Pulmonary haemorrhage syndrome associated with dengue haemorrhagic fever.

Dengue fever is a major public health problem in India. Dengue haemorrhagic fever (DHF), a more serious form of disease, occurs when a person previously infected with dengue is reinfected with a different serotype. Besides common manifestations pleural effusion, pneumonitis, haemoptysis and pulmonary haemorrhage have rarely been seen. We report a case of 30 years old male, who developed pulmonary haemorrhage, haemoptysis requiring blood transfusion. Serology was consistent with the diagnosis of dengue haemorrhagic fever.

Choledochoduodenostomy: a study of 28 consecutive cases.

OBJECTIVES: Choledocholithiasis is a common problem in South Asia. Proper drainage of the CBD is essential to reduce the chance of residual stones and recurrent stones. The paper highlights the surgical management of choledocholithiasis by side to side choledochoduodenostomy and the post surgical complications. METHOD: 28 cases of choledocholithiasis treated by choledochoduodenostomy between March 1995 and June 2003 were studied. After pre operative diagnosis and per operative confirmation, side to side choledochoduodenostomy was done. It is a triangulated anastomosis between the bile duct and post bulbar duodenum using single layer interrupted suture. The cases were meticulously followed up for detecting complications RESULTS: 79% of the patients who underwent choledochoduodenostomy were female and majority (43%) belonged to the 51 to 60 age group. All the patients selected for CDD had a dilated common duct of at least 1.5 cm diameter and 71% of them had multiple stones. 79% were asymptomatic during the follow up, two patients developed wound infection. 18% developed alkaline reflux gastritis and only one patient suffered from recurrent cholangitis because of inadequate stoma size. No case of sump syndrome was observed in this series. CONCLUSION: Side to side CDD is an easy, effective and definitive method of decompression, especially when there are multiple stones in a dilated CBD.

Cases of perforated duodenal ulcer treated in College of Medical Sciences, Bharatpur over a period of one year.

BACKGROUND: Eighteen patients were studied in our institution between January and December 2002. Simple closure followed by eradication of Helicobacter Pylori was used to manage the cases of perforated duodenal ulcer. METHOD: After resuscitation, laparoscopy followed by simple closure of perforation reinforced with pedicled omental patch was performed for all the patients. H- Pylori eradication using "triple regime" was done in all. Follow-up between 6 to 12 months was done, for which endoscopy and Visick's grade was used. Results: All the patients were male, maximum incidence (39%) noted in 51 to 60 age group. Mean time interval between start of symptoms and surgery was 60 hours. As a result the patients were moribund with gross purulent peritonitis and poor general condition. Chest infection was the commonest complication (44%) and two patients (11%) with very poor prognosis died during post operative period. Good to excellent results using Visick's grades were obtained in 81% surviving patients. Endoscopy did not show active ulcer in any of the patients. CONCLUSION: Patients with perforated duodenal ulcer were late in presenting to the hospital, precluding the option of definitive surgery for peptic ulcer disease. Simple closure of perforated duodenal ulcer if combined with eradication of H-Pylori is an effective method of treatment of duodenal perforation and is not associated with high recurrence of symptoms of peptic ulcer disease.

Evaluation of communication skills of physicians about asthma.

OBJECTIVE: Communication skills in medical practice are important. To assess the communication skills of physicians about asthma, we undertook this study. METHODS: One thousand four hundred and twenty one physicians attending the annual conference of association of physicians of India volunteered to participate in the study. They were divided into three categories. 'Teachers' group 1, (n = 131), 'Clinicians', group 2, (n = 951) and 'Students' group 3, (n = 339). Questionnaire containing ten most frequently asked questions by asthmatic patients were given to the physicians. A panel of three patients assessed the replies of these question and graded them as 'Convincing', 'Just convincing' and 'Not convincing'. RESULTS: Replies of only 2% of physicians were graded as convincing, 15.6% just convincing and 82.4 as not convincing. Among group 1 none gave a convincing reply while replies of 2.2% of group 2 and 2.4% of group 3 were graded as convincing. The difference in results was not significant statistically on comparing the three groups (p > 0.1). CONCLUSIONS: Communication skills are the integral part of patient care and management. Our study demonstrated lack of effective communication skills among physicians.

Lipid profile in rheumatoid arthritis and its relation to disease activity.

AIM OF THE STUDY: To ascertain whether--1. Serum lipids are altered in rheumatoid arthritis (RA) patients and 2. Disease activity has any role in altering lipid profile. METHODOLOGY: Lipid profiles of 25 RA cases were compared with age and sex matched controls. RESULTS: Serum triglycerides (STG) and total cholesterol (TC) were found to be significantly lower in RA patients. In patients with very active disease, activity index (AI) > 80, STG, TC and low-density lipoprotein (LDL-C) were significantly lower as compared to controls. For TG 'r' value of -0.483 indicated negative correlation between disease activity and TG values, though the correlation is not significant (p > 0.05). For TC 'r' value (-0.0551) indicates negative correlation between disease activity and serum TC.

Mitochondrial diseases: an overview of genetics, pathogenesis, clinical features and an approach to diagnosis and treatment.

Defects in structures or functions of mitochondria, mainly involving the oxidative phosphorylation, mitochondrial biogenesis and other metabolic pathways have been shown to be associated with a wide spectrum of clinical phenotypes. The ubiquitous nature of mitochondria and their unique genetic features contribute to the clinical, biochemical and genetic heterogenecity of mitochondrial diseases. This article focuses on the recent advances in the field of mitochondrial disorders with respect to the consequences for an advanced clinical and genetic diagnostics. In addition, an overview on recently identified genetic defects and their pathogenic molecular mechanisms are given.

Serum, CSF, RBC & urinary levels of magnesium & calcium in idiopathic generalised tonic clonic seizures.

Serum, cerebrospinal fluid (CSF) and urinary levels of magnesium and calcium and RBC magnesium levels were studied in 100 patients of idiopathic generalised tonic clonic seizures and 95 healthy controls matched for age and sex. There was a significant reduction in serum, CSF and RBC magnesium levels and a rise in serum and CSF calcium levels in epileptic patients. The 24 h urinary excretion of calcium and magnesium in the epileptics did not differ from controls. Post ictal (within 24 h of seizure) serum and CSF magnesium levels were significantly lower and calcium levels significantly higher as compared to inter ictal levels (4 wk after seizure). There was no correlation between serum magnesium, serum calcium and CSF calcium levels and the frequency, control or duration of fits. Low CSF magnesium levels correlated with increased frequency, poor control and longer duration of fits. Patients with status epilepticus and those in the EEG abnormalities had low CSF magnesium levels.

Cerebrospinal fluid free N-acetyl neuraminic acid levels--a diagnostic and prognostic test in meningitis.

Cerebrospinal fluid (CSF) free N-acetyl neuraminic acid (NANA) levels were estimated in 20 cases each of pyogenic and tubercular meningitis (TBM) and 10 controls. The levels of free NANA were significantly high (P less than 0.001) in pyogenic and partially treated pyogenic meningitis when compared to TBM. The CSF free NANA levels had direct correlation with severity of the disease, CSF sugar and protein levels in pyogenic meningitis. The CSF free NANA can even be a prognostic criterion in management of pyogenic meningitis. Higher the levels, poorer the prognosis.