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Costs incurred by patients with diabetes mellitus in a tertiary care hospital - a cross sectional study
VV Anupamaa, K Nagaraj
October-December 2017, 6(4):203-207
Background: Diabetes mellitus has emerged as a disease with huge economic burden in developing countries. As sparse data are available from South India regarding the costs incurred by patients with diabetes mellitus the present study was conducted. Methods: In this cross-sectional study, a pre-structured questionnaire had been administered to 80 patients with diabetes mellitus admitted to our tertiary care teaching hospital to assess the direct and indirect costs incurred. Results: The median [inter quartile range (IQR)] total direct costs incurred by the study subjects was found to be 8145 (IQR 4600-12150) during hospitalization at the time of the study. The median (IQR) direct costs incurred during two years prior to the study were found to be 19050 (IQR 12020-55400). The median (IQR) indirect costs incurred due to hospitalization during the study period were 0 (0-2025). Conclusions: The present study provides a real-time measurement of the direct and indirect costs incurred by patients with diabetes mellitus. This information could be useful to health administrators to plan providing care for patients with diabetes mellitus.
[ABSTRACT]   Full text not available  [PDF]
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Transfusion-related acute lung injury
V Arun Raja, C Rahul, M Krishna Kumar, V Pradeep, KV Sreedhar Babu, J Harikrishna
January-March 2018, 7(1):24-29
Transfusion-related acute lung injury (TRALI), an important non-infectious risk of blood transfusion is a leading cause of morbidity and mortality. Activation of polymorphonuclear (PMN) leucocytes by the mediators released due to the interaction of donor antibodies against the recipient monocytes is thought to trigger TRALI. Major histocompatibility complex Class II antibodies have been implicated in the direct causation of TRALI by direct activation of PMN leucocytes. TRALI has been reported in patients receiving all blood components that contain plasma. Awareness regarding TRALI among clinicians and a high index of suspicion will facilitate early diagnosis of the condition. TRALI is a clinical diagnosis that is suspected when new acute lung injury (ALI) develops within six hours of a transfusion. Diagnostic work-up should focus on ruling out other risk factors for ALI like sepsis, aspiration, among others. TRALI mitigation strategies are helpful to ensure blood safety and facilitate lessening of other transfusion reactions transfusion associated circulatory overload as well. The treatment for TRALI is symptomatic and supportive and is similar to that administered for ALI.
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A prospective study on the common infectious causes of thrombocytopenia (dengue fever, leptospirosis, scrub typhus and malaria) in a tertiary care teaching hospital
G Nibandhana, Usha Kalawat, KK Sharma, Rashmi Patnayak, DT Katyarmal, Abhijit Chaudhury
January-March 2018, 7(1):2-6
Background: The present study was undertaken to know the contribution of four infectious causes of fever namely dengue, chikungunya, scrub typhus and malaria in patients presenting with fever of more than one week duration with thrombocytopenia in a tertiary care teaching hospital, Tirupati, Andhra Pradesh. Methods: In this prospective study, 1014 samples from different patients who presented with fever and of more than one week duration and thrombocytopenia were collected over a period of six months and were processed for the detection of non-structural 1 (NS1) glycoprotein antigen for dengue, immunoglobulin M (IgM) antibodies for leptospirosis and scrub typhus by ELISA and malaria parasite by quantitative buffy coat (QBC). Results: Among 1014 samples obtained from patients with fever with thrombocytopenia, 111 (10.94%) were due to thrombocytopenia due to infectious causes. Ninety (81.08%) were due to single infection and twenty one (18.92%) due to co-infections. Males were more affected. Peak incidence was in 40-49 years of age with scrub typhus as the predominant infection. Grade-3 thrombocytopenia was more common in all the four infections. Conclusions: Our observations suggest that scrub typhus was the predominant cause of fever with thrombocytopenia, along with dengue, leptospira and malaria. Diagnostic evaluation should include search for these causes in patients presenting with fever with thrombocytopenia. This can be helpful as both are easily treatable infections with commonly available oral antibiotics.
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The Journal of Clinical and Scientific Research: The leap forwards!
TS Ravi Kumar, P. V L. N Srinivasa Rao
January-March 2018, 7(1):1-1
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Mycobacterium tuberculosis: A perpetual health care challenge
S Ramakumar
October-December 2017, 6(4):201-202
Full text not available  [PDF]
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Drug-drug interactions: experience at a tertiary care hospital
S Radhika, M.V.S Subbalaxmi, P Usharani
October-December 2017, 6(4):208-215
Background: Drug-drug interaction (DDI) is one important factor that influences relationship between prescribed dose and drug-effects by interfering with either pharmacokinetics or pharmacodynamics of the co-administered drug. DDIs can cause toxicity or inhibit the drug effect, both of which have deleterious effect on patient care. This study was done to report the impact of prevention of DDIs. Methods: In this retrospective study, demographic details, relevant clinical information of the cases with suspected DDIs and the opinion given regarding suspected DDIs, with anticipated outcomes and further management were recorded and analyzed. Results: Of the 124 cases, 21 (16.9%) cases had suspected DDIs, among them 5 (23.8%) were pharmacodynamic and 13 (61.9%) were pharmacokinetic. Of the 21 DDIs, in 38.1% interactions, concomitant administration of interacting drugs was to be avoided and in 33.3% interactions, monitoring of effect was necessary to guide dosage adjustment. In ten (47.6%) cases, the DDIs were identified on day one and necessary action was taken to prevent the deleterious outcome and in rest of the 11 (52.4%) cases, adverse events have occurred due to DDIs, for which most of the patients were hospitalized. Conclusion: The present demonstrated that early identification of DDIs on day one, could prevent undesired consequences in 10 cases (47.6%). As DDIs is an important factor that can be prevented, if identified early, clinicians should be vigilant regarding DDIs when more than two drugs are prescribed.
[ABSTRACT]   Full text not available  [PDF]
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Incidence of infections in hospitalized subjects with diabetes mellitus
Naval Chandra, K Premkumar, M.V.S Subbalaxmi, P Umabala, Y.S.N Raju
October-December 2017, 6(4):216-224
Background: The risk of infection is higher in patients with diabetes mellitus (DM) compared to those without DM and significantly affects morbidity and mortality when these patients are admitted to a hospital. Hence, this study was undertaken to determine the type of infections, presentation of illness and to correlate with the severity of diabetes. Method: We studied 115 patients with DM (60 males) admitted in acute medical ward of our Institute with subacute, acute and chronic illnesses in all of them. Blood glucose and glycosylated haemoglobin were (HbA1c) determined by the standard methods. The type of organisms isolated from blood/urine/ pus /sputum and drug sensitivity pattern was determined. Results: Coronary artery disease (CAD) was seen in 22.6%, retinopathy in 2.6% and nephropathy in 9.6% of cases. Eighty six of the 115 patients (75%) had infections. Of these, acute, subacute and chronic presentation were seen in 67, 12 and 7 patients respectively; 76 had community acquired infections and nosocomial infection were seen in 10 cases. Pulmonary infections were most common (29.1%) followed by urinary tract infection (26.7%). Of the 86 patients with infection 9 had HbA1c < 7%, 56 had HbA1c of 7%-10%, and 21 patients had HbA1c of >10%. The mean HbA1c in patients with sepsis/multiorgan dysfunction syndrome (MoDS) was 11.3 ±2.8% as against 8.4% ± in the non sepsis group. Conclusion: We observed that infections were a common cause of hospital admissions in patients with uncontrolled DM.
[ABSTRACT]   Full text not available  [PDF]
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Evans' syndrome- haemolytic anaemia with thrombocytopenia - a rare autoimmune disorder
Majed Momin, Anamika Aluri, Santhosh Reddy, Nanda Kishore Pasupala
October-December 2017, 6(4):237-240
Evans syndrome is an uncommon condition defined as the combination (either simultaneously or sequentially) of immune thrombocytopenia (ITP) and autoimmune haemolytic anaemia (AIHA) with a positive direct antiglobulin test (DAT) in the absence of known underlying aetiology. It poses great diagnostic dilemma due to its variable presentation. We present a case of a 56-year-old female who had similar difficulty as it was not diagnosed initially when she presented with anaemia and thrombocytopenia and was treated by packed cell transfusion and platelet concentrate transfusion respectively. However, the patient showed repeated thrombocytopenia and low a haemoglobin and referred to us and diagnostic work-up confirmed Evans's; syndrome. This case stresses on the diagnostic importance of peripheral blood picture, reticulocyte count and direct antiglobulin test in every patient presenting with anaemia and / or thrombocytopenia to rule out haemolytic anaemia and thrombocytopenia of autoimmune etiology and thus help in arriving at right diagnosis.
[ABSTRACT]   Full text not available  [PDF]
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Stroke in patients with and without diabetes mellitus
Avin Subhash, Chinta Raj Kumar, Neelam Kumari Singh, Suresh Krishnamurthy, MV Nagabushana, YJ Visweswara Reddy
January-March 2018, 7(1):7-11
Background: Diabetes mellitus (DM) is a well-recognized risk factor for stroke. Stroke in diabetic patients is different from stroke in non-diabetics from several perspectives. This study was carried out with the aim to identify and compare distinctive patterns between diabetic and non-diabetic stroke cases. Methods: It is a hospital based cross-sectional study, carried out at PESIMSR Hospital, Kuppam, Andhra Pradesh, in which 80 consecutive patients with stroke (40 patients with and 40 without DM) were studied. Clinical features, risk factors, stroke patterns and outcome were studied. Results: The mean age (years) in stroke patients 57.5 ± 12.7 and 61.3 ± 12.9 (p=NS) stroke in patients with and without DM respectively. Males outnumbered females in both the groups (p=NS). Stroke patients with DM known to have hypertension were 75% and that of non-DM group was 42.5%. Diabetic stroke patients with history of coronary artery disease formed 32.5% and that of non-diabetic group was 27.5%. The mean high density lipoprotein (HDL) cholesterol (mg/dL) was lower in the diabetic group (38.8 ± 12.6) compared to that in the non-diabetic group (50.1 ± 6.9). The mean triglycerides (TG) (mg/dL) was significantly higher in the diabetic (216.9 ± 67.6) than in the non- diabetic group (150.05 ± 60.58). Both diabetic and non-diabetic patients had greater incidence of ischemic stroke (about 75%) than hemorrhagic stroke. In the present study, 37.5% of stroke patients with diabetes had a poor outcome compared to 22.5% of stroke patients without diabetes. Conclusions: DM is an independent risk factor for stroke. Stroke in patients with DM differs from that of stroke in persons without DM with respect to age, gender, stroke severity, prevalence of risk factors and outcome. Hypertension, HDL level and TG were significantly associated with DM. Diabetics stroke patients were having significantly higher levels of mean TG level, lower mean HDL level.
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A prospective randomised study on comparison of weekly versus 3 weekly cisplatin chemotherapy as an adjunct to radiotherapy in treatment of carcinoma of the uterine cervix
VL Anusha Konakalla, Pranabandhu Das, Jilla Swapna, Amitabh Jena, K Radhika, B Sreenivasa Rao, Jayasree Kuna, KV Jagannathrao Naidu, BV Subramanian
January-March 2018, 7(1):12-18
Background: The present study attempted to compare concurrent weekly and three weekly cisplatin with radiotherapy in locally advanced cervical cancer. Methods: This prospective randomised study was conducted in 40 patients with locally advanced cervical cancer randomised into 2 arms. Arm A patients received external beam Radiotherapy (EBRT) to pelvis with concurrent weekly cisplatin at dose of 40 mg/m2 and arm B patients received EBRT to pelvis with concurrent cisplatin at dose of 75 mg/m2 three weekly followed by brachytherapy. Acute haematological, gastrointestinal (GI) and genitourinary toxicities and response rates were assessed. Results: All the patient and disease characters were comparable in both arms. There was no significant difference in both arms in terms of upper GI toxicity (75% Vs 80%; P = 0.208), haematological (25% Vs 10%; P = 0.195) and nephrotoxicity (10% Vs 25%; P = 0.212). Compliance to chemoradiation was better in three weekly cisplatin arm but not statistically significant. After a median follow up of 12 months, tumor response rates in both arms were almost similar (85% Vs 90%; P = 0.128). Conclusions: Our observations suggest that either concurrent weekly or three weekly cisplatin chemoradiation is equally effective in treatment of cervical cancer. However randomised trials with larger sample sizes and longer duration of follow up are required.
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Common fungal isolates from routine clinical specimens: a two years’ studyfrom a tertiary care hospital in South India
R Jayaprada, M Nagaraja, G.L.S Sumanth Kumar, B Venkataramana, Usha Kalawat
January-March 2017, 6(1):2-9
Background: Fungal infections are gaining prominence in recent years and are becoming a cause of significant morbidity as well as mortality. Reliable data from India about the spectrum of pathogens causing fungal infection in various body systems, and particularly about the antifungal susceptibility pattern of Candida spp., which is the most common isolate worldwide is not available. Methods: We prospectively studied 48,155 clinical samples submitted for fungal work-up to the microbiology laboratory at our tertiary care teaching hospital. Standard procedures were followed for fungal identification. Candida isolates were differentiated into Candida albicans and non-albicans candida (NAC) by germ tube test. Antifungal susceptibility of Candida isolates was determined by disc diffusion technique using amphotericin B (10 μg), fluconazole (25 μg), and voriconazole (1 μg) discs. Results: A total of 555 fungal isolates were obtained of which 541 were Candida spp, while the others were filamentous fungi. Male gender and age over 50 years were found to be independent risk factors. Proportion of NAC isolates (n =384, 69.2%) were greater compared to C. albicans (n = 157, 28.3%). Aspergillus spp. was the second most frequent isolate. Azole resistance was significantly more in NAC group as compared to C. albicans. For fluconazole, 57.5% of the NAC showed resistance compared to 24.8% seen in strains of C. albicans while the corresponding figure for voriconazole was 56.8% Vs 22.9%. Overall resistance for amphotericin B was low (8.9%). Conclusions: Our observations bring to light the spectrum of common fungal isolates and their susceptibility patterns. This information will be useful for health planners and policy makers, as early institution of appropriate antifungal treatment can be life saving.
[ABSTRACT]   Full text not available  [PDF]
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Pre-analytical phase in clinical chemistry laboratory
Sohini Sengupta Neogi, Mohit Mehndiratta, Stuti Gupta, Dinesh Puri
July-September 2016, 5(3):171-178
The laboratory testing process is divided into the pre-analytical, analytical and post-analytical phases. For obtaining reliable test results, the prevention and detection of errors at all steps is required. While analytical standards have been developed by recognized quality control criteria, there is a scarcity in the development of standards for the pre- analytical phase. This phase is most prone to errors as the steps involved are directly dependent on humans and are out of direct control of the laboratory. Such errors in preanalytical stage often only become apparent in the analytical or post-analytical phase. The development of a pre-analytical quality manual is essential in achieving total quality control. Correct practices and strategies of error prevention can reduce preanalytical errors. This review focuses on prevention of pre-analytical errors that occur while collecting a specimen of blood, urine and cerebrospinal fluid. Most of these can be easily prevented with understanding and education of the personnel involved in and responsible for executing this crucial pre-analytical phase.
[ABSTRACT]   Full text not available  [PDF]
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Clinico-epidemiological study of melasma in men
Keerthi Charupalli, TS Rajasekhar, Madhusudan Mukkara
January-March 2018, 7(1):19-23
Background: Melasma is one of the most common and distressing pigmentary disorders presenting to dermatology clinics. There is paucity of data regarding the aetiological factors and clinical presentation of melasma in men. The present study was taken up to fill this lacuna and to understand the unique aspects of melasma in this group. Methods: Study was conducted in the Department of Dermatology at University teaching hospital from January 2015 to July 2016. A total of 72 male patients with melasma were studied. A detailed history including occupation, onset, duration and evolution of melasma, predisposing factors like sun exposure and genetic factors, were taken followed by general physical examination, cutaneous examination and Woods lamp examination and recorded in a proforma. Laboratory investigations like complete haemogram, hormonal profile, liver function tests were done whenever necessary depending on the presenting condition. Results: The mean age of onset was 31.5 years. The duration of melasma varied from 3 months to 6.5 years. The aetiological factors identified were, sun exposure in 42 patients (58.3%) and family history in 29 (40.3%). Laboratory investigations revealed hepatic disorders in 5 patients(6.9%), increased luteinizing hormone (LH) and low testosterone in 2 (2.8%) and hypothyroidism in 4 patients (5.6%). According to clinical patterns, malar pattern was seen in 65.3% of patients, centro-facial in 31.9% and mandibular in 2.8% of patients. The most common skin type found to be type IV. Conclusion: Melasma was evident in men in their fourth decade of life; malar pattern, type IV skin type were most commonly seen.
  48 14 -
An unusual case of sphenoid wing meningioma and adenocarcinoma of the caecum
Sachin Ranganatha Goudihalli, Ashis Pathak, Rahat Brar, Rajeev kapoor, Meenakshi Malhotra
October-December 2017, 6(4):249-252
Background: Sphenoid wing meningiomas are common in females and association with colon cancer in females is known. An unusual case of meningioma with co-existant caecal cancer is being reported in a male patient. Case description: A 76-year-old male patient diagnosed with left lateral sphenoid wing meningioma underwent total excision of the tumour. Post-operatively he developed intestinal obstruction due to perforation of colonic growth. Histopathology confirmed the lesion as adenocarcinoma. The patient succumbed to septic shock. Conclusion: The uniqueness of male presentation and a perforated colonic cancer manifesting post-operatively has not been reported in the past. The possibility of syndromic presentation should always be kept in mind.
[ABSTRACT]   Full text not available  [PDF]
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Fever of unknown origin (FUO): Evolution of case definition, changing aetiological spectrum
D Prabath Kumar, D Arun Kumar, K Rajeshwari, D Neeharika, G Sindhu, B Sreevidya
January-March 2016, 5(1):33-39
Prolonged fever is a common problem faced by clinicians in everyday practise. Since the first description of the entity “fever of unexplained origin” by Petersdorf and Beeson in 1961, the case definition of this entity was further refined with modifications over the last 55 years. Durack and Street proposed noteworthy changes in the definition of “fever of unknown origin (FUO)”. First, they divided FUO into four groups, namely, classic, nosocomial, human immunodeficiency virus (HIV) related and neutropenic FUO. They also proposed a change in the time frame from “one week hospital study” to “three outpatient visits or three days of in-hospital investigations”. The more recent definition modified the temperature recording of above 38.3 °C (101 °F) on “several occasions” to “at least two occasions” and has listed the minimum essential laboratory testing required for diagnosis. The last five decades have also witnessed a change in the aetiological spectrum of FUO. Infectious diseases like tuberculosis are still common causes of FUO in India; an increase in non-infectious causes of FUO are increasingly being documented in studies form the west. Inspite of great advances in imaging and laboratory diagnostic methods a significant number of patients with FUO remained undiagnosed. Studies from other parts of the world have shown 9%-78% cases of FUO to remain undiagnosed while studies from India have shown this figure to be 0%-27.4%. Generating reliable epidemiological data regarding the aetiological spectrum of FUO will facilitate development of optimal work-up strategy to establish the aetiological diagnosis and facilitate the specific tests.
[ABSTRACT]   Full text not available  [PDF]
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Acute tension gastrothorax in an adult
K Gowrinath, M Gayatri, G Varaprasada Rao
October-December 2017, 6(4):241-244
Tension gastrothorax is a rare life threatening condition and may occur as an unusual complication of Bochdalek's hernia (BH) in an adult. We report the rare occurrence of acute tension gastrothorax in a 21-year-old male with BH. The tension gastrothorax was due to acute organo-axial volvulus and the diagnosis was established by the computed tomography (CT) of chest. The risk of misdiagnosis is high when air and fluid in the dilated stomach simulates hydropneumothorax clinically and is interpreted through postero-anterior chest radiograph alone. In our case, percutaneous fine needle aspiration of fluid within the dilated stomach facilitated nasogastric tube insertion decompressing the stomach and allowed surgery to be done electively.
[ABSTRACT]   Full text not available  [PDF]
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A child with chronic glomerulonephritis with Beau's lines
G Sindhu, A Sunnesh, N Sai Sameera, V Sarat Chandra, N Praveen, B Sangeetha Lakshmi, Ram , V Siva Kumar
October-December 2017, 6(4):253-253
Full text not available  [PDF]
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Unprecedented behaviour of chronic myeloid leukaemia
Balambika Radhakrishna Gopinath, Venkata Sampath Vanakamamidi, Sudheer Reddy Kataru, Ananth Pai, Dayakar Reddy, Manickavasagam Meenaksisundaram, Vijayalakshmi Devi Bodagala, Rashmi Patnayak, Asha Thota
July-September 2016, 5(3):179-183
We report the occurrence of leukaemic infiltration of cervical spinal cord secondary to chronic_myeloid leukaemia (CML) in a 31-year-old male patient. He presented with left upper limb monoplegia. On examination he had asymmetric quadriparesis, graded sensory loss and urinary retention. Diagnosis was suggested by magnetic resonance imaging. He responded dramatically to radiotherapy and corticosteroids treatment. Infiltration of the cervical spinal cord in a patient with CML has seldom been reported in literature till date, and hence we are reporting this case.
[ABSTRACT]   Full text not available  [PDF]
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HIV seropositivity and its ethical implications for blood donors in a tertiary care hospital of Andhra Pradesh
IS Chaitanya Kumar, KV Sreedhar Babu, A Yashovardhan, DS Jothi Bai
January-March 2012, 1(1):8-14
Background: Blood is a scarce, but lifesaving resource; it is also the most efficient vehicle for the transmission of human immunodeficiency virus (HIV). Hence there is a need for accurate screening of HIV among blood donors. The present study was designed to assess the seroprevalence of HIV, among the blood donors in a tertiary care hospital, Andhra Pradesh. Methods: Prospective study over a period of one year. A total of 5,329 donor blood samples were screened for HIV status using enzyme linked immunosorbent assay. The reactive samples have been tested again twice using different kits. The samples reactive all three times were considered positive. The samples which were positive only in first test were labelled as false positive. Results: Out of 5,329 blood donors screened, 27 (0.5%) were initially reactive and 15 (0.28%) were reactive after triple testing. Conclusions: Our study showed similar HIV seroprevalence as that reported by National acquired immunodeficiency syndrome control organization statistics. But there was a mild increase in HIV prevalence among rural donors in our region compared to the urban donors.
[ABSTRACT]   Full text not available  [PDF]
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A rare case of autoimmune hypoglycaemia
Srinivasa P Munigoti, CV Harinarayan
October-December 2017, 6(4):245-248
We report the rare case of a female who presented with episodes of spontaneous hypoglycaemia. Although she had high baseline insulin and C-peptide levels during the time she was symptomatic, she tested negative on hypoglycaemia provocation test with ‘72 hour extended fast’. Patient was later found to have very high titres of insulin antibodies suggestive of insulin antibody syndrome (IAS). She developed this autoimmune antibody response with no known triggering factor. Her symptoms subsided completely after a short course of oral corticosteroid treatment.
[ABSTRACT]   Full text not available  [PDF]
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Vitamin D deficiency in India: Fortify or let the sun shine in?
PM Srinivasa, CV Harinarayan
July-September 2015, 4(3):220-226
Vitamin D plays a pivotal role in calcium and mineral metabolism. It is astonishing to find vitamin D deficiency in India despite plentiful sunlight. This could probably because of urbanization, life style and dress code changes, and revision of vitamin D adequacy range. Recent studies in south India using in vitro ampoule model with 7- dehydrocholesterol have shown adequate formation of active form of vitamin D in mid-day sun. In India 70% of populations reside in rural areas. Only 35% of Indian populations have access to regulated milk supply. We as humans can get vitamin D from abundant sunshine, by exposing 18% of body surface area (without sunscreen) to mid-day sun for 30-45 min to cause 1 minimal erythemal dose (MED) which is equivalent to taking about 600 to 1000 IU of vitamin D. This is about the recommended daily dose by expert group on human nutrient requirements and the dose used in studies with fortified milk supplementation studies. Vitamin D synthesized in the skin lasts two-times longer in the body. In populations where there is limited exposure to sunlight, like dress-code limiting sun-exposure, usage of sunscreen with (SPF) greater than 8 etc., vitamin D supplementation may also be required. Since there is widespread calcium deficiency in Indian population, calcium supplementation should be an integral part of vitamin D supplementation therapy.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
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Disseminated strongyloidiasis with acute kidney injury
AVSSN Sridhar, N Harini Devi, T Usha Kalawat, P Sri Ram Naveen, Ch Krishna Kishore, V Siva Kumar
July-September 2017, 6(3):190-192
Strongyloides stercoralis, an intestinal parasitic nematode, infects more than 100 million people worldwide. Strongyloides are unique in their ability to exist as a free-living and autoinfective cycle. Strongyloidiasis infection usually remains asymptomatic, but in immunocompromised hosts hyperinfection and dissemination can occur, which has a high mortality. We report a 30-year-old male patient with membranous nephropathy who was receiving oral corticosteroids and cyclophosphamide who presented with disseminated strongyloidiasis. Larvae of S. stercoralis were isolated from the stool and the sputum specimens. Seven days later despite anti-helminthic therapy and intensive care support the patient died. Early detection and diagnosis of this condition is based on a high index of clinical suspicion, especially in immunocompromised hosts. Screening for Strongyloidiasis infection before the initiation of immunosuppressive therapy can be considered.
[ABSTRACT]   Full text not available  [PDF]
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Adenosine deaminase activity in type 2 diabetes mellitus
S Aruna, MM Suchitra, V Suresh
October-December 2017, 6(4):254-256
Full text not available  [PDF]
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Central nervous system infections in the intensive care unit
B Vengamma, M Rajguru, B.C.M Prasad, VV Ramesh Chandra
April-June 2014, 3(2):106-113
Neurological infections constitute an uncommon, but important aetiological cause requiring admission to an intensive care unit (ICU). In addition, health-care associated neurological infections may develop in critically ill patients admitted to an ICU for other indications. Central nervous system infections can develop as complications in ICU patients including post-operative neurosurgical patients. While bacterial infections are the most common cause, mycobacterial and fungal infections are also frequently encountered. Delay in institution of specific treatment is considered to be the single most important poor prognostic factor. Empirical antibiotic therapy must be initiated while awaiting specific culture and sensitivity results. Choice of empirical antimicrobial therapy should take into consideration the most likely pathogens involved, locally prevalent drug-resistance patterns, underlying predisposing, co-morbid conditions, and other factors, such as age, immune status. Further, the antibiotic should adequately penetrate the blood-brain and blood- cerebrospinal fluid barriers. The presence of a focal collection of pus warrants immediate surgical drainage. Following strict aseptic precautions during surgery, hand-hygiene and care of catheters, devices constitute important preventive measures. A high index of clinical suspicion and aggressive efforts at identification of aetiological cause and early institution of specific treatment in patients with neurological infections can be life saving.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
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Plummer–Vinson syndrome
P Gopalakrishna, M Rajendra Prasad, PT Joyes, MS Sridhar
January-March 2018, 7(1):30-32
The clinical findings of a 36-year-old female who presented to Medicine out-patient service with the triad of dysphagia, iron deficiency anaemia, splenomegaly and oesophageal web are reported. Clinical pathology of anaemia is diagnostic of iron deficiency anaemia. Dysphagia was treated with endoscopic dilation of the web and was prescribed iron therapy. This relatively rare condition is reported as the physician should be alert to its possibility because of its association with increased risk of hypopharyngeal carcinoma.
  33 12 -