A 10-year-old female child presented to ophthalmic outpatient department with history of decreased vision and painless swelling of left eye since birth. Clinical examination of left eye revealed an infero-lateral limbal dermoid with normal fundoscopic examination. There were multiple preauricular appendages in front of the left ear. Both ears were normal in all other respects. The X-ray of cervical spine showed fused third to fifth cervical vertebrae with loss of intervertebral disc but clinical examination found no neurological deficits.  X-ray of occipital-mental view found hypoplasia of left maxilla with normally appearing mandible. Clinical examination of the airway revealed restricted head and neck movements with Mallampatti class II which reliably predicted difficult laryngoscopy and intubation. The history, clinical examination of vertebral, auricular and ocular regions, and radiological evaluation confirmed her to be a case of Goldenhar syndrome. A difficult airway continues to be a major cause of anesthesia-related morbidity and mortality and fiberoptic intubation of the spontaneously breathing patients is the technique of choice for elective management of a difficult airway. Therefore, fiberoptic intubation under sedation was planned for the surgery. The intraoperative and postoperative period was uneventful. Lack of anesthesia-related and surgical complications encouraged us to present the advantage of fiberoptic intubation under sedation for successful management of predicted difficult airway.

A 50-year-old male patient with multi-organ failure and gangrene of the face was brought to the operation theater for an emergency debridement of the gangrenous tissue. Poor oral hygiene with loose teeth and limited mouth opening led to failure of rigid Macintosh laryngoscopy. Fiberoptic tracheal intubation was not adopted as an intubating aid as the patient was suspected of having pulmonary tuberculosis and there was a risk of equipment contamination. Lightwand (Trachlight^Tm) assisted tracheal intubation proved successful on the first attempt under general anesthesia despite the difficult airway of the patient. During lightwand assisted tracheal intubation, patient maintained good oxygenation as he continued to receive apneic oxygenation via a nasal catheter.

BACKGROUND: In this study the possible toxic effects of prolonged administration of three of the widely used food coloring agents are tested.

 METHODS: Adult female albino rats were administered amaranth (4.7 and 47 mg/kg body weight), sunset yellow (31.5 and 315 mg/kg bwt.) and curcumin (15.75 and 157.5 mg/kg bwt.) at doses equal to and 10 times the acceptable daily intake (ADI). Following which liver and kidney parameters (glutathione, lipid peroxides, activities of transaminases and alkaline phosphatase and urea and creatinine concentration) were measured. Furthermore, the effects of these coloring agents on blood picture and on the development of rat embryo were also studied.

 RESULTS: Our study revealed no effect of amaranth and sunset yellow on liver and kidney glutathione and lipid peroxide levels. Oral administration of curcumin in its low and high doses for 2 months decreased hepatic lipid peroxide concentration. Colorants also did not alter the liver and kidney function when given at the ADI dose but administration of sunset yellow at doses equaling 10 times ADI increased aminotransferases and that of amaranth at 10 times ADI elevated alkaline phosphatase levels. Administration of amaranth at 10 times ADI dose caused skeletal abnormalities in 25% of the examined foeti.

CONCLUSION: It could be concluded that high doses of 47 mg/kg bwt. of amaranth and sunset yellow could impair hepatic function. Moreover, based on the results from this study, amaranth should be avoided during pregnancy.

BACKGROUND: Congestive heart failure (CHF), a chronic debilitating disease, is often accompanied by anxiety and/or depression, even after optimal control with therapy. The aims of our study were to estimate the frequency of depression among Chinese patients suffering from CHF and to assess the association of depression with their clinical parameters.

 METHODS: A questionnaire-based study was conducted at Tongji Medical College hospital, Wuhan, China from June 2009 to May 2010. 200 patients with systolic CHF [Left Ventricular Ejection fraction (LVEF) <40%] were classified according to NYHA Functional Classification for heart failure. Depression was evaluated by Beck Depression Inventory (BDI). Patients with a previous history of major depression, psychological disorders, or severe debilitating diseases were excluded. Chi-square and t-test were used to assess the relationship between variables.

RESULTS: The mean age of participants was 62 ± 9 years. 76% (n=152) were in NYHA class II, 21% (n=42) were in Class III and 3% (n=6) were in Class IV. A majority of the participants (60%, n=120) suffered from depression with a significant female predominance

(73.9% females and 47.1% males, p=0.024). We found that worse NYHA functional status was associated with more severe depression. Majority of the participants in class II heart failure (67.4%) were mildly depressed (BDI ≥10 to <17); whereas majority of patients in class III (64%) and class IV (80%) were severely depressed (BDI score ≥17). Among the 36 patients who were severely depressed, mean blood pressure (140 ± 12/90 ± 9mmHg vs. 135 ± 8/86 ± 7mmHg, p=0.03) and mean blood glucose (147 ± 62mg/dl vs. 131 ± 55mg/dl, p=0.01) were significantly worse than those in patients with mild depression, whereas the converse was true about the LVEF (30 ± 3% in severely depressed vs. 32 ± 4% in mildly depressed, p=0.02).

CONCLUSION:

Depression is common among CHF patients. Severe depression is more frequent than mild depression at higher NYHA Classes of CHF and is associated with worse physiologic parameters.

BACKGROUND: This study aimed to present a simple scoring system incorporating ultrasound (US) examination, clinical, and laboratory data for improving diagnostic accuracy of acute appendicitis (AA), and to evaluate the performance of this scoring system in comparison to other scoring systems. A new score, together with 11 previous ones, was applied to a prospective independent population of subjects with suspected AA, and the respective performances were compared in terms of accuracy.

METHODS: 134 (70 males and 64 females) patients with suspected acute appendicitis were included in the study (mean age 28.7 ± 11.9 years). Demographic, clinical, and laboratory characteristics of the patients with suspected appendicitis were assessed using SPSS and four independent, statistically significant (p<0.01) predictors of the presence of AA were expressed as an integer-based scoring system.

 RESULTS: Among 134 subjects, 72 went on to surgery and 58 had AA at operation. Four independent correlates of AA were identified and used for the derivation of the following integer-based scoring system: number of points = 6 for US demonstrating AA + 4 for tenderness in the right lower quadrant + 3 for rebound tenderness + 2 for leukocyte count >12,000/uL. In the study, the cut-off of ≥ 8 points for AA was used and sensitivity, specificity and accuracy of the proposed score were 95.4%, 97.4% and 96.5%, respectively.

CONCLUSION: The proposed scoring system introduces a quantitative combination of the clinical, laboratory, and imaging data, which may enhance the diagnostic accuracy of AA especially in those geographical regions where ultrasound scanning is readily available.