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1.
Indian Pediatr ; 2022 Sept; 59(9): 710-715
Article | IMSEAR | ID: sea-225372

ABSTRACT

Student doctor method of clinical training or clinical clerkship provides students with exposure to the entire longitudinal illness of the patient. The students participate in patient care as a part of treating team and can refine their clinical, communication and procedural skills. It provides them with an opportunity to work with the faculty and experience the future workplace. Although the graduate medical education regulations (GMER) provide for student doctor method of training, the time provided is too little and opportunistic. Electives have also been recently added to the new curriculum for the first time. We propose a model to deliver the electives using the clerkship method, so as to consolidate what students learn from the ongoing clerkship. This model is feasible, practical and can be introduced in the current GMER for Indian medical undergraduates without any major disruptions.

2.
Indian J Physiol Pharmacol ; 2022 Jun; 66(2): 120-125
Article | IMSEAR | ID: sea-223946

ABSTRACT

Objectives: Cardiopulmonary exercise testing (CPET) is an integrative assessment of multiple interdependent variables contributing to exercise response. CPET parameters such as maximum or peak oxygen uptake (VO2max/peak) are used to estimate this response. VO2max/peak varies with physiological predictors such as age, sex, body mass index (BMI), and activity level. The existing normative values for Indian subjects have, thus, far been adapted from Western populations who have a different body habitus in terms of these physiological predictors. We aimed to determine the relation and a prediction equation of these variables with VO2peak. Materials and Method: One hundred and twenty-one healthy subjects underwent CPET on a treadmill (Cortex Metalyzer) in a tertiary care hospital and VO2peak was calculated through Metasoft software. Statistical analysis: Student’s t-test and one-way analysis of variance (ANOVA) were used for calculating the between-group difference. Logistic regression with univariate and multivariate ANOVA was used for computing the reference equation. Results: Mean VO2peak (ml/min/kg) was 29.9 ± 7.7. It was higher for males (32.81 ± 7.9 vs. 26.79 ± 6.1 [P < 0.001]) and active individuals (32.8 ± 7 vs. 26.1 ± 6.9 [P < 0.001]). Higher values were observed in younger and non-obese population (P < 0.001). Regression coefficient (r2) was 0.44 and 0.36 for male and female, respectively. Reference equation was then calculated for males and females using the r2 value. Conclusion: VO2peak was higher in males and active individuals, it declined with increasing age and BMI. The values obtained were much lower than the Western population, therefore stressing the need for the development of our own set of reference equations.

3.
Article | IMSEAR | ID: sea-196036
4.
Article | IMSEAR | ID: sea-196349

ABSTRACT

Actinomyces naeslundii is a commensal flora of the oral cavity and is generally considered as an avirulent saprophytic bacterium in immunocompetent patients. It can become an opportunistic anaerobic pathogen in oral cavity in patients with poor oral hygiene or tooth extraction and can cause periodontal disease. Pulmonary Actinomycosis is a rare manifestation and may be suspected in middle-aged male patients with cough and hemoptysis showing radiological findings of a peripheral mass or chronic consolidation in whom repeated aerobic cultures have yielded negative results. Here, we report isolation of A. naeslundii from the bronchoalveolar lavage sample from an immunocompetent patient who presented with chronic nonresolving pneumonia of 6 months duration.

6.
Article | IMSEAR | ID: sea-195642
7.
Article | IMSEAR | ID: sea-195479

ABSTRACT

Background & objectives: The prevalence of anaemia in pregnancy in India is among the highest in the world. In the last two decades, several national surveys have estimated haemoglobin levels in pregnant women. In this study, data from these surveys were analyzed to find out changes, if any, in prevalence of anaemia in pregnancy. Methods: National and State-level estimates on the prevalence of anaemia were tabulated from the reports of the National Family Health Survey (NFHS) 2, NFHS 3, Fact Sheets of NFHS 4 and District Level Household Survey (DLHS) 2. Unit level data from DLHS 4 and Annual Health Survey Clinical Anthropometric and Biochemical component (AHS CAB) were obtained and State level prevalence of different grades of anaemia was estimated. Time trends in the prevalence of anaemia and different grades of anaemia were assessed from these surveys. Results: NFHS 2, 3 and 4 reported relatively lower prevalence of anaemia as compared to DLHS and AHS CAB. There was not much change in the prevalence or severity of anaemia between NFHS 2, 3 and 4. There was substantial reduction in the prevalence and severity of anaemia in all States except Uttarakhand between DLHS 2 and 4 and DLHS 2 and AHS CAB. Interpretation & conclusions: There was a reduction in the prevalence and severity of anaemia in the last 15 years. The two-pronged strategy of increasing iron intake (dietary diversification and use of iron-fortified iodized salt) in all the population and testing, and detecting and treating pregnant women with anaemia will accelerate the pace of reduction in anaemia.

8.
9.
Indian Heart J ; 2008 Nov-Dec; 60(6): 554-7
Article in English | IMSEAR | ID: sea-5064

ABSTRACT

OBJECTIVE: To assess the efficacy and safety of tenecteplase in Indian patients with ST-segment elevation MI (STEMI). METHODS: Cardiologists/physicians who had used tenecteplase for management of STEMI, recorded safety and efficacy parameters from consecutively treated patients. Tenecteplase was administered as per the prescribing information. Adjunctive therapy which included clopidogrel and UFH/LMWH was administered as routinely practiced and indicated by guidelines. RESULTS: Five hundred and seven patients (male = 415, females = 92; mean age = 58.28 +/- 12.23 yrs; weight (kg) = 70.12 +/- 11.06) with STEMI were treated with weight-adjusted tenecteplase within median chest pain to drug interval of 120 minutes. Resolution of chest pain within median interval of 45 minutes occurred in 436 patients with median duration required for > or = 50% resolution of ST segment of 75 minutes. Clinically successful thrombolysis was reported in 80.67% patients. Five patients suffered intra-cranial hemorrhage (ICH), of which 3 patients had received Gp IIb/IIIa inhibitors. Incidence of intra-cranial hemorrhage attributable to tenecteplase was 0.39% (2 out of 507 patients). Incidence of myocardial re-infarction was 2.96% (15 out of 507 patients). There were 12 deaths (2.36%). CONCLUSION , This data shows that tenecteplase is safe and effective in Indian patients with STEMI and conforms to the international ASSENT-2 trial data.


Subject(s)
Anticoagulants/therapeutic use , Female , Fibrinolytic Agents/adverse effects , Heparin, Low-Molecular-Weight/therapeutic use , Humans , India , Male , Middle Aged , Myocardial Infarction/drug therapy , Platelet Aggregation Inhibitors/therapeutic use , Retrospective Studies , Ticlopidine/analogs & derivatives , Tissue Plasminogen Activator/adverse effects
11.
Indian Heart J ; 2004 Mar-Apr; 56(2): 147-9
Article in English | IMSEAR | ID: sea-3989

ABSTRACT

Bioprostheses frequently become calcified and stenosed, especially when implanted in younger patients. The general recommendation in such cases is to repeat surgery. Balloon valvuloplasty has hitherto been attempted with mixed success. Calcification and limitation of the balloon size due to the valve ring can lead to suboptimal long-term results. We report a case where balloon dilation of the stenosed bioprosthesis at pulmonary position was successfully performed with good immediate result. Cardiac catheterization after 3 years showed only a minimal increase (5 mmHg) in the gradient.


Subject(s)
Abnormalities, Multiple/diagnosis , Adult , Angioplasty, Balloon/methods , Bioprosthesis/adverse effects , Echocardiography, Doppler , Follow-Up Studies , Cardiac Catheterization , Heart Defects, Congenital/diagnosis , Heart Valve Prosthesis/adverse effects , Humans , Male , Prosthesis Failure , Pulmonary Artery , Pulmonary Valve Stenosis/diagnostic imaging , Risk Assessment , Treatment Outcome
12.
Indian Heart J ; 2004 Jan-Feb; 56(1): 64-6
Article in English | IMSEAR | ID: sea-3594

ABSTRACT

Anterior mediastinal teratoma presenting clinically as cardiac tamponade is unusual. We report the case of a 58-year-old woman, with an unremarkable prior history, who was admitted with cardiac tamponade. Emergency pericardial aspiration showed a thick, yellow fluid. Computed tomography scan of the chest was suggestive of anterior mediastinal teratoma rupturing into the pericardium. Within 24 hours, just before the planned surgery could be performed, it re-ruptured, warranting emergency surgery. Histopathology confirmed the diagnosis of a teratoma. Early surgery is recommended for even asymptomatic benign mediastinal teratomas to avoid this potentially lethal complication of rupture into the pericardial cavity, and cardiac tamponade.


Subject(s)
Cardiac Tamponade/etiology , Female , Humans , India , Mediastinal Neoplasms/complications , Middle Aged , Rupture, Spontaneous , Teratoma/complications
13.
Article in English | IMSEAR | ID: sea-92209

ABSTRACT

Turpentine is a volatile hydrocarbon used in polishes, solvents, paints and textile industry. When hydrocarbons are aspirated into the lung, they cause chemical pneumonitis, acute respiratory distress syndrome (ARDS), and rarely pneumatoceles and pneumothorax. We report a 20-year old boy with turpentine-induced chemical pneumonitis that evolved into a bronchopleural fistula. He was treated with oxygen, steroids and intercostal tube drainage. This is the first reported case of turpentine-associated bronchopleural fistula.


Subject(s)
Adult , Bronchial Fistula/chemically induced , Dexamethasone/therapeutic use , Drainage , Glucocorticoids/therapeutic use , Humans , Male , Pleural Diseases/chemically induced , Pneumonia/chemically induced , Prednisolone/therapeutic use , Turpentine/poisoning
14.
Article in English | IMSEAR | ID: sea-95011

ABSTRACT

OBJECTIVE: The aim of this study was to determine the safety and efficacy of adenosine Tc99m sestamibi myocardial perfusion study under controlled conditions and to correlate the adenosine Tc99m sestamibi perfusion defects and the coronary angiography in patients investigated for coronary artery disease. METHODS: This prospective study included 122 consecutive patients who underwent adenosine Tc99m sestamibi single photon emission computed tomography (SPECT) myocardial perfusion study. Seventy two patients had coronary angiographic correlation. All the patients who were referred by the cardiologists for stress myocardial perfusion scan who could not be stressed physiologically for one reason or the other were included in the study. RESULTS: Among the coronary angiography group the overall sensitivity, specificity, positive predictive value and negative predictive value of adenosine Tc99m sestamibi single photon emission computed tomography myocardial perfusion study for detecting significant coronary obstruction (diameter > or = 50%) were 94.4%, 79%, 85% and 92% respectively. The side effects were transient and required no treatment. CONCLUSION: We conclude adenosine Tc99m sestamibi single photon emission computed tomogram myocardial perfusion study is a reliable test with high sensitivity and specificity for the detection of coronary artery disease.


Subject(s)
Adenosine/diagnosis , Adult , Aged , Coronary Angiography , Coronary Circulation/drug effects , Coronary Disease/diagnosis , Female , Humans , Male , Middle Aged , Predictive Value of Tests , Radiopharmaceuticals/diagnosis , Sensitivity and Specificity , Technetium Tc 99m Sestamibi/diagnosis , Tomography, Emission-Computed, Single-Photon , Vasodilator Agents/diagnosis
15.
Article in English | IMSEAR | ID: sea-88738

ABSTRACT

Marfan's syndrome is an autosomal dominant disorder with risk of premature death from rupture of an aneurysm or aortic dissection. A case of acute severe aortic regurgitation due to flail aortic valve in a patient with family history of Marfan's syndrome which may be a form fruste of this syndrome is reported.


Subject(s)
Acute Disease , Adult , Aortic Valve Insufficiency/etiology , Cardiac Catheterization , Humans , Male , Marfan Syndrome/complications , Pedigree
16.
J Indian Med Assoc ; 2003 Apr; 101(4): 248-9, 265
Article in English | IMSEAR | ID: sea-105583

ABSTRACT

Pulmonary embolism and deep venous thrombosis account for hundreds of thousands of hospitalisation and afflict millions of individuals worldwide. A brief overview on the subject concerned is presented here.


Subject(s)
Diagnosis, Differential , Humans , Pulmonary Embolism/diagnosis , Risk Factors , Thrombolytic Therapy
17.
J Indian Med Assoc ; 2003 Apr; 101(4): 227-8
Article in English | IMSEAR | ID: sea-101796

ABSTRACT

Circadian variations in the incidence of hypertension and coronary events are well known with early morning surges. Effect of lunar cycles on various medical illnesses like seizures and psychiatric disturbances are documented. However, the effect of lunar cycles on coronary events has been sparsely documented. The authors studied the incidence of acute coronary events and admission patterns in the departments of emergency medicine and cardiology. Inclusion criteria included unstable angina, non-ST elevation myocardial infarction (MI) and ST elevation MI. Exclusion criteria included chest pain syndromes which were subsequently deemed non-cardiac by invasive or non-invasive investigations. Data from 1999 to 2001 were analysed. Admissions on full moon days were compared with those on new moon days. There were 30 full moon days and 30 new moon days and 223 admissions on full moon days and 266 on new moon days. This difference was statistically significant [p = .005]. Sixty-seven per cent were males and the rest were females. Subgroup analysis of mortality, postinfarction angina, effect on diabetics and hypertensives were done which showed an increased trend in new moon days. It is concluded that there is increased incidence of acute coronary events associated with new moon days.


Subject(s)
Acute Disease , Angina, Unstable/epidemiology , Female , Humans , Incidence , India/epidemiology , Male , Moon , Myocardial Infarction/epidemiology , Periodicity , Prognosis , Retrospective Studies
18.
Article in English | IMSEAR | ID: sea-88521

ABSTRACT

OBJECTIVE: To study clinical profile, risk factors and pattern of coronary artery involvement in females. MATERIAL AND METHOD: Female patients undergoing coronary angiography at Apollo Hospitals, Chennai during 1996-1998 for angina were analysed for risk factors. RESULTS: Out of 5997 angiograms, 660 (11%) were females of which 574 (88%) post-menopausal. 48% had atypical chest pain, 11% had unstable angina, 1% had acute myocardial infarction (MI). Past history of MI was present in 48%. Risks factors were hypertension in 60%, diabetes in 52%, obesity in 41%, dyslipidemia in 32%, family history in 36%. 71% patients used oral contraceptive. None of the patients were smoker, 34.8% pre-menopausal and 72.2% post-menopausal had coronary artery disease. Single vessel disease 33% vs 22.1% two vessel disease 43.3 vs 31.2%. Triple vessel 22.3 vs 46.6% and diffuse disease 10% vs 38.7% was seen in pre-menopausal vs post-menopausal females, respectively. CONCLUSIONS: Family history was the predominant risk factor in pre-menopausal and diabetes mellitus and hypertension in post-menopausal females. Diffuse and triple vessel disease were significantly common in post-menopausal females.


Subject(s)
Adult , Coronary Angiography , Coronary Disease/epidemiology , Female , Humans , India/epidemiology , Middle Aged , Postmenopause , Premenopause , Prospective Studies , Risk Factors
20.
J Indian Med Assoc ; 2002 Jul; 100(7): 461-2, 464
Article in English | IMSEAR | ID: sea-97407

ABSTRACT

Here one case of bronchial carcinoid is reported, which presented as intrabronchial obstructing lesion with sequelae. Carcinoid syndrome is quite uncommon with bronchial carcinoids and x-ray or CT usually gives non-specific appearances. Still, the relatively younger age group of patients and presence of obstructing lesions in major bronchi with features like extraluminal extension and mucoid impactions are helpful signs. However, a few instances of carcinoid mimics do occur during imaging studies, like other types of intrabronchial tumours and long standing foreign bodies.


Subject(s)
Adult , Bronchial Neoplasms/pathology , Carcinoid Tumor/pathology , Diagnosis, Differential , Humans , Male , Tomography, X-Ray Computed
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