Microalbuminuria: As an Indicator of Sepsis and to Predict Mortality in Patients Admitted to Intensive Care Unit

Background: Sepsis is an important healthcare concern in India as well as globally. This study shows how the level of microalbuminuria predict mortality of patients diagnosed with sepsis and those without sepsis. Methods: In this study total 150 patients of which 75 patients belonging to each sepsis and non-sepsis group, with age >15 years admitted in Medical Intensive Care Unit (ICU) were enroled Microalbuminuria levels were analyzed at admission and after 24 hours after admission. Results: Microalbuminuria levels were significantly high in patients with sepsis as compared to non sepsis. Microalbuminuria has highest sensitivity of 90 % and specificity of 98 % to differentiate between sepsis and non sepsis in comparison to APACHE II and SOFA scores. Conclusion: Serial monitoring of bedside urine albumin-creatinine measurement might help in the early identification of patients with sepsis that requires early targeted therapy. The 24-hour ACR assessment predicts ICU survival and may have the potential to monitor the efficacy of therapeutic interventions delivered, such as fluid resuscitation, appropriate antibiotics, vasopressors, and ionotropes that affect the endothelium.

A Cross-Sectional Study of Attitude and Practices Regarding Animal Bite Among Attendees of Anti Rabies Clinic of a Teaching Hospital, Jaipur

Introduction: Rabies is a zoonotic disease having almost100% fatality. Proper and timely management of animal bitecases can prevent the fatal disease. We conducted this studyto assess the attitude and practices of animal bite victimregarding animal bite management at Anti rabies clinic, RDBPJaipuria hospital.Methods: This observational study was conducted among 107attendees of anti-rabies clinic of Govt. R.D.B.P. Jaipuriahospital associated with RUHS College of medical sciences,Jaipur from February 2018 to July 2018. Data was collectedusing a predesigned semi-structured questionnaire. Data wereanalysed using IBM SPSS software version 20.0.Results: 107 participants were enrolled in the study. Maximumparticipants were males (72%), from age group of 26–35 years(43%), urban area (72%), and studying in 10th standard(22.5%). 76% of the participants were having good attitude butonly 36% participants were having good practices regardingmanagement of animal bite cases. Good attitude regardingreaction after animal bite, seriousness of disease, whom toconsult, what to do immediately after bite of animal, vaccinationof bite victim, pet dog vaccination and vaccination of contactswas among 55.14%, 48.6%, 88.78%, 56.07%, 93.46%,66.35% and 37.38% respondents respectively. Only 56% werehaving practice of washing wound with soap and water while16.82% were practicing application of red chilli, 14% werepracticing lime application and 13% participants were havingpractice of applying nothing on animal bite wound. 44% victimsdid not wash the wound before visiting the clinic. Majority(98.13%) visited doctor after animal bite while 1.87% visited totraditional healers first.Conclusion: Practices of applying red chilli and lime on theanimal bite wound is widely prevalent in the community.Community health awareness campaign should involvepreventive measures of rabies and immediate actions afteranimal bite.

Neonicotinoid insecticides: an emerging cause of acute pesticide poisoning

Neonicotinoids are a new class of insecticides widely applied for crop protection. Information on human exposures to neonicotinoids is limited. The most common routes of exposure were ingestion (51%), dermal (44%), and ocular (11%). These insecticides act as agonists at nicotinic acetylcholine receptors, which cause insect paralysis and death the high specificity for receptors in insects was considered to possess highly selective toxicity to insects and relative sparing of mammals. However, an increasing number of cases of acute neonicotinoid poisoning have been reported in recent years. Present study report three cases presented to us with acute neonicotinoid poisoning with different manifestations including acute myocardial infarction, central nervous system (CNS) depression, and acute kidney injury, who recovered subsequently with supportive care. A detailed literature review found that respiratory, cardiovascular and certain neurological presentations are warning signs of severe neonicotinoid intoxication. Supportive treatment and decontamination are the practical methods for the management of all neonicotinoid-poisoned patients.

Pattern of hepatobiliary involvement in HIV/AIDS patients: study in a tertiary care centre

Background: Diseases of hepatobiliary system is a major problem in patients with HIV infection. It has been estimated that approximately one third of the death of patients with HIV infection are in some way related to liver disease. While this is predominantly a reflection of the problems encountered in the setting of co-infection Hepatitis B or C, it is also a reflection of the hepatic injury in the form of hepatic steatosis, that can be due to antiretroviral therapy. There had been little work done on liver function tests in HIV patients without pre-existing liver disease like viral hepatitis, or alcoholic hepatitis. So, this study was designed to assess the pattern of liver function test derangement in HIV patients. Aims and objective was to study the different pattern of hepatobiliary involvement in HIV positive patients, and to gauge the extent of liver damage.Methods: The study included 50 HIV positive patients coming to SMS hospital and Medical College, Jaipur, in medicine and HIV clinic of skin and VD department. Subjects having HIV test positive by ELISA, are included in this study. Other causes of liver function derangements were excluded from the study.Results: Maximum number of the patients were in the age group of 23-32 years. Out of 50 cases studied, 41 (82 %) cases had abnormal liver function tests, while 9 (18%) had normal liver function tests. Most of the cases had liver function abnormalities, and most common abnormality was raised SGOT/SGPT.Conclusions: Almost all types of liver function tests are found to be deranged in HIV patients. The pattern of hepatobiliary involvement varied from fatty liver, cholestasis to Toxic necrosis and granulomas.

Complete Fistula of the Second Branchial Cleft Managed by Single Neck Incision-our Experience and Review of Literature.

Introduction: Branchial fistulas and cysts, involving soft tissues of the neck, are quite uncommon anomalies of embryonic development that are commonly encountered by pediatric surgeons. Approximately 17% of all cervical masses in the pediatric age group are due to branchial anomalies. Although branchial cleft cysts are usually benign, infection, discharge, mass effect, and other surgical complications account for its morbidity. Aim: To assess 10 rare cases of a complete second branchial fistula which were diagnosed and treated in last 5 years by single neck incision in the Department of Surgery S. N. Medical College, Agra. Material and Methods: 10 cases of complete second branchial fistula were reported and managed in our institute. The age group of patients was from 2 to 12 months of age. These patients presented with an intermittent serous and mucoid discharge from an external opening in the lower aspect of the neck since birth. Most of the patients presented with opening on the right side of the neck. A pre-operative fistula gram done in all cases revealed the internal opening of tracts up to the peritonsillar fossa. In all cases, complete excision of the tracts was done by single step neck incision. Results: All the 10 patients underwent surgery with satisfactory results. Regular follow-up was done at biweekly for 1 month followed by monthly intervals up to 12 months. None developed any complications and no patient had recurrence. Conclusion: Although second branchial fistulae are common, complete fistulae with internal opening up to tonsillar fossa are rare, single step management of these cases merits the publication of this series. The report also guides on the need to perform a pre-operative fistulogram for the management of these cases.

Use of Dorsal Dartos Pedicled Flap Single or Double Layered in Preventing the Fistula Rate Following Tubularized Incised Plate Repair in Distal Hypospadias: A Prospective Randomized Study.

Introduction: Hypospadias is defined as an anomaly involving the ventral aspect of the penis with variable location of meatus from the tip with or without chordae. Objective: To study the role of dorsal dartos pedicled flap for reducing the fistula rate in tubularized incised plate (TIP) repair for distal hypospadias. Methods: Between November 2012 and August 2015, a total of 65 patients with distal penile hypospadias age between 1 and 18 years were included in this study. Patients were divided into 2 groups. Group (A) had 35 patients in which a single layer of dartos flap was used to cover the neourethra during TIP repair while in Group (B) which had 30 patients, the dartos flap was split into two halves and used to cover the neourethra in a double breasting fashion. Patients were followed regularly up to 6 months postoperatively. Results: The success rate shows no statistically significant difference between Group A 35 (94.29%) and B 30 (96.67%) P > 0.05. All successful patients had a satisfactory cosmetic result with a conical glans and vertical slit-like meatus. These results were compared with our 30 cases done previously without using a dartos flap which had a success rate of only 80%. Conclusion: Dartos pedicled coverage of TIP repair offers a significant reduction in fistula rate after TIP in distal hypospadias even though single or double layers of dartos coverage had no significant difference in results.

Mayer-Rokitansky-Küster-Hauser Syndrome with Imperforate Anus: A Rare Association and an Innovative Surgical Management.

Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is one of the rare disorder of Mullerian agenesis leading to non-development of uterus and vagina. Its association with anorectal malformation is rare. We report a case of MRKH syndrome with recto-vestibular in a female child. The child had undergone a sigmoid loop colostomy in the neonatal period. On clinical examination of the perineum, a fistula was present in the vestibule just below the urethral opening, but no vaginal canal was found. It was managed with an innovative surgical technique, preserving the fistula and lower rectum to function as vagina.