Role of peak current in conversion of patients with ventricular fibrillation

<p><b>INTRODUCTION</b>Peak currents are the final arbiter of defibrillation in patients with ventricular fibrillation (VF). However, biphasic defibrillators continue to use energy in joules for electrical conversion in hopes that their impedance compensation properties will address transthoracic impedance (TTI), which must be overcome when a fixed amount of energy is delivered. However, optimal peak currents for conversion of VF remain unclear. We aimed to determine the role of peak current and optimal peak levels for conversion in collapsed VF patients.</p><p><b>METHODS</b>Adult, non-pregnant patients presenting with non-traumatic VF were included in the study. All defibrillations that occurred were included. Impedance values during defibrillation were used to calculate peak current values. The endpoint was return of spontaneous circulation (ROSC).</p><p><b>RESULTS</b>Of the 197 patients analysed, 105 had ROSC. Characteristics of patients with and without ROSC were comparable. Short duration of collapse < 10 minutes correlated positively with ROSC. Generally, patients with average or high TTI converted at lower peak currents. 25% of patients with high TTI converted at 13.3 ± 2.3 A, 22.7% with average TTI at 18.2 ± 2.5 A and 18.6% with low TTI at 27.0 ± 4.7 A (p = 0.729). Highest peak current conversions were at < 15 A and 15-20 A. Of the 44 patients who achieved first-shock ROSC, 33 (75.0%) received < 20 A peak current vs. > 20 A for the remaining 11 (25%) patients (p = 0.002).</p><p><b>CONCLUSION</b>For best effect, priming biphasic defibrillators to deliver specific peak currents should be considered.</p>

Peritonitis secondary to ruptured splenic abscess: a grave complication of typhoid fever

Splenic abscesses are increasingly being identified, possibly due to widespread use of imaging modalities in clinical practice. The commonest clinical features are high grade fever and exclusively localised left upper quadrant abdominal pain. These symptoms are similar to most infectious diseases prevalent in the tropics, making imaging by ultrasonography or computer tomography a necessity in the diagnosis. There are reports from different geographic areas on splenic abscesses associated with typhoid fever. We reported ruptured splenic abscess presenting with peritonitis as a rare and grave complication of typhoid fever.

study to correlate carotid intima thickness by B-mode ultrasonography in patients documented with coronary artery disease

To study the IMT of the common carotid arteries and correlate with documented coronary artery disease. The study was conducted in subjects with history of coronary artery disease in the past and who presented with acute coronary syndrome. After detailed history and examination, investigations were carried out as per our protocol. The sample size was 100, with 70 in the case group and 30 in the control group [matched].B-mode ultrasonography scanning of the carotid arteries was performed and measurements were made at proximal, middle and distal segments of the common carotid arteries. Univariate analysis was used to confirm the significance of the variables and multiple regressions were used to predict the risk, based on significant variables. The total study sample consisted of 100 subjects, of whom 70 were cases and 30 were controls. The case group comprised of a total of 70 patients with a mean age of 58.72 years. In the control group of 30 patients, the mean age was 62.73 years. In the study group, 77.1% [n=54] were males and 22.9% [n=16] were females. In the study group, 51.4% [n=36] were smokers compared with 13.3% [n=4] among the control group [P=0.001 vhs]. In the study group, 20% [n=14] had diabetes while this was 13.3% [n=4] among the control group. In the study group, 52.96% [n=37] had hypertension while 16.7% [n=5] had hypertension in the control group [P=0.001 vhs]. The mean total cholesterol among the study group was 197.4mg/dl while in the control group it was 175.9 mg/dl. Thirty-two percent of the patients with CAD had anterior lateral wall ischemia, 21% had anterior wall, 21% lateral wall, 19% inferior wall and 7% unstable angina. The mean carotid IMT in the study group was 0.923 +/- 0.123 and in control group it was 0.689 +/- 0.051 [P=0.001]. The mean carotid intima thickness was significantly high in the case group as compared with the control, and the P-value was highly significant. The carotid IMT was found to be higher in patients with coronary artery disease, and there was a statistically significant difference between cases and controls. Thus, our study shows that carotid IMT is a marker of atherosclerosis that is strongly associated with risk factors and can be used as a surrogate marker in the prediction of atherosclerosis in coronary artery disease. As it is easily reproducible, carotid B-mode ultrasonography is a safe, non-invasive and reproducible procedure that helps in the early identification of clinical coronary artery disease

Two uncommon manifestations of leptospirosis: Sweet's syndrome and central nervous system vasculitis

To leptospirosis is the commonest spirocheatal infection in the tropical and temperate countries of Indian sub-continent and Africa and the most common zoonosis worldwide. The protean manifestation of this infectious disease is a challenge for practising clinicians across the world. In poor developing countries, at most clinical suspicion it is essential in the diagnosis of this disease. In this report, we are able to document two uncommon manifestations of leptospirosis, namely Sweet's syndrome and central nervous system vasculitis.