Clinical profile of thyrotoxicosis and related cardiovascular morbidities among patients attending endocrine outpatient department in a tertiary care centre

Background: Thyroid disorders are common in India. Symptoms and signs of thyrotoxicosis are nonspecific. Graves disease is an autoimmune condition and is the most common cause of thyrotoxicosis. Cardiovascular system is frequently affected in thyroid disorders but there is not much data on prevalence of thyrotoxicosis and related cardiovascular morbidities in central India. Objectives of study the clinical profile of patients with thyrotoxicosis and outline the related cardiovascular manifestations in a tertiary care center. Design-over a period of nine months a descriptive cross sectional study was conducted in a tertiary health care center.Methods: A total of 150 patients with thyrotoxicosis were studied. Patients with known diagnosis of thyrotoxicosis and newly diagnosed cases were included. The participants were investigated for thyroid profile, Electrocardiogram, Complete blood count, serum electrolytes and kidney function test.Results: Out of 150 patients of thyrotoxicosis, 87 (58 %) were diagnosed with Graves’s disease. Hypertension was observed in 78 (52 %) of participants. Atrial fibrillation was found in 18 (12%) and sinus tachycardia in 53 (35.33 %) of the participants.Conclusion: Grave’s disease is the commonest cause of thyrotoxicosis. Hypertension, sinus tachycardia and Atrial Fibrillation are the common cardiovascular diseases observed to be associated with thyrotoxicosis.

Assessment of core capacities for antimicrobial stewardship practices in indian hospitals: Report from a multicentric initiative of global health security agenda

Introduction: Antimicrobial-resistant HAI (Healthcare associated infection) are a global challenge due to their impact on patient outcome. Implementation of antimicrobial stewardship programmes (AMSP) is needed at institutional and national levels. Assessment of core capacities for AMSP is an important starting point to initiate nationwide AMSP. We conducted an assessment of the core capacities for AMSP in a network of Indian hospitals, which are part of the Global Health Security Agenda-funded work on capacity building for AMR-HAIs. Subjects and Methods: The Centers for Disease Control and Prevention's core assessment checklist was modified as per inputs received from the Indian network. The assessment tool was filled by twenty hospitals as a self-administered questionnaire. The results were entered into a database. The cumulative score for each question was generated as average percentage. The scores generated by the database were then used for analysis. Results and Conclusion: The hospitals included a mix of public and private sector hospitals. The network average of positive responses for leadership support was 45%, for accountability; the score was 53% and for key support for AMSP, 58%. Policies to support optimal antibiotic use were present in 59% of respondents, policies for procurement were present in 79% and broad interventions to improve antibiotic use were scored as 33%. A score of 52% was generated for prescription-specific interventions to improve antibiotic use. Written policies for antibiotic use for hospitalised patients and outpatients were present on an average in 72% and 48% conditions, respectively. Presence of process measures and outcome measures was scored at 40% and 49%, respectively, and feedback and education got a score of 53% and 40%, respectively. Thus, Indian hospitals can start with low-hanging fruits such as developing prescription policies, restricting the usage of high antibiotics, enforcing education and ultimately providing the much-needed leadership support.

A Study Of Accessory Foramen Transversarium In Dry Cervical Vertebrae And Its Clinical Implications.

Background & Objective: The foramen transversarium in the transverse process is the characteristic feature for cervical vertebrae and distinguish it from other vertebrae. It transmits the vertebral artery, vertebral vein and sympathetic nerves. These foramina show variations in its size, shape and number. The present study was done to find out the incidence of accessory foramen transversarium and compare it with other study. Methodology: A total 150 dried cervical vertebrae were observed macroscopically for accessory foramen transversarium in the department of anatomy. Results: Out of 150 vertebrae, accessory foramen transversarium was found in 41(27.33%) vertebrae. Among 41 vertebrae unilateral accessory foramen transversarium was found in 27(18%) vertebrae and bilateral was found in 14(9.33%) vertebrae. Conclusion: The knowledge of accessory foramen transversarium is useful for spine surgeons in surgery around cervical vertebrae. It helps radiologists in interpretation of computed tomogram and magnetic resonance image scans. It is also helpful for anatomist, anthropologist and clinicians.

Impact of the International Quality Improvement Collaborative on outcomes after congenital heart surgery: A single center experience in a developing economy.

Background: The International Quality Improvement Collaborative (IQIC) for Congenital Heart Surgery in Developing Countries was initiated to decrease mortality and major complications after congenital heart surgery in the developing world. Objective: We sought to assess the impact of IQIC on postoperative outcomes after congenital heart surgery at our institution. Methods: The key components of the IQIC program included creation of a robust worldwide database on key outcome measures and nurse education on quality driven best practices using telemedicine platforms. We evaluated 1702 consecutive patients ≤18 years undergoing congenital heart surgery in our institute from January 2010-December 2012 using the IQIC database. Preoperative variables included age, gender, weight at surgery and surgical complexity as per the RACHS-1 model. The outcome variables included, in- hospital mortality, duration of ventilation, intensive care unit (ICU) stay, bacterial sepsis and surgical site infection. Results: The 1702 patients included 771(45.3%) females. The median age was 8 months (0.03-216) and the median weight was 6.1Kg (1-100). The overall in-‑hospital mortality was 3.1%, Over the three years there was a significant decline in bacterial sepsis (from 15.1%, to 9.6%, P < 0.001), surgical site infection (11.1% to 2.4%, P < 0.001) and duration of ICU stay from 114(8-999) hours to 72 (18-999) hours (P < 0.001) The decline in mortality from (4.3% to 2.2%) did not reach statistical significance. Conclusions: The inclusion of our institution in the IQIC program was associated with improvement in key outcome measures following congenital heart surgery over a three year period.

Stroke patients; assessment of cognitive impairment

To assess the cognitive impairment in stroke patients. Observational study. Department of Medicine, Liaquat University of Medical and Health Sciences Hospital Jamshoro and Hyderabad. 01[st]August 2013 to 1[st]Feburary 2014. One hundredpatients with the established diagnosis of cerebrovascular accident [CVA]or stroke were recruited by purposive sampling technique after obtaining a well informed consent. Socio-demographic data on a semi-structured proforma were recorded. Mini-Mental State Examination test was used to assess the cognitive impairment. Cognitive impairment was found in all the patients with stroke. Moderate cognitive impairment was found in 57%, mild cognitive impairment in 29% and severe cognitive impairment in 14% of stroke patients. Cognitive impairment was present in almost all the stroke patients and we noticed that moderate cognitive impairment was very common

Compression with active movements in osteoarthritis of knee: a case study.

The objective of this case study was to find out the immediate effectiveness of an innovative approach in form of CAM (Compression with Active movements) in a woman with chronic osteoarthritis of knee. Participant was an individual with chronic osteoarthritis of knee participated in this study. The intervention was hands on manual therapy approach called compression with active movements where hamstrings muscle were compressed with therapist hands as if they were splinted or supporting by hand and simultaneously patient was asked to perform the active knee flexion and extension for three bouts of 10 repetitions. Main outcome measured in this case was pain relief in terms of visual analogue scale and active knee flexion. Pain was reduced by 3.1 cm on VAS scale and active knee flexion improved by 16 degree. Compression with active movements may be used for immediate relief of pain in chronic osteoarthritis of knee when it is associated with hamstrings spasm so as to get confidence of patient in performing active movements.

A Study on Division of Brachial Artery and Its Clinical Correlations.

Background: The brachial artery begins as the continuation of 3rd part of axillary artery at the distal border of teres major muscle. It terminates about a centimetre below the elbow joint at the level of neck of radius into radial and ulnar arteries. Context & purpose of study: The present study was done on 30 cadavers in department of anatomy to find out any variations in division pattern of the brachial artery. Results: Variations were found in two cadavers. An unusual short segment of the brachial artery which divide at middle of arm was found in right upper limb of one cadaver. There was a high origin of the radial artery from axillary artery found in right upper limb of one cadaver. The variations can be explained on the basis of embryological development. conclusions: The knowledge of branching pattern of brachial artery is useful for physicians, surgeons, nephrologists, radiologist and interventionist in various surgical procedures and also for diagnostic and therapeutic approaches.

Prevalence of metallo-β-lactamase producing pseudomonas spp.(in Tertiary Care Hospital).

Background: Metallo-β-lactamase (MBL) mediated resistance to carbapenem is an emerging threat in Pseudomonas isolates. The aim of this study is to detect metallo-β-lactamase producing isolates of Pseudomonas spp. from various clinical samples from indoor patients in a teaching hospital. Materials and Methods: Total 900 bacterial strains were isolated from different clinical samples from indoor patients. The bacterial strains were isolated and identified as per the standard guidelines. Amongst them 100 isolates of Pseudomonas were taken for the present study. All pseudomonas isolates were subjected to antimicrobial susceptibility testing by Kirby-Bauer disc diffusion method (CLSIs). In all imipenem resistant isolates of Pseudomonas spp., MBL detection was carried out by Imipenem-EDTA combined-disc synergy test (CDST). Results: Out of 100 isolates of Pseudomonas, 44 (44%) were imipenem resistant. Of these 44 isolates, 30 were producing MBL enzyme. 30 MBL positive isolate included 12 (40%) from surgical wards, 10 (33.33%) from tuberculosis ward, 4 (13%) from medicine ward, 2 (7%) from paediatric ward, 1 (3%) from urology ward and 1 (3%) from neonatal ICU. All MBL positive strains were resistant to β-lactams, aminoglycosides and fluoroquinolones. Conclusion: Prevalence of MBL producing Pseudomonas spp. is 30%. The MBL producing Pseudomonas spp. isolates were multidrug resistant. It is important to identify MBL producing pseudomonas isolates in laboratory as may cause serious infections and may cause a nosocomial outbreak.

Anterior ischemic optic neuropathy precipitated by acute primary angle closure.

A 59-year-old man with a history of longstanding systemic hypotension developed asymmetric non-arteritic anterior ischemic optic neuropathy (NAION) apparently precipitated by bilateral sequential acute primary angle closure. NAION is very rarely reported in association with raised intraocular pressure. In contrast to optical coherence tomography, the failure of scanning laser polarimetry to detect axonal swelling was another interesting finding. Possible reasoning for these observations is discussed.

Thiamine responsive megaloblastic anemia.

This report describes a female child with thiamine responsive megaloblastic anemia syndrome (Rogers syndrome), presenting with anemia and diabetes mellitus responding to thiamine. She also had retinitis pigmentosa. The anemia improved and blood sugar was controlled with daily oral thiamine. Previously unreported olfactory abnormalities, as described in Wolfram syndrome, were also present in our patient.

Acute myopia and angle closure caused by topiramate, a drug used for prophylaxis of migraine.

Acute transient myopia with shallowing of the anterior chamber is a rare idiosyncratic response to many systemic and topical medications, including sulfonamides. Several such cases have been reported in the past, but are less frequently reported in recent times. We report a case of acute progressive myopia and bilateral angle closure due to Topiramate--a drug used for epilepsy and migraine prophylaxis.