Omeprazole-induced cardiac arrhythmia – A case report

Omeprazole, a Proton pump inhibitor, is widely prescribed in patients with chronic gastroesophageal reflux. Patients continue to use omeprazole for long period of time even without the supervision of the doctor. The authors report a 50-year-old male patient with a 5-year history of omeprazole use, who complained of chest discomfort. ECG on admission showed atrial fibrillation. Laboratory findings showed hypomagnesaemia, hypocalcaemia, and hypokalemia. The case report emphasizes the importance of patient education regarding the use and adverse drug reactions of the prescribed medications.

Effect of intermittent fasting on various health parameters in obese type 2 diabetics: A pilot study

Background: Diabetes mellitus type 2 is fast becoming a cause of concern for governments world over and people at large as it has immense socio-economic impact. A diabetic patient usually goes through phases of being overweight, obese, and insulin-resistant before being classified as a patient of type 2 diabetes. Fasting, though practiced for centuries, is a novel approach for delaying progression and possibly reversing diabetes mellitus. Aim and Objectives: The aim of the study is to look for the effect of intermittent fasting on various health parameters in obese type 2 diabetics. Materials and Methods: The study was conducted at a tertiary care facility in Amritsar. Twelve obese volunteers in the age group of 20–60 years with type 2 diabetes mellitus not controlled with metformin alone were included in the study. All the participants were told to follow intermittent fasting protocol of 16:8 for a period of 4 weeks. At the beginning of the study, weight, height, body mass index, waist circumference, waist-hip ratio, fasting blood sugar, and serum insulin, were recorded in each participant. At the end of the 4 weeks period, all the measurements were repeated and compared with baseline values using the student t-test. Results: There was a highly significant decrease in the anthropometric indices and fasting blood sugar as compared to baseline values at the end of the 4-week period without any change in fasting serum insulin levels. Conclusion: There is a favorable effect of intermittent fasting on anthropometric indices and fasting blood sugar levels without any improvement in fasting serum insulin.

Awareness among pregnant women regarding the use and safety of drugs during pregnancy in the state of Punjab: A cross-sectional observational study

Background: Indiscriminate use of drugs and cosmetics among a pregnant woman is always a challenge in the antenatal care for health-care providers especially in developing countries. There is a potential risk to the growing fetus due to irrational use of drugs and cosmetics during pregnancy awareness, and adequate knowledge of their use can prevent many drug-induced complications during pregnancy. Objective: The objective of the study was to evaluate the awareness among pregnant women regarding the use and safety of drugs and cosmetics. Materials and Methods: A cross-sectional observational study was conducted in various antenatal clinics of the state of Punjab. 500 pregnant women were enrolled in the study and the questionnaire was prepared in the local language to assess the knowledge and beliefs of pregnant women. Data analysis was done using Chi-square test. Results: A very few pregnant women had knowledge that drugs have any effect on the fetus and less than half believe that drugs should be taken only by consultation by the doctor. Majority pregnant women believe that sufficient time and attention are not given by a doctor during an appointment. Only 2% of women had the idea of antenatal sessions. More than half of the pregnant women considered alternative remedies to be more safe in pregnancy while a very few had the idea that cosmetics are safe in pregnancy. Conclusion: Thus, it can be concluded that the majority of participants in the study have poor knowledge regarding benefits and adverse effects of the use of drugs and cosmetics during pregnancy.

Correlation of body fat distribution and lipid profile in males of the Northwest region of Punjab

Background: The prevalence of obesity has substantially increased over the past few decades. Central obesity, in particular, has a major role in the development of various metabolic disturbances including deranged lipid profile which leads to increased risk of cardiovascular diseases. Timely assessment of any changes in lipid profile can help the prevention of cardiovascular diseases in obese men. Objectives: The objective of this study was to evaluate the association of abnormal waist-hip ratio (WHR) with the lipid profile in healthy men. Materials and Methods: The study was conducted in the tertiary care center of Amritsar. Two groups of 50 men each of the age group of 20–40 years were enrolled in the study. Group I included men with normal WHR while Group II included men with increased WHR. Lipid profile including cholesterol, triglycerides (TGs), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and very low-density lipoprotein (VLDL) was measured by standard methods. Statistical analysis was done by Student’s t-test and correlation was established using correlation coefficient. Results: Evaluation of lipid profile showed that serum cholesterol, TGs, LDL, and VLDL were higher in Group II than in Group I while HDL was lower in Group II than in Group I. Central obesity (WHR) has direct association with deranged lipid profile. Conclusion: It can be concluded that visceral or central obesity has direct correlation with the fasting lipid profile in men of the Northwest region of Punjab and WHR is a more reliable predictor of risk.

Methicillin-resistant Staphylococcus aureus intracranial abscess: An analytical series and review on molecular, surgical and medical aspects

Purpose: Intracranial abscess caused by methicillin-resistant Staphylococcus aureus (MRSA) is rare and unexplored. The aim of the present study is to examine the prevalence, clinical and molecular characteristics, treatment options and outcome of MRSA intracranial abscess over a period of 6 years. Patientsand Methods: A total of 21 patients were included in this retrospective study. The demographic and clinical details of all the patients were collected. Molecular typing including staphylococcal cassette chromosome mec typing, spa typing and polymerase chain reaction of Panton–Valentine leucocidin toxin (PVL) gene for the latter 6 isolates was performed. Results: The paediatric population was the most affected group (33.3%). The primary route of infection was post-operative/trauma in 7 (33.3%) cases. All the patients were treated surgically either by aspiration or excision. Fifteen (71%) patients received anti-MRSA treatment with vancomycin or linezolid, where linezolid-treated patients showed better prognosis. Of the 11 patients who were on follow-up, unfavourable outcome was observed in 3 (27.3%) cases and 8 (72.7%) cases improved. The molecular typing of six isolates revealed four community-associated (CA) MRSA, one each of livestock-associated (LA) and healthcare-associated MRSA with PVL gene noted in all. Conclusion: We propose that timely diagnosis, surgical intervention and appropriate anti-MRSA treatment would contribute to better outcome. The occurrence of CA-MRSA and LA-MRSA infection in the central nervous system signifies the threat from the community and livestock reservoir, thus drawing attention towards surveillance and tracking to understand the epidemiology and implement infection control measures.

A comparison of results by sequential and concurrent chemo radiotherapy in locally advanced carcinoma esophagus.

Aim: Many Trials using sequential and concurrent chemo radiotherapy have been done so far and has established the role of concurrent chemo radiotherapy in treatment of inoperable carcinoma esophagus. In this study, we have compared the results of concurrent chemo radiotherapy with sequential chemo radiotherapy. We have treated inoperable carcinoma esophagus in both the settings and present here the comparison of results in the two settings. Materials and Methods: There were 26 patients of carcinoma esophagus in sequential and 31 in concurrent chemo radiotherapy arm. In sequential arm methotrexate and Cisplatin followed by radiotherapy was given whereas in concurrent arm, Cisplatin was given once weekly along with radiotherapy. Results: The 2 year survival was 38% in sequential and35.5% in the concurrent setting and the median survival was 19.5 and 18 months respectively in the two arms.The toxicities in both the arms were comparable. P value of 0.4774 with confidence interval of 95% was obtained, which is not significant. Dysphagia was improved earlier in sequential than in the concurrent arm. Conclusion: As the results and toxicities in both the arms are almost similar with better symptom control, so larger randomized trials are required to assess the response and the use of methotrexate in sequential chemo radiotherapy can be further explored.

Nosocomial sepsis in neonates with single lumen vascular catheters.

Catheter-related sepsis is commonly encountered in the neonatal intensive care unit. We retrospectively studied infants with vascular catheters at 2 NICUs. Data were obtained from the computerised admission records available at both the hospitals. Our aims were to describe the clinical and microbial profile of nosocomial sepsis in infants with vascular catheters [umbilical artery (UA), umbilical venous (UV), central venous Broviac (CV), percutaneously placed central venous (PC), peripheral artery (PA)], and to determine the association between catheter type, duration and sepsis in a subset of the population. Nosocomial sepsis (positive blood culture after the 3rd postnatal day) occurred in 217 of 2091 (10.4%) infants. Infected infants, in contrast to non-infected, had a significantly (P < 0.001) greater number of multiple catheters (2.3 vs 1.4) had lower birth weights (1.2 vs 2.1 kg), were younger (28 vs 33 weeks) and had lower 1 and 5 minute Apgar scores (4.3 and 6.7 vs 5.5 and 7.4). The most common organism was coagulase negative Staphylococcus. In a subset population as analyses revealed, longer duration of UA use was associated with higher infection rates [13.6% with UA use for > or = 8 days vs 1.3% for < or = 7 days (P < 0.0001)]. PC use had a lower rate of sepsis than CV use (5.1% vs 15.2%; P < 0.05). Use of intravascular catheters should be balanced between the need for vascular access and the risk of sepsis.

Some medico-socio-demographic factors and intra-uterine growth retardation.

In the present prospective pilot study an attempt has been made to find out the correlation between some maternopaternal factors (demographic, socio-economic and medical) that suggest a high risk for intra-uterine growth retardation. The mean height and booking weight of women in study group were significantly less than the height and weight of women in control group (p < 0.001 for both). The mean paternal height and weight were also significantly less in the study group as against controls (p < 0.05 for and p < 0.01 respectively). In the study group 54.54% of women consumed less than 1500 calories/day as compared to 32.72% in the controls (statistically significant difference, (p < 0.01). The mean haemoglobin was significantly lower in the study cases (8.1 g/dl) as compared to controls (9.6 g/dl) (p < 0.001). The mean platelet count in study cases (1.64 +/- 0.34 lac/cmm) was significantly lower than that in the controls (2.08 +/- 0.25 lac/cmm) (p < 0.001). The rate of instrumental vaginal delivery, emergency caesarean section for foetal distress, incidence of intrapartum foetal distress, and number of babies with low Apgar scores at 1 and 5 minutes were significantly more in the study group (p < .05 and p < 0.001 respectively for operative delivery and Apgar scores).

Autonomic and peripheral neuropathy in insulin dependent diabetics.

Twenty five diabetics (all insulin dependent) and 20 age and sex matched controls were studied to assess peripheral nerve functions and autonomic (cardiovascular and urinary bladder) nerve functions. Impotence was the commonest symptom followed by postural dizziness, atonic bladder, shooting pains in the limbs and gustatory sweating. Cardiac autonomic neuropathy was found in 60% of the diabetics while 68% of them had diabetic cystopathy. Peripheral nerve dysfunction was present in 80% of the patients. Forty percent of the diabetics had all the three forms of neuropathies (cardiac, urinary bladder and peripheral), while another 40% of the patients had at least two forms of neuropathy.

Brain stem electric response audiometry in neonates with hyperbilirubinemia.

Auditory evoked responses using BERA were studied in 30 newborn babies with plasma bilirubin > or = 15 mgm/dl and repeated after treatment of neonatal jaundice with bilirubin levels of < or = 10 mgm/dl. A few jaundiced babies (16.5%) showed absent BERA response at the initial/subsequent examination. After treatment, 3/30 babies showed absent wave form responses and 2 of these were clinically kernicteric. Jaundiced babies had prolonged wave peak latencies and inter peak latencies. Treated babies showed a tendency towards recovery in their BERA responses which were however not complete. Total plasma bilirubin value at the time of BERA examination and mean maximal bilirubin values had no correlation with the incidence and degree of BERA abnormalities.

Persistent pulmonary arterial hypertension of the newborn.

Persistent pulmonary hypertension of the newborn (PPHN) characterised by right to left shunting with intense cyanosis is difficult to manage, and in the best of centres carries a 40-60 percent mortality. We report our one year's experience of managing six neonates with PPHN. There were 5 males and 1 female with mean birth weight of 2.59 +/- 0.487 kg and gestation period 39 +/- 2.0 wks and 1 minute Apgar score 2.8 +/- 2.1. Four to six babies were born by cesarean section and 3-6 babies had aspiration pneumonia. All babies presented within 12 hours of age (mean 5.08 +/- 5 hrs) with intense cyanosis and respiratory distress. Diagnosis were confirmed in all by (a) hyperoxia test, (b) simultaneous determination of preductal and postductal paO2 (c) contrast echocardiography and (d) hyperoxia-hyperventilation test. Babies were managed with hyperventilation using mean ventilatory rates of 100 +/- 45 per minute, an inspired oxygen concentration of 100%, peak inspiratory pressures 27 +/- 9 cm of H2O, and expiratory pressures 5 +/- 1.6 cms of H2O, and mean air way pressures of 10.4 +/- 2.7 cms H2O. Alkali therapy was used in 3 of the six babies whereas low dose dopamine was infused in all six babies. Inspite of aggressive ventilatory therapy, only 3 out of 6 babies could be salvaged.

Thermoregulatory alterations as a marker for sepsis in normothermic premature neonates.

To evaluate the core-peripheral temperature alterations as a marker for sepsis in normothermic premature newborns, 50 normal term neonates and 11 preterms with sepsis and 11 normal preterms (controls) were studied. Axillary, rectal and sole temperatures were recorded in all babies using a single mercury-in-glass thermometer by a single observer. There was significant widening of the rectal-sole and axillary-sole temperatures in the preterms with sepsis (p less than 0.001). There was no significant difference (p greater than 0.05) between the axillary and rectal temperatures in the term, normal preterms or those with sepsis. With an overall accuracy of 90.9%, a rectal-sole temperature difference of greater than or equal to 2.3 degrees C (100% sensitivity) or greater than or equal to 3.2 degrees C (100% specificity) is a useful marker to differentiate normothermic preterms with or without sepsis. Using the axillary-sole temperature difference, the respective values were greater than or equal to 2.2 degrees C and greater than or equal to 3.0 degrees C.

Prediction of airway responsiveness to allergen from skin sensitivity to allergen, airway responsiveness to histamine and serum IgE levels.

Immediate allergic reaction of the skin, non allergic airway responsiveness of the bronchi, and serum IgE levels were estimated in 25 atopic non asthmatic subjects and 15 controls. A good correlation was observed between these three parameters i.e. patients with positive skin response to allergen had increased airway responsiveness and significantly increased levels of serum IgE. However, the serum levels of IgE provided a significantly better indication of the likely presence of bronchial allergic reactivity than did the skin reactivity. The results indicate that knowledge of the airway responsiveness to histamine, skin sensitivity to allergen and serum IgE levels can predict the presence of airways responsiveness to an allergen. In all atopic non asthmatic individuals with a significant correlation between these parameters, the relevant allergen could stand identified as having the potential to provoke attacks of clinical asthma.

Histamine bronchoprovocation tests in subjects with gastro-oesophageal reflux disease.

The relationship of gastro oesophageal reflux (GER) with bronchial asthma has already been well documented in asthmatic subjects and it has been postulated that their asthma might have been caused by GER disease. Thus, it was planned to establish an association, if any, between GER and increased bronchial reactivity by histamine broncho provocation. The study was done in 25 GER disease patients and 15 controls. The difference in bronchial reactivity between the two groups was found to be significant (p less than 0.01). It was concluded that GER subjects expressed greater bronchial reactivity and it has been discussed that at a later stage of life they may be more prone to develop asthma.

Cerebrospinal fluid free N-acetyl neuraminic acid levels--a diagnostic and prognostic test in meningitis.

Cerebrospinal fluid (CSF) free N-acetyl neuraminic acid (NANA) levels were estimated in 20 cases each of pyogenic and tubercular meningitis (TBM) and 10 controls. The levels of free NANA were significantly high (P less than 0.001) in pyogenic and partially treated pyogenic meningitis when compared to TBM. The CSF free NANA levels had direct correlation with severity of the disease, CSF sugar and protein levels in pyogenic meningitis. The CSF free NANA can even be a prognostic criterion in management of pyogenic meningitis. Higher the levels, poorer the prognosis.