A review of role of lung ultrasound and clinical congestion score in acute left ventricular failure

Congestive cardiac failure (CCF) is a worldwide phenomenon and affects millions of people years and is accompanied with high mortality. The present review is undertaken to evaluate the usefulness of Lung Ultrasound Scan in diagnosis and to identify its role as a marker of clinical outcome in patients with Acute LVF. A review of literature was done to find the role of lung ultrasound and clinical congestion score in acute left ventricular failure from search engines such as PubMed, google scholar. Major exclusion criteria were the studies that included patients with Right Ventricular Failure, renal insufficiency, other respiratory causes of breathlessness like pneumonia, pulmonary embolism, pneumothorax and pleural effusion. This review concluded that lung ultrasonography is as a rapid, non-invasive, bedside tool for the diagnosis and risk assessment of pulmonary congestion in Acute LVF.

Clinical Profile And Outcome Of Acute Kidney Injury Related To Pregnancy In A Tertiary Care Centre In Southern Tamilnadu

Acute kidney injury is a threatening complication of pregnancy causing serious maternal and fetal morbidity and mortality,common in developing countries.METHODS:A observational study was done between January 2018 to November 2018 to report the incidence,clinical spectrum and maternal&fetal outcome in AKI.RESULTS:Total number of patients 40,Mean age–25.3± 4.3 yrs.The incidence of AKI in pregnancy was 6%.Incidence of AKI most common in Postpartum period(80%),causes of AKI was Sepsis(40%),HELLP(20%),Postpartum hemorrhage (20%),Auptio placenta (15%),Acute fatty liver of pregnancy (5%).Among them 80% of patients having preeclampsia as common risk factor.Live births was 80%.Among total pregnancy related AKIs 14 patients were managed conservatively and 26 needed dialysis. recovered patients were (N=38) 95%,and mortality was (N=2)5%.CONCLUSION:AKI in pregnancy commonly occurred in Postpartum period and Sepsis is the most common etiology

Tripe palm: a paraneoplastic manifestation of carcinoma stomach

Usually gastrointestinal malignancies present with low SAAG ascites. But when there is diffuse liver infiltration following malignancy, high SAAG ascites can occur. So liver infiltration can masquerade as cirrhosis. Malignant acanthosis and tripe palm are the paraneoplastic manifestations seen in GI malignancies. We are reporting a case which was initially managed as a  straightforward case of cirrhosis ,but later turned out to be a case with tripe palms, malignant acanthosis and carcinoma stomach as primary with diffuse liver infiltration having high SAAG ascites.

Diagnostic Significance Of Serum Ascites Cholesterol In Malignant And Non Malignant Ascites

INTRODUCTION: Ascites is a very common clinical problem. However, the ability to distinguish malignant from non-malignant and tubercular causes of ascites using various biochemical techniques would obviate the need of many expensive and time-consuming diagnostic studies on patients presenting with ascites of unknown etiology. Therefore, this study was planned to evaluate usefulness of ascitic uid albumin, protein, SAAG and ascitic uid cholesterol level in diagnosis of malignant, non-malignant and tubercular ascites. MATERIALS AND METHODS: We conducted a prospective observational study in Department of medical gastroenterology, Madras Medical College from time period of January 2018 to December 2018. All cases of ascites of unknown etiology were evaluated and were grouped into malignant and benign ones. Patient having peritonitis were excluded from the study. In this groups, serum albumin,ascitic uid albumin, cholesterol were done. The data was processed in MS Excel and analysis was carried out using SPSS Ver. 23. RESULTS: Out of 80 patients, 30 were malignant (37.5%) and 50 were benign (62.5%).Cirrhosis was the most common cause of benign ascites and carcinoma stomach was the most common cause of malignant ascites. Ascitic uid cholesterol above the level of 100mg/dl has a specicity of 100% in detecting malignant ascites. CONCLUSION: SAAG, ascitic uid cholesterol having high specicity, can be used for differentiating between non-malignant and malignant ascites. It can also be used to differentiate tubercular ascites from malignant ascites.

Bacteriological Profile And Antibiotic Susceptibility Pattern Of The Isolates Among The Neonatal Septicemia In Northeast India

Background: Bacterial resistance to antibiotics was a global problem. Multidrug-resistant bacteria causing neonatal septicemiaswere increasing in the world. It was difficult to compare the bacterial profile and antibiotic susceptibility pattern of the isolatesamong the neonatal septicemia between countries because the epidemiology of neonatal septicemia was extremely variable.Objective: Timely identification of bacterial profile and antibiotic susceptibility pattern of the isolates among the neonatalsepticemias are essential to guide the clinicians regarding both the empirical and definitive treatments of neonatal septicemia.Materials and Methods: Based on the AIIMS protocol 2014 of neonatal sepsis-World Health Organization newborn CC,an operational definition of clinically diagnosed neonatal septicemia was established for the selection of participants inthe study for blood culture and sensitivity test (CST). Hence, in this study, blood CST was done only among the selectedpatients for clinically diagnosed neonatal septicemia as recommended in the National Committee for Clinical LaboratoryStandards.Results: This study observed that there was a shift from the predominance of Gram-negative organisms to Gram-positiveorganisms, especially Staphylococcus aureus. Acinetobacter and Citrobacter were emerging organisms.In this study,aminoglycosides and fluoroquinolones were sensitive to organisms, especially in Gram-negative organisms. Imipenem andmeropenem were also sensitive in both Gram-positive and Gram-negative organisms. Imipenem was more sensitive toorganisms than meropenem. Tobramycin, doxycycline, gatifloxacin, and chloramphenicol were more sensitive to organismsthan erythromycin, azithromycin, and clindamycin.Conclusion: Early clinical diagnosis and prompt initiation of empirical antimicrobials therapy to patients of pending culturesensitivity reports for definitive therapy may be life-saving. Hence, periodic surveillance for bacteriological profile and antibioticsusceptibility pattern of the isolates among the neonatal septicemia for appropriate choice of antimicrobials for empirical therapycan be outlined and reevaluated in a timely manner to save the life of 5 million neonatal deaths a year, with 98% occurringin developing countries and limited resource rural areas. This study concluded that empiric therapy for clinically diagnosedneonatal septicemia should cover both Gram-negative and Gram-positive organisms. Hence, the combination of one antibioticfrom each of the following two groups, (1) Imipenam/piperacillin/cefotaxime and (2) amikacin/gentamicin/netilmicin, can beincluded as an initial therapy for neonatal septicemia.

​Interpretation And Clinical Correlation Of Tuberculin Skin Test Results Among Clinically Diagnosed Childhood Tuberculosis

Background: Diagnosing tuberculosis (TB) was still a worldwide big challenge in cases with negative reports of Xpert MTB/RIF, smear, and culture test of acid-fast bacilli (AFB). A single, direct Xpert MTB/RIF test identified 98.2% of the sputum smearpositive TB cases and 72.5% of those with sputum smear-negative TB. Such a diagnosis was often made based on the clinicalcriteria and other supportive findings like tuberculin skin test (TST).Objective: Hence, this study was to help in the diagnosis and treatment of clinically diagnosed childhood TB, especially in thelimited resource rural areas and developing countries.Materials and Methods: Based on the WHO revised criteria of TB diagnosis, to include clinically diagnosed TB instead ofsmear-negative TB disease, an operational definition of clinically diagnosed TB for the selection of participants for TST wasestablished for this study. Based on the recommendation of the CDC team at the Saskatchewan Lung Association, 2007-03-21at the Wayback Machine, the TST results of the study were interpreted.Results: Hence, in our study, the sensitivity of TST was 82.35% (≥10 mm) in the age group of 1–4 years and 60.16% (≥15 mm)in the age group of >4–12 years. However, this study shows that the positivity rate of TST was increased from 60.16% (≥15 mm)to 86.15% (≥10 mm), if the TST results≥10 mm were interpreted as positive even in this age group of >4 years–12 years.Conclusion: In such very difficult situations of clinically diagnosed TB, this study observed that empiric anti-TB treatment may bestarted without microbiological confirmation to clinically diagnosed childhood TB patient with negative reports of Xpert MTB/RIF,smear, and culture test of AFB, presented with one or more of the following symptoms and signs of clinically diagnosed childhoodTB: (1) Chronic anorexia, (2) ill health and fatigue, (3) weight loss of >5% during the past 3 months or documented failure to striveduring the preceding 3 months, (4) night sweating and persistent fever >2 weeks, and (5) non-remitting cough >2 weeks but cannot bediagnosed clinically by any possible causes than TB, and positive TST report, in resource-limited rural areas anddeveloping countries.

Clinical Profile And Outcome Of Paraquat Poisoning Induced Acute Kidney Injury

Paraquat poisoning is one of the causes of AKI, the mechanism of toxicity being the production of reactive oxygen species,thereby causing toxicity at the cellular level. The aim of this study is to determine the requirement of haemodialysis and the severity of toxicity, depending upon the amount ingested.It is found that in Paraquat poisoning, the intervention with pre–emptive haemodialysisis not useful in decreasing the mortality. Ingestion under the influence of alcohol has higher mortality.Amount of poison ingested has a great impact and is directly proportional to the mortality. Oral ulcers, hepatic involvement, ARDS and MODS all reflected grave prognosis ultimately leading to death. The overall mortality in the study is 51%.

Prevalence of Iron Deficiency Anemia in Patients with Chronic Heart Failure

Background:Introduction: Anemia is a frequent comorbidity of heart failure and is associated with poor outcomes. Anemia in heart failure is considered to develop due to a complex interaction of iron deficiency, kidney disease, and cytokine production, although micronutrient insufficiency and blood loss may contribute. Aim: To study the prevalence anemia in patients with chronic heart failure. Methods: In this prospective study, chronic heart failure patients were evaluated for anemia. Investigations included are complete blood count, peripheral smear, renal function test, ESR, CRP, serum ferritin and total iron binding capacity. Results: In our population, the prevalence of anemia was 38% of patients, and Iron deficiency anemia was detected in 11 out of 103 patients (11%). The prevalence of anemia of chronic disease was 27 out of 103 patients (26%), and the remaining patients (64%) had normal hemoglobin levels. Conclusion: Early diagnosis and treatment of anemia can improve Ejection Fraction in patients with CHF.

Low dose CT guided percutaneous sacroiliac screw fixation

To describe the procedure and compare the radiation to the patient between a conventional CT and low dose CT and show the percentage reduction of dose to the patient under the latter protocol whilst still ensuring clinical efficacy. The study was performed in a 100 bed secondary care hospital which caters principally to the local industrial community. Patients were included in the presence of an unstable pelvic ring injury requiring posterior ring fixation. However, patients who were haemodynamically unstable; patients with head, thoracic and extensive abdominal wounds, and those who might require an open reduction procedure for posterior pelvis repair were excluded from the study. The low dose CT scan image quality was satisfactory for planning the procedure. Also, with CT guidance, the placement of screws in all cases was exactly as desired with a high level of confidence there was no complications. Fixation of sacroiliac joint fractures under CT guidance is easier than with conventional fluoroscopic guidance or open surgery. The procedure can be done even in a small set-up. Low dose CT guidance makes it more acceptable for patients and surgeons

Exploring conformational space using a mean field technique with MOLS sampling.

The computational identification of all the low energy structures of a peptide given only its sequence is not an easy task even for small peptides,due to the multiple-minima problem and combinatorial explosion. We have developed an algorithm, called the MOLS technique,that addresses this problem, and have applied it to a number of different aspects of the study of peptide and protein structure. Conformational studies of oligopeptides, including loop sequences in proteins have been carried out using this technique. In general the calculations identified all the folds determined by previous studies,and in addition picked up other energetically favorable structures. The method was also used to map the energy surface of the peptides. In another application, we have combined the MOLS technique, using it to generate a library of low energy structures of an oligopeptide, with a genetic algorithm to predict protein structures. The method has also been applied to explore the conformational space of loops in protein structures.Further, it has been applied to the problem of docking a ligand in its receptor site, with encouraging results.

Idiopathic charcot joint of knee

A Charcot joint or neurogenic arthropathy is seen in conditions where proprioceptive afferents from the joint are altered or destroyed. In many cases a definite cause for developing a Charcot joint can be identified but there are some cases [the idiopathic variant] where the etiology remains obscure. Few have been reported. We present such a case and discuss the treatment involved

Indomethacin prophylaxis for intraventricular hemorrhage in very low birth weight babies.

OBJECTIVE: To study the efficacy and complications of low dose indomethacin in the reduction of major intraventricular hemorrhage (IVH) in very low birth weight (VLBW) babies. DESIGN: prospective randomized controlled trial (interim analysis) SETTING: Level III neonatal intensive care unit of a perinatal tertiary care center. PATIENTS: Newborn babies with birth weights between 750-1250 g were randomized into indomethacin or control groups. They were further stratified into two birth weight groups 750-999 g and 1000-1250 g for subgroup analysis. INTERVENTIONS: 3 doses of indomethacin were administered to the indomethacin group at the dose of 0.1 mg/kg/dose intravenously. The control group did not receive any specific intervention other than standard neonatal intensive care. OUTCOME MEASURES: The primary outcome measure was the occurrence of IVH and the secondary outcome measures were necrotising enterocolitis, symptomatic patent ductus arteriosus (PDA), bleeding episodes, renal failure, chronic-lung disease and death. RESULTS: Out of 115 eligible newborn babies, 56 babies received indomethacin and 59 were controls. Perinatal characteristics were similar between the two groups. There was no difference in the incidence of IVH between the groups but on subgroup analysis the incidence of major IVH (grades III and IV) were significantly increased in babies in the lower birth weight category who received indomethacin P = 0.03). The incidence of chronic lung disease was significantly higher in the indomethacin group (P = 0.005) and bleeding episodes other than IVH were also significantly increased in the indomethacin group (P = 0.04) in the lower birth weight category. The incidence of PDA was lower in the indomethacin group but only reached significant level in the higher birth weight subgroup (P = 0.02). There were no significant differences in the other outcome measures studied. CONCLUSIONS: Indomethacin prophylaxis did not confer protection against IVH in very low birth weight babies. Instead it showed an increase in the risk of IVH, other bleeding episodes and chronic lung disease. Based on this data we felt that we were not ethically justified in continuing the use of indomethacin and have since terminated this study.