness, and hyomental distance can act as a promising tool for predicting difficult laryngoscopy in the emergency scenario. [ABSTRACT FROM AUTHOR]

Airway edema following burns is a typical occurrence. It poses a threat, independent of percent Total Burn Surface Area (TBSA), to the life of the patient. Fiber optic bronchoscopy is the gold standard in its diagnosis and is preferred if the facilities are present. Its availability remains a problem in the majority of burn centers in developing countries like India. A scoring system based on clinical findings, if formulated in a manner that reflects bronchoscopy results, may help not only with diagnosis but also with airway management in inhalation burns. One hundred patients suffering from facial burns were included in the study. They were observed clinically and bronchoscopically and airway was managed on the basis of clinical, biochemical and bronchoscopic findings. Fifty patients who showed significant bronchoscopic findings on day 1 were followed up. Clinicobronchoscopic correlation revealed a positive correlation of various clinical variables as well as bronchoscopic grading with subsequent need for endotracheal intubation. Edema of tongue/floor of the mouth and palatal edema showed a positive correlation with subsequent need for tracheostomy. This clinicobronchoscopic correlation was then used retrospectively to formulate the Safdarjung Hospital 'INHALATION' score. This score can be used for predicting impending airway compromise when bronchoscopy facilities are not readily available. [ABSTRACT FROM AUTHOR]

Background: Multidrug-resistant (MDR) organisms in the critical care unit are a worldwide concern. The vulnerability to MDR infection in pediatric patients admitted in neurocritical care are due to altered mental status, immature immune system, higher risk of aspiration, and more frequent use of invasive devices. We aimed to measure the burden of MDR infection in pediatric neurosurgical intensive care unit (NSICU) patients. Methods: All pediatric patients between 1 and 18 years for intracranial and spine surgeries admitted for more than 48 hours in NSICU were enrolled in the study. If patients showed a clinical picture of pneumonia, blood stream infection (BSI), or urinary tract infection (UTI) after receiving mechanical ventilation or an indwelling device for at least 48 hours, samples of tracheal aspirates, urine, blood, and cerebrospinal fluid (CSF) were sent for microbiological culture. We noted the type of organism, MDR infection rate, and associated risk factors. Pearson Chi-squared test and Fisher's test were used for statistical analysis; p < 0.05 was considered statistically significant. Results: A total of 274 pediatric patients were studied. In 1 year, there was a total of 1790 patient days. The inclusive MDR infection rate was 17.3/1000 patient days. Also, Klebsiella pneumoniae (38.7%) was the commonest MDR pathogen. The commonest source of infection was BSI (32.3%). The risk factors associated with MDR infections were the length of stay in NSICU, mechanical ventilation of more than 5 days, emergency surgery, respiratory and cardiac comorbidities, and poor nutrition status (p < 0.05). Conclusion: The MDR infection rate in our study was 17.3/1000 patient days in pediatric patients. Also, K. pneumonias was found to be the commonest MDR pathogen. Blood stream was the commonest source of infection. [ABSTRACT FROM AUTHOR]

The present study was undertaken to understand the prevalence of Mycoplasma galliseptucum (MG) and Mycoplasma synoviae (MS) in 80 commercial layer chicken with respiratory disease and production drops in Namakkal region of South India. Necropsy examination was carried out and pooled tissue samples showing lesions including trachea, lungs, and oviduct were collected for diagnostic studies. Epidemiological and pathological details were recorded. The samples were screened for MG and MS infections by polymerase chain reaction (PCR) targeting for 16S rRNA. Out of 80 flocks screened, 11/80 flocks were positive for MG and 50/80 flocks were positive for MS. The prevalence rate of MG was 13.75% and MS was 62.15%, respectively. All the affected flocks were multi aged and size of the flocks ranging from 5000 to 50000. The mortality ranged from <0.5 % to 7%. The clinical and pathological observations were overlapping between MG and MS. Young birds aged between 6-14 weeks exhibited severe respiratory disease, whereas the clinical signs in older birds were ranged from asymptomatic to severe clinical signs. The clinical signs were undetectable in uncomplicated cases except 2-6% drop in egg production and 0.3 -1.5% egg shell defects. Post-mortem examination of the affected flocks revealed sinusitis, catarrhal tracheitis, thickened, frothy airsacs with edema and increased vascularization and accumulation of caseous material in the thoracic and abdominal airsacs and salphingitis. In conclusion our study confirmed the association of MG and MS with drop in egg production, egg quality issues including egg shell apex abnormalities, respiratory disease, and salpingitis in commercial layer chicken in Namakkal region of Tamil Nadu. [ABSTRACT FROM AUTHOR]

Introduction: There is a wide variation in different dimensions of trachea in same age group as well as in different age groups in both sexes. Besides anthropometry, the study of these morphometric variations is of profound clinical importance as it may help the pulmonologists to understand the aetiology of several pulmonary diseases like bronchitis, emphysema, pulmonary fibrosis and tuberculosis. Aim: To determine the variations in the dimensions of human trachea in the cadavers of age group 20-70 years in Northern India. Materials and Methods: This cross-sectional study was conducted in the Department of Anatomy, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India, during March 2019 to December 2021. A total of 40 tracheas were obtained from adult human cadavers which were included in present study by convenience sampling. The trachea was dissected with the larynx and principal bronchi and measurements were taken. Data collected was saved on Microsoft excel and was analysed by calculating percentages, mean and Standard Deviation (SD). Results: Mean length of trachea was 109.25 mm, mean subcarinal angle was 75.45°. Mean anteroposterior diameter, transverse diameter, mean height and distance between posterior ends of rings was 16.70 mm and 18.10 mm, 4.53 mm and 12.15 mm respectively and mean of inter-ring distance between 1st-2nd, 5th-6th, 10th-11th, 15th-16th tracheal rings was 1.12 mm. Conclusion: The present study revealed a wide variation in different dimensions viz. length, transverse and anteroposterior diameters, mean height, intertracheal ring distance and the subcarinal angle. Accurate anatomical knowledge of the variations is essential for understanding the pathophysiology and management of different airway disorders and in reconstructive surgery of tracheobronchial tree. [ABSTRACT FROM AUTHOR]

Dehydration of the upper airways increases risks of respiratory diseases from COVID-19 to asthma and COPD. We find in human volunteer studies involving 464 human subjects in Germany, the US, and India that respiratory droplet generation increases by up to 4 orders of magnitude in dehydration-associated states of advanced age (n = 357), elevated BMI-age (n = 148), strenuous exercise (n = 20) and SARS-CoV-2 infection (n = 87), and falls with hydration of the nose, larynx and trachea by calcium-rich hypertonic salts. We also find in a protocol of exercise-induced airway dehydration that hydration of the airways by calcium-rich salts increases oxygenation relative to a non-treatment control (P < 0.05). In a random control study of COVID-19 positive subjects (n = 40), thrice-a-day delivery of the calcium-rich hypertonic salts (active) suppressed respiratory droplet generation by 51% ± 11% and increased oxygen saturation over three days of treatment by 48.08% ± 9.61% (P < 0.001), while no changes were observed in the nasal-saline control group. Self-reported symptoms significantly declined in the active group and did not decline in the control group. Hydration of the upper airways appears promising as a non-drug approach for reducing risks of respiratory diseases such as COVID-19. [ABSTRACT FROM AUTHOR]

Newcastle disease (ND) is an acute viral disease of poultry as distributed throughout the world and causing severe economic losses to the farmers by means of drop-in egg production and sudden mortality of entire flock in severe cases. The main limiting factor in controlling the Newcastle disease virus (NDV) is controlling the disease spread because of its wide host range including domestic, backyard, wild and migratory birds. The ND samples were collected from an outbreak in backyard poultry and processed the samples (n=27). Detection of Avian Paramyxovirus-1 (APMV-1) or NDV in birds was studied by using haemagglutination (HA), haemagglutination inhibition (HI), histopathology, embryonic mean death time (MDT), IntraCerebral Pathogenicity Index (ICPI) in day-old chicks and Reverse Transcription-Polymerase Chain Reaction (RT-PCR). Proventriculus, spleen, trachea, lung and brain samples were collected and tissue lysates were propagated in allantoic fluids for haemagglutination (HA) by using chicken erythrocytes and serum from vaccinated birds for haemagglutination inhibition (antibody titers>1/16) tests. The RT-PCR product of 356 bp was amplified from HI positive infected allantoic fluids by targeting a partial Fusion (F) protein gene. Tissue lysates grown in Embryonated Chicken Eggs (ECE) showed virulent pathotype based on Embryonic Mean Death Time (MDT) of 52 hours and the Intra-Cerebral Pathogenicity Index (ICPI) in day-old chicks was 1.6 by means of Velogenic pathotype. This is the first instance of NDV identification in the Karnataka region in backyard poultry. In this scenario, more epidemiological works are suggested for surveillance of NDV in backyard poultry of an area of work with suitable prevention and control measures. [ABSTRACT FROM AUTHOR]

Introduction: Anticipation of difficulties in airway management is of prime importance in avoiding potential catastrophies. Obese patients form part of a population that is believed to have difficult airway. Ultrasound imaging has recently come forth as a simple, portable, noninvasive adjunct for bedside assessment. We hypothesized that there is an association between ultrasonographic measurements of the anterior neck soft-tissue thickness at level of vocal cords (VCs) and hyoid bone (HB) in predicting difficult laryngoscopy in the obese patients and evaluated the feasibility of ultrasound in predicting difficult laryngoscopy in Indian population. Materials and Methods: A total of 70 obese patients with body mass index >30 kg/m2 and American Society of Anesthesiologists Grade I and II undergoing elective surgeries and receiving general anesthesia were enrolled in the study. Ultrasound quantification of the anterior neck soft tissue was performed using a high-frequency (13-6 MHz) linear transducer. The distance from the skin to the anterior aspect of the trachea was measured at two levels: VCs and HB. Results: The incidence of difficult laryngoscopy (III and IV) in our study population was 24.3% (17 of 70 cases). The sonographic measurements of the skin thickness of the anterior neck were greater at the level of VCs in the difficult laryngoscopy group at 13.5 ± 1.5 mm as compared to the easy laryngoscopy group at 10.2 ± 1.6 mm, with the difference being statistically significant, P < 0.001. The soft-tissue thickness at the level of HB was also greater in the difficult laryngoscopy group in contrast to the easy laryngoscopy group (16.4 ± 1.9 mm vs. 12.4 ± 2.0 mm; P < 0.001). Conclusions: Ultrasonographically measured skin thickness at the level of HB and VCs has got a good correlation with difficult intubation. [ABSTRACT FROM AUTHOR]

Background: Fatal burns and related injuries are major cause of death and disability. There are certain pathological changes such as lungs shows necrotizing pneumonia, congestion of alveolar walls, capillary proliferation, intra alveolar oedema, giant epithelial cells Objective: To study on the cause of death due to burn cases and histopathological changes in north Indian setting. Method: This was a cross-sectional study. All autopsies with history of burn injury were studied to find out the significant histopathological change in lung. Cases was thoroughly studied using specially designed proforma that included demographic profile of deceased, history from relatives, police & hospital records, autopsy findings. Results: The most common cause of death due to burn injury was found to be Sepsis (48.2%) and neurogenic shock (29.5%). On histopathological examination, Congestion in trachea was present in majority 434 (78.9%) cases while Tracheal soot particles were present in only 40 (7.3%) cases. Specimens of 375 cases were available for histopathology out of which 52 (13.9%) specimens were autolyzed. Changes suggestive of Pneumonia (50.1%), Congestion (83.7%), alveolar and interstitial haemorrhage (63.2%) were present in majority of the cases while changes suggestive of alveolar interstitial edema (64.3%), alveolar wall disruption (66.1%), inflammatory cells (55.5%), hyaline membrane (79.7%) and Fibrin strands (79.7) were absent in majority of cases. Capillary dilatation was present in 39.2%. Conclusion: In the present study, an important observation in burn deaths is the Sepsis and Neurogenic shock. Congestion in trachea was most common on histopathological change. [ABSTRACT FROM AUTHOR]

Background and Aims: CMAC video laryngoscope size 2 D-Blade has been recently introduced for management of pediatric difficult airway. Our primary outcome was to compare glottic view, intubation time, and ease of intubation with the size 2 Macintosh versus D-Blade of C-MAC video laryngoscope in simulated cervical injury in children. Material and Methods: This randomized crossover study was conducted in a tertiary care hospital of Northern India. Forty children of 4–14 years of age were enrolled in this study. After induction of anesthesia, video laryngoscopy was performed either with size 2 CMAC Macintosh (group M) or D-Blade (group D) with manual in-line stabilization. After removal of the first blade, second video laryngoscopy was performed with the alternative blade. Endotracheal intubation was done with the second laryngoscopy. Best glottic view, time for best glottic view, and difficulty in blade insertion were recorded during both the video laryngoscopies. During second video laryngoscopy, difficulty of tube insertion and time for intubation were noted. Results: The glottic view grade was significantly better in group D compared with the group M (P = 0.0002). Insertion of D-Blade was more difficult than Macintosh blade (P = 0.0007). There was no statistical difference in terms of time for best glottic view in group M and group D (13.40 ± 4.90 vs 13.62 ± 5.60 s) and endotracheal tube insertion time (24.80 ± 7.90 vs 27.90 ± 10.90 s), respectively. Number of intubation attempts was similar in both the groups. Conclusions: Size 2 D-Blade of C-MAC video laryngoscope provided a better glottic view in children with simulated cervical spine injury as compared with CMAC Macintosh blade. Success of intubation, intubation time, and ease of intubation were comparable with both the blades. [ABSTRACT FROM AUTHOR]

Objectives: To find the correlation of manner of death with histopathological changes in fatal burns in a tertiary care hospital in north India. Method: This was a comparative study. Cases were thoroughly studied usingspecially designed proforma that included the demographic profile of deceased along with information gathered from relatives, police & hospital records and autopsy findings. Before taking the lung sample, proper consent was taken from the relatives after explaining the purpose of the study. After gross examination, sections were taken from different lobes of lungs. Results: Tracheal congestion was found mainly in accidental deaths (49.77%), followed by suicidal deaths with 28.57% and homicidal deaths with 21.66%. This difference was found to be statistically significant (p<0.001). Lung Consolidation was more commonly seen in accidental and suicidal deaths (48.4%) as compared to homicidal deaths (3.19%). Various other variables were also correlated with type of burns. Conclusion: This association of histopathological changes in lung tissue could help to ascertain the mode of Death, as well as can hint towards conduction of proper inquest in suspicious cases of so called suicidal deaths [ABSTRACT FROM AUTHOR]

ABSTRACT Background of the study: Breathing is important aspect of life. For good breathing airway patency is necessary. Pneumothorax, Meconium aspiration syndrome, hypoxia, asphyxia, respiratory distress syndrome, chronic obstructive pulmonary disease are the common respiratory problems which effects the airway of the neonates and leads to the airway obstruction. It is usually a life-threatening emergency requiring immediate medical attention. If help is delayed, death or brain damage can result from the lack of vital oxygen. Therapeutic methods to maintain patency of both the upper and lower airway may include: Mechanical ventilation, pediatric advanced life support therapy, oxygenation, intubation, tracheotomy, along medication therapy as prescribed by Physician etc are used to promote airway of the patient. Endotracheal suctioning is the most common procedure used in airway management for patients requiring mechanical ventilation and intubation who are admitted in the neonatal intensive care unit. This procedure may be required in an emergency situation or as a part of patient's planned care to carry out various operation procedures. The purpose of endotracheal suctioning is to remove pulmonary secretions effectively to prevent atelectasis secondary to blockage of smaller airways and to ensure that adequate gas exchange occurs. Endotracheal suctioning is a necessary procedure for patients with artificial airway. Most contraindications are relative to the patient's risk of developing adverse reactions or worsening clinical condition as result of the procedure. So, all nurses who perform suction must have received approved training and demonstrated competence under supervision. They should ensure that their knowledge and skills are maintained. Objective 1. To assess the pre test knowledge score and skills score regarding the endotracheal suctioning among the staff nurses in experimental and control groups. 2. To develop and implement the self instructional module regarding the endotracheal suctioning among the staff nurses in experimental group. 3. To assess the post test knowledge score and skills score regarding the endotracheal suctioning among the staff nurses in experimental and control groups. 4. To compare the pre test and post test knowledge score and skills score regarding the endotracheal suctioning among the staff nurses in experimental and control groups. 5. To find association between the post test knowledge score and skills scores with selected socio-demographic variables. Methodology Research Design: Non-equivalent Pre test Post test control group research design Setting: Selected Hospitals, district Jalandhar, Punjab. Target Population: Staff nurses working in neonatal intensive care unit of selected hospitals, Jalandhar, Punjab. Sample Size: 50 staff nurses (25 in experimental group and 25 in control group) Sampling Technique: Purposive sampling technique. Result and conclusion: The findings of the study revealed that the Pre test mean knowledge score of experimental group & control group were 16.92±3.47 &15.56± 3.13 respectively. The post test mean knowledge score in experimental & control group were20.52±3.29 &16.16±2.83. The Pre test mean skills score of experimental & control group were 20.21±2.51 & 19.16±2.32. The post test mean skills score of experimental and control group were 22.92±2.64 &19.96±2.42. It is indicated that there was significant difference in Pre and post test interventional knowledge score and skills score among staff nurses working in neonatal intensive care at 0.05% level of significance. Hence the research hypothesis (H1) is accepted and null hypothesis (H0) is rejected. The study was found that duration of posting in NICU was found associated with knowledge of staff nurses and age (in years), professional experience and in-service education are significantly associated with skills. So, the study concluded that self instructional module had significant effect on knowledge and skills regarding endotracheal suctioning among staff nurses working in neonatal intensive care unit. [ABSTRACT FROM AUTHOR]

Objectives:Multidetector computed tomography virtual bronchoscopy is a non-invasive diagnostic tool which provides a three-dimensional view of the tracheobronchial airway. This study aimed to evaluate the usefulness of virtual bronchoscopy in cases of vegetable foreign body aspiration in children.Methods:The medical records of patients with a history of foreign body aspiration from August 2006 to August 2010 were reviewed. Data were collected regarding their clinical presentation and chest X-ray, virtual bronchoscopy and rigid bronchoscopy findings. Cases of metallic and other non-vegetable foreign bodies were excluded from the analysis. Patients with multidetector computed tomography virtual bronchoscopy showing features of vegetable foreign body were included in the analysis. For each patient, virtual bronchoscopy findings were reviewed and compared with those of rigid bronchoscopy.Results:A total of 60 patients; all children ranging from 1 month to 8 years of age, were included. The mean age at presentation was 2.01 years. Rigid bronchoscopy confirmed the results of multidetector computed tomography virtual bronchoscopy (i.e. presence of foreign body, site of lodgement, and size and shape) in 59 patients. In the remaining case, a vegetable foreign body identified by virtual bronchoscopy was revealed by rigid bronchoscopy to be a thick mucus plug. Thus, the positive predictive value of virtual bronchoscopy was 98.3 per cent.Conclusion:Multidetector computed tomography virtual bronchoscopy is a sensitive and specific diagnostic tool for identifying radiolucent vegetable foreign bodies in the tracheobronchial tree. It can also provide a useful pre-operative road map for rigid bronchoscopy. Patients suspected of having an airway foreign body or chronic unexplained respiratory symptoms should undergo multidetector computed tomography virtual bronchoscopy to rule out a vegetable foreign body in the tracheobronchial tree and avoid general anaesthesia and invasive rigid bronchoscopy. [ABSTRACT FROM PUBLISHER]

Introduction:Thyroid cancers infiltrating the upper aerodigestive tract are not uncommon. The management of these cases can be demanding, with a high level of surgical skill required to achieve adequate primary resection and reconstruction.Materials and methods:This study was a single institution series of seven patients, managed over two years, who underwent tracheal resection for advanced thyroid cancer. All patients were older than 45 years (range, 45–65 years) and were predominantly male (six of seven). All patients presented to us with a swelling in the neck. Fine needle aspiration cytology detected thyroid cancer in all patients. None of the patients required a tracheostomy prior to surgery; however, they all had varying levels of airway compromise. One patient had lung metastasis at presentation. In all patients, the airway was successfully secured with fibre-optic assisted intubation prior to surgery. All patients underwent a total thyroidectomy with tracheal resection and anastomosis. Montgomery's suprahyoid release was utilised to achieve adequate laryngeal drop. None of the patients required a tracheostomy in the post-operative period. All patients received adjuvant therapy with either radioiodine ablation and/or radiotherapy.Conclusion:Tracheal resection and primary reconstruction is a feasible surgical procedure for patients with thyroid cancer infiltrating the upper aerodigestive tract, with good clinical outcomes. However, the morbidity of the procedure mandates careful case selection, airway management and meticulous surgical technique. [ABSTRACT FROM PUBLISHER]

Abstract: Purpose: Closed endotracheal suctioning (CES) may impact ventilator-associated pneumonia (VAP) risk by reducing environmental contamination. In developing countries where resource limitations constrain the provision of optimal bed space for critically ill patients, CES assumes greater importance. Materials and Methods: In this prospective, open-labeled, randomized controlled trial spanning 10 months, we compared CES with open endotracheal suctioning (OES) in mechanically ventilated patients admitted to the medical intensive care unit (ICU) of a university-affiliated teaching hospital. Patients were followed up from ICU admission to death or discharge from hospital. Primary outcome was incidence of VAP. Secondary outcomes included mortality, cost, and length of stay. Results: Two hundred patients were recruited, 100 in each arm. The incidence of VAP was 23.5%. Closed endotracheal suctioning was associated with a trend to a reduced incidence of VAP (odds ratio, 1.86; 95% confidence interval, 0.91-3.83; P = .067). A significant benefit was, however, observed with CES for late-onset VAP (P = .03). Mortality and duration of ICU and hospital stay were similar in the 2 groups. The cost of suction catheters and gloves was significantly higher with CES (Rs 272 [US $5.81] vs Rs 138 [US $2.94], P < .0001). Nine patients need to be treated with CES to prevent 1 VAP (95% confidence interval, −0.7 to 22). Conclusions: In the ICU setting in a developing country, CES may be advantageous in reducing the incidence of VAP, particularly late-onset VAP. These results mandate further studies in this setting before specific guidelines regarding the routine use of CES are proposed. [Copyright &y& Elsevier]

Objective:We report a rare case of successful surgical management of tubercular tracheal stenosis. There was no history of tracheostomy except for trauma management.Case report:A 24-year-old man presented with breathing difficulty. He had previously sustained blunt chest injury, a fractured mandible and minor head injury in a traffic accident. Despite successful mandibular fracture fixation, he subsequently developed progressive breathing difficulty with stridor. The patient was treated successfully with surgical resection and bronchoplastic reconstruction. Post-operatively, endotracheal tuberculosis was diagnosed.Conclusion:Endotracheal tuberculosis is rare despite the high incidence of pulmonary tuberculosis in India. Early diagnosis and prompt treatment are necessary to prevent tuberculous tracheobronchial stenosis, an extremely rare but serious clinical problem which can cause obstructive pneumonia and exertional dyspnoea. Surgical resection and bronchoplastic reconstruction is the established treatment for such stenosis. Patients with active tuberculosis usually respond to conventional antitubercular treatment. [ABSTRACT FROM PUBLISHER]

Background: A significant number of esophageal atresia and tracheoesophageal fistula patients have long gaps and a high propensity to leak. Anastomotic leak in esophageal atresia is associated with a significant morbidity and mortality. Aim: In a prospective randomized trial, we analyzed the risk factors leading to anastomotic dehiscence and studied the effect of pleural wrap as an additional vascular cover around the esophageal anastomosis. Materials and Methods: Forty patients were divided into two groups A and B randomly. In 20 patients of group A, pleural wrap was utilized for covering the anastomosis and in 20 patients of group B, no such wrap was utilized. Results: Both the groups were comparable regarding age, sex, weight, gap length, tension at anastomosis and the hospital stay. The overall leak rate was 25% (10/40) in both the groups. The leak rate was not significantly different in two groups whenever a gap length was less than 2 cm or more than 3 cm. However, for a gap length of 2-3 cm, the leak rate in group A was 18% (2/11) and in group B was 50% (4/8) (P = 0.05). Thirty percent (3/10) of patients, whose anastomosis was under tension, leaked in group A as compared to 75% (6/8) in group B patients (P = 0.001). Conclusions: Use of pleural wrap was associated with less anastomotic dehiscence in patients with moderate gap esophageal atresia (2-3 cm) especially when the anastomosis was under tension. [ABSTRACT FROM AUTHOR]

Abstract: Ethnopharmacological relevance: The sacred tree Peepal (Ficus religiosa family: Moraceae) has numerous therapeutic utility in folk medicine. Aim of the study: It has been reported to be used in ethno medical treatment of asthma and also in epilepsy due to its high serotonin content, which has been implicated in pathophysiology of asthma, this led us to carry out the present study. Materials and methods: The in vivo studies of histamine induced bronchospasm in guinea pigs and in vitro isolated guinea pig tracheal chain and ileum preparation. Results: Pre-treatment of guinea pigs with ketotifen (1mg/kg, p.o.) has significantly delayed the onset of histamine aerosol induced pre-convulsive dyspnea, compared with vehicle control (281.8a ±11.7 vs. 112.2±9.8). The administration of methanolic extract (125, 250 and 500mg/kg, p.o.) did not produced any significant effect on latency to develop histamine induced pre-convulsive dyspnea. On the other hand, methanolic extract of the fruits at the doses employed (i.e., 0.5, 1 and 2mg/ml) has significantly potentiate the EC50 doses of both histamine and acetylcholine in isolated guinea pig tracheal chain and ileum preparation. In addition, HPLC analysis of the methanolic extract showed the presence of high amounts of serotonin (2.89%, w/w). Conclusions: On the basis of data, it may be concluded that Ficus religiosa fruits have been found to be ineffective against histamine induced bronchospasm in guinea pigs. In addition, methanolic extract of the fruits have shown to potentiate the bronchoconstriction induced by both histamine and acetylcholine on guinea pig tracheal chain preparation. [Copyright &y& Elsevier]

Avian mycoplasmosis, mainly caused by Mycoplasma gallisepticum (MG) and Mycoplasma synoviae (MS), is an economically important disease of poultry industry. The present study was aimed to develop duplex PCR as a rapid, specific and economical method for accurate detection of MG and MS in poultry and its comparison with single (monoplex) MG/MS PCR. During present investigation, a total of 146 poultry flocks having clinical history of respiratory disease were screened. Pooled tissue samples (trachea, lungs and air sacs) from 4-5 birds of each flock were collected during necropsy at disease investigation laboratories, Hisar, Haryana, India. The single and duplex PCR assays were standardized using primers of intergenic spacer region (IGSR; 16S-23S rRNA) for MG and hemagglutinin vlhA gene for MS, with expected amplicon size of 812 bp and 1200 bp products, respectively. In single PCR, 6.85%, 2.74% and 2.74% tissue samples were found positive for MG, MS and both MG and MS, respectively. However, duplex PCR showed, 7.53%, 2.74% and 1.37% positivity for MG, MS and both MG and MS, respectively. Taking the results of monoplex PCR as a gold standard, sensitivity and specificity of the developed duplex PCR was found to be 94.44% and 100%, respectively. Moreover, Cohen's kappa statistic (k = 0.97) measured a 'perfect' agreement between monoplex and duplex PCR assays. The positive and negative predictive values of duplex PCR was found to be 1.0 and 0.9922, respectively at 95% confidence interval (CI), as compared to monoplex PCR. The simultaneous use of two genes in a duplex PCR was more rapid and economical than two separate single PCR reactions. • Duplex PCR was developed for simultaneous detection of MG and MS. • Efficacy of developed duplex PCR was compared with gold standard single PCR. • Duplex PCR showed good sensitivity and specificity as compared to single PCR. • Duplex PCR was more rapid and economical as compared to single PCR assay. [ABSTRACT FROM AUTHOR]

Tracheocele is a herniation of the tracheal mucosa through a defect in the tracheal wall. Familiar and/or genetical factors have never been taken into consideration in the etiopathogenesis of acquired tracheocele. Acquired tracheocele occurred in a brother and a sister from India. CT scan of the neck showed an air cyst next to the right tracheal wall. They underwent surgical excision through a transverse cervical incision. Histopathology of the lesion revealed a fibrous sac lined by a pseudostratified columnar respiratory epithelium in both patients. They had no recurrence of tracheocele at 12 months follow up. Genetic counseling did not evidence any significative associated abnormalities. No previous cases of familiar acquired tracheocele have been reported in the literature. Given the rarity of the lesion occurring in more than one member of a family, hereditary factors could be supposed as contributing factors in the etiopathogenesis of acquired tracheocele., (© 2020. Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Neonates born through meconium-stained amniotic fluid (MSAF) are at risk of developing meconium aspiration syndrome (MAS). Neonates who are non-vigorous due to intrapartum asphyxia are at higher risk of developing MAS. Clearance of meconium from the airways below the vocal cords by tracheal suction before initiating other steps of resuscitation may reduce the risk of development of MAS. However, conducting tracheal suction may not only be ineffective, it may also delay effective resuscitation, thus prolonging and worsening the hypoxic-ischaemic insult.  OBJECTIVES: To evaluate the efficacy of tracheal suctioning at birth in preventing meconium aspiration syndrome and other complications among non-vigorous neonates born through meconium-stained amniotic fluid., Search Methods: We used the standard search strategy of Cochrane Neonatal to search Cochrane Central Register of Controlled Trials (CENTRAL 2020, Issue 11) in the Cochrane Library; Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Daily and Versions(R) (1946 to 25 November 2020) for randomised controlled trials (RCTs) and quasi-randomised trials. We also searched clinical trials databases and the reference lists of retrieved articles for RCTs and quasi-randomised trials (up to November 2020)., Selection Criteria: We included studies enrolling non-vigorous neonates born through MSAF, if the intervention being tested included tracheal suction at the time of birth with an intent to clear the trachea of meconium before regular breathing efforts began. Tracheal suction could be performed with an endotracheal tube or a wide-gauge suction catheter. Neonates in the control group should have been resuscitated at birth with no effort made to clear the trachea of meconium., Data Collection and Analysis: Two review authors independently assessed trial quality and extracted data, consulting with a third review author about any disagreements. We used standard Cochrane methodological procedures, including assessment of risk of bias for all studies. Our primary outcomes were: MAS; all-cause neonatal mortality; and incidence of hypoxic-ischaemic encephalopathy (HIE). Secondary outcomes included: need for mechanical ventilation; incidence of pulmonary air leaks; culture-positive sepsis; and persistent pulmonary hypertension. We used the GRADE approach to assess the certainty of evidence., Main Results: We included four studies (enrolling 581 neonates) in the review. All four studies were conducted in tertiary care hospitals in India. Three of the four studies included neonates born at and beyond term gestation, whereas one included neonates born at and beyond 34 weeks of gestation. Due to the nature of the intervention, it was not possible to blind the healthcare personnel conducting the intervention. Tracheal suction compared to no suction in non-vigorous neonates born through MSAF In non-vigorous infants, no differences were noted in the risks of MAS (RR 1.00, 95% CI 0.80 to 1.25; RD 0.00, 95% CI -0.07 to 0.08; 4 studies, 581 neonates) or all-cause neonatal mortality (RR 1.24, 95% CI 0.76 to 2.02; RD 0.02, 95% CI -0.03 to 0.07; 4 studies, 575 neonates) with or without tracheal suctioning. No differences were reported in the risk of any severity HIE (RR 1.05, 95% CI 0.68 to 1.63; 1 study, 175 neonates) or moderate to severe HIE (RR 0.68, 95% CI 0.43 to 1.09; 1 study, 152 neonates) among non-vigorous neonates born through MSAF. We are also uncertain as to the effect of tracheal suction on other outcomes such as incidence of mechanical ventilation (RR 0.99, 95% CI 0.68 to 1.44; RD 0.00, 95% CI -0.06 to 0.06; 4 studies, 581 neonates), pulmonary air leaks (RR 1.22, 95% CI 0.38 to 3.93; RD 0.00, 95% CI -0.02 to 0.03; 3 studies, 449 neonates), persistent pulmonary hypertension (RR 1.29, 95% CI 0.60 to 2.77; RD 0.02, 95% CI -0.03 to 0.06; 3 studies, 406 neonates) and culture-positive sepsis (RR 1.32, 95% CI 0.48 to 3.57; RD 0.01, 95% CI -0.03 to 0.05; 3 studies, 406 neonates). All reported outcomes were judged as providing very low certainty evidence., Authors' Conclusions: We are uncertain about the effect of tracheal suction on the incidence of MAS and its complications among non-vigorous neonates born through MSAF. One study awaits classification and could not be included in the review. More research from well-conducted large trials is needed to conclusively answer the review question., (Copyright © 2021 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.)

Objective: We report an extremely rare case of rhinosporidiosis with involvement of both larynx and trachea, together with coexisting nasal, nasopharyngeal and oropharyngeal lesions, in a 32-year-old man. Method: Case report and review of the world literature concerning laryngotracheal and disseminated rhinosporidiosis. Results: A 32-year-old, South Indian man presented with a nasal mass of four years' duration, with progressive hoarseness for one year. Strawberry-like rhinosporidial masses were seen in both nasal cavities. Fibre-optic laryngoscopic examination revealed reddish masses with whitish surface specks, involving the glottis, subglottis and trachea. Computed tomography revealed soft tissue opacities involving both nasal cavities and the nasopharynx and extending to the oropharynx, with involvement of the larynx and trachea. Direct laryngoscopy and rigid bronchoscopy guided excision of the laryngeal and tracheal lesions was performed. Conclusion: Rhinosporidiosis is a chronic, granulomatous disease which usually affects the mucous membranes of the nose and nasopharynx. Lower dissemination into the trachea is extremely rare. Laryngotracheal involvement poses many diagnostic and therapeutic challenges, due to the potential risk of bleeding and aspiration. In the presented case, local spread of rhinosporidiosis, due to direct spillage of spores from the nasopharynx into the larynx during episodes of bleeding or previous surgery, may have resulted in laryngotracheal involvement, although systemic spread cannot be excluded. [ABSTRACT FROM AUTHOR]

A 70-year-old Indian woman presented with an acute anterior wall myocardial infarction and a large multinodular goiter causing tracheal compression and dyspnea. Coronary artery angiography revealed severe triple-vessel disease, with an 80% occlusion of the left main stem, necessitating early coronary artery bypass grafting combined with total thyroidectomy. The procedure was performed successfully. At the 1-year follow-up, the patient remains euthyroid and in New York Heart Association functional class I. This case provides further evidence that combined coronary artery bypass grafting and total thyroidectomy is both feasible and safe. [Copyright &y& Elsevier]

Objective: Tracheobronchial foreign body aspiration (FBA) is a common cause of respiratory distress between 1 and 3 years of age. Literature on airway foreign bodies in this age group is abundant; however no study has addressed this problem in infants exclusively. This study aimed to review the clinical presentation, management and outcome of infants with tracheobronchial foreign bodies at a referral tertiary care hospital over a decade., Methods: 102 infants who underwent bronchoscopy for suspected FBA from 1997 to 2007 were retrospectively reviewed. Details of demographic data, clinical features, radiologic and bronchoscopic findings, postbronchoscopy events and eventual outcome were analysed., Results: The mean age was 10.5 months. 8 (7.8%) were 0-6 months of age, the youngest being 2 months. Males outnumbered (72:30) females. 10 (9.8%) presented secondarily after treatment elsewhere, 6 of them were initially misdiagnosed. The onset-presentation interval ranged from 1 day to 3 months, 41 (40.2%) reporting within a day and 19 (18.6%) a week after onset. 20 (19.6%) had no history suggestive of FBA but harboured airway FBs at bronchoscopy. The clinical triad of cough, respiratory distress and stridor was highly predictive of FBA. 8 (7.84%) had no abnormal physical findings while 8 (10.81%) had grossly normal chest radiographs. All the patients underwent emergency/elective rigid bronchoscopy (Karl Storz system) under general anesthesia as in-patients. The physical findings did not always correlate with radiology or bronchoscopic location of the FB. A peanut cotyledon was the commonest FB retrieved across infancy; in 5 (4.9%) no FB was found/identifiable. 2 required postbronchoscopy mechanical ventilation and 1 a repeat bronchoscopy. There were 6 complications but no mortality in the series. The average hospital stay was 1.4 days. At a week's follow-up, all were asymptomatic and well., Conclusions: The clinical presentation, diagnosis and management of FBA in 102 infants are presented and certain peculiar features are described. A high index of suspicion coupled with a combination of history, physical signs and radiology is more conclusive than any of them in isolation. Availability of expertise and endoscopic equipment ensures a favourable outcome without significant morbidity and mortality.

In Northern India, in an institution like ours which receives quite a number of patients from surrounding rural areas, we found groundnut as the most common foreign body of tracheobronchial tree in children particularly in winter months of October to January. This article attempts to address the potential hazard of groundnut inhalation in children. In Northern India, in an institution like ours which receives quite a number of patients from surrounding rural areas, we found groundnut as the most common foreign body of tracheobronchial tree in children particularly in winter months of October to January. This article attempts to address the potential hazard of groundnut inhalation in children.

Three cases of rhinosporidiosis with high rate of recurrence are presented. Recurrences in the cases reported here were: 49, 21 and 23 times respectively. These are much higher than that described in the literature so far. The clinico -- epidemiological aspects of the cases are discussed.