ABSTRACT
Pulmonary complications are common in cardiac surgical patients. Limited respiratory reserves along with the pain associated with sternotomy add to the morbidity. Patients undergoing cardiac surgery who have had a pneumonectomy done before can be even more challenging to manage perioperatively due to a single-functioning lung. We present a case of a postpneumonectomy patient who underwent off-pump coronary artery bypass grafting. Perioperative optimization of lung function tests was stressed upon including the chest physiotherapy and early mobilization. Preoperative thoracic epidural catheter was inserted for postoperative pain and other proven benefits of thoracic epidural in coronary artery disease patients. We could conclude from our experience that proper optimization of lung function tests and meticulous pain management along with fast-tracking are keys to the management of such patients.
ABSTRACT
Introduction: Dengue fever epidemics pose a serious issue of public health in India. Early clinical features of dengue infection are variable among patients, and initial symptoms are often non-specific resembling any viral illness. Therefore, specific laboratory tests are necessary for an accurate diagnosis. In the present study, we planned to study hematological profile of seropositive (Igm) dengue fever patients. Materials and methods: Total 100 patients with positive serology for dengue infection were studied in detail to evaluate the haematological changes. Case definition of dengue fever was based on W.H.O criteria and confirmed by positive serology to dengue fever. Results: Most common hematological abnormality was thrombocytopenia (92%) followed by leucopoenia (68%) in present study. Raised hematocrit was found in 23 patients. Thromboplastin time was significantly raised in 15 patients. Peripheral smear examination showed atypical lymphocytes in 49 patients, the characteristic findings were plasmacytoid lymphocytes. Conclusion: Dengue fever does not have specific medical therapy hence clinical recovery monitoring is largely dependent on hematological parameters. The study results are relevant in the characterization of evolution of the disease as well as the hematological dynamics involved and can be used as screening tools by physicians to chart early therapeutic response.