A Novel Obturator Device for Management of Dilated Trachea-esophageal Puncture Tract Fistulas

Voice rehabilitation in laryngectomized patients by tracheoesophageal puncture is a time tested technique. In some patients the tracheoesophageal puncture gets inordinately dilated leading to leakage around the prosthesis. Most of these fistulas are managed by a variety of conservative treatments like temporary removal of prosthesis, placement of silastic ring over the prosthesis, placement of nasogastric tube and airway protection by a cuffed tracheostomy tube. Intractable fistulas are tackled by surgical closure but are fraught with failures. We hereby suggest a novel temporary obturator that can be can be easily made at a very low cost in any hospital having prosthetic rehabilitation services and obviates the need for a tracheostomy tube, nasogastric tube and repeated hospital visits.     

Determination of teliospore concentration as surface contaminants in Karnal bunt-infected seed samples of wheat using indirect ELISA

The study describes the indirect ELISA method for the determination of teliospore concentration in infected seed lots employing anti-teliospore antiserum generated against intact teliospores of Tilletia indica – a quarantined pathogen. The detection limit is as small as 5–1000 teliospores. The teliospores were extracted by washing seed either one or three times using detergent to ensure complete removal of teliospores present as surface contaminants in wheat samples with varying per cent of Karnal bunt infection. To ensure the concentration of teliospores within the sensitivity range, optimal volume of different extracted samples was determined. The ELISA reactivity was used to extrapolate the number of teliospores present in wheat samples. Forty-nine wheat samples received for certification based on per cent of infection were also subjected to indirect ELISA to determine the sensitivity of the protocol. The samples having 0.05–26% infection were having teliospore concentration in the range of 7×10² to 6.6×10⁴/1000 seeds.     

Intracerebral haematomas after deep brain stimulation surgery in a patient with Tourette syndrome and low factor XIIIA activity

A 24-year-old male patient with refractory Tourette syndrome was treated with deep brain stimulation (DBS) and developed subsequent bilateral subcortical haematomas. Additional blood tests revealed abnormalities of plasma factor XIIIA and tryptophan levels, which may be associated with Tourette syndrome. Neurosurgeons who perform DBS surgery on patients with Tourette syndrome must be aware of possible disastrous complications resulting from factor XIIIA disorders of blood haemostasis. Routine screening for this condition is not typically performed prior to surgery in these patients.     

Can nutrition rehabilitation centers address severe malnutrition in India?

Madhya Pradesh has made remarkable progress in facility based management of severe acute malnutrition, and has developed a model that is being replicated in many states. India has uniquely high prevalence of both stunting and wasting, implying that both severe acute malnutrition and severe chronic malnutrition co-exist. This study sought to explore design issues of nutritional rehabilitation centers in order to inform its effectiveness in settings where the prevalence of chronic poverty and malnutrition is high. Our analysis attributes the limited success (marked by poor cure rates and high non-responder rates) to high prevalence of chronic malnutrition, particularly in nutritional rehabilitation centers located in pheripheral areas. There is a failure to recognize severe chronic malnutrition as an epidemiological entity and gear wide-ranging programmatic and social interventions.     

Health and Poverty: Global Health Problems and Solutions

Poor outcomes from behavioral treatments of severe obesity have led to a dependence on invasive medical interventions, including surgery for morbidly obese individuals. Improved methods to self-regulate eating will be required to reduce obesity. The use of self-regulation methods for completing physical activity may carry over to increased self-regulation for eating through improved feelings of competence (self-efficacy) and mood. The study recruited women (Mean_age = 43 years) with morbid obesity (Mean_BMI = 44 kg/m²) to participate in 26 weeks of cognitive-behavioral support of physical activity paired with either nutrition education (n = 51) or cognitive-behavioral nutrition (n = 51) methods. Data collected were from 2011 and 2012. Significant improvements in self-regulation for physical activity, self-regulation for eating, overall mood, and self-efficacy for eating, with greater improvement in self-regulation for eating, were observed in the cognitive-behavioral nutrition group. Changes in mood and self-efficacy for eating significantly mediated the relationship between changes in self-regulation for physical activity and self-regulation for eating. When subscales of overall mood and self-efficacy were entered into separate regression equations as mediators, the only significant mediators were vigor, and controlling eating when socially pressured and when increased cues to overeat were present.     

Analysis of blood-culture isolates from neonates of a rural hospital

All blood culture reports obtained from newborns admitted in a neonatal care unit during 1983-87 were reviewed to determine the current bacteriological profile of neonatal septicemia. A total of 1160 neonates of high risk category or having clinical features suggestive of septicemia were subjected to blood culture study during this period. The culture positivity rate was 73%. Of these, 24.9% cultures were polymicrobial. Among the 1059, growths obtained, 60.1% were Gram negative, with Klebsiella, E. coli and Pseudomonas as the commonest pathogens. In Gram positive group, coagulase negative Staphylococci were most frequent, constituting 24% of the total isolates. An increasing incidence of coagulase positive Staphylococci and Pseudomonas infections was observed in recent years. Another significant finding was a comparatively high prevalence of Group D beta hemolytic isolates among streptococcal growths, with S. fecalis as the single commonest streptococci isolate.