Domestic cooking fuel and lung functions in healthy non-smoking women

OBJECTIVE: The objective of this study was to compare the pulmonary functions in healthy non-smoking women who used either biomass or liquified petroleum gas (LPG) as their sole cooking fuel. The effects of passive smoking, ventilation, over crowding and cooking index were also taken into account. METHODOLOGY: The study was conducted over a period of two years from January 1994. One hundred healthy non-smoking women were included 50 cooked solely with biomass and 50 cooked with LPG. A standardised respiratory symptoms questionnaire was administered to all the subjects and spirometry was carried out. RESULTS: Passive smoking showed no significant difference between the two groups. No statistically significant differences was found in lung functions in the two groups except for the PEFR, which was significantly lower (P < 0.01) in women using biomass. No correlation was observed between different variables and pulmonary functions. The step-wise multivariate linear regression analysis showed no correlation between cooking fuel and the pulmonary functions. CONCLUSION: The absence of the expected adverse effects of biomass on pulmonary functions was possibly due to better ventilation in the kitchens of subjects in the biomass group compared to previous studies.     

Respiratory pressures in normal Indian subjects

Regression equations for the prediction of maximum inspiratory pressures (MIP) in North Indian adults are reported, based on observations in 120 females and 153 males. Age and sex were the only significant predictor variables. MIP was significantly related to vital capacity, FEV1 and peak flow rate. The MIP observed in the present study are similar to those reported earlier in Caucasians and Chinese. The lower lung volumes and flow rates in Indians are not explained by differences in MIP.     

Indirect assessment of lung compliance in chronic lung diseases

The slope of the flow volume curves was analysed in 20 normal subjects 28 patients with irreversible chronic airway obstruction, 24 patients with bronchial asthma, 8 patients with diffuse interstitial fibrosis and 7 patients with extensive bronchiectasis. Time constant of the system was taken as the slope of the curve between 50 and 25% of the vital capacity. When considered along with plethysmographically obtained airway resistance, an indirect estimate of the lung compliance was obtained. Significant differences in the estimated lung compliance in the normal subjects, patients with obstructive lung disease or diffuse interstitial fibrosis were demonstrated.     

Peripheral chemoreceptor insensitivity in chronic severe anaemia

Ventilatory response to central and peripheral chemoreceptor stimulation by carbon dioxide was assessed in 15 severely and chronically anaemic subjects before and after the correction of anaemia. Whereas the central CO2 responsiveness was found to be normal in the anaemic state, the peripheral response to CO2 was remarkably depressed. This blunted peripheral response to CO2 was restored to normal with the correction of anaemia.     

Association of extent and infection of pancreatic necrosis with organ failure and death in acute necrotizing pancreatitis.

BACKGROUND & AIMS: Organ failure is the usual cause of death in acute necrotizing pancreatitis. Our objective was to study whether the extent and infection of pancreatic necrosis correlate with organ failure and mortality. METHODS: All consecutive patients with acute pancreatitis were prospectively studied. They underwent a detailed clinical and investigative evaluation. Pancreatic necrosis, diagnosed on a computed tomography scan, was graded as <30%, 30%-50%, and >50% necrosis and characterized as either sterile or infected. Logistic regression analysis was done to find out the association of the extent and infection of pancreatic necrosis with organ failure and mortality. RESULTS: Of 276 patients (mean age, 41.25 years; 172 men), 104 had pancreatic necrosis: 30 had <30% necrosis, 37 had 30%-50% necrosis, and 37 had >50% necrosis; 74 had sterile necrosis, and 30 had infected necrosis. Of them, 37 (35%) patients developed organ failure. Two significant factors were associated with the development of organ failure, the extent of necrosis (<30% necrosis vs 30%-50% necrosis: P = .03; odds ratio [OR], 5.82; 95% confidence interval [CI], 1.15-29.45; <30% necrosis vs >50% necrosis: P = .0004; OR, 18.86; 95% CI, 3.75-94.92) and infected pancreatic necrosis (P = .02; OR, 3.29; 95% CI, 1.17-9.24). The overall mortality was 22%. Infected pancreatic necrosis (P = .006; OR, 4.99; 95% CI, 1.56-16.02) and Acute Physiology, Age, and Chronic Healthy Evaluation II score (P = .004; OR, 1.28; 95% CI, 1.08-1.52) were 2 independent predictors of mortality. CONCLUSIONS: Extent of necrosis and infected pancreatic necrosis were associated with the development of organ failure in patients with acute necrotizing pancreatitis. Infected pancreatic necrosis was the most significant predictor of mortality.     

Emergency presentation of retrograde intussusception as a late complication of gastric bypass

Retrograde intussusception is a rare complication of a Roux-en-Y gastric bypass. With the rising number of gastric bypass operations being performed in the UK, the incidence of retrograde intussusception is likely to increase. We report the first case in the UK and highlight its insidious presentation and the importance of considering intussusception in any patient with a history of a Roux-en-Y gastric bypass.     

Postoperative conjunctival chemosis in cataract surgery caused by subconjunctival gentamicin injection.

A prospective study of 75 patients undergoing cataract surgery was conducted to identify the cause of postoperative conjunctival chemosis seen in patients with cataracts in this department. The patients were split in three groups of 25 each. Group G patients were given a subconjunctival injection of gentamicin at the end of the cataract procedure; group W patients did not receive subconjunctival gentamicin, but a cellulose wick drain was used during the procedure; and Group GW patients received a subconjunctival injection of gentamicin and a wick drain was also used. The incidence, severity, and the duration of chemosis were observed in the three groups. Chemosis was seen only in groups G and GW, and the difference between the number of patients who received gentamicin and those who did not receive gentamicin was significant (p less than 0.001).     

Do first impressions count?: A comparison of subjective and psychologic assessment of spinal patients

Psychologic factors may have a major influence on the outcome of treatment for back pain. Psychologic disturbance is manifest as emotional distress and may be associated with inappropriate symptoms and signs. Few outcome studies describe the patient population in terms of their psychologic profile. Anecdotal evidence suggested that the routine use of psychologic screening tests in British spine practice was rare. An audit of the prevalent use of psychologic testing amongst a selected group of British spinal surgeons was conducted. This was followed by a prospective, double blind comparison of subjective evaluations of patients with formal psychologic tests. The principal aim was to determine how accurately treating physicians could identify psychologically distressed patients. A postal questionnaire was sent to all consultant members of the British Orthopaedic Spine Society. Details of their current practice and frequency of use of psychologic tests was obtained. In a subsequent study, 125 consecutive new patients attending a back pain clinic were initially evaluated by questionnaires and classified as either psychologically distressed or non-distressed. These patients were then interviewed and examined by treating physicians, who then allocated them to one of four psychologic categories, using predefined criteria. The two results were compared and sensitivity, specificity and predictive values for the subjective evaluations were calculated. Sixty-three percent of respondents to the postal survey either never or only occasionally used any form of psychologic testing in assessing back pain patients. The follow-up prospective study demonstrated that experienced spinal surgeons achieved only a 26% sensitivity when trying to identify distressed patients. The specificity for identifying non-distressed patients was 96%. The predictive value of a “distressed” evaluation was 69%. The predictive value for non-distressed patients was 77%. Subjective psychologic assessment of back pain patients has a low sensitivity and predictive value for distressed patients. Formal psychologic screening should be routinely included in the clinical decision making process. Received: 27 September 1997 Revised: 10 January 1998 Accepted: 20 January 1998     

Platelet ultra-structure study in Budd-Chiari syndrome

Abstract: Morphologic characteristics of circulating platelets were studied in 20 patients with primary Budd-Chiari syndrome (BCS) without any known etiology, using transmission electron microscopy (TEM). Significant platelet ultrastructural changes were observed in all the patients (in 10←90% platelets) as compared to 20 normal healthy controls (in up to 4% of their platelets). The prominent changes in the platelets were paucity or absence of alpha granules, hypertrophy of the open canalicular systems (OCS) and clumping and fusion of the granules and other organelles in the centre of platelets. Some other changes observed in platelets were dilated channels of OCS, pseudopodial protrusion of cytoplasm and presence of prominent masses of glycogen particles. Platelets from 20 normal controls processed along with the patients' platelets showed only a few such abnormalities. Most of these changes observed in patients' platelets were akin to the changes observed in platelets undergoing activation. Assay of plasma beta-thromboglobulin showed significantly higher levels in all the patients (p< 0.001) further confirming on-going in vivo platelet activation with morphologic changes most likely reflecting the thrombotic process present in BCS patients.