ST elevated myocardial infarction: clinical manifestation and outcomes of thrombolysis in a tertiary care hospital

Background: Acute myocardial infarction has reached enormous proportion in the developing countries and it is speculated that atherosclerotic heart disease will replace infectious disease as the leading cause of death in India. It has been shown that the thrombolytic therapy is underutilized. So, the study was taken to study the clinical manifestations and outcome of thrombolytic therapy in STEMI.Methods: The study was conducted for a period of 18 months in a tertiary care centre during which 100 cases of STEMI admitted to ICCU were included in the study, after fulfilling the inclusion criteria for thrombolysis, data related to clinical profile and outcome of thrombolysis was collected. SPSS 16 was used to analyse the data. Descriptive statistics like proportions mean and SD were computed.Results: Incidence of STEMI was high among subjects in the age group 51-60 years. Males were more affected (72%). Smoking, hypertension, hyperlipidemia and diabetes mellitus were the most common risk factors. Chest pain (92%) was the most common symptom. Majority (56%) were admitted within 6 hours of onset of symptoms. Anterior wall infarction was most common type of myocardial infarction. Majority (82%) were admitted in either Killips I/II class. Left Ventricular failure and Arrhythmias were most common complication. 64% patients had objective evidence in a form of ECG with ST-T resolution (>50%) between 1-6 hours, 18% between 6-24 hours and 18% patients had no significant resolution even after 24 hours. Echocardiography showed good left ventricle function (LVEF >45%) in 70% and 30% of the patients showed reduced ejection fraction (LVEF<45%). Mortality was seen in 8% of cases.Conclusions: Smoking, hyperlipidemia, diabetes mellitus and hypertension were most important risk factors for MI in the study. Coronary pain relief was most frequent and early marker of reperfusion. The ST segment elevation resolution has been widely accepted as most reliable objective criteria of coronary reperfusion. Hence ST segment resolution is regarded as a marker of salvaged myocardium by post-thrombolytic reperfusion. Early reperfusion of the ischaemic myocardial tissue with thrombolytic therapy decreases the morbidity and mortality.

Ciprofloxacin induced erythema multiforme: a case report.

Erythema multiforme (EM) is an acute, self-limited, and sometimes recurring skin condition that is considered to be a type IV hypersensitivity reaction associated with certain infections, medications, and other various triggers like flavorings and preservatives, such as benzoic acid and cinnamon, immunologic disorders, such as transient selective C4 deficiency of infancy, collagen diseases, vasculitides, sarcoidosis, non-Hodgkin lymphoma, leukemia, multiple myeloma, myeloid metaplasia, and polycythemia, physical or mechanical factors, such as tattooing, radiotherapy, cold, and sunlight, foods, including salmon berries and margarine, malignancy, and hormonal. EM may be present within a wide spectrum of severity. EM minor represents a localized eruption of the skin with minimal or no mucosal involvement. According to a consensus definition, Stevens-Johnson syndrome (SJS) was separated from the EM spectrum and added to toxic epidermal necrolysis (TEN). The two spectra are now divided into the following: (1) EM consisting of erythema minor and major and (2) SJS/TEN. Ciprofloxacin is a second generation fluoroquinolone. Fluoroquinolones are rapidly bactericidal in vitro and are considerably potent against Escherichia coli and various species of Salmonella, Shigella, Enterobacter, Campylobacter, and Neisseria. Mainly used in urinary tract infections, prostatitis, sexually transmitted diseases, gastrointestinal and abdominal infections, respiratory tract infections, bone-joint and soft tissue infections. Metronidazole is a nitroimidazole antimicrobial medication used particularly for anaerobic bacteria and protozoa. It is on the World Health Organizations list of essential medicines, a list of the most important medications needed in a basic health system. Here we report the case of a 39-year-old male patient who presented with EM to the dermatology outpatient department, Adichunchanagiri Hospital and Research Centre. The patient gave a history of taking antimicrobials ciprofloxacin and metronidazole for the treatment of a non-healing wound on the right leg which he sustained in a road traffic accident. The review of the literature has revealed very rare associations of metronidazole and pantoprazole with EM, but cases of ciprofloxacininduced EM have been reported. Hence, the reported adverse drug reaction has been attributed to ciprofloxacin. In this event, casualty assessment using Naranjo’s scale revealed that ciprofloxacin was a probable cause for the adverse drug reaction.

Cefotaxime-induced Stevens–Johnson syndrome: a case report.

Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis are two forms of a life-threatening skin condition, in which cell death causes the epidermis to separate from the dermis. The syndrome is thought to be a hypersensitivity complex that affects the skin and the mucous membranes. The most well-known causes are certain medications, but it can also be due to infections, or more rarely, cancers. SJS usually begins with fever, sore throat, and fatigue, which is commonly misdiagnosed and therefore treated with antimicrobials. Ulcers and other lesions begin to appear in the mucous membranes, almost always in the mouth and lips, but also in the genital and anal regions. Conjunctivitis of the eyes occurs in about 30% of children who develop SJS. A rash of round lesions about an inch across arises on the face, trunk, arms and legs, and soles of the feet, but usually not the scalp. SJS is a medical emergency that usually requires hospitalization. Treatment focuses on eliminating the underlying cause, controlling symptoms and minimizing complications. Recovery after SJS can take weeks to months, depending on the severity of the condition. If it was caused by a medication, then the medication and others closely related to it has to be avoided permanently. An 18-month-old male child was admitted to a private health setup in Kolar with the complaints of peeling and discoloration of the skin, ulcerations in the oral cavity, eyelids, and genitalia. The parents gave the history of cefotaxime injection being administered to the child for treating typhoid 20 days back. Seven days after the administration of cefotaxime, the child had developed maculo-papular lesions all over the body. Later on there was peeling and discoloration of the skin. Itching was present. Ulcerations in the oral cavity, eyelids and genitalia were also noticed by the parents, who then brought the child to the health care center. According to the Naranjo’s adverse drug reaction probability scale, there is a possible relation between this adverse drug reaction (SJS) and cefotaxime.

Ciprofloxacin induced fixed drug eruption.

Fixed drug eruption (FDE) is a clinical entity occurring in the same site or sites each time the drug is administered. Acute lesions appear as sharply marginated erythematous plaques, which are usually found on lips, genitalia, abdomen, and legs. The eruptions usually occur within hours of administration of the offending agent and resolves spontaneously without scarring after few weeks of onset. Most common drugs causing FDE are sulfonamides, tetracyclines, salicylates, barbiturates, doxycycline, fluconazole, clarithromycin, etc. Ciprofloxacin, a widely used fluoroquinolone antimicrobial, induces cutaneous adverse drug reactions (ADRs) in about 1-2% of treated patients. Urticaria, angioedema, maculopapular exanthems, and photosensitivity are the most frequently documented cutaneous adverse reactions. In this case report, the patient soon after taking ciprofloxacin tablets, developed itching in the lips, palms and in scrotal region. On continuing the treatment, the next day he developed fluid filled lesions over palm, knuckle, and hyperpigmentation. He gives a history of severe itching and rashes in scrotal region. He gives a history of similar complaints in the previous month after taking ciprofloxacin medication. There was no history of intake of any other medication. On examination, bullous lesions and pustules in finger webs, hyperpigmentation on knuckles, and scrotal erosions were seen. In the present case report, the patient presented with FDE immediately after oral administration of ciprofloxacin and got completely cured after stopping the drug and taking adequate treatment. According to the Naranjo’s ADR probability scale (score=8), this ADR is categorized as a “probable” reaction to the drug.

Metasone furoate induced acneiform eruption.

Acne is the chronic inflammatory disease of the pilosebaceous unit, characterized by the formation of comedones, erythematous papules and pustules. Steroid induced acne is an acneiform eruption characterized by sudden onset of follicular papules and pustules shortly after starting topical or oral corticosteroid. Here, we report a case of a 25-year-old female patient who presented herself to the Dermatology out-patient department with the complaints of acne all over the face after the application of mometasone furoate ointment.

Evaluation of the wound healing effect of Jasminum grandiflorum by wound contraction studies and wound breaking strength.

Background: Wound is a common process leading to inflammation and healing process. Jasminum grandiflorum is a plant widely grown in Karnataka and is mention in ancient medical systems to promote healing. So the study was taken up to confirm the anti-inflammatory effect of the plant. Methods: Excision and incision wound models in albino rats were used to study the wound healing effect. It was mainly studied by the degree of epithelisation at various intervals and compared with control group. The strength of the wound was assessed by its wound breaking strength at the end. Results: It was found that jasmine extract increased the degree of epithelisation and thus promoting wound healing. It was also found that the wound breaking strength was more in the drug treated group compared to normal. Conclusions: Jasminum grandiflorum leaf extract is known to have wound healing property.

Evaluation of wound healing effect of Jasminum grandiflorum in albino rats by histopathological studies.

Background: Wound healing is an important process in regeneration of the lost tissue, it involves various steps. Varieties of substances are known to interact in the healing process, some of the plant products are found to be beneficial. Jasmine leaves are mentioned to have healing effect in ancient literature. Hence the study was carried out to evaluate the wound healing effect by assessing the histopathological parameters. Methods: The study was done in the albino rats which were divided into various groups. The histopathological parameters were studied at regular intervals. Results: It was found that jasmine paste improved the wound healing process at all the stages. Conclusion: Jasminum grandiflorum has wound healing effect in albino rats.

Pseudo-infarct in ECG in A Case of Asymmetric Septal Hypertrophy.

A 68-year-old male with a history of type 2 diabetes and hypertension presented for a routine check-up. His routine ECG revealed recent inferior infarct. He was admitted and later echocardiography showed it to as asymmetric septal hypertrophy. The ECG findings of the disease and various causes of pseudo-infarct are discussed.

Audit of operation theatre utilization in general surgery.

BACKGROUND: The operation theatre complex of a hospital represents an area of considerable expenditure in a hospital budget and requires maximal utilization to ensure optimum cost-benefit. There is paucity of data in India on the use of available operating time and the reasons for less-than-optimal utilization have not been studied. METHODS: This audit was done prospectively over a period of 12 months in the department of general surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry. Operation theatre utilization was studied with respect to the starting and closing of the operation theatre, interval between surgical procedures, cancellation of surgical procedures and reasons thereof. RESULTS: The operation theatre was functional for 279 days during the year of the study, and 1773 cases were operated (6.3 cases per day). The total operating time utilized was 91.5%. The major reasons for cancellation of a total of 310 cases were lack of operating time (65.2%), emergency surgery during the elective list (13.9%), and preoperative lack of fitness (11.3%). Among all the lists, 43.6% started late and 63.6% of lists finished well before the scheduled closing time. Absence of monitoring equipment and non-availability of additional qualified anaesthetists necessitated induction of anaesthesia in the main operating room and accounted for 11% of the total operating time. CONCLUSION: Delay in starting lists, under-scheduling, interruption due to emergency surgeries, administrative reasons, induction of anaesthesia and recovery policies are the main factors that account for inefficient use of operating facilities. The correction of these factors would increase the available operating time by nearly 20%.

Blood utilization in elective surgery--requirements, ordering and transfusion practices.

BACKGROUND: Preoperative over-ordering of blood is very common and leads to holding up of the blood bank reserve, ageing of the blood unit and wastage of blood bank resources. We evaluated the preoperative blood-ordering and transfusion practices for common elective general surgical procedures at a major Indian hospital. The principal aim of this study was to identify the surgical procedures where type and screen can be introduced and to formulate a maximum surgical blood-order schedule for those procedures where a complete cross-match appears mandatory. METHODS: Six hundred and eighty patients undergoing 21 different surgical procedures between April 1993 and March 1995 were studied. Blood-ordering and transfusion details were noted and the data used to calculate cross-matched to transfused ratio (C/T ratio), transfusion probability (%T) and transfusion index (Ti). The maximum surgical blood-order schedule was calculated using Mead's criterion. RESULTS: There was gross over-ordering of blood in 10 out of the 21 procedures studied. Three hundred and seventy (40%) of the cross-matches performed were unnecessary. Sixty per cent of the patients studied had blood loss of less than 10% of the total blood volume and 90% of the cross-matches performed for this group were unnecessary. Based on these data, the maximum surgical blood-order schedule was calculated for 11 common surgical procedures. CONCLUSION: This study shows that blood was over-ordered in 10 out of the 21 procedures studied. Implementation of the recommended maximum surgical blood-order schedule and introduction of type and screen for eligible surgical procedures is a safe, effective and economic solution to preoperative over-ordering of blood.