Cuffed vs Uncuffed Endotracheal Tubes for Pediatric Patients: A Review

The use of uncuffed endotracheal tubes (ETT) in patients younger than 8 years old has been in practice for the last 60 years. In the last decade, there has been a change in clinical practice with a transition to cuffed ETT use, and there continues to be debate between cuffed vs uncuffed ETT use. This narrative review article aims to review the current literature on the topic and highlight some key points in the argument of cuffed vs uncuffed ETT use in pediatric patients. Cuffed ETTs are increasingly being used with several studies over the last 20 years demonstrating its benefits. Studies have claimed cuffed ETT has a clinical, environmental, and economical benefit over uncuffed ETT. Despite shortcomings of various studies and no definitive conclusion of a superior type of endotracheal tube, cuffed ETTs are here to stay in the world of anesthesia.

Role of Bile juice in Accha Snehapana

Snehapana is an internal administration of sneha (medicated or non-medicated) has an important therapeutic application in Ayurveda. This therapy aims to prepare the body for Shodhana karma and helps in bringing the doshas from Shakha (peripheral tissues) to koshtha so that they can expel out easily. Accha sneha pana is superior type of internal oleation. Digestion of sneha is all depending upon the Agni bala. Digestion and absorption of sneha shows various physiological changes in the body. Adahstad sneha darshanam is a classical sign of Samyak snigdha lakshana. Mode of action of sneha in koshtha and its relationship with bile salts and lipid metabolism process should be thoroughly studied for the success of snehapana therapy.

Superior-Type Fast-Slow Atrioventricular Nodal Reentrant Tachycardia Phenotype Mimicking the Slow-Fast Type

Background: Superior-type fast-slow (sup-F/S-) atrioventricular nodal reentrant tachycardia (AVNRT) is a rare AVNRT variant using a superior slow pathway (SP) as the retrograde limb. Its intracardiac appearance, characterized by a short atrio-His (AH) interval and the earliest site of atrial activation in the His-bundle, is an initial indicator for making a diagnosis. Methods: Among 22 consecutive patients with sup-F/S-AVNRT, 3 (age, 68–81 years) patients had an apparent slow-fast (S/F-) AVNRT characterized by a long AH interval and the earliest site of atrial activation in or superior to the His-bundle region (tachy-long-AH). Results: The diagnosis of sup-F/S-AVNRT was based on the standard criteria in 2 patients and on the occurrence of Wenckebach-type atrioventricular block during tachycardia, which was attributable to a block at the lower common pathway (LCP) below the circuit of the AVNRT, detected owing to the lower common pathway potentials, in one patient. As with the typical S/F-AVNRT, tachy-long-AH was induced after a jump in the AH interval. In contrast to typical S/F-AVNRT, fluctuation in the ventriculoatrial interval was observed during the tachy-long-AH. Ventricular overdrive pacing was unable to entrain or terminate the tachy-long-AH. Moreover, the tachy-long-AH reciprocally transited to/from sup-F/S-AVNRT spontaneously or was triggered by ventricular contractions while the atrial cycle length and earliest site of atrial activation remained unchanged. Both tachycardias were cured by ablation at a single site in the right-side para-Hisian region of 2 patients and the noncoronary aortic cusp of one patient. Collectively, the essential circuit of both tachycardias was identical, and the tachy-long-AH was diagnosed as another phenotype of sup-F/S-AVNRT accompanied by sustained antegrade conduction via another bystander slow pathway breaking through the His-bundle owing to the repetitive antegrade block at the lower common pathway, thus representing a long AH interval during the ongoing sup-F/S-AVNRT. Conclusions: An unknown sup-F/S-AVNRT phenotype exists that apparently mimics the typical S/F-AVNRT and is also an unknown subtype of apparent S/F-AVNRT.

The Presence of Patent Foramen Ovale in the Superior Type of Sinus Venosus Atrial Septal Defect

Background: The superior type of sinus venosus atrial septal defect (SVASD) is a rare form of the atrial septal defect (ASD) in which the upper part of the atrial septum does not exist. The presence of other cardiac anomalies such as anomalous pulmonary venous connections has been reported in this type of congenital heart disease. This study aimed to assess the presence of the patent foramen ovale (PFO) in patients with the superior type of SVASD. Methods: This retrospective case-control study on 387 patients, consisting of 187 patients with a definite SVASD and 200 patients with problems other than the ASD, was conducted in Rajaie Cardiovascular Medical and Research Center between February 2005 and July 2014. Seven patients with inadequate data were excluded from the analysis. The presence/absence of the PFO was also evaluated in the case and control groups. Results: The analyses were performed on 182 male and 198 female patients at a mean age of 39.07±14.41 and 51.01±15.80 years in the case and control groups, respectively. The PFO was significantly more frequent in the patients with the superior type of SVASD than in those without the condition (P<0.001). The persistence of the left superior vena cava was seen in 34 out of 180 patients with SVASD and in 1 out of 200 patients without the condition (18.9% vs 0.5%; P<0.001). Conclusion: This study was the first to highlight the coexistence of the PFO and the superior type of SVASD. Physiological, genetic, or fetal factors may play an important role in the association between the PFO and the SVASD.

The Organization of Enterprise in Japan

Recent research indicates the joint stock form was not a superior type of business organization in many countries historically. In Japan, however, its role was more pervasive. From 1896 to 1939 joint stock enterprises accounted for 44 percent of registered businesses and 80 percent of total capital. From 1922 to 1939 these enterprises outperformed other forms and generated 94 percent of aggregate profits. External finance factors, Japan's development phase, industrial structure, public policy, and culture led to high joint stock usage. The private limited liability company, introduced in 1938, did not displace the joint stock form.

First detection of superior-type caval vein defect in foetus

We present the images of the first superior-type caval vein defect diagnosed in a foetal echocardiogram.