ABSTRACT
Dengue fever is an arboviral infection, which is highly prevalent in tropical and subtropical climates. It is frequently associated with neurological complications but its association with ischemic stroke is ill defined. We present a case of an apparently healthy young male admitted with dengue fever complicated by ischemic infarct in corpus callosum. Our patient was managed conservatively, improved clinically and discharged in satisfactory condition.
ABSTRACT
Multiple primary cancer is no longer a rarity. As life expectancy has increased, more individuals are living long enough to develop not only one but also two or more cancers. Herein, we report on three cases of synchronous malignancies associated with the primary esophagus cancer. All three patients posed a challenge for the treatment. These patients carry a dismal prognosis so early diagnosis of subsequent cancer at a curable stage by regular follow-up is encouraged. The early investigation of new symptoms and signs may help to diagnose, initiate early treatment, and reduce the number of deaths from subsequent primary cancers in patients.
ABSTRACT
Dengue fever is an arboviral infection, which is highly prevalent in tropical and subtropical climates. It is frequently associated with neurological complications but its association with ischemic stroke is ill defined. We present a case of an apparently healthy young male admitted with dengue fever complicated by ischemic infarct in corpus callosum. Our patient was managed conservatively, improved clinically and discharged in satisfactory condition.
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Context: Cleaning and shaping of the canals damages the root dentin which becomes a gateway to dentinal cracks and thereby causes failure of the treatment. Aim: The aim of this study was to assess and compare dentinal crack formation caused by three different nickel–titanium (NiTi) rotary file systems in primary anterior teeth. Settings and Design: The present in vitro study is an experimental, comparative study. Materials and Methods: One hundred fifty extracted primary anterior teeth were included in this study. The teeth were randomly divided into five groups. Group 1: Pedoflex rotary file system, Group 2: Prime Pedo™ rotary file system, Group 3: Kedo-S2 rotary file system, Group 4: K-files, and Group 5: no instrumentation. Roots were sectioned and viewed under a stereomicroscope for the presence of any cracks. Statistical Analysis Used: The data were analyzed using the Chi-square test and Kruskal–Wallis test. Results: In the coronal, middle, and apical thirds, Group 2 showed a maximum number of crack formations in the middle third (57%), followed by Group 3 (43.3%) and Group 1 (36.7%). Groups 4 and 5 showed no crack formation in all the root sections. The middle third showed a maximum number of crack formations compared to the coronal and apical thirds. Conclusions: Rotary systems render various benefits with an acceptable success in comparison to conventional hand instrumentation. Within the limitation of this study, it was found that Pedoflex rotary file system was the best with the least number of crack formations.
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Background & objectives: Inflammation has been studied to be an important contributory factor to carcinogenesis through pro-inflammatory markers such as interleukin (IL)-6 and C-reactive protein (CRP). Furthermore, K-ras mutation is an important genetic alteration in the pathogenesis of pancreatic cancer. This study aimed to compare these inflammatory markers in pancreatic ductal adenocarcinoma (PDAC) with the diseased and healthy controls (HCs) and to check for any association between IL-6 and CRP serum levels with the disease status, survival and K-ras mutation status of PDAC patients. Methods: The study included 135 PDAC, 25 chronic pancreatitis (CP) patients and 25 HCs. The serum levels of IL-6 and CRP were detected by enzyme-linked immunosorbent assay and K-ras mutations were detected by polymerase chain reaction-restriction fragment length polymorphism technique. Results: The serum levels of both these markers were elevated in PDAC cases than that in HCs. High IL-6 levels and higher CRP levels were found to be associated with locally advanced disease, lymphatic invasion, metastasis and advanced stage of the PDAC. In patients with unresectable PDAC, higher IL-6 levels were found to be associated with the presence of K-ras mutations. Interpretation & conclusions: Higher IL-6 and CRP levels in patients with advanced PDAC suggest an important role of these inflammatory markers in tumour progression. Furthermore, the association of mutations in the K-ras gene with serum IL-6 indicates cross-talks that may contribute to the progression of the PDAC.
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Background: This randomized prospective double-blind study was designed to evaluate the efficacy and side effects of low doses clonidine for perioperative haemodynamic stability and postoperative recovery.Methods: Patient’s with ASA grade I–II undergoing laparoscopic cholecystectomy were randomized into three groups of 30 patients each. All patients received either normal saline 10 ml (Group I) or 0.8 µg/kg (Group II) or 1 µg/kg (Group III) over duration of 180 seconds, 10 min prior to laryngoscopy and intubation. Anaesthesia was induced with 1% propofol (2 mg/kg) and maintained with nitrous oxide 60% in oxygen and isoflurane. The parameters assessed at various time intervals were heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure and sedation score.Results: Both doses of clonidine proved to be effective in perioperative haemodynamic stability. Clonidine 0.8 mcg/kg was as effectve and safer to Clonidine 1 mcg/kg for attenuatíon of the hemodynamíc responses to laparoscopy. There were no significant differences in the parameters of recovery between groups.Conclusions: Significant hemodynamic derangements can occur during laproscopic cholecystectomy at intubation, pneumoperitoneum and extubation. These were effectively attenuated by premedication with 0.8 mcg/kg and 1 mcg/kg of intravenous clonidine. Dose of 1 mcg/kg though found to be effective but produced adverse effects in form of hypotension and bradycardia.
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Background: The practice of giving antibiotic prophylaxis has resulted in the reduction of surgical site infections (SSI), thus reducing cost, morbidity, and mortality. Common nosocomial infections in surgical patients include SSIs, urinary tract infections (UTIs), pneumonias and blood stream infections (BSIs). The present study was, therefore, designed to analyze the efficacy of antimicrobials used for prophylaxis during surgery in a tertiary care hospital in India.Methods: Total 100 patients were enrolled. Name, timing, route, dose of antimicrobials given were recorded. All the relevant data was taken from the patient抯 medication charts and medical records. Chi-square test and t-test were applied.Results: The optimal time of giving antimicrobial prophylaxis in present study was 1 hour before the surgery. A total of 8 different antimicrobials were prescribed to 100 patients, out of which most commonly prescribed were cephalosporin i.e. 82%. Majority of SSI (57.12%) occurred when the duration of surgical antimicrobial prophylaxis (SAP) was for ?2 hours (p value <0.05). Common organisms seen in SSI were E. coli, S. aureus, Pseudomonas and Kleibsella species. The hospital stay of patients with SSI was more as compared to patients without SSI in present study (p value <0.05).Conclusions: It has been observed that inappropriate selection and timing of giving SAP play an important role in developing SSI, which can be adequately controlled by adopting SAP guidelines, good infection control practices and risk factor analysis.
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Background: In India, a proper reporting of medication errors in the hospital is not available. Drugs worth crores of rupee are consumed every year but a substantial part of these drugs are irrationally prescribed. In order to promote rational drug usage standard policies on use of drugs must be set, and this can be done only after the current prescription practices have been audited. The prescriptions were analyzed based on the objectives of the study in order to promote rational use of drugs in a population. Methods: The study was carried out prospectively over a period of two months and 15 days in general medicine OPD of our tertiary care hospital. A specially designed performa was used with pre-inserted carbons. Results: Two hundred and thirty seven prescriptions were analyzed. Total no. of drugs in 237 prescriptions were 1001. Therefore average number of drugs/prescription is 4.22. Drugs were prescribed by generic names in 3.79% of cases, drugs on EDL are only 53.25% and fixed dose combinations are 26.87% of total drugs. Dosage forms used were mostly oral -93.51%. Injectables were only 6.19% and topical forms were least 0.299%. Doctors profile indicates that maximum number i.e. 93.67% were general practitioners. Basic information of patient was written in 72.57% prescriptions. Complete diagnoses were written in 70.04% prescriptions. Only 88.61% prescriptions were legible and only 76.79% prescriptions were complete in terms of dose, route, strength, frequency and dosage forms. Disease pattern seen was variable. Diseases of respiratory system were maximum 44.72 % followed by infectious and parasitic diseases - 16.03 % and diseases of digestive system - 13.92 %. The most common drug groups prescribed were NSAIDs± serratiopeptidases, antibiotics, antihistaminics, multivitamins, minerals, enzymes and expectorants & bronchodilators. The incidence of polypharmacy was also common with maximum number of drugs which were prescribed per prescription were four in 39.24% of prescriptions. The prescriptions also had other minor anomalies. Conclusions: This study showed that there is scope for improvement in prescribing patterns in areas of writing generic names of drugs, essential drugs, writing legible and complete prescriptions. Polypharmacy was also evident from our study. Establishment and implementation of appropriate clinical guidelines, use of essential medicines list, public education about medicines and regular update to the clinicians will help in implementing the principles of rational pharmacotherapeutics.