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  Citation statistics : Table of Contents
   2014| January-February  | Volume 58 | Issue 1  
    Online since February 13, 2014

 
 
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CLINICAL INVESTIGATIONS
Dexmedetomidine versus midazolam for conscious sedation in endoscopic retrograde cholangiopancreatography: An open-label randomised controlled trial
Priyanka Sethi, Sadik Mohammed, Pradeep Kumar Bhatia, Neeraj Gupta
January-February 2014, 58(1):18-24
DOI:10.4103/0019-5049.126782  PMID:24700894
Background: Traditionally, midazolam has been used for providing conscious sedation in endoscopic retrograde cholangiopancreatography (ERCP). Recently, dexmedetomidine has been tried, but very little evidence exists to support its use. Objective: The primary objective was to compare haemodynamic, respiratory and recovery profile of both drugs. Secondary objective was to compare the degree of comfort experienced by patients and the usefulness of the drug to endoscopist. Study Design: Open-label Randomised Controlled Trial. Methods: Subjects between 18 and 60 years of age with American Society of Anaesthesiologist Grade I-II requiring ERCP were enrolled in two groups (30 each). Both groups received fentanyl 1 μg/kg IV at the beginning of ERCP. Group M received IV midazolam (0.04 mg/kg) and additional 0.5 mg doses until Ramsay Sedation Scale (RSS) score reached 3-4. Group D received dexmedetomidine at loading dose of 1 μg/kg over 10 min followed by 0.5 μg/kg/h infusion until RSS reached 3-4. The vital parameters (heart rate (HR), blood pressure (BP), respiration rate, SpO 2 ), time to achieve RSS 3-4 and facial pain score (FPS) were compared during and after the procedure. In the recovery room, time to reach modified Aldrete score (MAS) 9-10 and patient and surgeon's satisfaction scores was also recorded and compared. Any complication during or after the procedure were also noted. Results: In Group D, patients had lower HR and FPS at 5, 10 and 15 min following the initiation of sedation (P<0.05). There was no statistically significant difference in BP and respiratory rate. The procedure elicited a gag response in 29 (97%) and 7 (23%) subjects in Group M and Group D respectively (P<0.05). MAS of 9-10 at 5 min during recovery was achieved in 27 (90%) subjects in Group D in contrast to 5 (17%) in Group M (P<0.05). Dexmedetomidine showed higher patient and surgeon satisfaction scores (P<0.05). Conclusion: Dexmedetomidine can be a superior alternative to midazolam for conscious sedation in ERCP.
  11 7,041 1,290
Health-care-associated infections: Risk factors and epidemiology from an intensive care unit in Northern India
Priya Datta, Hena Rani, Rajni Chauhan, Satinder Gombar, Jagdish Chander
January-February 2014, 58(1):30-35
DOI:10.4103/0019-5049.126785  PMID:24700896
Background and Aims: Health-care-associated infection is a key factor determining the clinical outcome among patients admitted in critical care areas. The objective of the study was to ascertain the epidemiology and risk factors of health-care-associated infections in Intensive Care Units (ICUs) in a tertiary care hospital. Methods: This prospective, observational clinical study included patients admitted in ICU over a period of one and a half years. Routine surveillance of various health-care-associated infections such as catheter-associated urinary tract infections (CAUTI), central-line-associated blood stream infections (CLABSI), and ventilator-associated pneumonias (VAP) was done by the Department of Microbiology through specific Infection Surveillance Proforma. Results: Out of 679 patients, 166 suffered 198 episodes of device-associated infections. The infections included CAUTI, CLABSI, and VAP. The number of urinary tract infection (UTI) episodes was found to be 73 (10.75%) among the ICU patients who had indwelling urinary catheter. In addition, for 1 year CAUTI was calculated as 9.08/1000 catheter days. The number of episodes of blood stream infection was 86 (13.50%) among ICU patients having central line catheters. Also, CLABSI was found to be 13.86/1000 central line days. A total of 39 episodes (6.15%) of VAP was found in ICU patients over 18 months and VAP present for 6.04/1000 ventilator days. Conclusions: The organisms most commonly associated with health-care-associated infections were Pseudomonas aeruginosa and Acinetobacter species. The risk factors identified as being significantly associated with device associated infections in our ICU were diabetes, COPD and ICU stay for ≥8 days (P < 0.05).
  7 15,514 1,021
Prevalence of acute neuropathic pain after cancer surgery: A prospective study
PN Jain, Durgesh Padole, Sumitra Bakshi
January-February 2014, 58(1):36-42
DOI:10.4103/0019-5049.126788  PMID:24700897
Background and Aims: Acute neuropathic pain (ANP) is an under-recognised and under-diagnosed condition and often difficult to treat. If left untreated, it may further transform into persistent post-operative chronic pain leading to a disability. Aims: This prospective study was undertaken on 300 patients to identify the prevalence of ANP in the post-operative period by using a neuropathic pain detection questionnaire tool. Methods: This is an open-label study in which patients with six different types of cancer surgeries (Thoracic, gastro-intestinal, gynae/urology, bone/soft-tissue, head and neck and breast subgroups-50 each) were included for painDETECT questionnaire tool on the 2 nd and 7 th day surgery. Results: This study found a 10% point prevalence of ANP. Analysis showed that 25 patients had 'possible' ANP, the maximum from urological cancer surgery (6) followed by thoracic surgery (5). Five patients were found to have 'positive' ANP including 2 groin node dissection, 2 hemipelvectomy and 1 oesophagectomy. Conclusion: Significant relationship between severity of post-operative pain was found with the occurrence of ANP in the post-operative period requiring a special attention to neuropathic pain assessment. Larger studies are required with longer follow-up to identify accurately the true prevalence and causative factors of ANP after surgery.
  4 3,938 609
CASE REPORTS
Unexpected refractory intra-operative hypotension during non-cardiac surgery: Diagnosis and management guided by trans-oesophageal echocardiography
Sundara Reddy, Kenichi Ueda
January-February 2014, 58(1):51-54
DOI:10.4103/0019-5049.126796  PMID:24700900
We present a case of severe refractory hypotension in a patient undergoing de-bulking liver resection for massive polycystic liver disease. Emergent trans-oesophageal echocardiography (TOE) revealed dynamic left ventricular outflow tract (LVOT) obstruction with systolic anterior motion (SAM) of the anterior mitral leaflet (AML). Notably, he had a structurally normal heart on pre-operative trans-thoracic echocardiography (TTE). Diagnosis of SAM by TOE, possible mechanisms and specific management of refractory hypotension in this context are discussed.
  3 3,843 592
BRIEF COMMUNICATIONS
An adult non-obese male, a case of obstructive sleep apnoea posted for tonsillectomy and septoplasty - challenges faced
Pradnya M Bhalerao, Sunita M Khedkar, Vijay H Patil, Bhausaheb R Kawade
January-February 2014, 58(1):82-84
DOI:10.4103/0019-5049.126810  PMID:24700911
  2 2,867 494
CASE REPORTS
Emergency caesarean delivery in a patient with cerebral malaria-leptospira co infection: Anaesthetic and critical care considerations
Sukhen Samanta, Sujay Samanta, Rudrashish Haldar
January-February 2014, 58(1):55-58
DOI:10.4103/0019-5049.126797  PMID:24700901
Malaria-leptospira co-infection is rarely detected. Emergency surgery in such patients has not been reported. We describe such a case of a 24-year-old primigravida at term pregnancy posted for emergency caesarean delivery who developed pulmonary haemorrhage, acute respiratory distress syndrome, acute kidney injury, and cerebral oedema. Here, we discuss the perioperative management, pain management (with transverse abdominis plane block), intensive care management (special reference to management of pulmonary haemorrhage with intra pulmonary factor VIIa) and the role of plasmapheresis in leptospira related jaundice with renal failure.
  2 2,670 535
A novel method using Seldinger's technique for submental intubation in major craniomaxillofacial fractures: A case series
Shaik Mastan Saheb, Vemuri Nagendra Nath, K Phani Kumar, Pilli Parama Geetha Padmaja
January-February 2014, 58(1):48-50
DOI:10.4103/0019-5049.126795  PMID:24700899
Airway management is a challenge to anesthesiologists particularly in maxillofacial surgeries. The oral tracheal tube is unsuitable because it interferes with the surgical field and prevents dental occlusion. Nasotracheal intubation may not always be possible due to structural deformity or trauma to the nasal bones. Tracheostomy and submental intubation have their drawbacks. To overcome these shortcomings we used Percutaneous Dilatational Tracheostomy Kit (PDTK) to modify the technique of submental intubation. Serial dilatations were performed over the guide wire before passing the tracheal tube by submental route, using the PDT kit in four patients. Submental intubation could be achieved in all the four cases with this technique and there were no associated complications. Seldinger's technique is a simple and easy technique with minimal bleeding, imperceptible scar, and more importantly anesthesiologists feel more comfortable because of their familiarity with the Seldinger technique.
  2 3,688 715
Anaesthesia for a child with adrenoleukodystrophy: A case report and review of the literature
Sien Hui Tan, Vivienne HY Ng
January-February 2014, 58(1):63-65
DOI:10.4103/0019-5049.126802  PMID:24700903
We present a 9-year-old boy with X-linked cerebral adrenoleukodystrophy (X-linked ALD) and previous umbilical cord transplant who required general anaesthesia. An anaesthetic plan for each individual should be tailored to ensure the best possible anaesthetic care for these patients. The anaesthetic considerations include mental retardation, seizure disorder, hypotonia, liver function abnormalities, gastro-oesophageal reflux, impaired adrenocortical function and immunosuppression. Pre-operative sedation should be avoided because of hypotonia of the pharyngeal muscles. Anti-convulsants are continued, and potentially epileptogenic anaesthetic agents are avoided. The patient was intubated using a modified rapid sequence induction with a head up position of 30 degrees. Four other cases have been reported in literature. Nevertheless, there is still no established anaesthetic management for these patients, and total intravenous anaesthesia can be considered as a safe and alternative method of anaesthesia. To the best of our knowledge, this is the first reported use of total intravenous anaesthesia with propofol and remifentanil in a case of cerebral adrenoleukodystrophy, and with a favourable outcome.
  2 3,419 480
CLINICAL INVESTIGATIONS
Suction catheter guided insertion of ProSeal laryngeal mask airway: Experience by untrained physicians
Valter Perilli, Paola Aceto, Teresa Sacco, Nunzia Martella, Maria Teresa Cazzato, Liliana Sollazzi
January-February 2014, 58(1):25-29
DOI:10.4103/0019-5049.126784  PMID:24700895
Background: The use of suction catheter (SC) has been shown to improve success rate during ProSeal laryngeal mask airway (PLMA) insertion in expert users. Aims: The aim of this study was to compare insertion of PLMA performed by untrained physicians using a SC or the digital technique (DT) in anaesthetised non-paralysed patients. Methods: In this prospective randomised double-blind study, conducted in the operating setting, 254 patients (American Society of Anaesthesiologists I-II, aged 18-65 years), undergoing minor surgery were enrolled. Exclusion criteria were body mass index >35 kg/m 2 , laryngeal or oesophageal varices, risk of aspiration or difficult face mask ventilation either referred or suspected (Langeron's criteria ≥2) and modified Mallampati classification score >2. Participants were randomly allocated to one of the two groups in which PLMA was inserted using DT (DT-group) or SC (SC-group). Statistical Analysis: Chi-square test with Yates' correction, Mann-Whitney U-test or Student's t-test were carried-out as appropriate. Results: The final insertion success rate was greater in SC-groupcompared with DT-group 90.1% (n = 109) versus 74.4% (n = 99) respectively (P = 0.002). Mean airway leak pressure was higher in SC-group compared to DT-group (23.7 ± 3.9 vs. 21.4 ± 3.2 respectively; (P = 0.001). There were no differences in insertion time, post-operative airway morbidity and complications. Conclusion: The findings of this study suggest that SC-technique improves the success rate of PLMA insertion by untrained physicians.
  2 2,925 462
Survival pattern in patients with acute organophosphate poisoning on mechanical ventilation: A retrospective intensive care unit-based study in a tertiary care teaching hospital
Syed M Ahmed, Bikramjit Das, Abu Nadeem, Rajiv K Samal
January-February 2014, 58(1):11-17
DOI:10.4103/0019-5049.126780  PMID:24700893
Background and Aims: Organophosphorus (OP) compound poisoning is one of the most common poisonings in India. The aim of the study was to study the outcomes and predictors of mortality in patients with acute OP poisoning requiring mechanical ventilation. Methods: A retrospective study was conducted in the intensive care unit and 117 patients were included. Diagnosis was performed from the history taken either from the patient or from the patient's relatives. Demographic data, month of the year, mode of poisoning, common age group, duration of mechanical ventilation, time of starting pralidoxime (PAM), and mortality were recorded. Chi square test, Pearson correlation test, and multivariate binary logistic regression analysis was used. Data are presented as mean ± SD. Results: 91.86% (79/86) of cases were suicidal and remaining cases were accidental. Duration of mechanical ventilation varied from less than 48 hours to more than 7 days. Mortality rate was 33.3%, 7.2%, and 100% in those who required mechanical ventilation for more than 7 days, 5 to 7 days, and 2 to 4 days, respectively. Lag time was less than 6 hrs in 13 patients and all of them survived. 17.1% and 28.1% patients died in whom PAM was started 6 to 12 hrs and 13 to 24 hrs after poisoning, respectively. There was statistically significant positive correlation between lag time of starting of PAM with duration of mechanical ventilation and total dose of PAM (P < 0.0001). None of the predictors age, lag time, severity of poisoning, and duration of ventilation were independent predictors of death. Overall mortality rate was 18.6%. Conclusion: Mortality from OP compound poisoning is directly proportionate to the severity of poisoning, delay in starting PAM, and duration of mechanical ventilation. Death is not dependent on a single factor, rather contributory to these factors working simultaneously.
  2 6,527 1,053
LETTERS TO EDITOR
Low dose spinal with epidural volume extension for renal transplantation in a patient with uremic cardiomyopathy
Vinit K Srivastava, Sanjay Agrawal, Praveen K Das, Mukadder Ahmed
January-February 2014, 58(1):93-94
DOI:10.4103/0019-5049.126845  PMID:24700918
  2 2,384 390
CASE REPORTS
Radiographic mislead: apparent arterial placement of subclavian central venous catheter due to mediastinal shift
Shaji Mathew, Kush Goyal, Souvik Chaudhuri, Arun Kumar, Amjad Abdulsamad
January-February 2014, 58(1):69-71
DOI:10.4103/0019-5049.126804  PMID:24700905
Optimal placement of central venous catheters (CVC) is essential for accurate monitoring of central venous pressure (CVP) in major surgeries and ensuring long-term use of the catheter for managing the critically ill patient. Accidental subclavian artery catheterization is one of the most serious complications of the procedure. Radiography is commonly used to ensure optimal placement of CVC tip and rule out subclavian artery catheterization in the absence of Doppler ultrasound and a pressure transducer. We present a case of a haemodynamically unstable and hypoxaemic patient with mediastinal shift, in which the anaesthesiologist was in a dilemma about the arterial placement of the right subclavian CVC. The CVC crossing the midline due to mediastinal shift gave the false impression of it being placed in subclavian artery rather than the vein. Subsequently, it was proved to be correctly placed in the subclavian vein.
  1 3,233 397
CLINICAL INVESTIGATIONS
A comparative study between intrathecal clonidine and neostigmine with intrathecal bupivacaine for lower abdominal surgeries
N Yoganarasimha, TR Raghavendra, S Amitha, K Shridhar, MK Radha
January-February 2014, 58(1):43-47
DOI:10.4103/0019-5049.126794  PMID:24700898
Background and Aims: Spinal anaesthesia requires a small volume of drug to produce profound reproducible sensory analgesia and motor blockade, but has limited duration of action. A properly chosen adjuvant to local anaesthetic agent produces the best way to achieve a better quality regional block. Hence, a study was conducted to compare the effect of intrathecal clonidine 75 μg or neostigmine 50 μg added to intrathecal hyperbaric bupivacaine, with regards to sensory characteristics, motor characteristics, haemodynamic stability and side effects. Methods: This was a prospective randomized experimental study in 50 patients posted for lower abdominal surgery belonging to ASA I and II status and aged between18 and 60 years. One group received intrathecal clonidine 75 μg and 2.5 ml (12.5 mg) of intrathecal 0.5% hyperbaric bupivacaine (group BC) and second group received neostigmine 50 μg with 2.5 ml (12.5mg) of intrathecal 0.5% hyperbaric bupivacaine (group BN) and they were compared with regards to sensory characteristics, motor characteristics, haemodynamic stability and side effects. Results: Addition of 50 μg neostigmine significantly enhanced the onset of sensory block (BN - 90 ± 15 secs, BC-160 ± 20 secs, P value as <0.05) and motor block (BN-110 ± 15 secs, BC-210 ± 20 secs, P value as <0.05) compared to clonidine. Haemodynamics were well maintained in the neostigmine group. Group BC had prolonged analgesia (362 ± 36 mins) compared to BN group (300 ± 25 mins)(P < 0.05) with no serious adverse effects noted perioperatively in either groups. Conclusion: Intrathecal clonidine with hyperbaric bupivacaine produces prolonged postoperative analgesia and intrathecal neostigmine with bupivacaine produces a good sensory and motor for the surgical procedure.
  1 4,079 1,050
COMMENTS ON PUBLISHED ARTICLES
Airway management techniques for one lung ventilation in children - what else!
Rakesh Garg
January-February 2014, 58(1):100-101
DOI:10.4103/0019-5049.126855  PMID:24700923
  1 2,602 450
EDITORIAL
Pre-hospital treatment: The bane of organophosphorous poisoning in rural India
S Bala Bhaskar
January-February 2014, 58(1):5-6
DOI:10.4103/0019-5049.126775  PMID:24700890
  1 3,360 796
LETTERS TO EDITOR
Acute sialadenitis of parotid gland: Anaesthesia mumps
Koramutla Pradeep Kumar, P Kishore Kumar, Gudaru Jagadesh
January-February 2014, 58(1):97-98
DOI:10.4103/0019-5049.126852  PMID:24700921
  1 3,265 425
Laryngeal mask airway supreme TM for difficult airway management and establishing ventilation in the intensive care unit
Mohd Saif Ghaus
January-February 2014, 58(1):91-93
DOI:10.4103/0019-5049.126843  PMID:24700917
  1 2,449 396
Survival after fatal pentobarbital ingestion
Vinodkumar Singh
January-February 2014, 58(1):85-86
DOI:10.4103/0019-5049.126838  PMID:24700912
  1 9,988 356
BRIEF COMMUNICATIONS
Stellate ganglion block: An approach to prevent oesophageal injury
Ashok Jadon
January-February 2014, 58(1):72-73
DOI:10.4103/0019-5049.126805  PMID:24700906
  - 3,215 600
Acute fatty liver of pregnancy complicating a twin pregnancy
Shoba Philip, Sachin George, G Sunil
January-February 2014, 58(1):73-75
DOI:10.4103/0019-5049.126806  PMID:24700907
  - 2,380 506
Intraoperative interfascicular ventricular tachycardia: A rare occurrence
Vimi Rewari, Rashmi Ramachandran, Neeraj Parakh, PM Singh, Sreekumar E Jayanandan
January-February 2014, 58(1):76-78
DOI:10.4103/0019-5049.126807  PMID:24700908
  - 1,780 344
Successful anaesthetic management of a patient with prior history of malignant hyperthermia for corrective scoliosis surgery
Muralidhar Joshi, B Amarnath Reddy, Bhargavi Bollampally, Sachin D Joshi
January-February 2014, 58(1):78-80
DOI:10.4103/0019-5049.126808  PMID:24700909
  - 2,522 445
Sacral spinal anaesthesia
Radhashyam Paria, Smarajit Surroy, Mousumi Majumder, Baishakhi Paria, Anshuman Paria, Goutam Das
January-February 2014, 58(1):80-82
DOI:10.4103/0019-5049.126809  PMID:24700910
  - 7,226 805
CASE REPORTS
Cytoreduction with hyperthermic intraperitoneal chemotherapy: An anaesthetic challenge
Kavita Murughan, Malati Tiwari, Kalpana Balakrishnan
January-February 2014, 58(1):59-62
DOI:10.4103/0019-5049.126799  PMID:24700902
Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy plays a considerable role as a treatment modality in surgical oncology in western countries. The advantage of this procedure is that the heated chemotherapeutic agent is circulated in the abdominal cavity and achieves high peritoneal concentration with limited systemic absorption. This procedure is complex not only to the surgical team, but also to the anaesthetist because apart from managing the usual physiologic changes associated with major surgery, one should also be prepared to manage the physiologic changes during the hyperthermic phase. Here, we present our experience with our first case.
  - 5,843 845
Anaesthesia for autotransplantation after extracorporeal nephron sparing surgery for bilateral giant renal angiomyolipoma
Nisha Rajmohan, S Neeta, HK Das
January-February 2014, 58(1):66-68
DOI:10.4103/0019-5049.126803  PMID:24700904
Extracorporeal 'work bench surgery' with subsequent autotransplantation is a challenge from both anaesthetic and surgical point of view when performed bilaterally or in a solitary kidney. A 28-year-old female with bilateral giant angiomyolipoma of kidneys was taken up for renal autotransplantation. Patient had a huge tumour, which was the largest reported exophytic tumour to be excised by this technique. Both kidneys were operated at an interval of 1 month, under combined general and epidural anaesthesia. Anaesthetic challenges faced during the procedure were maintenance of adequate perfusion of the grafted kidneys, containment of massive blood loss and coagulopathy during the perioperative period. Patient recovered in due course with functioning autotransplanted kidney. A careful pre-operative preparation with intraoperative maintenance of adequate blood volume and blood pressure is the key for graft survival.
  - 2,595 345
COMMENTS ON PUBLISHED ARTICLES
Difficult mask ventilation due to a large oral tumour
Sukesh Kumar, Neeraj Kumar
January-February 2014, 58(1):101-102
DOI:10.4103/0019-5049.126856  PMID:24700924
  - 2,418 394
Organ retrieval and banking in brain dead trauma patients
Viroj Wiwanitkit
January-February 2014, 58(1):102-102
DOI:10.4103/0019-5049.126857  PMID:24700925
  - 2,242 463
GUEST EDITORIAL
Systolic anterior motion of the mitral valve in hypovolemia and hyper-adrenergic states
Mukul Chandra Kapoor
January-February 2014, 58(1):7-8
DOI:10.4103/0019-5049.126777  PMID:24700891
  - 3,498 647
LETTERS TO EDITOR
Unilateral laparotomy under paravertebral block in a desperate situation
Rajesh K Lalla, Chethan M Koteswara, S Ananth
January-February 2014, 58(1):86-87
DOI:10.4103/0019-5049.126839  PMID:24700913
  - 2,008 314
Palatal obturator: Perioperative concerns
Vanita Ahuja, Sunita Kazal, Shradha Sinha
January-February 2014, 58(1):87-89
DOI:10.4103/0019-5049.126840  PMID:24700914
  - 2,464 288
Dexmedetomidine to wean patient of severe kyphoscoliosis with cerebral palsy in intensive care unit
Surbhi D Mundada, Kundan S Gosavi, Chitra Upasani
January-February 2014, 58(1):89-90
DOI:10.4103/0019-5049.126841  PMID:24700915
  - 2,341 309
An unusual site for disconnection in a ventilated patient
Chhavi Sawhney, Arshad Ayub
January-February 2014, 58(1):99-99
DOI:10.4103/0019-5049.126854  PMID:24700922
  - 1,579 325
Myocardial infarction during pregnancy: A rare occurrence
Sadik Mohammed, Rakesh Karnawat, PK Bhatia, Ghansham Biyani
January-February 2014, 58(1):94-96
DOI:10.4103/0019-5049.126846  PMID:24700919
  - 2,575 434
Dexmedetomidine in the management of severe tetanus
Surhan Ozer-Cinar, Canan Tulay Isil, Inci Paksoy
January-February 2014, 58(1):96-97
DOI:10.4103/0019-5049.126847  PMID:24700920
  - 2,366 391
An unusual cause of airway obstruction!
Anila D Malde, Ruchi A Jain
January-February 2014, 58(1):90-91
DOI:10.4103/0019-5049.126842  PMID:24700916
  - 2,241 364
MESSAGES
Pages From Old Issues of IJA 1978

January-February 2014, 58(1):1-2
PMID:24700888
  - 2,290 608
Pages From Old Issues of IJA 1979

January-February 2014, 58(1):3-4
PMID:24700889
  - 2,074 548
PAST PRESIDENTíS MESSAGE
The President's Inaugural Address During ISACON 2013, on 28 th December 2013 at Guwahati
Brig T Prabhakar
January-February 2014, 58(1):10-10
DOI:10.4103/0019-5049.126779  
  - 2,256 258
PRESIDENTS MESSAGE
From the desk of the New President
SSC Chakra Rao
January-February 2014, 58(1):9-9
DOI:10.4103/0019-5049.126778  PMID:24700892
  - 2,690 495