Background:The addition of fentanyl to ropivacaine has shown to improve the quality of analgesia without compromising its benefits such as early mobilization and early voiding.Aim:The aim of the study was to evaluate the effects of the isobaric ropivacaine in combination with fentanyl and compare it with the isobaric ropivacaine alone in spinal anesthesia for lower abdominal and lower limb surgeries.Settings and Design:Double-blinded randomized controlled trial.Subjects and Methods:Hundred patients belonging to American Society of Anesthesiologists physical status I and II scheduled for either lower abdominal or lower limb surgery under spinal anesthesia were included. The study was a prospective double-blinded randomized controlled trial where patients were randomly allocated into two groups to receive either 2.5 ml of 0.75% (18.75 mg) isobaric ropivacaine with 25 μg fentanyl (Group RF) or 2.5 ml of 0.75% (18.75 mg) isobaric ropivacaine with 0.5 ml of 0.9% saline (Group R) intrathecally.Statistical Analysis:Data analysis was done by Student's unpaired t-test. SPSS version 16 was used. P < 0.05 was considered as statistically significant.Results:We found no significant difference in hemodynamics, onset of sensory and motor block, peak level of block, recovery from motor block, return of micturition and incidence of side effects with the addition of fentanyl to ropivacaine. First request for analgesia was required earlier in the control group. There was also a significant prolongation of the duration of sensory block (mean - 341.6 min) and postoperative analgesia in Group RF (mean - 442.2 min) (P < 0.001).Conclusion:The addition of fentanyl to ropivacaine significantly prolongs the duration of postoperative analgesia with clinically insignificant influence on hemodynamics and motor blockade with minimal side effects.

Asthma still causes considerable morbidity and mortality globally and minimal improvement has been seen in key outcomes over the last decade despite increasing treatment costs. This review summarizes recent advances in the management of asthma in children and adolescents. It focuses on the need for personalized treatment plans based on heterogenous asthma pathophysiology, the use of the terminology ‘asthma attack’ over exacerbation to instill widespread understanding of severity, and the need for every attack to trigger a structured review and focused strategy. The authors discuss difficulties in diagnosing asthma, accuracy and use of Fractional exhaled nitric oxide both as second line test and as a method to monitor treatment adherence or guide the choice of pharmacotherapy. The authors discuss acute and long-term management of asthma. Asthma treatment goals are to minimize symptom burden, prevent attacks and (where possible) reduce risk and impact of progressive pathophysiology and adverse outcomes. The authors discuss pharmacological management; optimal use of short acting β2 agonists, long acting muscarinic antagonist (tiotropium), use of which is relatively new in pediatrics, allergen specific immunotherapy, biological monoclonal antibody treatment, azalide antibiotic azithromycin, and the use of vitamin D. They also discuss electronic monitoring and adherence devices, direct observation of therapy via mobile device, temperature controlled laminar airflow device, and the importance of considering when symptoms may actually result from dysfunctional breathing rather than asthma.

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Background:Planning skills play a key role in higher developmental processes. The Tower of London test not only measures planning skills, but also the ability to execute plans. Yoga practices aim to bring about higher development. Can a Yoga-based education system be shown to meet this challenge?Aim:This study was aimed at comparing a Modern Education System (MES) with the ancient Yoga-based system of education, the Gurukula Education System (GES), in developing planning skills.Materials and Methods:Forty-nine boys with ages ranging from 11 to 13 years were selected from each of two residential schools, one MES and the other GES, providing similar ambience and daily routines. The boys were matched for age and socio-economic status. The GES educational program is based around integrated yoga modules while the MES provides a conventional modern education program. Planning and executive abilities were assessed using the Tower of London test at the start and the end of an academic year.Results:Within groups, the pre-post test differences were significant for both groups. However, the between-groups results showed improvement in the GES group compared to the MES group at a P < 0.001 significance level.Conclusions:The study suggests that whereas both MES and GES Yoga-based education improve planning and execution skills in school boys, GES is more effective of the two systems.