BACKGROUNDData regarding the agreement among multiple operators for measurement of quadriceps muscle thickness by bedside ultrasonography (USG) are sparse.AIMTo statistically assess the agreement among 5 operators for measurement of quadriceps muscle thickness on bedside USG.METHODSThis was a cross-sectional observational study. The 5 operators of varied experience (comprised of 1 critical care consultant, 2 fellows, and 2 nurses) independently measured quadriceps muscle thickness in triplicate for 45 critically ill patients each, using USG. Intra- and interrater agreement rates among the 5 operators were assessed using intraclass correlation coefficient (ICC) and expressed with 95% confidence interval (CI).RESULTSThe 5 operators produced a total of 135 readings and 675 observations for ICC calculations to determine the intraoperator and interoperator variations respectively. For intraoperator agreement, the overall ICC (95%CI) was 0.998 (0.997, 0.999) for operator 1, 0.998 (0.997, 0.999) for operator 2, 0.997 (0.995, 0.999) for operator 3, 0.999 (0.998, 0.999) for operator 4, and 0.998 (0.997, 0.999) for operator 5. For interoperator agreement, the overall ICC (95%CI) was 0.977 (0.965, 0.986; P < 0.001) for reading 1, 0.974 (0.960, 0.984; P < 0.001) for reading 2, and 0.975 (0.961, 0.985; P < 0.001) for reading 3.CONCLUSIONUSG measurement of quadriceps muscle thickness was not dependent on clinical experience, supporting training for nurses in it.

A 16-year-old female presented with a 6-month history of a gradually increasing swelling of the left side of her face. A panoramic radiographic view of the mandible showed diffuse radiolucency in the ramus of the mandible with a loss of cortication on the superior and anterior portion of the condyle. The computed tomography (CT) scan revealed destruction of the mandibular bone and a large retromandibular and inferior temporal fossa mass with areas of breakdown. The biopsy was consistent with tubercular osteomyelitis. Antitubercular therapy resulted in a marked reduction of the size of the swelling over a 9-month period.

Background:Chronic obstructive pulmonary disease (COPD) is characterized by an interaction of various environmental influences especially cigarette smoking and genetic determinants. The prevalence of this disease is ever increasing and characterization of the genetic determinants of the disease has been undertaken globally. The ‘A disintegrin and metalloprotease 33’ (ADAM 33) gene is one candidate gene that has been studied.Objective:Our objective was to investigate whether single nucleotide polymorphisms in ADAM33 gene are associated with COPD in long-term tobacco smokers in the ethnic Kashmiri population of northern India.Materials and Methods:This was a randomized case-control study, which included 78 stable COPD (GOLD stage11-IV) patients, who were compared with 77 age- and sex-matched long-term tobacco smokers (>20 pack years) without any evidence of COPD. Polymorphic analysis for three single nucleotide polymorphisms (SNPs), (T1, T2, and Q1) of the ADAM33 gene was done by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) followed by sequencing. The data were analyzed by descriptive statistics and comparative evaluation was done by parametric/non-parametric tests.Results:The analysis of the T1, T2, and Q1 SNPs, revealed that the frequencies of the T2GG, T1GG, and the Q1AG genotypes were significantly higher in patients with COPD in comparison with the controls (P < 0.001). Similarly, the T1G and T2G allele frequency was higher in the patients than in the controls (p = 0.177 and 0.43, respectively).Conclusion:Three SNPs of the ADAM33 gene were significantly associated with COPD in the Kashmiri population of India. This study establishes the possible role of ADAM33 SNPS in the causation of COPD. Further studies across different geographical areas in the country will unravel the contribution of this gene in the causation of COPD in India.

Pepper gas is used for riot control in many parts of the world. Yet, its effects on bystanders are largely unreported. We fielded a questionnaire-based survey of 500 bystanders exposed to gas when police used pepper grenades against belligerent 'stone-pelters' in the northern Indian state of Jammu & Kashmir. Of 294 non-combatants who consented to participate in our survey, 97 per cent developed cough and irritation of the throat within few seconds of breathing the pungent smelling gas. They reported respiratory problems, dermatologic symptoms, sleep disturbances, and mood changes with varying frequency. Sixteen reported exacerbations of underlying respiratory disorders, with one temporally related to death. Symptoms led 51 to get medical attention. Nearly all respondents reported that symptoms recurred on re-exposure. We conclude that use of pepper grenades can cause serious acute symptoms in non-combatants accidentally exposed. We recommend alternate methods of riot control - water cannons, baton charges, tasers, plastic or rubber bullets, and so on - that have no collateral side effects on non-combatants be considered for routine use.

SUMMARYA young woman was admitted with respiratory failure. Prior to her admission, she had been treated for clinical bronchial asthma for about 2 years for recurrent wheezing. Endotracheal intubation was difficult. A fibroptic brochoscopy, while the patient was ventilated, revealed a central tracheal tumour compromising >90% of the tracheal lumen. The tumour was cored out during rigid bronchoscopy while ventilating the patient through tracheostomy. Histopathology of the tumour was suggestive of adenoid cystic carcinoma. BACKGROUND