Background: Magnetic resonance neurography shows the brachial plexus cords in the subcoracoid tunnel beneath the pectoralis minor. With an ultrasound scan along the brachial line, the brachial plexus cords in the subcoracoid tunnel can be targeted using an in-plane needle approach. We describe this new approach to the infraclavicular block called the “subcoracoid tunnel block.”Case: Twenty patients were administered with the ultrasound-guided subcoracoid tunnel block for the below-elbow surgery. The contact of the needle tip with cords was visible in all 20 patients. With neurostimulation, the posterior cord was identified in 11 (55%) and medial cord in 9 (45%) patients on the first needle pass. The subcoracoid tunnel block was successful in 16 patients (80%). Conclusions Our case series shows that the subcoracoid tunnel block is an excellent alternative technique for the infraclavicular block. Its advantages include better needle-cord visibility and easy identification of the brachial plexus cords.

To explore the relationship between climate variables and enteric fever in the city of Ahmedabad and report preliminary findings regarding the influence of El Niño Southern Oscillations and Indian Ocean Dipole over enteric fever incidence. Method: A total of 29 808 Widal positive enteric fever cases reported by the Ahmedabad Municipal Corporation and local climate data in 1985-2017 from Ahmedabad Meteorology Department were analysed. El Niño, La Niña, neutral and Indian Ocean Dipole years as reported by the National Oceanic and Atmospheric Administration for the same period were compared for the incidence of enteric fever. Results: Population-normalized average monthly enteric fever case rates were the highest for El Niño years (25.5), lower for La Niña years (20.5) and lowest for neutral years (17.6). A repeated measures ANOVA analysis showed no significant difference in case rates during the three yearly El Niño Southern Oscillations categories. However, visual profile plot of estimated marginal monthly means showed two distinct characteristics: an early rise and peaking of cases in the El Niño and La Niña years, and a much more restrained rise without conspicuous peaks in neutral years. Further analysis based on monthly El Niño Southern Oscillations categories was conducted to detect differences in median monthly case rates. Median case rates in strong and moderate El Niño months and strong La Niña months were significantly dissimilar from that during neutral months (P<0.001). Conclusions: El Niño Southern Oscillations events influence the incidence of enteric fever cases in Ahmedabad, and further investigation from more cities and towns is required.