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   2014| October-December  | Volume 3 | Issue 4  
    Online since September 19, 2018

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Pulmonary aspiration of gastric contents: Prevention and prophylaxis
Aloka Samantaray
October-December 2014, 3(4):243-250
Pulmonary aspiration of gastric contents is one of the most fatal complications not only in the scenario of an operating room but also in critically ill patients, who have an increased risk for silently aspirating oropharyngeal secretions and regurgitated gastric contents. Prevention is the key to avoid this feared event. Strict adherence to guidelines regarding fasting in the preoperative period, avoidance of residual muscle paralysis and early return of protective airway reflexes by carefully choosing appropriate anaesthetic agents are corner stones of safe anaesthetic practice. Routine preoperative pharmacoprophylaxis to reduce gastric acidity and volume is not recommended and tolerance to commonly used histamine 2 receptor antagonists may occur and use of proton-pump inhibitors may be necessary. In the critical care arena small-volume clinically silent aspirations of oropharyngeal secretion are more common and head-of-bed elevation has been identified as the single most important factor which can greatly reduce the risk of aspiration and thereby reduce the incidence of ventilator associated pneumonia. Most of the intensivists favours use a continuous enteral feed and checking of correct placement of feeding tube at regular interval to reduce the frequency of pulmonary aspiration of gastric contents. In this review we summarise the pathophysiologic mechanism and predisposing factors to pulmonary aspiration of gastric contents. We will also present evidence for and rationale behind the practices adopted in critical care area and operation theatre setup to prevent aspiration.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  152 39 3
Comparison of dexmedetomidine combined with propofol Vs fentanyl combined with propofol for laryngeal mask insertion
A Sowmya Jayaram, P Janaki Subhadra, M Hanumantha Rao
October-December 2014, 3(4):228-236
Background: Few studies have assessed adequacy of anaesthesia provided by propofol in combination with dexmedetomidine and propofol in combination with fentanyl for laryngeal mask airway (LMA) insertion for minor to moderate elective surgical procedures. Methods: Sixty patients admitted for lower abdominal and lower limb surgery were randomized into Group F (n=30) and Group D (n=30). Thirty seconds after the study drug (fentanyl 1 μg/kg in Group F and dexmedetomidine 1 μg/kg in Group D diluted in 10 mL normal saline over 2 min) was administered, induction was done with i.v. propofol 2 mg/ kg in both groups. Ninety seconds after propofol injection, jaw relaxation was assessed and LMA of appropriate size was inserted. If the first attempt failed, another attempt was tried after an additional dose of i.v. propofol (0.5 mg/kg). Haemodynamic parameters, namely, heart rate, systolic blood pressure (SBP), mean blood pressure (MBP), diastolic blood pressure (DBP), arterial oxygen saturation measured with pulse oximeter and respiratory rate were recorded before and at the end of 1st, 2nd, 3rd, 5th and 10th minutes after insertion of LMA. Results: Both the groups were comparable in age weight, sex, age wise distribution and insertion conditions. The reductions in SBP, DBP, MAP were greater in Group F (p < 0.001). More patients developed apnoea in Group F than in Group D (p < 0.05). Conclusions: Dexmedetomidine combined with propofol provides the same conditions for LMA insertion as fentanylpropofol combinations with advantage of better maintainance of haemodynamic parameters.
[ABSTRACT]   Full text not available  [PDF]
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An outbreak investigation of suspected Chikungunya fever in Nalgonda District, Telangana state
Suguna Dumpala, Nagaraj Kondagunta, Varun Mohan Malhotra, Guru Prasad Venna, Kishore Yadav Jothula
October-December 2014, 3(4):219-223
Background: An outbreak of fever with joint pains occurred at Proddutur village, Nalgonda District, Telangana state, India. Methods: We investigated the out-break; attempted to identify the agent, source, mode of disease transmission, study clinico-epidemiological factors and recommend control measures during the period 11th-15th, February 2014. A rapid fever survey was conducted by using pre-tested, pre-designed epidemiological case sheets. Seventeen serum samples were collected for laboratory analysis. Entomological survey was conducted to identify and study the vectors. Results: The outbreak was observed to be a seasonal disease which started on 12th January, 2014 and continued till 18th February, 2014. Out of the total population of 1365 in the village, 259 cases were identified to have chikungunya fever as per case definition. Overall attack rate was 19%. Maximum cases occurred (24.1%) in the age group of 21-30 years and the least (1.9%) in the age group of less than one year and greater than 70 years (2.8%). Proportion of cases of Chikungunya was higher in females (51.9%) compared with males (48.2%). Fever (100%) and Joint pains (92.6%) were the most common clinical manifestations; 61% had severe disability and needed family help to do daily normal activities. Out of seventeen serum samples sent for laboratory confirmation, 5, 2 and 2 were positive for Chikungunya, dengue and both Chikungunya and dengue together respectively. No mortality was reported. Conclusions: The occurrence of this outbreak stresses the need for carrying out continuous surveillance for vector borne diseases so that appropriate remedial measures are initiated.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  155 26 1
Mixed infection with Plasmodium vivax malaria and scrub typhus
P Venkata Krishna, Shaik Ahmed, C Venkata Ravikumar
October-December 2014, 3(4):265-267
Concurrent occurance of scrub typhus with vivax malaria has seldom been reported in the literature. If the coinfection is missed fatal complications may occur as both malaria even by Plasmodium vivax and scrub typhus are also associated with fatal complications.
[ABSTRACT]   Full text not available  [PDF]
  157 19 -
Disseminated cryptococcosis in a patient with advanced HIV infection
A Krishna Prasad, M.V.S Subbalaxmi, P Umabala, T Roshni Paul, Mallikarjun Shetty
October-December 2014, 3(4):268-273
Antiretroviral therapy in human immunodeficiency virus (HIV) patients has prolonged survival and reduced the frequency of opportunistic infections (OI). However, following starting of antiretroviral therapy (ART), some patients experience a paradoxical worsening of clinical condition termed as immune reconstitution inflammatory syndrome (IRIS) an entity, characterized by an excessive inflammatory response to a preexisting antigen or pathogen. Cryptococcus neoformans is one of the important pathogens that can cause an IRIS, in patients with low CD 4 cell counts in HIV patients. It is important to consider the possibility of cryptococcal infection in patients with advanced HIV infection, look for cryptococcal antigen in serum and cerebrospinal fluid along with blood culture. Blood cultures should be kept for further incubation for slow growing organisms by as demonstrated in the present case. We herewith report a case of IRIS due to cryptococcal meningitis in a patient with HIV1 infection with very low CD4 counts.
[ABSTRACT]   Full text not available  [PDF]
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Comparison of enzyme linked immunosorbant assaay (ELISA) with indirect immunofluorescence for detection of anti-nuclear antibody
G.L.S Sumanth Kumar, Abhijit Chaudhury, Anju Verma, Usha Kalawat, BV Ramana, B Siddhartha Kumar
October-December 2014, 3(4):237-242
Background: Detection of antinuclear antibody (ANA) is used as one of the diagnostic criteria for autoimmune rheumatic diseases (ARD). Both indirect immunofluorescence (IIF) and enzyme linked immunosorbant assay (ELISA) methods are used for this purpose. However, there are lack of data comparing these two tests from India. Methods: We prospectively studed 294 patients clinically suspected to be having ARD between April 2012 and September 2013. They were tested for ANA by IIF and ELISA methods. Representative samples positive by both the tests were processed again by a line immunoassay test to detect the specific antinuclear antibodies. Considering the IIF results as the ‘gold standard’, the utility of ELISA for ANA detection was analyzed. Results: Of the 294 samples processed, 181 (61.5%) were from female patients. By IIF 30% of samples in males and 40.3% sample in females tested positive. We found ELISA to have a poor sensitivity (45.8%) but good specificity (99.5%). The positive predictive value for ELISA were 98% and negative predictive value 76.2% respectively. Forty four samples positive by both IIF and ELISA were tested by Western blot to detect individual autoantibodies. Of these, only 24 samples showed the presence of one or more bands, while the remaining 20 (45.4%) were negative by line immunoassay. In our study anti-nuclear ribonucleoprotein/Smith was the most common ANA detected. Conclusions: The poor sensitivity raises concerns regarding the practice of initial screening for ANA by ELISA.
[ABSTRACT]   Full text not available  [PDF]
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Adult onset Still's disease: 7 years experience at a tertiary care centre from South India
A Krishna Prasad, A Srujana, M.V.S Subbalaxmi, M Shetty, AC Upadhyay, M Nageswar Rao
October-December 2014, 3(4):224-227
Background: Adult onset Still's disease (AOSD) is uncommon condition regarding which sparse published data are available from India. Methods: Retrospective study of 6 patients, who presented with pyrexia of unknown origin (PUO) seen over a 7-year period who were diagnosed to have AOSD after a thorough work-up. Results: Their mean age was 24.6 (range 18-38) years; there were four males. Mean duration of symptoms was 7.8 (range 3-5) weeks. In addition to prolonged fever, patients presented with rash, arthropathy, hepato-splenomegaly and peripheral lymphadenopathy. Laboratory evaluation revealed neutrophilic leukocytosis, hepatopathy, serositis, raised serum ferritin levels; anti-nuclear antibody and rheumatoid factor were negative in all. One patient developed acute respiratory distress syndrome and died. The remaining five patients were treated with non-steroidal anti-inflammatory drugs, oral corticosteroids, and hydroxy chloroquine and responded well to treatment. Conclusions: Increased awareness and a high index of suspicion is required for the diagnosis of AOSD. Though mortality is rare, it may occur due to complications.
[ABSTRACT]   Full text not available  [PDF]
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Potpourri testicular tumour - combination of seminoma, teratoma and yolk sac tumour of testis in a young adult male
Amitabh Jena, Rashmi Patnayak, N Anil Kumar, Amit kumar Chowhan, B Vijaylakshmi Devi, AY Lakshmi
October-December 2014, 3(4):257-260
Testicular germ cell tumours are the most common malignant tumours seen in adult males in the 20-40 years age group. The cure rate of these tumours is quite high even with the presence of metastasis. But many patients present quite late in the course of the disease, often with complications. We present the case of a young male who presented with mixed germ cell tumour consisting of the unusual combination of seminoma, yolk sac tumour and mature teratoma. Though mixed germ cell tumour is a common entity, presence of seminomatous and non- seminomatous components is quite unusual.
[ABSTRACT]   Full text not available  [PDF]
  101 29 -
Haemophagocytic lymphohistiocytosis
B Manohar, Rashmi Patnayak, P Ravi Kumar, B Sasikumar Reddy, Shabbir Ali
October-December 2014, 3(4):261-264
We describe a 15-month-old child who presented with a history of fever for the preeding two days and multiple episodes of seizures of one day duration. Physical examination revealed generalized lymphadenopathy and hepatosplenomegaly. The child developed erythematous maculopapular rash, hypotension and required tracheal intubation and mechanical ventilation. Bone marrow aspiration confirmed the diagnosis of hemophagocytic lymphohistiocytosis (HLH). He was treated with dexamethasone, etoposide and cyclosporine, recovered and is doing well on follow-up. HLH is a rare haematological disorder involving the mononuclear phagocyte system. Since it mimics other disorders, its timely diagnosis remains a challenge. It is an aggressive and potential fatal disease of infancy and childhood, if left untreated. HLH may mimic a number of systemic infections thereby causing difficulty in early diagnosis.
[ABSTRACT]   Full text not available  [PDF]
  111 19 -
Ebola virus disease: An emerging global threat
Alladi Mohan, Aditya Kumar Pemmaraju Venkata
October-December 2014, 3(4):216-218
Full text not available  [PDF] [CITATIONS]
  98 23 1
Serum magnesium levels in patients with hypertension
BV Ravi, S.M.R Usha
October-December 2014, 3(4):282-285
Full text not available  [PDF]
  101 18 -
A physician's training: New challenges
MS Valiathan
October-December 2014, 3(4):278-281
Convocation address delivered on 13th October 2014, at Tirupati on the occasion of the 5th convocation of Sri Venkateswara Institute of Medical Sciences, Tirupati.
[ABSTRACT]   Full text not available  [PDF]
  97 18 -
Hypokalaemic paralysis due to Sjögren's syndrome
G Ramakrishna, P Sandeep, S NageshKumar, N Rukumangadha, AK Chowhan, MM Suchitra, R Ram, B Vengamma, V Siva Kumar
October-December 2014, 3(4):251-256
Acute generalized weakness has a wide differential diagnosis that includes neurologic, metabolic, and infectious aetiologies. Acute hypokalaemic paralysis is a rare but treatable cause of acute weakness. We present a 23-year old lady, with history of sudden difficulty getting up from recumbency. Her initial investigations revealed hypokalemia with non- anion gap metabolic acidosis and alkaline urine. Minor salivary gland biopsy confirmed the diagnosis to be Sjögren's syndrome.
[ABSTRACT]   Full text not available  [PDF]
  94 18 -
Cervical pseudomeningocoele following posterior cervical spine surgery: An uncommon cause of neurologic deterioration
VA Kiran Kumar, B.C.M Prasad, VV Ramesh Chandra, MA Jagdish Kumar, V Jayachandar
October-December 2014, 3(4):274-277
Cervical pseudomeningocele causing late onset neurological deterioration is a rare entity. We report our experience with surgical management of a patient with symptomatic cervical pseudomeningocele. A 49-year-old man who underwent posterior cervical laminectomy for cervical ossified posterior longitudinal ligament had neurological deterioration 7 years after undergoing surgery. On evaluation, magnetic resonance imaging of the cervical spine showed cervical pseudomeningocele extending from C2-C6 level causing cord compression at C2-C7 levels. He underwent C2, C7 laminectomy and excision of pseudomeningocele and closure of the communication with dural tube. The post-operative course was uneventful. We present this rare case specially emphasizing the pathogenesis, clinical features and management issues concerning late onset pseudomeningocele. Awareness of this rare possibility of late onset neurological deterioration from posterior cervical pseudomeningocele and its treatment options can help in early diagnosis and treatment.
[ABSTRACT]   Full text not available  [PDF]
  82 18 -
Novel cardiovascular risk markers in hypothyroidism patients
E Jayanthi, Aparna R Bitla, Alok Sachan, G Shivakrishna, PVLN Srinivasa Rao
October-December 2014, 3(4):286-287
Full text not available  [PDF]
  80 19 -
Journal Scan
V Suresh, AR Bitla
October-December 2014, 3(4):288-290
Full text not available  [PDF]
  26 14 -