Objectives:To study the difference in the prevalence of hypertension and associated risk factors in urban and rural populations and the association of hypertension with various determinants.Materials and Methods:A community-based cross-sectional study was conducted in 48 villages and 15 urban wards of Jabalpur District of Central India. Nine hundred and thirty-nine individuals aged 20 years and above (624 from rural areas and 315 from urban areas) were included in the study. The prevalence of hypertension and associated cardiovascular risk factors was assessed in the urban and rural populations. A pretested questionnaire was used to collect data on socio-demographic, behavioral, and dietary factors. Anthropometric measurements of weight, height, waist and hip circumference, and blood pressure measurements were taken using the standard methodology. The glucose oxidase–peroxidase and cholesterol oxidase–cholesterol peroxidase methods were used to measure plasma glucose and serum cholesterol, respectively. Bivariate analysis was followed by multivariate analysis to detect the odds of getting hypertension with various risk factors for the urban and rural populations separately. Hypertension was defined as per Joint National Committee (JNC) - VII criteria.Results:The response rate was 97%. Overall prevalence of hypertension was 17%, with 21.4% in the urban population and 14.8% in the rural population. Significantly higher mean values of weight, height, body mass index (BMI), hip circumference (HC), waist circumference (WC), waist hip ratio (WHR), systolic blood pressure (SBP), fasting blood sugar (FBS), and serum cholesterol levels were mapped in the urban population in comparison with the rural population. Multivariate logistic regression analysis identified increasing age, parental history of hypertension, tobacco smoking, tobacco chewing, physical inactivity, high estimated per capita salt consumption, and BMI ≥27.5 kg/m2 as independent predictors for hypertension in the urban population, while in the rural population, increasing age, physical inactivity, central obesity, tobacco chewing and tobacco smoking were independent predictors for hypertension.Conclusion:The prevalence of hypertension and other cardiovascular risk factors was high in both urban and rural communities. Therefore, there is a need for comprehensive health promotion programs to encourage lifestyle modification.

Background: Chemicals that are commonly used for artificial ripening and to increase the shelf life of fruits and vegetables are ethylene, ethane, calcium carbide, and ethephon. The present study was conducted to study the effect of ethephon on the morphometry of rat liver. Methods:Ethephon was administered by oral gavage tube to 10 adult Wistar albino rats at a dose of 200 mg/kg body weight/day for 14 days. Ten controls were maintained. The animals were sacrificed within 24 h of administering the last dose by perfusion with formal saline under anesthesia. Liver was dissected and processed for paraffin embedding. Histomorphometric studies were done on randomly selected sections of the liver and the data obtained were tabulated and statistically analyzed. Results:In the experimental rats, the hepatocytes had a mean long and short diameter of 15.02 ± 4.20 and 12.08 ± 3.02 µm, respectively. In the control animals, the mean long and short diameters were found to be 16.5 ± 3.59 and 13.9 ± 3.59 µm, respectively. The nucleus of the hepatocytes had a mean long and short diameter of 5.08 ± 1.93 and 5.08 ± 1.93 µm, respectively, in the ethephon-treated rats and 6.15 ± 1.72 and 6.05 ± 1.68 µm, respectively, in the control animals. The decrease in diameters of the hepatocytes and their nuclei was statistically significant. At some sites, the parenchyma showed pyknotic nucleus and inflammatory infiltrations. There was a statistically significant increase in the diameters of the central vein and sinusoids. Dilatation of the bile canaliculi was seen in between the hepatocytes. Conclusion: The plant growth regulator, insecticide, and fruit ripener, ethephon, caused inflammatory and degenerative changes in the liver with associated cholestasis, probably suggestive of toxic hepatitis. (Biomed J 2015;38:421-427)

Anesthetic management of superior vena cava syndrome carries a possible risk of life-threatening complications such as cardiovascular collapse and complete airway obstruction during anesthesia. Superior vena cava syndrome results from the enlargement of a mediastinal mass and consequent compression of mediastinal structures resulting in impaired blood flow from superior vena cava to the right atrium and venous congestion of face and upper extremity. We report the successful anesthetic management of a 42-year-old man with superior vena cava syndrome posted for cervical lymph node biopsy.

Introduction:In the recent years, ethephon, 2-chloroethylphosphonic acid, is one of the most commonly used plant growth regulators. At present, it is being used on fruits, vegetables, and cereals for promoting pre- and post-harvest ripening. The effect of artificial ripening has become questionable because of various health-related issues. This study was conducted to note the morphology of liver after ethephon administration as it is the site where chemicals undergo first pass metabolism and probably will be affected by ethephon. Materials andMethods:Adult Wistar albino rats were divided into experimental and control groups (10 each). Ethephon was administered at a dose of 200 mg/kg/day by a gavage tube in the experimental rats for 14 days. The animals were sacrificed within 24 h of the last dose; liver was dissected and processed for light microscopy. Hematoxylin and eosin-stained sections were studied using an image-pro express analyzer. The data obtained from control and experimental groups were statistically analyzed.Results:In the experimental rats, the body weight was found to be significantly decreased. The orderly arrangement of hepatocytes was disrupted and was replaced by blood-filled sinusoids. At sites, hepatocytes appeared to be degenerated. Councilman bodies with pyknotic nuclei and inflammatory infiltrations were seen. The population per unit area of the hepatocytes and Kupffer cells was 29.53 ± 10.65 versus 44.18 ± 10.31 and 25.12 ± 4.41versus 13.05 ± 6.5 in experimental and control groups, respectively. The decrease of hepatocytes and increase of Kupffer cells were found to be statistically significant.Conclusions:The observations in the liver are probably indicative of degenerative changes associated with ethephon. Hence, we can conclude that this plant growth regulator, Fruit and Vegetable Ripener, has hepatotoxic potential. General awareness and regarding the use of such plant growth regulators is must to reduce the intake.

CASE REPORTAs a part of routine dissection, we found right sided sigmoid colon with redundant loop of colon in two cadavers of age ranging from 40-65 years in the anatomy department. As per the instructions given in Cunningham's manual of practical anatomy [1] the midline incision was given extending from xiphoid process to the pubic symphysis to explore the peritoneal cavity without any damage to the peritoneum and structures covered by it. After exposing the abdominal cavity and removing peritoneal fat, the viscera were carefully separated and cleared from the field of view. In situ placement of small and large intestines and their peritoneal relations were studied in detail. The small intestine and its mesentery was reflected to the right, to study extent and location of parts of colon along with their peritoneal relations. The blood vessels supplying the small and large intestine were carefully dissected and studied.The right sided sigmoid colon and long loop of descending colon was observed in two cadavers. The mesentery of ascending and descending colon was retained. This mesentery along with the mesentery of transverse colon was continuous with the mesentery of small intestine [Table/ Fig-1,2]. In case one, the vertical segment of descending colon extended upto L4-L5 vertebral level and the horizontal segment crossed in front of the left gonadal vessels, left genitofemoral nerve, left ureter, abdominal aorta, common iliac vessels and superior rectal artery, right ureter, right genitofemoral nerve and right gonadal vessels [Table/ Fig-3] to reach to right lumbar region and at this point it ascended one vertebral level higher and then turned downwards to become sigmoid colon at the right pelvic brim. The sigmoid colon occupied right iliac fossa and caecum was in the right lumbar region. The right limb of mesentery of sigmoid colon was attached to the right pelvic wall and left limb extended from right pelvic brim to third sacral vertebra. The inferior mesenteric artery turned towards right side so as to supply the right sided sigmoid colon. The left colic branch of inferior mesenteric artery divided into, left colic1 and left colic2, to supply the long segment of descending colon. The left colic1 divided into ascending and descending branch. The descending branch ended by anastomosing with the left colic2. The ascending branch ended by anastomosing with the left branch of middle colic [Table /Fig-3 ABSTRACTAnatomical variations of colon are mostly developmental and can lead to variety of acute and chronic pathological conditions. So it becomes important to recognize and understand the importance of clinical implications of such anomalies to benefit surgeons, clinical geneticists and research community. We describe two cases of right sided sigmoid colon and long descending colon which had two segments: vertical and horizontal. The mesentery of ascending and descending colon was retained. This mesentery along with the mesentery of transverse colon was continuous with the mesentery of small intestine. There w...

The Montgomery silicone t-tube used for post-procedural tracheal stenosis has advantage of acting as both stent and tracheostomy tube. The anesthetic management of patient with t-tube in situ poses a challenge. Safe management of such patients requires careful planning. We describe anesthetic management for direct laryngoscopy of a patient with t-tube in situ.

A 74-year-old female with diabetes mellitus type II and Alzheimer's disease, taking donepezil for 4 months was operated for right modified radical mastectomy under general anesthesia. During the procedure a higher dose of non-depolarizing muscle relaxant was required than those recommended for her age yet the muscle relaxation was inadequate intra-operatively. Residual neuromuscular blockade persisted postoperatively, due to the cumulative effect of large doses of non-depolarizing muscle relaxant, needing post-operative ventilatory assistance. After ruling out other causes of resistance to non-depolarizing muscle relaxants, we concluded that acetylcholinesterase inhibitor donepezil was primarily responsible for inadequate muscle relaxation and delayed post-operative neuromuscular recovery.

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