Liver transplantation for fulminant hepatic failure in yellow phosphorus poisoning

Yellow phosphorus (YP) containing rodenticides is a readily available poison that may be accidentally or deliberately ingested, leading to symptoms ranging from simple gastrointestinal symptoms to fulminant hepatic failure, depending on the amount ingested. As there is no specific antidote, the treatment requires early gastric lavage and institution of supportive measures such as acetyl cysteine infusion and Vitamin K. Progression to fulminant hepatic failure is characterized by rapid deterioration of liver function tests, worsening coagulopathy, and sensorium. The only definitive treatment at this stage is a liver transplant and therapeutic plasma exchange (TPE) can serve as a bridge therapy until a compatible liver donor is found. We present a case of YP-containing rodenticide poisoning, in which the patient progressed to fulminant hepatic failure despite aggressive supportive therapy and was successfully managed with TPE until liver transplantation.

Assessment of ST Segment Resolution as a Predictor of Outcome in Acute Myocardial Infarction after Thrombolysis

Introduction: Coronary heart disease (CHD) is a major causeof mortality and morbidity all over the world. This study wasundertaken to assess the resolution of ST segment at 90 min ofthrombolysis in STsegment elevation myocardial infarction asa predictor of short term outcome in terms of adverse eventsand mortality during hospital stay.Material and methods: A total of 100 patients with firstepisode of ST elevation myocardial infarction without anyconventional contraindication for thrombolysis were takenfor the study. % of ST segment resolution after 90 minof thrombolysis was calculated and correlation with vitalparameters like Killip class, ejection fraction, incidence ofarrhythmias, prognosis in the patients with acute MyocardialInfarction.Results: Out of 100 patients who were thrombolysed, 30%had failed thrombolysis. Patient who presented within 6hours of chest pain had 7.7% failed thrombolysis which wassignificantly lower than patients who presented >6 hrs ofchest pain with 44.5% failure rate, p value 0.0002. Failure ofthrombolysis was higher in Diabetic patient (p value= 0.02)and hypertensive patient (p value= <0.0001). Risk factorslike diabetes, hypertension significantly affect the outcomeof thrombolysis. Mortality was seen in 10 patients, 80% hadfailed thrombolysis, p value< 0.001.Conclusion: Patients with No resolution of ST segment at 90min of thrombolysis had frequent adverse events and highermortality when compared to patients with partial and completeST segment resolution.

A rare case of duodenal carcinoid presenting as ectopic Cushing’s syndrome

ACTH-dependent Cushing syndrome (CS) due to an ectopic source is responsible for approximately 10-15% cases of Cushing’s syndrome. It is associated with various tumors such as small cell lung cancer and well-differentiated bronchial or gastrointestinal neuroendocrine tumors. Many a times ectopic ACTH production is difficult to manage, and identification of the source may take many years. Hormonal diagnostics include assessments in basic conditions as well as dynamic tests, such as the high-dose dexamethasone suppression test and corticotrophin releasing hormone (CRH) stimulation test. Treatment selection depends on the type of tumor and its extent. In the case of neuroendocrine tumors, the main treatments are surgery and administration of somatostatin analogues or bilateral adrenalectomy in refractory cases and if the source remains unidentified. Here, we report a case who presented with features of Cushing’s syndrome which eventually through workup led us to a diagnosis of duodenal carcinoid producing ectopic ACTH which is extremely rare and was successfully treated.

A Study Of Prognosis Of Stroke With Special Reference To Electrocardiographic Changes And 2d-Echo.

Introduction: Stroke is the second most common cause of death and major cause of disability worldwide. Approximately 20 million people each year suffer from stroke of which 5 million do not survive. Cerebral infarction is responsible for about 80% of all rst ever in a lifetime strokes. There are many risk factors for cerebrovascular accidents like hypertension, diabetes, aneurysm & coagulopathy . This study was undertaken to determine ECG changes in stroke with diabetic and its prognostic signicance. Aims & Objectives: The present study aims to determine the 2D ECHO and ST-T changes among stroke patients and its implication in assessing prognosis. Material and Methods: The present study was carried out in100 patients admitted in department of medicine, S.S. medical college and associated S.G.M.H hospital, Rewa (M.P.) from july 2014 to Jun. 2015. Inclusion Criteria: The stroke patients of both sexes aged >16 years admitted to SGMH, Rewa. Neurodecit lasting >24 hours. Detailed neurological examination including fundoscopy and cardiovascular examination was carried out in all the cases. A12 lead ECG was done within 24 hours of admission. Result: th th Stroke was most common in 5 and 6 decade (55%). Males had higher preponderance among stroke patients (Male-female ratio 1.5:1). Hypertension was the most common risk factor in 45% of patients. In infarct the most common presenting complaints were headache(25%), Vomiting(19.11%) & Convulsion(8.82%). Such complaints were signicantly higher in hemorrhage Headache(65.62%), vomiting(78.12%) & convulsion(12.50%). Abnormal ECG changes were more common among hemorrhagic patients (78.12%) compared to infarct patients (67.64%). LVdysfunction was the most common abnormality noted in both groups i.e., infarct (23.53%) and hemorrhage (56.26%). Conclusion: ST segment depression in infarct(30%),hemorrhage(53.33%), QTc prolongation infarct(35.71),hemorrhage(46.66%) and prominent U wave infarct(50%),hemorrhage(53.33%) are the common ECG abnormalities in strokes. ECG abnormalities in stroke patients do not have any prognostic signicance. 2D echo abnormalities were more common among hemorrhage group (75%) than in infarct (44.12%). LV dysfunction showed signicant mortality in stroke patients and was statistically signicant (p<0.001).

Human papilloma virus vaccination: practical guidelines.

Cervical cancer has a long latency period and established role of HPV lead to interest in development of HPV vaccine. Main goal of HPV vaccination is to decrease cervical cancer incidence. There are two vaccines available, for the prevention of HPV infection - gardasil and cervarix. Gardasil is quadrivalent and cervarix is bivalent. The FDA has approved gardasil in 2006 and cervarix in 2009 based on their efficacy in phase 3 trails. When recommending HPV immunization of females, it should be offered to girls 11 to 12 years of age, but can be administered as early as nine years. Catch-up vaccination should be offered for females aged 13 to 26 years who have not been previously vaccinated. HPV immunization is not effective in clearing cytological evident disease or HPV infection that is already present and it does not provide immunization for serotypes other than included in vaccine. Cervical cancer screening is recommended to continue as per guidelines.