Use of L-Arginine for Inhaled Nitric Oxide (iNO) Dependent Hepatopulmonary Syndrome (HPS) Post-Liver Transplant

Hepatopulmonary syndrome (HPS) is one of the recognised complications of liver cirrhosis which warrants urgent liver transplantation. The symptoms usually improve post transplantation but might take 6-12 months to resolve completely. Severe hypoxemia post liver transplantation, especially when done for hepatopulmonary syndrome has been reported. iNO use for the same has been reported in literature with good response. However, it is practically very difficult to continue iNO in a stable child on a portable ventilator due to problems of scavenging.We report a case of 7-year-old girl who underwent orthotopic liver transplantation (OLT) for severe HPS. Post transplantation the patient had a stormy respiratory course and became severely hypoxemic. She was started on inhaled NO and showed a good response. However, the patient then became NO dependent and multiple attempts to wean iNO failed albeit minimal ventilatory requirements. Following IV L-Arginine infusion, iNO could be weaned within 6 hours without recurrence of hypoxemia. L-Arginine infusion should be considered as a treatment option when facing difficulties to wean iNO in an otherwise well responding patient.

Primary retroperitoneum mucinous cystadenoma

Primary retroperitoneal mucinous cystadenomas (PRMCs) are observed more frequently in women with no specific symptoms. A 35 Years old female patient presented with Intermittent abdominal pain in her left flank associated with fullness in abdomen. CECT confirmed a well-defined smoothly marginated homogenous non-enhancing unilocular cystic lesion in retroperitoneum in left lumbar region, separated from the pancreas, left kidney and ovary. On Laprotomy, the retroperitoneal tumor was completely removed, without spillage of its contents.

Impact of Communication Skills Training Programme on Interns in a Medical College of India

Introduction: Communicative skills in medical education are inadequately met. Research has shown that poor communication can contribute to improper diagnosis and lack of understanding of patient's problems, investigations, and treatment options. Poor communication can lead to poor compliance to treatment and dissatisfaction among patients Objective: Assessment of the improvement in the communication skills after the training programme workshop Method: The interns posted in the department of community medicine were pre-tested using Kalamazoo Essential Elements Communication Checklist (Adapted) [KEECCA] who then underwent focused training by the trained faculty members. Two weeks following completion of training, all participants were subjected to a post-test and comparison between the pre-test and post-test scores was done using Wilcoxon Signed-Rank Test. The test was two sided and a p value less than 0.05 was considered as statistically significant. In order to know the effect of sensitization programme, feedback of the students and the faculty members as the assessors was taken after the completion of the posting Results: On the application of wilcoxon signed rank test, it was found that the difference between the pre and post test scores of assessment on kalamazoo scale after the training of interns on communication skills was found to be statistically significant as the t-value was 4.072 with the pvalue less than 0.001 that is also highly statistically significant Conclusions: The incorporation of communication skills in the medical curriculum will not only improve the doctor patient relationship but also help in arriving at the proper diagnosis through improved skills