With interest we read the recent article on methemoglobinemia by Chan et al.[1] Through this letter, we would like to add few additional comments regarding methemoglobinemia and its relevance in medicine practice with regards to food poisoning.

BACKGROUNDFracture shaft humerus is a major cause of morbidity in patients with upper extremity injuries. The aim of this study was to evaluate the outcome of interlocking nail in humeral shaft fractures.

METHODSThis study was conducted in the Department of Orthopedic Surgery in SMS and R Sharda University from January 2010 to November 2013. Seventy-eight patients were recruited from emergency and out-patient department having a close fracture of humerus shaft. All patients were operated under general anesthesia and closed reamed interlocking nailing was done. All patients were followed for 9 months.

RESULTSOut of 78 patients, 69 patients underwent union in 90-150 days with a mean of 110.68 days. Complications found in four patients who had nonunion, and five patients had delayed union, which was treated with bone grafting. All the patients were assessed clinically and radiologically for fracture healing, joint movements and implant failure. The results were excellent in 88.46% and good in 6.41% patients. Complete subjective, functional, and clinical recovery had occurred in almost 100% of the patients.

CONCLUSIONSThe results of the present study indicates that in the presence of proper indications, reamed antegrade intramedullary interlocked nailing appears to be a method of choice for internal fixation of osteoporotic and pathologic fractures.

Adult ; Bone Nails ; Female ; Fracture Fixation, Intramedullary ; methods ; Humans ; Humeral Fractures ; surgery ; Humerus ; injuries ; surgery ; Male ; Middle Aged ; Prospective Studies

OBJECTIVETo investigate the pharmacological effect of Nyctanthes arbortristis (NAT) leaf extract in the prevention of lung injury induced by silica particles.

METHODLung injury was induced in Swiss mice through inhalation exposure to silica particles (< 5 mu) using a Flow Past Nose Only Inhalation Chamber at the rate of -10 mg/m3 respirable mass for 5 h. Lung bronchoalveolar lavage (BAL) fluid collected between 48 and 72 h was subjected to protein profiling by electrophoresis and cytokine evaluation by solid phase sandwich ELISA. Lung histopathology was performed to evaluate lung injury.

RESULTSInhalation of silica increased the level of tumor necrosis factor-alpha (TNF-alpha), and of the 66 and 63 kDa peptides in the BAL fluid in comparison to sham-treated control. Pre-treatment of silica exposed mice with NAT leaf extract significantly prevented the accumulation of TNF-alpha in the BAL fluid, but the 66 and 63 kDa peptides remained unchanged. The extract was also effective in the prevention of silica-induced early fibrogenic reactions like congestion, edema and infiltration of nucleated cells in the interstitial alveolar spaces, and thickening of alveolar septa in mouse lung.

CONCLUSIONNAT leaf extract helps in bypassing silica induced initial lung injury in mice.

Administration, Oral ; Animals ; Bronchoalveolar Lavage Fluid ; Disease Models, Animal ; Enzyme-Linked Immunosorbent Assay ; Inhalation Exposure ; Male ; Mice ; Oleaceae ; chemistry ; Phytotherapy ; Plant Extracts ; pharmacology ; Pulmonary Fibrosis ; etiology ; prevention & control ; veterinary ; Silicon Dioxide ; adverse effects ; Silicosis ; prevention & control ; veterinary

BACKGROUND We read with great interest the recent article by Badheka et al published in your esteemed journal. Hereby we would like to address few additional points related to childhood retroperitoneal hematoma (RPH).

Background: Low-dose dexmedetomidine may be a suitable alternative to opioids for pediatric ambulatory procedures under general anesthesia (GA). However, the recovery profile remains unclear. Herein, we aimed to evaluate the effects of low-dose dexmedetomidine on the recovery profile of children. Methods: Seventy-two children undergoing ambulatory oral rehabilitation under GA were randomly and equally distributed into two groups (D and F). Group D received an infusion of dexmedetomidine 0.25 μg/kg for 4 min for induction, followed by maintenance of 0.4 μg/kg/h. Group F received an infusion of fentanyl 1 μg/kg over 4 min for induction, followed by maintenance at 1 μg/kg/h. The primary outcome was the extubation time. The secondary outcomes were awakening time, end-tidal sevoflurane (ET-Sevo) requirement, change in hemodynamic parameters, Richmond Agitation–Sedation Scale (RASS), Children's Hospital of Eastern Ontario pain scale (CHEOPS) score, length of PACU stay, and incidence of adverse events. Results: Statistically significant differences were observed in the recovery profile between the groups: the median time for extubation was 3.65 (3.44–6.2) vs. 6.25 (4.21–7) minutes in groups D vs. F (P=0.001), respectively, while the corresponding awakening times were 19 (18.75–21) and 22.5 (22–24) minutes, respectively (P < 0.001).The mean ET-Sevo was low in group D (1.1 vs. 1.2; P < 0.001). The heart rate was significantly low across all time points in group D, without resulting in bradycardia. The median RASS and CHEOPS scores were also significantly lower in group D. No significant differences were observed in the mean arterial pressure, incidence of adverse events, or length of PACU stay. Conclusion Low-dose dexmedetomidine was more effective than fentanyl as an opioid substitute at providing a better recovery profile in pediatric ambulatory oral rehabilitation under GA. Dexmedetomidine also significantly reduced sevoflurane consumption without causing adverse events or prolonging hospital stay.