A LITERATURE STUDY TO UNDERSTAND PHYSIOLOGICAL CHANGES OF PRE-VENEPUNCTURE SIRAA UTTHAAN IN HEAD –NECK REGION OF PATIENT W.S.R. TO SUSHRUTA SAMHITA

Position of patient in surgical procedures is an important assisting factor. Position of patient in minor and major surgical procedures are mentioned in Ayurveda as well as modern medical science. One of such po-sition is mentioned in Sushrut Samhita Sharirsthan chapter 8 and Shloka number 8. This reference is about Siravedh/venipuncture procedure. Siravedh is done at Sira or vein. Before this procedure a position is giv-en to patient by Vaidya. Patient is in specific sitting and Vaayu Purna Mukh i.e. air-filled mouth position. This study is about the correlation between specific sitting with Vaayu Purna Mukh and its expected effect on venous pressure in head and neck region. Venous pressure can be explained with the help of modern physiology. Specific sitting posture and Vaayu Purna Mukh can be correlated with forced expiratory effort with closed glottis. Its expected effect on peripheral veins of head and neck can be studied and correlated with Vaayu Purna Mukh position in Uttamaangiya Siravedh procedure or bloodletting or venipuncture procedure at veins of head and neck.

Pneumomediastinum in marijuana users: a retrospective review of 14 cases

IntroductionInhaled marijuana has been infrequently identified as a potential risk factor for the development of spontaneous pneumomediastinum (SPM), a rare finding of free air in the mediastinum likely caused by barotrauma during breathing manoeuvres. The mechanism of inhalation drug use is often not ascertained by physicians, thus little is known about how different smoking techniques precipitate pulmonary injury. We aimed to evaluate the frequency of marijuana use in patients with non-traumatic pneumomediastinum over a 12-month period, identifying additional relevant clinical features or risk factors, and determining the extent to which clinicians record smoking techniques.MethodsWe performed a retrospective chart review over a 1-year period, identifying patients presenting to the hospital with a diagnosis of pneumomediastinum in the absence of trauma, malignancy or iatrogenic cause.ResultsWe identified 21 cases, 14 of which (66.7%) were associated with marijuana use, average age was 22.5 years (range 18–30), with male predominance (64.2%). Daily or more use was reported in 50% of cases. Concurrent risk factors including vomiting (57.1%) and coughing (42.9%) were commonly present. The mechanism of smoking was described in only two cases (14.3%).DiscussionInhaled marijuana may be an underappreciated risk factor for the development of SPM, caused by air leakage around the bronchovascular sheaths during successive inhalation through a high-resistance smoking apparatus or forced exhalation against a closed glottis. Physicians should be aware of this association in order to provide appropriate counselling. Further research is needed to direct the safe use of smoking devices and techniques.

The Dangers of Sneezing: A Review of Injuries

Background Sneezing is an almost universal daily phenomenon as a reflex to evacuate irritants from the nasal cavities. An autonomic-controlled buildup of intrathoracic pressure against a closed glottis followed by sudden release results in a burst of 1 kPa of air through the upper airway. Active intervention to limit a sneeze can be deleterious. Closure of the airway during a sneeze can result in over 20 times the airway pressures resulting in a variety of untoward events. This review summarizes all reported injuries that occurred as the result of a sneeze. Objective The objective of this review is to summarize the risks of closed-airway sneezing and determine if there are any trends which can help understand such injuries. Methods A comprehensive literature review was performed from 1948 to 2018 to identify all reports of sneeze-related injuries. Information was compiled from reports to gain insights into comorbidities and risk factors for sneeze injuries. Results There were 52 unique reports of sneeze-related injuries in the literature that were categorized into 6 areas of injury: intrathoracic, laryngeal/pharyngeal, ocular/orbital, intracranial/neurological, otologic, and other. The mean age of subjects who suffered a sneeze injury was 40 years old (range: 15–84 years), with 81% being male gender. Thirty percent had a risk factor for injury of prior trauma (5) or respiratory compromise (5). Conclusion A variety of injuries can occur during a sneeze, especially when a closed-airway sneeze is attempted, and high Valsalva pressure is transmitted to the other systems. Men are more at risk for these injuries with the majority occurring in patients with no known risk factor. When triggered, a sneeze should be allowed to proceed without intervention to prevent associated injuries.

Cough

A cough is an explosive forced expiratory manoeuvre, usually against a closed glottis, and gives rise to a characteristic sound. Acute cough is defined as a cough of less than 3 weeks duration, and chronic cough as one of more than 8 weeks duration. Acute cough is the commonest presenting symptom in primary care: by far the most frequent cause is a viral respiratory tract infection. The main effect of coughing is on quality of life and this is particularly prominent in patients with chronic cough, as these frequently develop physical complications such as chest pain, retching and vomiting, hoarseness, incontinence, sleep disturbance, and syncope. In addition, psychological distress and social embarrassment are often features. This chapter covers the approach to diagnosis for acute and chronic cough as well as diagnostic tests, therapies, prognosis, and dealing with uncertainty.

Cough

Cough results from forced expulsion, usually against a closed glottis, creating a characteristic sound. It is a natural reflex and defense mechanism that helps the body clear excessive secretions and prevents foreign material from entering the respiratory tract. At times, cough can become excessive, nonproductive, disturbing to the patient, and potentially harmful. Cough is a complex symptom and often requires a multidisciplinary approach to ascertain its cause and effective treatment. Evaluation should be guided by a thorough history and physical examination, and testing should be individualized for cost effectiveness. Habit cough and unexplained cough are diagnoses of exclusion, and any tendency to underdiagnose or overdiagnose these conditions should be avoided. Most over-the-counter cough suppressants are not as effective as previously thought, and their use in routine practice should be minimized. Future research should be conducted to elucidate the mechanisms of cough production and to develop cough-suppressive pharmacotherapy. Allergists, as experts in the management of upper and lower airway disorders, should play a central role in the diagnosis and management of cough.

ARRHYTHMIC BREATHING, APNEA AND NON-STEADYSTATE OXYGEN UPTAKE IN HIBERNATING LITTLE BROWN BATS (MYOTIS LUCIFUGUS)

We measured the breathing pattern and oxygen consumption of hibernating little brown bats {Myotis lucifugus) in open- and closed-circuit metabolic chambers. At 5°C, hibernating M. lucifugus showed bouts of ventilation lasting on average 1.24min and separated by periods of apnea lasting on average 47.59min. The bats consumed 0.014 ml O2g−1 during ventilation bouts and 0.002 ml g−1 during apnea. The total O2 uptake was 0.016 ml g−1 for a complete ventilationapnea cycle, giving a Vo2 of 0.020 ml g−1 h−11. This value is considerably lower than most values previously published for Myotis spp. and we suggest that studies using open-circuit systems that did not account for the intermittent nature of gas exchange during hibernation may be in error. Based on the dimensions of the respiratory tract, we estimate that 0.026 ml O2g−1h−1 and 0.009mlCO2g−1h−1 could diffuse down the tract if the glottis was open. The low O2 uptake during apnea indicates that the glottis was closed. If CO2 retention acts to depress metabolism in hibernators, a closed glottis and arrhythmic breathing may be adaptive strategies in hibernation.