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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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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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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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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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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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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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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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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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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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Onychomycosis caused by Fusarium dimerum
Reena Ray, Mallika Ghosh, Mitali Chatterjee, Nibedita Chatterjee, Manas Banerjee
January-March 2016, 5(1):44-48
Fusraium is a non-dermatophytic hyaline mould found as soil saprophytes and plant pathogens. Human infections are probably a result of various precipitating predisposing factors of impaired immune status. Immunocompetent individuals of older age group are also vulnerable to various unassuming saprophytic and plant pathogen. We report 5 cases with onychomycosis caused by a rare species of Fusarium, namely, Fusarium dimerum. Fusarium is known to cause a variety of infections like keratitis, eumycetoma, onychomycosis, skin lesions and sometimes disseminated infection in individuals with impaired immunity. Hence it is of utmost importance to identify this newly emerging fungal pathogen correctly and institute appropriate treatment to control human infections at the earliest so that disseminated infections can be avoided.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
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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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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]
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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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Burden of transfusion transmissible viral infections among blood donors at a tertiary care referral teaching hospital in South India
B Suresh, KV Sreedhar Babu, B Venkataramana, P Chandra Mouli
July-September 2016, 5(3):160-163
Background: Blood serves as a vehicle for transmission of blood-borne pathogens including human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV). The present study was conducted to estimate the prevalence of these transfusion transmitted infections (TTIs) in blood donors. Methods: All blood donors presenting to the blood bank at our tertiary care teaching hospital were screened for HIV, HBV and HCV by using enzyme-linked immunosorbent assay (ELISA) method. Results: During the period January to December 2014, 9958 blood donors were screened for viral markers. The prevalence of HIV, HBsAg and HCV was 0.36%, 1.67%, and 0.56% respectively. Conclusions: Although multiple critical steps are taken to minimize the risk of infection from transfusion of blood or blood products, this risk can never be entirely eliminated. Stringent donor selection, proper counseling and deferral/ self exclusion may reduce the seroreactivity in donated blood and wastage of resources.
[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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Malignant acrospiroma of chest wall
M Ravikrishna, Pranabandhu Das, N Rukmangadha, Amitabh Jena, BV Subramanian
July-September 2017, 6(3):187-189
Malignant acrospiroma occurs very rarely and is found more commonly over face and extremities. We present the case of malignant acrospiroma of chest wall located behind the posterior axillary fold in subcutaneous plane without any axillary lymphadenopathy. Wide local excision of the mass was done which recurred in axillary lymph node after two months of default by the patient for adjuvant treatment. Patient had undergone right axillary lymph node dissection.The patient had then undergone adjuvant radiotherapy to the chest wall and right axillary region and is now completely free of disease two years after treatment.
[ABSTRACT]   Full text not available  [PDF]
  22 6 -
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]
  22 6 -
Situs inversus totalis with azoospermia in a patient presenting with liver abscess
P Mohan Rao, A Sridhar, IV Renuka, M Venugopal, C Aparna
April-June 2014, 3(2):138-140
Situs inversus with dextrocardia is a rare congenital anomaly. Azoospermia and situs inversus may be encountered in ciliary dyskinesia syndromes. We report the case of a 30-year-old male who manifested situs inversus totalis, dextrocardia and azoospermia with maturation arrest at primary spermatogenesis who presented with liver abscess. The patient responded well to treatment with i.v. metronidazole and oral chloroquine.
[ABSTRACT]   Full text not available  [PDF]
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Comparative study of induction of labour with Foley's catheter inflated to 30 mL versus 60 mL
I Indira, G Latha, V Lakshmi Narayanamma
July-September 2016, 5(3):153-159
Background: The ripeness of the cervix is an important determinant of the success of induction of labour. One of the mechanical methods of cervical ripening is the use of a transcervical Foley catheter. In this study we compared the efficacy in induction of labour of two insufflation volumes of Foley catheter bulb 30 mL and 60mL. Methods: This was a randomized, single-blind study conducted in 100 women, randomly allocated to the 30 mL group (n=50) and 60 mL group (n=50). Foley's catheter was removed after 12 hours if it was not spontaneously expelled. If the Bishop score was more than 6, oxytocin infusion was started. Labour was monitored and outcomes noted. Results: Both groups had similar demographic profile, gestational age and indication for induction of labour. The primary outcome i.e., induction delivery interval was not statistically different in the two groups. The secondary outcomes i.e., Foley's catheter expulsion time, change in Bishop score, need for and dose of oxytocin, mode of delivery and neonatal outcome also did not show any statistically significant difference between the two groups. Conclusions: Both 30 mL and 60 mL foley's catheter bulb insufflation volumes were comparable in inducing labour.
[ABSTRACT]   Full text not available  [PDF]
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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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A rare case of anti-termite solution poisoning presenting as methaemoglobinaemia
S Venkatesh, V Satyanarayana, A Krishna Simha Reddy, M Madhusudan
July-September 2017, 6(3):179-181
Methaemoglobinaemia should be considered in all patients who are cyanotic and not responding to oxygen therapy. We report the case of a 25-year-old male who presented to the emergency room with alleged history of suicidal poisoning with 20 tablets of alprazolam (0.5mg) and anti-termite solution. At presentation he was drowsy, dyspnoeic and cyanosed. He was immediately intubated and intiated on mechanical ventilatory support. Oxygen saturation by pulse oximetry remained at 82% and did not improve even with a fraction of inspired oxygen of 1.0. Arterial blood was chocolate brown in colour. Arterial blood gas analysis revealed presence of significant saturation gap. Co-oxymetric analysis was done which revealed increased methaemoglobin levels following which methylene blue (100 mg) was given intravenously (IV) and symptoms improved. Patient was extubated the following day and was discharged in a haemodynamically stable state. Early diagnosis and antidotal treatment are pivotal in methaemoglobinaemia.
[ABSTRACT]   Full text not available  [PDF]
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Plasmodium knowlesi: The fifth malaria parasite
Abhijit Chaudhury, B Venkataramana
July-September 2017, 6(3):171-178
In 2004, a large focus of human malaria infection in Malaysian Borneo alerted the world community about the emergence of Plasmodium knowlesi as a new threat to public health. It is a zoonotic disease transmitted primarily between nonhuman primate hosts by the Anopheles mosquitoes. At present it has become endemic in most of the South East Asian countries and human cases are being reported on a regular basis. The importance of this species lies in the fact that similar to P.falciparum, it can cause high parasitaemia and severe malaria which may require hospitalization. This review deals with the history, epidemiology, pathogenesis, clinical aspects, diagnosis, and treatment of P.knowlesi malaria, and the potential threat of this parasite for India.
[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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