RÉSUMÉ
A kidney transplant, sometimes known as a renal transplant, is the treatment of choice for kidney failure at end stage renal disease (ESRD). The renal transplant surgery is followed by a lifetime course of immunosuppressive agents, divided into initial induction phase and later maintenance phase. It is seen that the risk of acute rejection is maximum in the initial months after transplantation (induction phase) and then reduces later (maintenance phase). In induction phase there is use of high-intensity immunosuppression immediately after transplantation, when the risk of rejection is maximum and then the dose reduced for long- term therapy. The main challenge in the renal transplantation community is long- term transplant survival. Long-term graft loss is mainly due to acute and chronic graft rejection, and also due to complications of immunosuppressive therapy. Currently, there is triple therapy as conventional immunosuppressive protocol: a calcineurin inhibitor, an antimetabolite agent, and a corticosteroid. The main aim of development of new immunosuppressive agents is not only improvement of short- term outcomes but also to increase the long- term graft survival by less nephrotoxicity, and minimal side-effects.
RÉSUMÉ
Background: COVID-19 pandemic had affected majority of the population across the world. Majority of the cases still complaining of post COVID symptoms. This study was undertaken to study the various pattern of post COVID-19 manifestations in this region in a group of patients attending hospital. Methods: An observational study was undertaken in a group of 120 patients attending a tertiary care hospital. The patients were subjected for a detailed history and thorough physical examination and the details were entered in to a proforma. The data thus obtained was compiled and analysed. Results: This study had shown than majority of cases were aged more than 50 years and most of them were females. The common post COVID-19 manifestations included joint pain, continued loss of taste and smell, dyspnoea, Anxiety/ depression and sleep disturbances in this study. Conclusions: This study had observed continued symptoms from the episode of disease varying from mild to severe manifestations. This study urges for a comprehensive rehabilitation program for all COVID-19 patients.
RÉSUMÉ
Background: Use of irrational and unnecessary antimicrobials remains common in the developing countries. The present study was conducted to evaluate the use of antimicrobial agents in the tribal district hospital of Andhra Pradesh India. Methods: In this retrospective study, 200 hospitalized cases from medicine, surgery, obstetrics and gynaecology and paediatrics departments were randomly selected. Results: Most common diagnosis was febrile illness (15%) followed by gastroenteritis (10%) and malaria (8%). Antimicrobials were used in 57% cases. All the cases were managed by empirical treatment. Cefixime (40%) was the most common antimicrobial followed by ampicillin (32.50%), metronidazole (30%) and ciprofloxacin (26.50%). Use of antimicrobial monotherapy (41.67%) and 2 drug therapy (36.46%) was common. Conclusion: Empirical use of higher antimicrobial agents is routine and cheap antimicrobials like ampicillin are still most useful drugs in the region. There is a need of specific essential drug list for the region.
RÉSUMÉ
Recurrence of coiled aneurysm usually due to coil compaction is a known phenomenon. Extent of recurrence and its relation to re-bleeding is not known. The authors report a case of spontaneous asymptomatic extrusion of guglielmi detachable coils from the dome of a previously ruptured anterior communicating artery aneurysm two years after the initial endovascular obliteration. The initial aneurysm had a suitable neck-aspect ratio for endovascular obliteration with uncomplicated coiling procedure. Extreme degree of coil compaction with subsequent expulsion of the coils from the dome due to water-hammer effect of blood flow is thought to be the main pathogenic mechanism of this rare but worrying complication. Surgical management includes clipping at the neck ensuring complete obliteration of the aneurysm. Postoperative angiogram to confirm its satisfactory obliteration is advised.
RÉSUMÉ
The authors report a rare case of acute ipsilateral blindness that occurred after a standard fronto-temporal craniotomy for aneurysm in supine position. Posterior ischemic optic neuropathy caused by external pressure on the ipsilateral eye, its differentials and subsequent medico-legal implications are discussed.