Objective : To assess the incidence of post-hanging pulmonary distress in cases of attempted suicidal hanging and predictors of outcome among these patients. Design : Five-year retrospective analysis. Setting: Tertiary care center in south India. Patients :A total of 335 patients who attempted suicidal hanging, aged above 16 years, were admitted during this period. Thirty-eight of them with pulmonary distress established clinically and with radiological evidence of pulmonary injury post hanging met the inclusion criteria. Measurements : Data from ICU records of 5 years, X-rays and laboratory investigations were reviewed. In patients identified to have post-hanging pulmonary distress, the neurological status, chest x-rays, arterial blood gas values and outcome data were collected and analyzed. Results : Eleven percent (n = 38) of the 335 patients admitted following attempted suicidal hanging were diagnosed to have post-hanging pulmonary distress. The overall mortality among post-hanging patients was 5%, which increased to 34.2% (n = 13) in the presence of pulmonary distress (P ≤ 0.001). Among the prognostic factors evaluated, a PaO ₂ / FiO ₂ (P/F) ratio of <100 at admission predicted a poor outcome (P ≤ 0.001). Conclusion : Post-hanging pulmonary distress is a relatively common complication of hanging and is associated with increased mortality. P/F ratio from arterial blood gas at admission was the only significant predictor of outcome in this group of patients.

Background :The behavioral phenotype in Down syndrome follows a characteristic pattern. Aims: To find the incidence of behavioral abnormalities in Down syndrome, to compare these findings with other causes of intellectual disability and normal population and to cluster these abnormalities. Settings :One hundred forty mentally challenged people attending at tertiary care set up and from various non-governmental organizations were included in the study. Patients from both rural and urban set up participated in the study. The age-matched group from normal population was also studied for comparison. Design :The study design is a cross-sectional survey done independently by four observers. Materials and Methods :A semi-structured proforma for demographic profile has been used. The behavioral abnormalities are assessed by using DASH II (Diagnostic Assessment for the Severely Handicapped second modified version) scale. Statistical Analysis :Demographic comparison has been done by analysis of variance. Correlation matrix has been run to identify correlation between individual items. Principal component analysis has been used for grouping the behavioral pattern. Results :Behavioral abnormalities as expected are more common in people having intellectual disability than the normal population. The Down syndrome group unlike other causes of intellectual disability shows higher scores in Stereotypy. Impulse control and Mania subscales. Factor analysis yields five characteristic factor structures, namely, hyperactive-impulsive, biological functions, affective, neurotic and organic-pervasive developmental disorder clusters. Conclusions :Contrary to the conventional belief of docile-fun and music loving prototype, individuals diagnosed with Down syndrome show clusters of behavioral abnormalities and management can vary depending on these target symptoms.

Background : Continuous glucose-monitoring system (CGMS) is a tool for assessment of glycemic excursions. Glucose variability is a risk factor independent of glycosylated hemoglobin (HbA1c) for diabetic complications; hence CGMS may be a better method for management of diabetes. Aim: To evaluate the extent of glycemic excursions in well-controlled type 2 diabetic patients. Setting and Design :The study was carried out in 21 diabetic patients on oral agents. Materials and Methods: Patients underwent continuous glucose-monitoring by CGMS for 3 days. Number and duration of glycemic excursions, correlation coefficient (%) between CGMS and self-monitoring blood glucose (SMBG), mean absolute difference (%MAD) and complications of CGMS were analyzed. Statistical Analyses : The statistical analyses were performed with the use of mean ± SD, t-test and Mann-Whitney test. Results :The mean age of patients was 51.9 ± 9.7 years. The mean HbA1c was 6.7 ± 0.38%. The mean number of glycemic readings was 753.6 ± 203.5 times. The correlation coefficient was 0.83 and the MAD was 11.7 ± 8.0%, which were considerable. Three (14.2%) patients experienced, altogether, 9 hypoglycemic events with an average duration of 162 minutes. Twenty (94.7%) patients had hyperglycemic events. The mean duration of hyperglycemia was 19.4 ± 12.8 hours. All events were asymptomatic. Disconnection of device was the most common complication (3 patients). Conclusion : This study demonstrated that well-controlled type 2 diabetic patients have a considerable number of hypoglycemia and hyperglycemia events that may be missed by SMBG.

A 28-year-old patient operated for laparoscopic donor nephrectomy (LDN) developed overdose effect of fentanyl leading to poor postoperative recovery. Naloxone (200 µg) treatment was used to reverse fentanyl effects, but it was associated with hypertension. The patient developed pulmonary edema after 2 hours and required overnight mechanical ventilation with positive end-expiratory pressure. Volume overload prescribed in the management of LDN to overcome the immediate poor renal graft functioning probably predisposed this healthy young patient to develop cardiac failure during sympathetic surge associated with naloxone administration. The authors feel that the reversal of overdose effect of opioid by naloxone after intravascular blood volume expansion puts the patient at risk to develop pulmonary edema.