Introduction: Central venous catheterization is a vital intervention in critically ill patients. The proper route of insertion is essential for its success. The purpose of this study was to compare the procedural parameters and complications associated with anterior and posterior approaches to internal jugular vein catheterization under real-time ultrasound guidance in critically ill patients. Materials and methods: In this prospective randomized study, 90 patients admitted in various ICUs were randomly allocated two groups of 45 each, including both males and females aged between 18 and 80 years of age requiring central venous catheterization for various indications. Demographic data was comparable between both groups. The first attempt success rates, venous visualization time, venous puncture time, duration of catheterization, and complications of each route were compared. Results: The first attempt success rates were comparable between both groups. The venous visualization time was 38.52 seconds in group I and 14.65 seconds in group II (p < 0.001). The venous puncture time and the duration of catheterization was found to be 47.60 sec and 2 minutes in group I, respectively, and 24.16 sec and 1 minute 32 sec in group II, respectively (p < 0.001). No statistically significant differences were found between the two groups in terms of incidence of carotid arterial puncture, hematoma formation, and catheter displacement. Conclusion: It was concluded that the posterior approach is better than the anterior approach of ultrasonogram (USG) guided internal jugular vein catheterization as it improves the accuracy, reduces the access time and duration of catheterization, and fewer incidences of immediate complications like carotid arterial puncture and hematoma formation.

Aim: The aim of our study was to determine any correlation between age, height, and ocular biometric variables, namely, pachymetry (central corneal thickness [CCT]), axial length (AL), and anterior chamber depth (ACD) in candidates appearing for medical evaluation. Materials and methods: This was a cross-sectional, observational study conducted among the candidates reporting to a medical evaluation center of the Indian Air Force (IAF) for selection to military duties. A total of 724 emmetropic eyes of 362 candidates in the age group of 16–30 years were studied. All candidates were evaluated for AL, ACD, CCT, and height was measured. The data was analyzed by inferential statistics like unpaired t-test and Kruskal–Wallis test, followed by testing of Pearson's correlation coefficient r. The p-value < 0.05 is considered statistically significant. Results: A total of 334 males and 28 females were enlisted in this study. The mean height of males and females was 174.45 ± 6.510 and 159.04 ± 3.837 cm, respectively. The mean AL (23.73 vs 23.14 mm, p < 0.001) and CCT (512.88 vs 504.98 µ, p < 0.841) were significantly greater in male candidates and ACD (3.60 vs 3.68 mm, p < 0.229) was more in female candidates. The mean CCT in males and females was 512.88 ± 26.978 and 504.98 ± 21.794 mm, respectively. Mann–Whitney U test showed that there were no significant mean difference between CCT and gender (p - 0.841). Kruskal–Wallis test showed that there was no significant difference between age groups and AL (p < 0.05). The mean AL in males and females was 23.73 ± 0.678, and 23.14 ± 0.353 mm, respectively, and there was a significant mean difference between AL and gender (p - 0.001). There was a statistically significant positive correlation noted between AL and height of the candidates. Conclusion: The study revealed a positive correlation between AL and height. Individual height is one of the important parameters in assessing the fitness of candidates, along with axial biometry. Emmetropic refraction can be seen by the process of compensation or attenuation of variable axial biometric parameters. We recommend that AL criteria should be correlated with height parameters in candidates with myopia or any refractive surgeries prior to ascertaining the fitness status.

Background: In developing countries, significant number of deliveries, including preterm ones, is conducted at home by birth attendants and the neonate's first contact with pediatrician happens only after a few days of life. The present work aimed to study the validity of New Ballard Score (NBS) on day 7 of life for estimation of gestational age (GA) in preterm neonates. Objective of our study was to assess GA using Modified Ballard Score (MBS) on days 1, 3, and 7 of life among preterm neonates and find its correlation with GA assessed antenatally using USG report and last menstrual period (LMP). Materials and methods: It was a prospective observational study, GA was estimated by principal investigator based on NBS on days 1, 3, and 7. The principal investigator was blinded to calculate GA based on USG and LMP. The parents of the neonate were explained about the study and informed consent was obtained. Intraclass correlation (ICC) statistic was performed to detect correlation between the GA measured antenatally and MBS measured GA. Results: Correlation between GA assessed ultrasonographically and that assessed postnatally by MBS on days 1, 3, and 7 of life was found to be significant (r-value: 0.832, 0.837, 0.831; p < 0.01). Conclusion: In situation where newborn encounters physician after first few days of life and does not have an exact assessment of GA through an established LMP and ultrasonography (USG) MBS can be utilized even on day 3 or 7 of life.

Drugs used during the perioperative period by anesthesiologists are diverse often given rapidly and in large doses. Several drugs given intravenously are known to cause immunoglobulin E-mediated (IgE) (type I) hypersensitivity reactions, which may lead to severe anaphylactic shock. Amongst drugs commonly used to treat such events is hydrocortisone succinate. Although less frequently, hydrocortisone has also been reported to cause anaphylaxis in certain patients. Identification of the offending agent can be challenging in certain scenarios, such as preinduction phase of anesthesia when administered along with other drugs in a short span of time. Drug provocation tests and skin tests are known methods to check for allergenic potential, but protocols can be confusing and not widely accessible. We present a case report of an individual who developed anaphylactic shock two times before the responsible agent was identified.

Aim: To share our experience in diagnosing and managing an asymptomatic, long-standing impacted foreign body in the neck. Background: Head and neck is not an uncommon site for penetrating foreign body impaction. Nonspecific minor injuries may undergo unrecognized but vascular injuries due to sharp foreign bodies may have devastating outcomes. Most of these foreign bodies are recognized and retrieved in the early post-trauma period. Our patient had a long-standing foreign body which was incidentally discovered on a radiological scan. Case description: A 28-year-old patient was incidentally discovered to have a long-standing, asymptomatic, impacted metallic foreign body in the neck while he was undergoing magnetic resonance imaging (MRI) of the hip. The foreign body was surgically removed. Conclusion: Impacted metallic foreign bodies may lie asymptomatic for long durations of time without causing any morbidity to the patient. Clinical significance: The decision for removing the asymptomatic impacted foreign body can be taken on a case-to-case basis. We present a foreign body neck case to demonstrate how it can interfere with the radiological diagnosis of other diseases and needs to be retrieved.

Introduction: Lipomas are slow-growing, lobulated, soft, mobile mass, usually found subcutaneously but can be found anywhere in the body. Case description: Our hospital presented with a case of mesenteric lipoma causing acute intestinal obstruction. Patient had a large tumor on the mesenteric border of ileum which was resected and on histopathology came out to be a mesenteric lipoma. Discussion: Mesenteric lipoma presenting as acute intestinal obstruction is a rare instance with very few cases being reported so far around the globe. Conclusion: Though mesenteric lipoma causing intestinal obstruction is rare. But from this case report we conclude that it should be considered as a differential diagnosis when patient presents with acute abdomen or intestinal obstruction.