Journal of the Indian Medical Association
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Increased difficulty was encountered during manual ventilation following change of position from supine to prone in a patient intubated with a fresh flexometallic cuffed endotracheal tube, posted for elective lumbar discectomy. Prompt Identification of the problem was made and managed with replacement of the damaged tube with a new endotracheal tube in supine position. Following proper securing of the airway and repositioning of the patient, rest of the surgery and anaesthetic maintenance were uneventful. The cause of this unusual complication was ultimately found to be an obstruction along the length of lumen of the culprit endotracheal tube which was maximum at its proximal end by herniation of the deformed channel of the cuff with filled air generated due to backpressure from the tracheal cuff that might have been produced due to manufacturing defect.
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Historical Article
TB control in India--efforts, challenges and priorities.
TB control is a long battle. Since after the discovery of Mycobacterium tuberculosis by Robert Koch in 1882, endeavours have been made at different levels in the form of control measures like establishment of open-air sanatorium in Tilonia (Ajmer) in 1906, Tuberculosis Dispensary in Mumbai (1917), Tuberculosis Association of India (1939), Mass BCG campaign (1951), Establishment of Chemotherapy centre (TRC Chennai), National Sample Survey (1955-58), National Tuberculosis Institute Bangalore (1961), Developments of National Tuberculosis Programme (1962), Review of NTP by GOI, SIDA & WHO (1992), pilot testing of RNTCP (1993), implementation/expansion of RNTCP across the country (1997-2006). Shopping for health, marketing for TB diagnosis and treatment, MDR-TB, XDR-TB, TB-HIV combination and partnership related challenges are crucial and needs to be addressed. Universal access to DOTS for cutting the chain of transmission of bacilli, reducing the morbidity and mortality and reversing the TB epidemic in line with Millennium Development Goals, surveillance of notification, drug resistance, TB/HIV coinfection, operation researches, development of vaccines, immune therapeutic agents against tuberculosis and expansion of package of care to MDR-TB and XDR-TB would be the priorities for eradicating TB as a public health problem.
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Cauda equina compression and acute unilateral foot drop are commonly described associations with prolapsed intervertebral lumbar disc. The bilateral acute foot drop however is a rare occurrence. ⋯ An urgent magnetic resonance imaging (MRI) revealed large central disc prolapse at L3-L4 level with significant canal stenosis. He was operated on emergent basis following which he had progressive neurological improvement.
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Randomized Controlled Trial Comparative Study
A comparative study of oral tramadol and ibuprofen in postoperative pain in operations of lower abdomen.
The objective of this study was to assess efficacy and safety of oral tramadol in postoperative pain in operations of lower abdomen as compared to oral ibuprofen. Eighty patients undergoing operations in the lower abdomen under spinal anaesthesia were randomly assigned to two parallel groups--ibuprofen 400 mg thrice daily and tramadol 100 mg thrice daily, both orally after food. Treatment was given single-blind for 5 days in the postoperative period. ⋯ Both regimens were well tolerated. It can be thus concluded that oral tramadol is safe, effective and comparable to ibuprofen as analgesic for relieving pain in the postoperative period in patients undergoing operations in the lower abdomen. The need for rescue medication for breakthrough pain may be less with tramadol.