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   Table of Contents - Current issue
January-March 2020
Volume 9 | Issue 1
Page Nos. 1-54

Online since Tuesday, June 2, 2020

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The Journal of Clinical and Scientific Research: The leap forwards! Highly accessed article p. 1
B Vengamma, P. V.L.N. Srinivasa Rao
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Comparison of effects of 50 μg clonidine and 5 μg dexmedetomidine on characteristics of levobupivacaine spinal block p. 2
P Aruna, M Hanumantha Rao, Pudhota Santhi Swetha, Bommala Srihari, Chetana Karuturi, Satish Kadiyala
Background: Various adjuvants are being used with local anaesthetics for prolongation of intra- and post-operative analgesia. Methods: We randomly allocated and studied 60 patients, aged between 18 and 60 years into two groups. Group C received 3 mL (15 mg) of 0.5% isobaric levobupivacaine with 0.5 mL (50 μg) clonidine and Group D received 3 mL (15 mg) of 0.5% isobaric levobupivacaine with 0.5 mL (5 μg) dexmedetomidine. Onset and duration of sensory and motor blockade, haemodynamic parameters, and side effects were assessed. Results: Onset of sensory block (seconds) was faster in Group D than in Group C (141.7 ± 84.5 Vs 152.4 ± 77.8; P = 0.48). The mean time (minutes) for regression of sensory block to S1 dermatome was earlier in Group C compared to Group D (372.3 ± 69.3 Vs 395.3 ± 63.8; P = 0.10). The time of onset of motor block was earlier in Group D compared to Group C (3.5 ± 2.1 min Vs 3.3 ± 1.8 P = 0.81). The time required to achieve complete motor block (minutes) was more in Group C compared to Group D (9.7 ± 4.0 Vs 9.1 ± 3.1; P = 0.52). The mean time (minutes) taken for resolution of motor block was longer in Group D compared with Group C (309.5 ± 60.0 Vs 338.2 ± 61.6; P = 0.07). Conclusions: The supplementation of 50 μg clonidine and 5 μg dexmedetomidine to 0.5% isobaric levobupivacaine produced similar characteristics of the spinal block and maintained haemodynamic stability.
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Clinical profile of people living with human immunodeficiency virus p. 7
Vithal Narayan Dhadke, Mahesh Jadhav, Shubhangi Vithal Dhadke
Background: Clinical manifestations in people living with human immunodeficiency virus infection (PLHIV) can be protean. Methods: We studied the clinical profile, neurological, cardiac manifestations and opportunistic infections (OIs) at the time of diagnosis in PLHIV at our medical college tertiary care teaching hospital in Solapur, Maharashtra, India. Results: Majority of patients (36%) were observed in the age group of 31-40 years. The mmost common presenting complaint was fever (65%), followed by anorexia (34%), weight loss (33%), cough (22%) and fatigue (21%). Diarrhoea and headache were seen in 15% and 13% of the patients, respectively. Most of the patients had weight between 31 and 40 kg and 41 and 50 kg (48% in each). On general physical examination pallor (63%), oral thrush (30.4%) were commonly seen. Genital lesions and icterus were seen in 4.3% and 2.1% of the patients, respectively. Majority (31%) of patients had CD4+ counts (/mm3) in the range 151 and 200. Most of the of patients (30%) had respiratory system involvement. Central nervous system (CNS) and gastrointestinal system manifestations were seen in 21% and 15% of the patients, respectively. Among infections tuberculosis (TB) was most common (46%) followed by Candidiasis (18%), Pneumocystis carinii pneumonia (PCP) (9.2%) and cryptococcosis (8.7%). Other infections seen were herpes (5.2%), Cryptosporidium parvum (3.9%), Isospora belli (2.6%), toxoplasmosis (2.6%), cytomegalovirus (CMV) (1.3%), hepatitis B (1.3%) and Epstein–Barr virus (1.3%). Conclusions: TB is a common cause of morbidity in PLHIV. They further merit careful evaluation for assessing involvement of various organ systems, OIs.
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A study of prognostic significance of serum troponin I in patients with acute ischaemic stroke p. 11
Pranuthi Pynam, B Vengamma, SV Naveen Prasad, Sai Neelima Challa, R Rakesh
Background: Serum troponins have also been reported to be elevated in patients with acute cerebrovascular disease and poor clinical outcome. Methods: We prospectively evaluated 360 patients with acute ischaemic stroke (AIS) to study the relationship between serum troponin I (TnI) levels and severity of AIS and to compare serum TnI levels in patients with favourable and unfavourable functional outcomes. Results: Their mean age was 58.8 ± 13.3 years; there were 230 (63.9%) males. Majority (n = 288; 80%) had presented with anterior circulation stroke and 58 (16.1%) had posterior circulation stroke. Majority (52.5%) had large artery atherosclerosis. The median (interquartile range) National Institutes of Health Stroke Scale (NIHSS) score was 18 (16–20). Serum TnI was positive in 87 (24.2%) and negative in 273 (75.8%). The NIHSS score at admission was higher in the positive serum TnI group. Moderate-to-severe stroke, severe stroke and cardioembolic stroke were more frequently seen in the serum TnI-positive group. Outcome was favourable in 157 (47.7%) and unfavourable outcome was seen in 172 (52.3%) patients. Conclusions: Elevated serum TnI levels were associated with increased severity of AIS and poor functional outcome.
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Demographic characteristics, clinical presentation, risk factors and pathological types of lung cancer: A prospective study p. 16
M Soumya, Alladi Mohan, J Harikrishna, KM Bhargav, A Ravisankar, N Rukmangadha, Ranadheer Mantri
Background: Sparse published data are available regarding the epidemiology of lung cancer from Rayalaseema area of Andhra Pradesh State. Methods: Consecutive patients (n = 133) diagnosed to have and treated for lung cancer in medicine and medical oncology departments at our tertiary care teaching hospital in Tirupati, South India from March 2017 to June 2018, were prospectively studied. In all patients, risk factors, clinical manifestations, method of confirmation of diagnosis and histopathological and cytopathological types were documented. Results: Their mean age was 56.4 ± 11.2 years; there were 93 (70%) males. No risk factors were evident in 110 (83%) patients. Tobacco smoking (n = 69, 52%) (all males) was the most frequently evident risk factor; other risk factors included exposure to arsenic, silicone, passive smoking, environmental exposure, old pulmonary tuberculosis. Their mean Fagerstrom score for nicotine dependence was 8.2 ± 1.7. In 17% of patients, lung cancer was incidentally detected; the remaining 83% were symptomatic. Chief presenting complaints were cough (59%), dyspnoea (50%), haemoptysis (11%), amongst others. Cytopathological and histopathological diagnosis was done in 3% and 97%, respectively. Majority (n = 123, 92%) had non-small cell lung cancer (NSCLC) (60% adenocarcinoma and 17% squamous cell carcinoma), while small cell lung cancer was evident in 10 (8%). Most of them (52%) had presented in stage 4. Conclusions: Our observations suggest that tobacco smoking still remains the most common risk factor for lung cancer; majority of the patients had NSCLC, and most patients presented late with stage 4 disease.
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A study of microbiological profile and its antimicrobial susceptibility patterns related to central line-associated bloodstream infections in respiratory intensive care unit in a tertiary care hospital p. 25
S Noble Ujesh, Rangineni Jayaprada, Nukanboina Ramakrishna, Krishna Kanchan Sharma, Mangu Hanumantha Rao, Aloka Samantaray, M Madhusudhan
Background: Complications associated with central venous catheter central line central line-associated bloodstream infections (CLABSIs). Methods: We prospective by studied the microbiological profile and antimicrobial susceptibility patterns of isolated bacteria from CLABSIs in respiratory intensive care unit at our a tertiary care teaching hospital in Tirupati, Andhra Pradesh. Results: Colonisers were isolated from 110 of the 288 samples without any growth in blood cultures from among 288 samples that were submitted with a clinical suspicion of sepsis from patients with eligible central line. Among these, Staphylococcus aureus was the predominant coloniser. Seventy-four were blood culture positive, of which 36 showed other sources of infection. In our study, CLABSI rate was 12.9/1000 catheterised days. Among these culture positives, predominant isolate was S. aureus, followed by Staphylococcus hominis, Acinetobacter, Klebsiella and Escherichia coli. All the S. aureus strains were sensitive to linezolid, tetracycline and vancomycin. Among Gram-negative organisms, Acinetobacter baumannii and E. coli strains were 100% sensitive to polymyxin B and tigecycline. In our study, we have observed carbapenem resistance in E. coli and A. baumannii, which is alarming. Methicillin-resistant S. aureus accounted for 71.4% of S. aureus CLABSIs. All A. baumannii (n = 6), Klebsiella (n = 4) and E. coli (n = 4) isolates were extended spectrum beta-lactamase producers. Conclusions: Strict implementation of insertion and maintenance bundle care of the central lines is mandatory to prevent colonisation.
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Comparative evaluation of 2% lignocaine viscous gargling and intravenous lignocaine for insertion of laryngeal mask airway p. 31
M Hanumantha Rao, J Chaitanya, Peyyety Janaki Subhadra
Background: Few studies have compared the efficacy of 2% lignocaine viscous gargling with intravenous lignocaine given prior to induction with propofol and fentanyl for laryngeal mask airway (LMA) insertion for minor-to-moderate elective surgeries. Methods: Sixty patients were randomized into two groups: Group V (n = 30) and Group I (n = 30). Group V patients gargled with 25 ml 2% lignocaine for 2 min in sitting position. Three minutes after gargling, they were preoxygenated in supine position and fentanyl (1 μg/kg) was administered intravenously. In Group I, patients were preoxygenated and fentanyl (1 μg/kg) and lignocaine (1.5 mg/kg) were simultaneously administered intravenously. Sixty seconds after fentanyl, both the groups received propofol (2 mg/kg) intravenously over 30 s, and 90 s later, LMA insertion was attempted. Conditions of LMA insertion, SpO2and haemodynamic parameters, were recorded before and after the insertion of LMA at the end of the 1st, 2nd and 3rd min. Results: Both the groups were comparable demographically. There was no statistically significant difference in terms of conditions of LMA insertion, haemodynamic parameters and duration of apnea between the groups. However, there was a statistically significant fall in systolic blood pressure, diastolic blood pressure and mean arterial pressure 1, 2 and 3 min after LMA insertion from baseline values within each group. Conclusions: Both intravenous lignocaine and gargling with 2% viscous lignocaine were equally effective and safe adjuvants when administered before induction with propofol and fentanyl for providing adequate conditions for LMA insertion.
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Immune dysregulation in COVID-19 and its therapeutic implications p. 37
T Praveen, D Desai, M Soneja, N Wig
Many countries in the world are affected by severe acute respiratory syndrome (SARS) coronavirus-2 (SARS-CoV-2) disease-2019 (COVID-19) pandemic. Approximately 80% of the cases are mild symptomatic, 15% are severe and approximately 5% are critically ill. The mortality among severe and critically ill patients ranges from 17% to 78%. Elderly and patients with comorbidities have higher chances of progression to severe disease and subsequent mortality. There are no proven antiviral agents available for the management of COVID-19. Besides the viral cytopathic effects, dysregulation in immunity also contributes substantially to the pathogenesis. Treatment with immunomodulatory agents such as interleukin-6 blockers, glucocorticoids and mesenchymal stem cell therapy has been observed to be potentially beneficial. In this review, the immune response in SARS-CoV-2, the mechanism of immune dysregulation as well as potential therapeutic targets for immunomodulatory therapies are discussed.
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A rare case of re-expansion pulmonary oedema after medical thoracoscopy p. 42
Deependra Kumar Rai, Saurabh Karmakar, Somesh Thakur, Ravi Kirti
Re-expansion pulmonary oedema of the lung occurs after rapid removal of air or liquid from the pleural space by either chest drainage or thoracocentesis. Re-expansion pulmonary oedema is a rare but serious complication. A 29-year-old male patient presented to us with left-sided massive pleural effusion. We performed medical thoracoscopy; however, an hour after procedure, he started having cough and increased breathlessness. Chest radiograph showed left-sided homogeneous opacity in the left mid and lower zone consistent with unilateral pulmonary oedema. He was managed conservatively along with bi-level positive airway pressure non-invasive ventilator support. His condition improved gradually and was discharged successfully after 5 days.
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A rare case report of coexistent neurofibromatosis type 1 with sickle cell beta-plus thalassaemia p. 45
Prabhu Kiran Vanka, Raviteja Tejavath, Naval Chandra, D Swaroopa, MV S. Subbalaxmi, Dileep Raja Yedla
A 28-year-old male presented with fever with chills, jaundice, body pains and dyspnoea for 3 days. There was a history of recurrent jaundice in the past. Physical examination revealed massive hepatosplenomegaly, and hence, thought of haemolytic anaemia and haemoglobin electrophoresis was done which is suggestive of sickle cell-beta-thalassaemia. He also has café-au-lait spots, inguinal freckling, neurofibromas and lisch nodules all suggestive of neurofibromatosis type 1 (NF1). He was evaluated for fever and found to have an abnormality on computed tomography chest suggestive of pulmonary tuberculosis (TB). The patient was treated with anti-TB therapy. We report the case because of the rare occurrence of NF1 with sickle cell-beta-thalassaemia, after screening the literature available till now. This case also highlights the fact that haemolytic anaemia patients may have pre-existing jaundice, and hence, antitubercular therapy should be given with caution to prevent hepatotoxicity.
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The 2019 novel coronavirus (COVID-19) outbreak: An update p. 48
Alladi Mohan, Vasili Pradeep
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Nucleic acid amplification testing – A paradigm shift p. 50
Iruvaram Sudhir Chaitanya Kumar, B Suresh Babu, KV Sreedhar Babu
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Journal scan p. 53
V Suresh, AR Bitla
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