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   Table of Contents - Current issue
July-September 2019
Volume 6 | Issue 3
Page Nos. 103-154

Online since Monday, March 16, 2020

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Can we make private Medicare more affordable for masses? Highly accessed article p. 103
Sushil Kumar
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Patterns of culture positivity and antifungal sensitivity in dermatophytosis p. 105
Vedant Ghuse, Shylaja Someshwar, Hemangi Jerajani
Background: Antifungal drug resistance and a lack of clinical response in 20% of cases of dermatophytosis calls for an evaluation of resistant dermatophytes using a standardized simple and reproducible in vitro assay, to allow clinician to select the appropriate antifungal agent based on the susceptibility of the isolate to the antifungal agent. Objective: The objective of this study was to clinically correlate the patterns of antifungal susceptibility of dermatophyte isolates and study resistance patterns and cross-resistance among antifungal agents. Materials and Methods: A study was conducted with 60 patients. At visit 1, the patient was started on empiric treatment with terbinafine 250mg daily for 2 weeks. Skin scraping for potassium hydroxide (KOH) mount and fungal culture and antifungal susceptibility testing was collected. After 2 weeks of therapy, the treatment was either continued or changed to a sensitive antifungal agent depending on the susceptibility testing results. The patient was clinically reevaluated every fortnightly. The patient completed a total of 4 weeks of the susceptible antifungal agent. The outcome of therapy was assessed by means of a skin scraping for KOH mount examination. Results: There were 44 males and 16 females. Maximum belonged to the age-group 30–40 years. Maximum patients had tinea corporis (51.6%) followed by tinea cruris (20%). Conclusion: The study provided information regarding clinico-mycological correlation of terbinafine, which revealed terbinafine to be the most effective antifungal agent clinically as well as mycologically.
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Clinical profile and outcomes of patients presenting with acute coronary syndrome in a tertiary care hospital p. 113
Vijay K. Kadam
Objective: This article aimed to study the clinical profile and outcomes of patients presenting with acute coronary syndrome at a tertiary care hospital and to draw conclusions from the above data with regard to characteristics of Indian patients presenting with acute coronary syndrome. Materials and Methods: This cross-sectional study was carried out in one of the teaching medical college hospitals. All patients presenting to casualty with an acute coronary syndrome were admitted to the Coronary Care Unit. Standard history was taken, data were entered into a pro forma sheet, and relevant investigations were performed. Patients with ST-segment elevation myocardial infarction were thrombolysed, taken up for percutaneous transluminal coronary angioplasty (PTCA), or managed conservatively. Prompt medical treatment was started in all cases. The hospital course of the patients including complications, if any, was documented. Results and Conclusion: A total of 100 patients presenting with the acute coronary syndrome were studied. The majority of the patients were found to be male (77%). Hypertension was the most common risk factor followed by smoking, diabetes mellitus, and dyslipidemia. Of all patients, 63% presented with myocardial infarction. Serious complications occurred in 23% patients. The mean age of all patients was 55.5 ± 12.1 years. The age of presentation of females was on average a decade more than that of males. A small but significant percentage (11%) included premature patients younger than 40 years. Most of the patients presented between 1 and 6h of symptom onset. Of all patients, 33% underwent successful PTCA and were discharged on appropriate medication; moreover, 25% were advised PTCA but did not undergo due to various reasons. These were then managed medically. Of all patients, 15% were advised coronary artery bypass grafting and 24% were put on aggressive medical management. A majority of patients presented with single-vessel coronary artery disease (44%) and 3% died during the index hospitalization.
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Traumatic kidney injury in multiorgan trauma patients: Experience of trauma center p. 118
Leszek Sulkowski, Maciej Matyja
Introduction: Traumatic kidney injury (TKI) remains a challenging element of multiorgan trauma. We present a 9-year experience of a trauma center with surgical management of multiorgan trauma patients with TKI. Materials and Methods: The inclusion criteria for this study were TKI in multiorgan trauma patients receiving surgical management. During 9 years, 10,191 patients were hospitalized to the Department of General Surgery. Forty-nine of these multiorgan trauma patients had associated TKI. Results: The severity of the kidney injury was classified on a five-point Organ Injury Scale proposed by the American Association for the Surgery of Trauma. Injuries to other organs were also evaluated. The surgical approach was either laparotomy or laparotomy with thoracotomy, depending on the severity of trauma. Discussion: Abdominal trauma may involve kidneys, especially when the injury is severe and affecting multiple organs. This may be seen in both the adult and pediatric populations. The treatment depends on the severity of organ injuries, hemodynamic stability of the patient and may be either surgical or conservative. Hemodynamically unstable patients received damage control surgery, whereas the stable ones underwent computed tomography before the decision on optimal treatment modality. The most severe vascular injuries are associated with a high mortality rate. Conclusion: TKIs usually appear in young males and predominantly follow blunt abdominal trauma. TKI is usually an element of complex multiorgan trauma with severe injuries to other organs.
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Postflood morbidity pattern in flood-affected population of Alappuzha district in Kerala p. 123
Shaba C. Thomas, Sneha P. Kotian, Varsha Male, Sivakami A., Nevin S. Thomas, Prasad Waingankar
Background: Kerala had witnessed what is seen as the century’s worst flood in the state in 2018. The torrential rain since June 1 in sporadic places and continuous rain since August first week had created havoc in the state. The spread of infectious disease is likely to occur where such disasters occur. Timely interventions can curtail a second disaster arising out of such circumstances. Materials and Methods: Records of health camps conducted were analyzed to get an idea about the morbidity patterns immediately after floods. Results: Acute respiratory infection accounted for a majority of the cases, both among adults (40.2%) and children (55.6%) followed by generalized weakness and musculoskeletal pain. Conclusion: Most of the illnesses seen were of infectious origin. Health education can play an important role to prevent spread.
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Prospective analysis of arteriovenous fistula in hemodialysis patients p. 127
Anuradha J Patil, Aakanksha Vichare, Avinash Yelikar, Jiten Kulkarni
Introduction: Patients of end-stage renal disease (ESRD) are dependent on lifelong dialysis for which an arteriovenous fistula (AVF) is the preferred vascular access. Aim: The aim of this study was to evaluate the site, results, and postoperative complications of AVF creation. Materials and Methods: A prospective study involving 100 patients of ESRD was conducted from July 1, 2015 to August 30, 2017. Cimino–Brescia radiocephalic fistulae were created just proximal to the wrist joint of the nondominant hand. In patients with prior failed attempts of wrist fistulae creation, a brachiocephalic fistula was constructed. Results: Of 100 patients, 77 male and 23 female (M:F = 3.52:1) were studied. Twenty-three patients were diabetic and 40 were hypertensive. Ninety-three patients underwent surgery for radiocephalic fistula, and brachiocephalic fistulae were constructed in seven patients. The dominant side was used in 5% of patients and the nondominant side in 95%. Technical success was 87% after 6 weeks, and at 6 months, a higher (cubital) fistula was performed for the 13% unsuccessful cases. Conclusion: An AVF in patients with an ESRD requiring long-term vascular access for hemodialysis remains the procedure of choice if performed by experienced hands.
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Is extracorporeal shock wave lithotripsy still the treatment of choice for renal and upper ureteric calculi: Our experience with 274 cases and its comparison with retrograde intrarenal surgery literature p. 131
Aman Agarwal, Piyush Singhania, Ajinkya Patil, Kush Shah
Background: Extracorporeal shock wave lithotripsy (ESWL) is used in the management of renal calculi <2cm in size using shock waves under ultrasound/X-ray guidance. Nowadays, with the advancement of endourology the use of ESWL has become less. Newer techniques such as retrograde intrarenal surgery and percutaneous nephrolithotomy have replaced ESWL for treatment of renal stones. Materials and Methods: A total of 274 patients between age group of 15 months and 78 years from Department of Urology, MGM Medical College were enrolled in the study for 3 years from October 2015 to October 2018. All patients underwent intravenous pyelogram. The inclusion criteria of the study were patients with calculi between 6 and 20mm. The exclusion criteria of the study were patients having untreated urinary tract infection, pregnancy, musculoskeletal deformity, and deranged coagulation profile. Double J stenting was performed prior to the procedure for stones >1cm. A maximum of three sessions of ESWL were given. The procedure was performed under local anesthesia for adults and under general anesthesia for children. Results: There was no effect of age and sex on stone clearance. Overall success rate was 91.97%. Success rate for smaller calculi was more (6–10 mm: 97.7%; 10–15 mm: 90.1%; 15–20 mm: 87.5%) with P value <0.05. Success rate of calculi in lower calyx (83.63%) were less as compared to calculi in upper calyx (96.77%), middle calyx (96.15%), renal pelvis (90%), and upper ureter (88.23%) with P value <0.05. Complications of the procedure included pain (28 patients required no treatment and 3 patients required admission and treatment) and hematuria (15 patients required no treatment and 2 patients required admission and treatment), and 1 patient with perinephric hematoma who was treated conservatively. Conclusion: ESWL is a safe and effective procedure in treatment of renal and upper ureteric calculi. It can still be regarded as treatment of choice for appropriate cases of renal and upper ureteric stones especially in developing countries where cost is still a major factor.
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Human Vaccines in India: Present and Future Perspectives p. 137
Prasanta Kumar Ghosh
Vaccines are formulations that equip the human immune system to fight against a pathogen. All the vaccines approved for use are safe. On vaccination, the body produces enough clonal B and T cells to resist infection. Vaccines are the most cost-effective defense against infectious diseases. In India, there are at least 19 manufactures of vaccines. In addition, there are also a large number of companies that import specific vaccine formulations and sell these in India. These include two multinational companies that have also established repacking facilities. India has a well-established Universal Immunization Program (UIP) that targets vaccination of 30 million pregnant women and 27 million newborns annually. Indian vaccines are available at affordable prices to the private consumers but are supplied free of cost to the Indian beneficiaries through the UIP. Several kinds of vaccines technology are being researched all over the world. India has concentrated on the production and supply of conventional vaccines at cost-effective prices. India is also engaged in some level of research at manufacturing companies as well as at the institutional level. Effective vaccination of pregnant women and children would translate into a generally more healthy and productive society globally. India is poised to contribute in such an endeavor.
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Hemoglobin-D Punjab—rare hemolytic anemia in the elderly: a case report p. 148
Tushar Kanti Biswas, Anupa Pillai
A 62-year-old woman with no comorbidity presented with dyspnea since 2 months and fatigue since 1 month. She was having severe anemia with hepatosplenomegaly and icterus. Anemia due to blood loss was ruled out. With a history of blood transfusions and episodes of jaundice in the past, evaluation of hemolytic anemia was carried out. Her serum iron level was normal. Serum lactate dehydrogenase level was raised, and extracorpuscular causes were absent. Hemoglobin electrophoresis was performed in view of suspected hemoglobinopathy. It showed hemoglobin-D Punjab homozygous type, which is very rare. Its presentation in older age is even rarer to warrant this report.
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Bordetella bronchiseptica infection in an intensive care unit patient p. 152
Sana Islahi, Manodeep Sen, Anupam Das, Akansha Gupta, Shalini Trivedi, Jyotsna Agarwal
Bordetella bronchiseptica is a pleomorphic gram-negative coccobacilli typically causing respiratory tract infections in dogs. Its infection in humans is very uncommon. B. bronchiseptica was cultured from the pus swab taken from an ulcer on the chest at the site of chemo-port in a 15-year-old girl in intensive care unit having postviral encephalopathy with cerebral palsy. It is a unique case because we could not find any prior published case report of B. bronchiseptica associated with wound infection in humans. B. bronchiseptica can be a cause of wound infection in humans. In severely immunocompromised patients, this rare organism can become an opportunistic pathogen to cause severe wound infections and medical microbiologists should keep themselves updated in diagnosing such isolates and clinicians should be mindful of their diverse clinical manifestations and limited treatment options.
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