Pattern of changes in liver enzymes SGPT, SGOT level during Dengue infection in hospitalized pediatrics patients in tertiary care centre

Background: Hepatic involvement is not an uncommon in dengue viral infection, which presents with elevation in serum aminotransferases due to reactive hepatitis. The study is aimed to know the pattern of changes in hepatic enzyme levels in dengue infection in pediatric patients and to assess it with clinical presentation of dengue in particularly patients without and with shock.Methods: Pediatric patients with serologically confirmed Dengue viral infection were enrolled in the study and divided clinically into a shock group and a non-shock group. SGPT and SGOT levels were measured from day one of fever onset till 7 days and within 3 days after shock in the shock group. Student t-test was used to analyze the statistical data.Results: 100 patients with a mean age of 8'2.6 years were included in the study. The incidence of abnormal SGOT and SGPT levels were 96.9% and 51.1% in the shock group, and 92.2% and 45% in the non-shock group respectively. 30% and 17.9% of the patients in shock group and only 9.9% and 4.2% in non-shock group had the respective SGOT and SGPT levels > 200 U/L. Patients in shock group had statistically higher levels of Serum aminotransferase compared to the non-shock group. SGOT tended to increase starting from one day before shock and continued to increase within a few days whereas SGPT was less likely to be affected.Conclusions: Pediatric patients with Dengue infection have raised Aminotransferases in particular SGOT, which is higher than SGPT level. Aminotransferase levels in shock patients are significantly high and increases up to 3 days.

A clinical study on management of hydronephrosis detected antenatally

Background: It is important to detect and manage hydronephrosis early for improved clinical outcomes. The objective of this study is to detect and manage the hydronephrosis which occurs antenatally.Methods: Hospital based cross sectional study was carried out in 20 cases of hydronephrosis in pregnant women as per the inclusion and exclusion criteria laid down for the present study. Patients with mild hydronephrosis were observed. Patients with PUJ obstruction underwent pyeloplasty. Patients with posterior urethral valves underwent cystoscopic dilatation. Patients with VUR were put on prophylactic antibiotic and observed. The patients were followed up post operatively with USG and DTPA scan as indicated.Results: Among the 20 cases with hydronephrosis, majority were males. All cases in terms of side affected were found to be equally distributed. Hydronephrosis was found to be mild in seven (35%) of the cases. Renal dysplasia and bilateral hydronephrosis were found to be the predictors of post natal pathology. Grade 3 and grade 4 were 40% each. There was no persistent case. The most common cause of hydronephrosis was transient hypertension in 5 (33.3%) of the cases.Conclusions: Mild hydronephrosis resolves early and there is no persistence. Renal dysplasia and bilateral hydronephrosis are the important predictors of the post natal hydronephrosis.

Efficacy of MAGPI procedure in the management of hypospadias

Background: Hypospadias is a relatively common congenital defect of male external genitalia. It is present in approximately 1 in 300 males new born. The meatus may be located anywhere along the shaft of the penis from glans to scrotum or even perineum. The objective is to study the efficacy of MAGPI procedure in the management of hypospadias.Methods: Detailed case study was done as per the proforma, in majority of cases patient's mother were informants, thorough clinical examination was done in all cases and looked for any congenital anomalies and family history was also taken, and any drugs intake was also taken. All the cases routine investigation was done like (Hb, BT, Ct, Wt). USG was done in required cases. Routine pre-operative preparation was done like keeping nil orally, preparing parts was done. The type of surgery for each patient was assessed after clinical examination of location of meatus: Anterior, Middle, and Posterior. On discharge, the patients and mothers were advised to bring their children for regular check up to hospital.Results: Most common position of hypospadias was glanular and coronal. The most common surgery performed was Snodgrass technique and for distal and mid penile hypospadias and MAGPI for glanular type of hypospadias. MAGPI procedure was most commonly performed for glanular and coronal type of hypospadias. Other minor Complication was wound infection and penile torsion of mild degree and was managed conservatively.Conclusions: There is significant difference in outcome of hypospadias surgery done by pediatric urologist and other surgeons.

Acute Pulmonary Embolism - A Clinical Review.

Acute pulmonary embolism is a life threatening condition with a high mortality rate. If diagnosed early, the patient outcome is better. Therefore, early assessment, diagnosis and appropriate treatment are a key to successful management of the patient. This article discusses two (2) cases of acute pulmonary embolism of different aetiologies and also undertakes a review of the literature with regards to classification systems, risk stratification, diagnostic tools and recent advances in management of pulmonary embolism.

A retrospective study of atrial septal defect

Background: An Atrial Septal defect is an abnormal hole of variable size in the atrial septum, which generally permits left to right shunting of blood at the atrial level. ASD is one of the most common congenital cardiac anomalies, present in 10-15 percent of patients with congenital heart disease. Aim: To study the clinical profile, diagnostic modalities used, post operative morbidity and mortality of patients operated for atrial septal defect in a major teaching hospital in Telangana. Materials and Methods: This study was based on a patient population of 50, admitted to undergo surgical correction for atrial septal defect. Results: The incidence of ASD is more in females. The male to female ratio was 1:2.1 in this study. The majority of the patients were symptomatic (96%). The commonest symptom was dyspnoea on exertion (76%). Most of the patients were in NYHA class II (62%). Consanguineous marriage of parents was present in 28% of patients. Most of the patients were in sinus rhythm (94%). ASD were of fossa ovalis type (96%). In 74% of the patients, the size of ASD was between 2-4 cm in diameter. 78% of the patients were repaired by direct closure of ASD. Most of the patients (96%) were supported by ventilation, out of which 62% (31/50) of patients were ventilated for 1-6 hours. Patients (70%) were discharged by 9th –12th post operative day. Mortality was 2% in this study. Conclusion: Surgical repair of atrial septal defects is a safe procedure which is associated with excellent results and low morbidity.

Symptomatic improvement with gluten restriction in irritable bowel syndrome: a prospective, randomized, double blinded placebo controlled trial

BACKGROUND/AIMS: The existence of non-celiac gluten sensitivity has been debated. Indeed, the intestinal and extra-intestinal symptoms of many patients with irritable bowel syndrome (IBS) but without celiac disease or wheat allergy have been shown to improve on a gluten-free diet. Therefore, this study set out to evaluate the effects of gluten on IBS symptoms. METHODS: We performed a double-blind randomized placebo-controlled rechallenge trial in a tertiary care hospital with IBS patients who fulfilled the Rome III criteria. Patients with celiac disease and wheat allergy were appropriately excluded. The participants were administered a gluten-free diet for 4 weeks and were asked to complete a symptom-based questionnaire to assess their overall symptoms, abdominal pain, bloating, wind, and tiredness on the visual analog scale (0-100) at the baseline and every week thereafter. The participants who showed improvement were randomly assigned to one of two groups to receive either a placebo (gluten-free breads) or gluten (whole cereal breads) as a rechallenge for the next 4 weeks. RESULTS: In line with the protocol analysis, 60 patients completed the study. The overall symptom score on the visual analog scale was significantly different between the two groups (P<0.05). Moreover, the patients in the gluten intervention group scored significantly higher in terms of abdominal pain, bloating, and tiredness (P<0.05), and their symptoms worsened within 1 week of the rechallenge. CONCLUSIONS: A gluten diet may worsen the symptoms of IBS patients. Therefore, some form of gluten sensitivity other than celiac disease exists in some of them, and patients with IBS may benefit from gluten restrictions.

Symptomatic improvement with gluten restriction in irritable bowel syndrome: a prospective, randomized, double blinded placebo controlled trial

BACKGROUND/AIMS: The existence of non-celiac gluten sensitivity has been debated. Indeed, the intestinal and extra-intestinal symptoms of many patients with irritable bowel syndrome (IBS) but without celiac disease or wheat allergy have been shown to improve on a gluten-free diet. Therefore, this study set out to evaluate the effects of gluten on IBS symptoms. METHODS: We performed a double-blind randomized placebo-controlled rechallenge trial in a tertiary care hospital with IBS patients who fulfilled the Rome III criteria. Patients with celiac disease and wheat allergy were appropriately excluded. The participants were administered a gluten-free diet for 4 weeks and were asked to complete a symptom-based questionnaire to assess their overall symptoms, abdominal pain, bloating, wind, and tiredness on the visual analog scale (0-100) at the baseline and every week thereafter. The participants who showed improvement were randomly assigned to one of two groups to receive either a placebo (gluten-free breads) or gluten (whole cereal breads) as a rechallenge for the next 4 weeks. RESULTS: In line with the protocol analysis, 60 patients completed the study. The overall symptom score on the visual analog scale was significantly different between the two groups (P<0.05). Moreover, the patients in the gluten intervention group scored significantly higher in terms of abdominal pain, bloating, and tiredness (P<0.05), and their symptoms worsened within 1 week of the rechallenge. CONCLUSIONS: A gluten diet may worsen the symptoms of IBS patients. Therefore, some form of gluten sensitivity other than celiac disease exists in some of them, and patients with IBS may benefit from gluten restrictions.

Rare case of Hirayama’s disease.

Hirayama‟s disease is a rare benign neurological disorder also known as monomelic amyotrophy, Sobue disease, Juvenile Muscular Atrophy of Distal Upper Extremity (JMADUE). It mainly affects young males in their second or third decades and is most commonly seen in Asian countries like Japan, Malaysia and India. In majority of the cases the cause of the disease is unknown. An 18 year male came with weakness in his right hand and forearm since 1 year. Examination revealed weakness and wasting of muscles of forearm and hand without lower limb involvement and normal deep tendon reflexes. MRI showed focal short segment hyperintense signal in the ventral and right lateral aspect of the cervical cord at C5-C6 level with the involved segment measuring 4x3mm in size. Based on clinical and radiological features a diagnosis of focal amyotrophy was made. Patient is given a cervical collar to prevent flexion at the neck and physiotherapy in the form of hand and forearm exercises were started. Regular follow up of the patient once every 2 months is being done. Hirayama‟s disease is a rare, benign, self-limiting neurological disorder. Early diagnosis and management by preventing cervical flexion with the help of a cervical collar has shown to halt the progression of the disease.

Thoracic outlet syndrome due to compression of subclavian artery at first rib.

Thoracic Outlet Syndrome (TOS) refers to a constellation of signs and symptoms that arise from compression of the neurovascular bundle within the confined space of the thoracic outlet. Neurogenic (nTOS) from brachial plexus compression (95%), venous (vTOS) from subclavian vein compression (3%), & arterial (aTOS) from subclavian artery compression (1%). Most common clinical presentation of aTOS patients is distal upper extremity arterial emboli in otherwise healthy patient. Presenting a case report of arterial thoracic outlet syndrome.

Attenuation of hemodynamic responses to laryngoscopy and endotracheal intubation by intravenous esmolol.

Background: Sympathetic response associated with laryngoscopy and endotracheal intubation is a potential cause for a number of complications especially in patients with cardio-vascular compromise. The aim of our study was to evaluate and study the efficiency of intravenous esmolol in the attenuation of hemodynamic response to laryngoscopy and intubation in normotensive individuals. Methods: 100 surgical patients of either sex of physical status ASA I/II were randomly divided into 2 groups. Group C (10 ml of 0.9% normal saline) and group E (Esmolol 100 mg IV) given 2 minutes before induction. Baseline parameters - heart rate, systolic blood pressure, diastolic blood pressure and rate pressure product were noted at baseline level, just before induction, 1 min., 3 min., 5 min and 10 minutes after tracheal intubation. Results: Intravenous esmolol showed statistically significant attenuation of hemodynamic response to laryngoscopy and intubation when compared with the control. Conclusion: We conclude that esmolol in a dose of 100 mg given 2 minute before induction is highly effective in attenuation hemodynamic response to laryngoscopy and intubation.