Background: Adolescence is a period of transition between childhood and adulthood. Nutritional requirements during this period increase tremendously compared to preceding years of growth. The nutritional status of adolescent girls, the future mothers, contributes significantly to the nutritional status of the community. The present study was aimed to assess the current nutritional status of the adolescent girls. Materials and Methods: This one-year community-based, cross-sectional study was undertaken at a village Peeranwadi of District Belgaum, Karnataka among 400 adolescent girls of 10 to 19 years. Information on socio-demographic variables was collected by an interview using pre-designed and pre-tested questionnaire. A 24-hour recall method was used to assess nutrient intake. The nutrient intake was calculated using tables of nutritive value of Indian foods. For the comparison of anthropometric data, National Center for Health Statistics and National Health and Nutrition Examination Survey standards were used. Results: The mean age among the study population was 12.9 ± 2.06 years. Majorities (73.5%) of them were Hindus, 98.5% were literate, and 90% were currently studying. Adolescent girls between 10 and 14 years were more stunted (63.82%) as compared to 15 to 19 years (40.84%) (P = 0.0003) and thin (60.79% vs. 39.43%; P = 0.0009). Overall, the mean calorie intake was observed to be 1272.20 ± 133.28 kcal/day, protein intake was 40.99 ± 3.32 gm, and iron intake was 14.42 ± 2.58 mg. Conclusion: Overall, majority of girls were having dietary intake less than 50% of RDA, and almost three fourth of girls were anemic.

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Background: Awareness of glaucoma is low in spite of being the second leading cause of preventable blindness in the world. Aim: To study the awareness and knowledge levels of glaucoma in a tertiary eye care hospital in a tier-2 city. Materials and Methods: This is a hospital-based crosssectional study. A total of 704 patients attending ophthalmology outpatient department of Sri Dharmasthala Manjunatheshwara College of Medical Sciences and Hospital (SDM) Dharwad, aged 40 years and above were administered a questionnaire after a written informed consent to assess their awareness and knowledge levels of glaucoma. Subjects "having heard of glaucoma" even before they were recruited for the study were defined as "aware", and subjects having some understanding of the eye disease were defined as "knowledgeable". Results: Out of 704 subjects recruited for the study, only 34 (4.8%) subjects were aware of glaucoma and 22 (3.1%) had some knowledge of glaucoma. Determinants of glaucoma awareness were higher levels of education, diabetes, or glaucoma and family history of glaucoma. Conclusion: Awareness and knowledge of glaucoma was very low among the subjects. The findings of the study stress the need for health awareness for effective prevention of blindness due to glaucoma.

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This article provides an insight towards diagnosing and managing thalassemias. It begins by describing the structure of normal hemoglobin and elaborates on our understanding of the pathophysiology of thalassemia. An overview of transfusion therapy and its complications including endocrinopathies and cardiomyopathy has also been discussed.

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Background: Resistance to broad-spectrum beta-lactams, mediated by extended-spectrum beta-lactamases (ESBL), AmpC beta-lactamase, and metallo-beta-lactamase (MBL) enzymes, is an increasing problem worldwide. Aim of the study: This study was undertaken to detect ESBL, AmpC beta-lactamase and metallo-beta-lactamase producing Pseudomonas aeruginosa and Acinetobacter species from the endotracheal aspirates. Materials and Methods: A prospective study was performed over a period of 15 month in a tertiary care hospital. A total of 26 clinical isolates of P.aeruginosa and 40 of Acinetobacter species were tested for the presence of ESBL, AmpC beta-lactamase, and metallo-beta-lactamase enzyme. Detection of ESBL was done by the combined disk diffusion method as per Clinical and Laboratory Standards Institute (CLSI) guidelines, and MBL was detected by imipenem-Ethylenediaminetetraacetic acid (EDTA) combined disk method. Isolates showing reduced susceptibility to cefoxitin (30 μg) disk were considered 'screen positive' for AmpC beta-lactamases and selected for detection of plasmid-mediated AmpC by the AmpC disk test. Results : 42.30% isolates of P.aeruginosa were positive for ESBL while 53.85% were MBL producers. Among 39 isolates of Acinetobacter baumannii, 43.59% were AmpC producers while 48.72% were MBL-producing strains. Conclusion: The study emphasizes the high prevalence of multidrug-resistant P.aeruginosa and A.baumannii producing beta-lactamase enzymes of diverse mechanisms. Thus, proper antibiotic policy and measures to restrict the indiscriminative use of cephalosporins and carbapenems should be taken to minimize the emergence of this multiple beta-lactamase-producing pathogens.

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Context: Nephrectomy is a common procedure in surgical practice. It is indicated in patients presenting with a wide range of clinical conditions ranging from symptomatic chronic infections, obstruction, calculus disease, and severe traumatic injury to renal cell carcinomas. It is performed increasingly in the context of end-stage renal disease and to treat renovascular hypertension from non-correctable renal artery disease, or for severe unilateral parenchymal damage resulting from nephrosclerosis, pyelonephritis, vesicoureteric reflux, and congenital dysplasia. Objective: This study aimed to assess the patterns and morphology of lesions in nephrectomy specimens in a tertiary care hospital, observe variations if any from the conventional pattern, and clinico-morphological correlation for proper postoperative management. Materials and Methods: A hospital-based five-year study included all nephrectomy specimens received in the department over a period of five years (November 1, 2005 to October 31, 2010). Results: A total of 140 cases over a period of five years were studied. A wide range of lesions were found on histopathological examination. The histopathological analysis correlated well with the clinical diagnosis; however, few benign lesions like xanthogranulomatous pyelonephritis may be misdiagnosed clinically as malignant. Similarly, cases of cystic diseases of kidney, renal sarcomas, renal squamous cell carcinomas, and angiomyolipomas were confirmed on histopathological analysis only. Conclusions: The present study provides a fair insight into the histological patterns of lesions in nephrectomy specimens at our institution. In conclusion, a wide range of lesions are encountered on histopathology of nephrectomy specimens, many of which may be misdiagnosed clinically and radiologically; therefore, it is mandatory that every nephrectomy specimen be subjected to detailed histopathological examination for a clinico-morphological correlation to ensure proper management.

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Background: Aerobic non-fermenting Gram-negative bacilli (NFGNB) once considered as contaminants now associated with life-threatening infections and emerging as multi drug resistant nosocomial pathogens. Aim: Isolation and identification of NFGNB in all the clinical samples and to determine antibiotic susceptibility pattern of the isolated NFGNB. Materials and Methods: This study has been conducted in the Department of Microbiology at a tertiary care teaching hospital over a period of 2 months from September to October 2013. NFGNB were isolated and identified from clinical specimens by standard procedure and antibiotic sensitivity test was performed. Results: NFGNB isolation rate in the present study was 3.58%. Male to female ratio was 2.125. Pus was the most common specimen (21%) followed by tracheal aspirate (17%). Pseudomonas aeruginosa was the most common isolate (60%) followed by Acinetobacter baumannii (22%) and Acinetobacter lwoffii (12%). P. aeruginosa has shown good sensitivity to amikacin (83.3%), imipenem (80%) and piperacillin-tazobactam (73.3%) whereas A. baumannii showed multidrug resistance. Conclusion: It is necessary to identify NFGNB and to monitor their susceptibility pattern to guide the clinician for better care and management of patients. NFGNB are now emerging as organisms of nosocomial infections. Hence, antibiotic sensitivity testing and infection control measures are needed to prevent the emergence and spread of multi drug resistant NFGNB in health care settings.

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Background: Effective keloid management is still a distant dream in spite of many recent modalities being tried for the same. Although many treatment protocols have shown efficacy of varying degrees, there are few systematic randomized trials comparing them. Objective: To compare the efficacy of intralesional 5-Fluorouracil versus Triamcinolone acetonide in the treatment of Keloids. Materials and Methods: This randomized controlled trial was conducted on 30 patients with keloids, randomly divided into two groups of 15 each, treated with intralesional 5-fluorouracil (Group A) or triamcinolone acetonide (Group B). The groups were compared for reduction in the size of keloid, pain relief, and the incidence of adverse effects. Statistical analysis was done using the unpaired student t- test and test of proportion. Results: The reduction in the size of the keloid was found to be significantly better in Group B (71.23%) than in Group A (57.48%) with a P value of 0.04. The difference in the reduction of pain, as assessed by the visual analog scale, between Groups A (18%) and B (24%), was found to be insignificant (P value - 0.47). Although the incidence of complications in Group A was three times higher than those in Group B, the difference was not statistically significant (P value - 0.13). Conclusion: Reduction in the size of the keloid, which was the main aim of this study was significantly better in those treated with triamcinolone acetonide than those treated with 5-fluorouracil. The other parameters like reduction of pain and the incidence of adverse effects were comparable in both the groups.

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Teratoma is a neoplasm with tissue components derived from more than one germ layer - ectoderm, mesoderm, and endoderm. They are commonly found in ovaries, testes, retroperitoneum, and sacrococcygeal region. Mediastinal teratomas are relatively rare comprising of only 8-13% of all tumors in mediastinum and only 1-10% of germ cell tumors occurring in mediastinum. We are presenting a case of a 1-year-old male who came with a history of on and off fever and frequent cough and cold since 3-4 months. On x-ray chest, differential diagnosis of congenital diaphragmatic hernia and left pleural effusion were given and computed tomography (CT) scan of abdomen and chest were advised, which revealed symptoms of mediastinal germ cell tumor. Final diagnosis of mature teratoma was given on histopathology. The case is being presented here because mediastinum is a rare site for teratoma and children are less commonly affected.

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Masturbation (gratification behavior) is rarely seen in young children. It occurs in children between the age of 3 months and 3 years with a second peak incidence at about the adolescent age. A 26-month-old child presented to us with gratification behavior. On evaluation, she did not have any physical illness mimicking gratification behavior. The parents were counseled, and 6 sessions of behavior therapy were carried out. Gratification behavior in young children is not pathological. Waxing and waning of the symptoms may be present.

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Objectives: The present study was undertaken to assess the antibiotic susceptibility patterns of Pseudomonas aeruginosa isolated from healthcare associated infections at a tertiary care hospital. Due to significant changes in microbial genetic ecology, as a result of indiscriminate use of anti-microbials, the spread of anti-microbial resistance is now a global problem. Materials and Methods: A total of 290 Pseudomonas aeruginosa isolates from various clinical samples like urinary catheters, tips of endotracheal tube, and central venous catheter were tested for antibiotic sensitivity pattern using disk diffusion method as per Clinical and Laboratory Standards Institute guidelines. Results: The highest number of Pseudomonas infections was found in urinary catheters, followed by endotracheal tips and central venous catheters. Maximum resistance was seen to cefotaxime and gentamycin (40%) followed by ciprofloxacin (39%), amikacin (26%), cefoperazone- sulbactum (22%), piperacillin-tazobactum (16%), and imipenem (14%). Conclusion: Over all we have observed that there is increased antibiotic resistance which may be due to the selective pressure from the use of anti-microbial agents is a major determinant for the emergence of resistance strains. Antimicrobial surveillance should be done periodically to monitor the current susceptibility patterns in local hospitals.

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Introduction: The stone disease in children shows wide geographic variations, and its incidence has increased worldwide in children of all ages. Percutaneous nephrolithotomy (PCNL) has gradually emerged as one of the standard treatment options for the management of renal stones >1.5 cm in pediatric cases. PCNL just like in adults has been performed in the prone position. Of late observing the successful use of supine position for PCNL in adults, pediatric urologists have been encouraged to use the supine access for PCNL in children. We report our early experience with supine PCNL in children. Materials and Methods: All children with symptomatic renal stones presenting to the pediatric urological services of our hospital were prospectively included into the study to undergo supine PCNL. Children with skeletal anomalies, bleeding diathesis, and active urinary tract infection were excluded from the study. Results: Ten children (six males and four females) with a mean age of 11.48 ± 2.08 years (9–18 years) underwent supine PCNL. The mean size of the stone was 22 mm (range 17–47 mm). The initial stone-free rate was 90% immediately after a single PCNL session. One child needed an additional extracorporeal shockwave lithotripsy session to clear a 7-mm fragment. The average operative time (from the beginning of the puncture trial to nephrostomy tube insertion) was 70 ± 5 min. Conclusions: Supine PCNL in children is feasible, safe, and an effective means for management of renal stones in the pediatric population.

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Purpose: Pyrazolines and its derivatives are reported to possess a wide spectrum of biological activities. Many class of chemotherapeutic agents containing pyrazoline nucleus are in clinical use. The purpose of this present study was to examine whether the molecular modification might result in detection of new potent anti-tubercular agent. Materials and Methods: A series of 2-pyrazoline compounds (P13-P24) have synthesized by treating N-(substituted aryl)-acrylamide (C13-C24). The starting material was synthesized from substituted P-aminoacetophenone and substituted benzaldehyde. Their structure was confirmed by infrared and ¹ H NMR spectral data. The synthesized compounds were screened for anti-tubercular activity by Microplate Alamar Blue Assay method. Results: Compound P ₁₅ and P ₂₀ have shown excellent anti-tubercular activity; compound P ₁₆ and P ₂₂ have shown significant activity as compared with the standard and rest of them have shown moderate to low anti-tubercular activity. Conclusion: These compounds may result in the potent anti-tubercular entity with molecular modification and manipulations.

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Objectives: To evaluate the relationship between symptoms, clinical severity, neurophysiological characteristics with median nerve cross-sectional area (CSA) at the level of carpal tunnel inlet at ultrasonography (USG) and its utility in diagnosis of carpal tunnel syndrome (CTS). Materials and Methods: Prospective study of 30 patients with symptoms of CTS, attending to the Neurology out patient department (OPD) at University Teaching Hospital. A multidimensional assessment of CTS was done using historic and objective scale (Hi-Ob scale) for clinical severity, Boston carpal tunnel questionnaire (BCTQ) for patient-oriented measures, neuro physiologic studies of median nerve at wrist and USG to measure median nerve CSA at carpal tunnel inlet. Results: Thirty patients included in the study (22 women and 8 men). Mean of CSA was 12.69 mm ² (SD2.67). Association between BCTQ score value and inlet values was assessed by Karl Pearson correlation coefficient ( r = 0.376, P = 0.04). There was positive association with BCTQ scores and CSA of median nerve at carpal tunnel inlet. To compare clinical severity scale (Hi-Ob) and USG CSA, analysis of variance was performed (F value) and Scheffe's multiple comparison test was used to find group difference (grades 1 and 2 P < 0.001, grades1 and 2P P < 0.001, grade 2 differs with grade 2P P < 0.006). As the number of patients is less in minimal, mild and severe groups, the difference between neurophysiological groups and mean of CSA was not statistically significant. Conclusion: A positive correlation exists between USG findings and all the conventional measures of CTS severity.

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Calcium sulfate has multifaceted properties and has versatile use in the field of periodontal practice. Calcium sulfate can function as a resorbable space filler, a resorbable barrier (compatible with guided tissue regeneration principles), as a combination with other bone grafts in intrabony defects and in socket preservation procedures for implant placement. This review is an attempt to shed light on various applications of this bone graft in periodontal regeneration.

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Background: The designing of ocular dosage form off ers complicated issues. Numerous protective mechanisms are present in the eye to prevent the absorption of drug candidate from the corneal membrane. The poor bioavailability and therapeutic response exhibited by conventional ophthalmic solutions due to rapid precorneal elimination of the drug may be overcome by the use of in situ gel forming systems, which are instilled as drops into the eye and then undergo a sol-gel transition in the cul-de-sac. In situ forming polymeric formulations drug delivery systems is in sol form before administration in the body, but once administered, undergoes gelation in situ to form a gel. The formulation of gel depends upon factors like temperature modulation, pH changes, presence of ions, and ultraviolet irradiation, from which drug gets released in sustained and controlled manner. Objective: The present investigation deals with formulation and evaluation of Pluronic; based in situ gel of ofloxacin. Material and Method: Pluronic as gelling agent, HPMC as viscosity modifying agent was used. Ofloxacin was used as Active Pharmaceutical Ingredient. Results: In vitro drug release studies indicated that the formulated in situ gel retained the drug better than the conventional dosage forms. The formulations were therapeutically efficacious, sterile, stable, and provided controlled release of the drug over a period of time. Conclusion: The results demonstrate that the developed system is an alternative to conventional ophthalmic drops, patient compliance, industrially-oriented, and economical.

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Background: Burn injuries rank among the most severe types of injuries suffered by the human body with an attendant high mortality and morbidity rate. In previous studies, incidence, severity and deaths due to burn were found higher in young married women in India. Study to find out mortality pattern in burn patient was not carried out in this part of country. Objective: To identify demographic and sociocultural factors, type, modes, causes and risk factors for burn injuries and their gender-wise association. Materials and Methods: It was a retrospective study. Data were collected from all burn patients who admitted and died while on the treatment from 2004 to 2009. A total of 586 patients were included in this study. Data were gathered from hospital records and entered in the excel sheet. Analysis of data was done by using SPSS version 17 statistical software. Results: The mean age of patients was 22.66 years (range 1 m to 80 years). Episodes of burn were 4.63 times common in female (82.25%) than in male (17.75%). It was statistically significant in females of age group 21-30 years (93.93% vs. 15.33% P < 0.0001). Married females (86.80%) burned more commonly than married males (13.19%) P < 0.0001. Flame burn was the major cause of death (95.56%). Kerosene was the most common (69%) source of flame burn. Clothes caught fire while working on Chullha were 25% cases ( P < 0.0001). Accidental (86.44%) burn was the most common intention of injury. The majority of burn deaths (68%) occurred within one week of the incident due to septicemia (57%). Conclusion: Factors associated with an increase in mortality were accidental burns, burn size, young age, married women, and flame burns. For planning and implementing prevention programs, the approach has to be multidisciplinary and coordinated.

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Introduction and Objectives: The brachial plexus is highly variable, in its formation and branching pattern thus, knowledge of its anatomical patterns, may be insufficient for the surgeon operating on or around these nerves or for the regional anesthesiologist working in this area. Therefore, the present study was an attempt to study further about variations of brachial plexus encountered during routine dissection classes. Materials and Methods: The present descriptive study was carried out by dissection of 60 upper limbs of 30 cadavers, in the age group of 18 to 85 years, obtained during a study period of 2 years from the Department of Anatomy. The plexus was studied in its entire course commencing from the formation in cervical region, course through root of the neck and axilla, up to the main terminal branches of the upper extremity. During the dissection, variations of brachial plexus pertaining to its formation from the roots, trunks, divisions and cords and the branching pattern were observed and data was collected. Results: Out of the 60 cadaveric upper limbs studied for the anatomical variations of the brachial plexus, 2 limbs (3.33%) were pre-fixed plexuses. Fusion of adjacent trunks was detected in 2 limbs (3.33%). Variations in branches of lateral cord were detected in 8 limbs (13.33%). Among Posterior cord variations 2-thoracodorsal nerves were detected in 2 limbs (3.33%). All the other branches from brachial plexus had been found to have no anatomical variations. Conclusion: In the present study, an attempt has been made to know the possible variations of the brachial plexus. Though the variations mentioned may not alter the normal functioning of the limb of the individual, but knowledge of the variations is of prime importance to be kept in mind, during anaesthetic and surgical procedures.

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Background : Anencephaly is a lethal neural tube defect which is due to the defective closure of rostral pore of neural tube. In more than 50% of cases it is associated with other systemic anomalies. Hence this study was undertaken to assess pathological parameters associated with anencephaly in particular attention to associated systemic anomalies. Materials and Methods: It is a study on 41 anencephaly fetuses conducted in the Department of Pathology. The period of study is from January 2001 to December 2011. Results: Out of 41 cases, 30 (73%) cases showed presence of systemic anomalies, 48.5% of the cases were observed in primigravida. Most common associated anomaly was spina bifida followed by gastrointestinal anomalies. Conclusion: Pathological examination of the abortus is essential to document the associated anomalies.

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Background: Triple negative breast cancers (TNBC) are defined by absence of estrogen and progesterone receptors (ER and PR) and absence of overexpression of human epidermal growth factor receptor 2 (Her2). They are associated with poor prognosis. The purpose of this study is to study the clinicopathologic parameters of TNBC such as age, tumor size, stage, grade, and lymph node involvement and compare them with nonTNBC tumors. There are many studies which have shown that TNBC are similar to basal-like breast cancers (BBC). We have found the proportion of BBC in the TNBC group using surrogate immunohistochemical (IHC) markers cytokeratin5 (CK5) and epidermal growth factor receptor (EGFR). Materials and Methods : This is a retrospective study of 102 cases of carcinoma breast. Clinical records of the cases were retrieved. Histopathology slides and the IHC slides (ER, PR, Her2) were reviewed. Thus, two groups of patients were made TNBC and nonTNBC. Using the software SPSS version 16 statistical significance of the difference between clinicopathologic variables of the two groups was calculated. TNBC group was later studied for the presence of basal markers CK5 and EGFR using tissue microarray. Results: Statistically significant difference was found between the two groups in the variables such as mean age at diagnosis, mean tumor size, tumor grade, and the presence of lymphovascular invasion. Conclusions: TNBC formed 23.5% of total cases. Overall, TNBC were high grade tumors with larger size at diagnosis, presenting in younger women and showing lymphovascular invasion in a higher number of cases. 87.5% of TNBC were BBC.

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Background: Pulmonary tuberculosis can be easily diagnosed by simple techniques such as microscopy. However, extrapulmonary tuberculosis (EPTB) often presents a diagnostic dilemma. Microscopy and culture have proved to be insensitive techniques for diagnosis of EPTB. There is an urgent need for rapid and sensitive diagnostic methods. Aim: The present study was conducted to evaluate the role of polymerase chain reaction (PCR) in the early diagnosis of clinically suspected cases of EPTB. Materials and Methods: A total of 80 clinical specimens comprising pleural fluid, cerebrospinal fluid, ascitic fluid, fine-needle aspiration biopsy, and pus and biopsy from clinically suspected EPTB cases were processed and followed up by conventional methods and PCR using MPB64 primer. Results: Tuberculous pleural effusion (71%) was found to be the most common clinical presentation of EPTB. Overall, PCR could detect EPTB in 61.2% cases. Microscopy and culture could detect 18.7% and 22.5% EPTB cases, respectively. PCR was positive in all tissue samples suggestive of tuberculosis on histopathological examination. Of the 62 EPTB patients who responded to antituberculosis treatment (ATT), 49 patients were PCR positive. Conclusion: PCR using MPB64 had a significant advantage over the conventional methods to detect the presence of M. tuberculosis in specimens of clinically suspected EPTB patients for early diagnosis of tuberculosis.

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Context: Direct laryngoscopy and endotracheal intubation are the most stressful periods during induction of anesthesia. These events can lead to hypertension, tachycardia, arrhythmias and myocardial ischaemia. Aims: (1) To evaluate the haemodynamic response to laryngoscopy and endotracheal intubation with a single preinduction infusion of dexmedetomidine (DEX) 1 μg/kg over a 10 min period, (2) To assess the incidence of side effects, that is, rebound hypertension, bradycardia and hypotension etc., associated with the use of DEX. Settings and Design: This was a prospective, double-blind, parallel group randomized clinical trial of DEX (1 μg/kg) before anesthetic induction to study the attenuation of hemodynamic response to endotracheal intubation in 60 adult patients undergoing elective off pump coronary arterial bypass grafting. Materials and Methods: Patients were randomly allocated to receive either DEX (DEX group, n = 30) or 0.9% normal saline (PLA group, n = 30). Hemodynamic variables were recorded at baseline (Abbreviated as TB), after completion of drug infusion (Abbreviated as TC), 3 min after induction and immediately before intubation (T0), at the 1 ^st (T1), 3 ^rd (T3) and 5 ^th (T5) min after intubation. Statistical Analysis Used: The data are presented as mean ± standard deviation. Demographic data were analysed by Student's t-test between the two groups. Analysis of variance for repeated measures f-test was used to analyze changes over time. A P < 0.05 was considered as significant and P < 0.01 or 0.001 was considered as highly significant. Results: All the hemodynamic variables were comparable in both groups at baseline. Heart rate values were statistically significantly lower in the DEX group at TC and highly statistically significantly lower at T1, T3 and T5 values. Systolic blood pressure values were statistically significantly lower in the DEX group at T0 and highly statistically significantly lower at T1, T3 and T5. Diastolic blood pressure and mean blood pressure values and systolic pulmonary artery pressure values were highly statistically significantly lower in the DEX group at T1, T3 and T5. Diastolic pulmonary artery pressure were statistically significantly lower in the DEX group at TC, T0 and T1 and highly statistically significantly lower at T3. Mean pulmonary artery pressure were statistically significantly lower in the DEX group at T0 and highly statistically significantly lower at TC, T1 and T3. Arterial oxygen saturation was statistically significantly lower in the DEX group at TC. There was no case of hypotension or bradycardia in our case series. Conclusions: Dexmedetomeditine (1 μg/kg) attenuates hemodynamic response to laryngoscopy and intubation in elective surgery for off pump coronary artery bypass grafting.

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Carcinoid tumors are rare, slow-growing neoplasms of neuroendocrine tissues from enterochromaffin or kulchitsky cells, which have the potential to metastasize. The mediators released from these tumors when bypass the hepatic metabolism, can lead to the possible development of carcinoid syndrome. This is a life-threatening complication, which can lead to profound hemodynamic instability, especially in a peri-operative period, when the patient is exposed to various types of noxious stimuli. Off late, use of octreotide, a synthetic analog of somatostatin, has significantly reduced the peri-operative morbidity and mortality. The current review discusses the various anesthetic challenges and considerations during peri-operative management of carcinoid tumors.

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The world population reached 7 billion in 2012, which is 6 billion more than in 1800. This remarkable population growth is the result of several factors like advances in the medical, technological and public health systems resulting in the control and treatment of communicable diseases, the control of pandemics, the end of large-scale wars, improvements in living conditions and the revolutions in the field of agriculture. Because of all these factors, there has been a considerable improvement in the life expectancy of human beings. There is also an alarming reduction in fertility rates. The combination of declining fertility rate and augmented life expectancies has led to a change in the demographics of the population with the strata of older individuals growing faster than the younger individuals. The aging of populations is poised to become the next global public health challenge. Advances in medicine and socioeconomic development have substantially reduced mortality and morbidity rates due to infectious conditions and, to some extent, non-communicable diseases. These demographic and epidemiological changes, coupled with rapid urbanization, modernization, globalization, and accompanying changes in risk factors and lifestyles, have increased the prominence of chronic non-infective conditions. Health systems need to find effective strategies to extend health care and to respond to the needs of older adults. This review highlights the pathophysiology of aging, biological and physiological changes, impact of aging on health, epidemiological transitions, multi-morbidity in elderly and challenges for health care system.

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Introduction to the use of Mitomycin C in ophthalmology was a significant development in the 1960s. Its use and application in ophthalmology has been increasing in recent years, because of its modulatory effects on wound healing. Current applications of this drug in ophthalmology include pterygium surgery, glaucoma surgery, corneal refractive surgery, cicatricial eye disease, conjunctival neoplasia, dacryocystorhinostomy surgeries, squint surgeries, and allergic eye disease. Although it has been used successfully in these conditions, it has also been associated with significant complications. This article reviews the current trends and uses of mitomycin C in the eye and its reported complications.

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