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1.
J Mycol Med ; 29(2): 180-184, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31056403

RESUMO

Emergence of saprophytic fungi thriving in dead plant material and soil as opportunistic human pathogens is of great concern. Cladosporium species are environmental saprophytes reported to cause various superficial and invasive fungal infections worldwide. C. sphaerospermum, a predominantly indoor fungus has been reported from cases of meningitis, subcutaneous and pulmonary fungal infections in the past. Herein we report the first case of cerebral abscess due to C. sphaerospermum in an immunocompetent host who was successfully managed by combined medical and surgical therapy.


Assuntos
Abscesso Encefálico/microbiologia , Cladosporium/isolamento & purificação , Cladosporium/patogenicidade , Micoses/diagnóstico , Adulto , Antifúngicos/farmacologia , Encéfalo/diagnóstico por imagem , Abscesso Encefálico/cirurgia , Humanos , Imunocompetência , Imagem por Ressonância Magnética , Masculino , Micoses/tratamento farmacológico , Resultado do Tratamento
2.
Indian J Nephrol ; 28(3): 220-225, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29962673

RESUMO

Hepatitis C virus (HCV) infection in renal allograft recipient is associated with increased morbidity and mortality. At present, only few studies related to treatment and outcomes of HCV-infected renal allograft recipients with DAAs have been published. We aimed the study to assess the efficacy and safety of sofosbuvir-based regimens in HCV-infected renal allograft recipients. We analyzed data of 22 eligible HCV-infected renal allograft recipients (14 genotype-3, 6 genotype-1, one each genotype-2 and 4) who were treated with DAAs at our institute. DAA regimen included sofosbuvir and ribavirin with or without ledipasvir or daclatasvir for 12-24 weeks. Patients were followed up for 24 weeks after completion of treatment. A rapid viral response of 91%, end of therapy response of 100%, and sustained viral response at 12 and 24 weeks of 100% with rapid normalization of liver enzymes were observed. Therapy was well tolerated except for ribavirin-related anemia. A significant decrease in tacrolimus trough levels was observed and most patients required increase in tacrolimus dose during the study. Treatment with newer DAAs is effective and safe for the treatment of HCV-infected renal allograft recipients.

3.
Epidemiol Infect ; 143(1): 71-80, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24641916

RESUMO

We conducted a case-control study involving 150 genotype 3 chronic hepatitis C virus (HCV) patients and 150 healthy controls to investigate the association of polymorphisms in the interleukin-10 (IL-10) gene with chronic HCV infection and the association of these polymorphic variants with the combination of pegylated interferon (Peg-IFN) and ribavirin therapy response. Our data revealed that the GG genotype of IL-10 -1082A/G exhibited significant association with genotype 3 chronic HCV infection compared to controls. Treatment response data also showed a significant increase in risk for the GG genotype of IL-10 -1082A/G in response-relapse patients or non-responder patients compared to sustained virological response patients. Further, a significant increase in risk was also revealed for the CC genotype of IL-10 -592A/C in response-relapse patients or non-responder patients compared to sustained virological response patients, suggesting a role of the GG genotype of IL-10 -1082A/G and CC genotype of IL-10 -592A/C in the treatment outcome of combined Peg-IFN/ribavirin therapy.


Assuntos
Predisposição Genética para Doença , Hepatite C Crônica/tratamento farmacológico , Hepatite C Crônica/genética , Interferon-alfa/uso terapêutico , Interleucina-10/genética , Polimorfismo Genético , Ribavirina/uso terapêutico , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Estudos de Associação Genética , Genótipo , Hepacivirus/genética , Hepatite C Crônica/imunologia , Hepatite C Crônica/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
4.
Indian J Cancer ; 51(2): 142-4, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25104196

RESUMO

OBJECTIVE: To study the incremental role of positron emission tomography (PET)/computed tomography (CT) in the detection of primary site in cases of occult primary with neck metastasis. STUDY DESIGN: A prospective study on 79 consecutive patients. SETTING: A tertiary care otolaryngology and head and neck surgery center. MATERIALS AND METHODS: This prospective study compares the results of PET/CT in 79 patients of occult primary with neck metastasis with that of detailed comprehensive head and neck examination including imaging and panendoscopy. This study also attempts to define the incremental role of PET/CT in patients of occult primary. RESULTS: The sensitivity of PET/CT in identifying the primary tumor was 62.4%, the specificity was 64.7%, the positive predictive value was 69.7% and the negative predictive value was 93%. We had a false positive rate of 33.6% and a false negative rate of 2.6%. CONCLUSION: PET/CT is a sensitive investigation for detection of occult primary. However, it has a low specificity rate and a high false positivity rate. Due to a high false positive rate, multiple biopsies from suspicious sites should be taken rather than solely relying on PET/CT. PET/CT guided fine needle aspiration cytology should be utilized more frequently than we did in this study.


Assuntos
Carcinoma de Células Escamosas/diagnóstico , Neoplasias de Cabeça e Pescoço/secundário , Imagem Multimodal , Neoplasias Primárias Desconhecidas/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/secundário , Endoscopia , Reações Falso-Positivas , Feminino , Neoplasias de Cabeça e Pescoço/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons , Estudos Prospectivos , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X , Adulto Jovem
5.
Nepal Med Coll J ; 14(3): 207-11, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24047017

RESUMO

Tracheostomy is a common surgical procedure performed in patients with severe head injury to facilitate prolonged airway and ventilatory support. Decannulation is the procedure of removing the tracheostomy tube either gradually by downsizing the tube or abruptly in a single sitting. This prospective study was done to evaluate gradual vs abrupt techniques for successful decannulation in tracheostomised severe head trauma patients in Post Graduate Institute of Medical Education and Research (PGIMER), a central government tertiary centre in Chandigarh, India. A total of 118 patients, recruited over one and half years duration were arbitrarily divided into 2 groups: Gradual and Abrupt. Particulars were taken. Time since tracheostomy, timing of decannulation, Glasgow Coma Scale, amount of secretions, breath holding time, CXR and STN radiographs and cough reflex were all assessed. Follow up was done at one month to classify those who were re-tracheostomised or re-intubated as decannulation failures. Sixty-eight patients were decannulated gradually and 50 abruptly. Of the various factors assessed, only cough reflex, number of suctioning required per day, X-ray STN and use of antibiotics for more than 7 days were found to be statistically significant. One hundred and fourteen patients, 67 out of 68 in the GD group and 47 out of 50 in the AD group, had successful outcome. The study showed that success or failure of decannulation is independent of mode of decannulation.


Assuntos
Traumatismos Craniocerebrais/terapia , Remoção de Dispositivo/métodos , Traqueotomia/métodos , Adulto , Estado de Consciência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índices de Gravidade do Trauma , Adulto Jovem
6.
Singapore Med J ; 51(6): e103-6, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20658097

RESUMO

Vascular malformation of the small bowel is an uncommon cause of gastrointestinal haemorrhage. Phlebectasia or venous ectasia is a rare benign vascular anomaly of the gastrointestinal tract. We report a 39-year-old Egyptian man presenting with multiple jejunal phlebectasia, liver haemangioma and port-wine naevus. Despite recurrent melaena, the results of various routine investigations, including repeated endoscopic procedure, were negative. The site and aetiology of bleeding was detected using multidetector computed tomography (MDCT) angiography and was further confirmed by double-balloon enteroscopy. This report emphasises the potential of MDCT angiography in the diagnosis of small intestine lesions presenting as obscure bleeding.


Assuntos
Hemorragia Gastrointestinal/diagnóstico , Jejuno/fisiopatologia , Tomografia Computadorizada por Raios X/métodos , Malformações Vasculares/diagnóstico , Adulto , Enteroscopia de Duplo Balão/métodos , Endoscopia/métodos , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemangioma/diagnóstico , Humanos , Jejuno/anormalidades , Jejuno/diagnóstico por imagem , Masculino , Mancha Vinho do Porto , Resultado do Tratamento , Malformações Vasculares/diagnóstico por imagem
7.
Br J Neurosurg ; 22(3): 447-9, 2008 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-18568739

RESUMO

Primary giant cell tumours of the craniospinal axes are rare lesions. These are benign, localized and lytic bony lesions with occasional malignant behaviour. Their clinical behaviour is unpredictable and, hence, management remains controversial. Radical excision of bony lesion, with adjuvant therapy helps in achieving the desired outcome. In the present communication, we present malignant giant cell tumour of clivus, managed successfully with surgical decompression and adjuvant therapy. Patient remains symptom-free at 2 years of follow-up.


Assuntos
Fossa Craniana Posterior , Tumores de Células Gigantes/diagnóstico , Neoplasias da Base do Crânio/diagnóstico , Adolescente , Feminino , Humanos
8.
Indian J Pathol Microbiol ; 51(1): 49-50, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18417854

RESUMO

The brainstem is an unusual location for a pyogenic abscess. Stereotactic aspiration or microsurgical drainage may be required in antibiotic refractory cases. Prolonged antibiotic therapy, along with symptomatic treatment may provide successful outcome. We report a case of cerebellar and brainstem abscess, managed successfully with prolonged antibiotic administration.


Assuntos
Abscesso Encefálico/diagnóstico , Tronco Encefálico/patologia , Cerebelo/patologia , Antibacterianos/uso terapêutico , Abscesso Encefálico/tratamento farmacológico , Tronco Encefálico/diagnóstico por imagem , Cerebelo/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Radiografia
11.
Spinal Cord ; 45(8): 583-5, 2007 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-17102810

RESUMO

STUDY DESIGN: Human tails continue to elicit curiosity till the present times. A unique case of human cervical dysraphism is described. OBJECTIVES: In addition to the cosmetic stigma, these cutaneous markers provide a lead to reach the underlying spinal dysraphic states. SETTING: Plains of North India. METHODS: A case of human tail at the neck region is presented, whose cutaneous deformity lead the clinicians to his underlying spinal dysraphic state. RESULTS: The final outcome of the patient was favorable. CONCLUSION: Such markers should always be looked upon with a caution. The present report describes a unique case of a human neck tail, a causing cervical cord tethering.


Assuntos
Vértebras Cervicais/anormalidades , Defeitos do Tubo Neural/etiologia , Anormalidades da Pele/complicações , Disrafismo Espinal/complicações , Disrafismo Espinal/patologia , Vértebras Cervicais/diagnóstico por imagem , Cabelo/patologia , Humanos , Processamento de Imagem Assistida por Computador , Imagem Tridimensional , Lactente , Masculino , Procedimentos Neurocirúrgicos , Anormalidades da Pele/patologia , Disrafismo Espinal/diagnóstico por imagem , Disrafismo Espinal/cirurgia , Tomografia Computadorizada por Raios X
12.
AJNR Am J Neuroradiol ; 27(6): 1217-21, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-16775267

RESUMO

Primary amebic meningoencephalitis and granulomatous amebic meningoencephalitis are central nervous system infections caused by free-living amebae. We describe the neuroimaging findings in 5 such cases on CT and MR imaging. A spectrum of findings was seen in the form of multifocal parenchymal lesions, pseudotumoral lesions, meningeal exudates, hemorrhagic infarcts, and necrosis in the brain. Familiarity with the imaging findings is important for the diagnosis and management of this nearly universally fatal disease.


Assuntos
Acanthamoeba , Amebíase/diagnóstico , Meningoencefalite/diagnóstico , Naegleria fowleri , Adolescente , Adulto , Amebíase/patologia , Animais , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Criança , Diagnóstico Diferencial , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Meningoencefalite/patologia , Tomografia Computadorizada por Raios X
13.
Br J Neurosurg ; 20(6): 420-3, 2006 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-17439096

RESUMO

Trivial injuries among paediatric patients are usually underestimated. Such injuries may account for delayed problems such as growing fractures of skull vault. Growing fracture of the orbital roof is rarely reported. Four cases of paediatric cranial trauma with growing orbital roof fractures are presented. Three cases required only dural repair, while the fourth patient underwent both duraplasty and cranioplasty, due to a large orbital roof defect. At follow-up, all had satisfactory outcome. Trivial injuries among children should be evaluated with caution. The development of orbital symptomatology should ask for a complete radiological survey. The orbital roof growing fractures are potentially important cause of orbital problems. The dural repair alone, usually provides satisfactory outcome, while calvarial bone graft may be of help in cases with large bony defects. Early diagnosis and management of such cases may prevent permanent neurological deficits.


Assuntos
Traumatismos Cranianos Fechados/complicações , Fraturas Orbitárias/diagnóstico , Fraturas Cranianas/diagnóstico , Pré-Escolar , Exoftalmia/etiologia , Feminino , Humanos , Lactente , Imagem por Ressonância Magnética , Masculino , Fraturas Orbitárias/cirurgia , Fraturas Cranianas/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
14.
Br J Neurosurg ; 19(6): 490-4, 2005 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-16574562

RESUMO

Development of a contralateral epidural haematoma during or immediately after cranial surgery is a well-described entity. However, in a case of acute subdural haematoma where the brain is usually tense, postoperative development of contralateral extradural haematoma is uncommon. We report two cases of contralateral extradural haematoma after decompressive surgery for acute subdural haematoma. We recommend routine postoperative CT immediately after cranial surgery for head trauma. This would help in timely detection and treatment of such a complication.


Assuntos
Craniotomia/efeitos adversos , Descompressão Cirúrgica/efeitos adversos , Hematoma Epidural Craniano/etiologia , Hematoma Subdural Agudo/cirurgia , Adulto , Edema Encefálico/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
15.
Br J Neurosurg ; 19(4): 352-4, 2005 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-16455544

RESUMO

The use of wound drains in surgical practice, very often falls into the realm of habit, rather than science. The utility of a prophylactic drain in surgical wounds may be questionable, but this practice is not uncommon, despite complications. We report a case of fatal haemorrhage from the superior sagittal sinus, due to a closed negative suction drain of the craniotomy wound in an infant operated upon for a growing fracture skull.


Assuntos
Hemorragia Cerebral/etiologia , Cavidades Cranianas/lesões , Complicações Pós-Operatórias , Fraturas Cranianas/cirurgia , Craniotomia , Evolução Fatal , Humanos , Lactente , Masculino , Cuidados Pós-Operatórios/efeitos adversos , Fraturas Cranianas/diagnóstico por imagem , Sucção/efeitos adversos , Tomografia Computadorizada por Raios X
16.
Br J Neurosurg ; 18(5): 556-60, 2004 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-15799167

RESUMO

Intraparenchymal posterior fossa neoplasms containing intratumoural abscesses are rare. Intrasellar or parasellar tumours are among the common neoplasms developing such a complication, as the result of direct extension of the microbial flora from the contiguous infected sinuses. All meningiomas reported with such a complication have been located parasagittally. A short series of three posterior fossa tumours, containing intra-tumoural abscesses, are described, of which only one was diagnosed pre-operatively. A haematogenous pathway was considered as the mode of spread in all three patients. Magnetic resonance imaging was performed in all patients and the features are discussed.


Assuntos
Abscesso Encefálico/etiologia , Neoplasias Meníngeas/complicações , Meningioma/complicações , Neoplasias da Base do Crânio/complicações , Adulto , Abscesso Encefálico/diagnóstico , Fossa Craniana Posterior , Humanos , Lactente , Imagem por Ressonância Magnética , Masculino , Neoplasias Meníngeas/diagnóstico , Meningioma/diagnóstico , Neoplasias da Base do Crânio/diagnóstico
17.
J Health Popul Nutr ; 19(3): 204-8, 2001 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-11761775

RESUMO

Coeliac disease is an important cause of chronic diarrhoea, failure to thrive, and anaemia in children. Little information on the disease is available in India. This study was undertaken to determine the prevalence, clinical, anthropometric and histological profiles of coeliac disease in patients attending a tertiary referral centre in India. Coeliac disease was diagnosed in 42 (16.6%) of 246 children with chronic diarrhoea, failure to thrive, and anaemia. The mean ages at onset of symptoms and at diagnosis were 2.4 (range 0.5-10) years and 8.3 (range 3-14) years respectively, and a mean period of delay in diagnosis was 5.9 (range 1-13.5) years. Of the 42 cases, history of failure to thrive was observed in 38 (90%), chronic diarrhoea in 37 (88%), and anaemia in 6 cases. Short stature, under-nutrition, anaemia, oedema of feet, rickets, clubbing of fingers, features of vitamin A deficiency, and B-vitamin deficiency were found in 42, 26, 38, 9, 8, 6, 3, and 2 cases respectively. Onset of symptoms, such as, chronic diarrhoea and failure to thrive, was earlier in children with subtotal villous atrophy than in those with partial villous atrophy (mean +/- SD; 2.00 +/- 1.46 years vs 3.30 +/- 2.72 years; p < 0.05). Results of the study suggest that coeliac disease is not uncommon in Indian children. Coeliac disease should be considered in the differential diagnosis, particularly in children without any symptoms of diarrhoea.


Assuntos
Doença Celíaca/epidemiologia , Adolescente , Anemia/epidemiologia , Anemia/etiologia , Doença Celíaca/complicações , Doença Celíaca/diagnóstico , Criança , Pré-Escolar , Diagnóstico Diferencial , Diarreia/epidemiologia , Diarreia/etiologia , Insuficiência de Crescimento/epidemiologia , Insuficiência de Crescimento/etiologia , Feminino , Humanos , Índia/epidemiologia , Lactente , Masculino
19.
Indian J Pediatr ; 66(1 Suppl): S94-6, 1999.
Artigo em Inglês | MEDLINE | ID: mdl-11132478

RESUMO

Neonatal cholestasis syndrome (NCS) in India has largely remained ignored. Three questions need to be addressed: (a) What is known about NCS in India (b) Where do we stand and (c) What needs to be done? Current data on etiology of NCS indicates that biliary atresia contributes to about 40% of all NCS cases. There is considerable delay in the referral of patients to appropriate centres for management. A delay of 120.8 +/- 60.5 days in biliary atresia and 65.9 +/- 39.2 days in neonatal hepatitis were documented. Biliary atresia cases need to be diagnosed and operated by eight weeks of age so as to have the best results. Delayed referral after 3 months of age, not only bring down the success rate considerably but also adversely affect the management with regard to surgical procedures, nutritional support, control of ascites and finally the cost. Cirrhosis rapidly develops in children with biliary atresia. At this stage the only option left is liver transplantation. An important obstacle in the care of infants with NCS is the misconception of jaundice in newborns. This needs to be handled at a professional level in the training of undergraduates and postgraduates and the lay public. Public awareness campaigns like "Yellow Alert" may be useful in this direction.


Assuntos
Colestase/epidemiologia , Colestase/etiologia , Colestase/terapia , Feminino , Humanos , Incidência , Índia/epidemiologia , Recém-Nascido , Masculino , Prognóstico , Medição de Risco , Fatores de Risco
20.
Ann Emerg Med ; 22(8): 1349-52, 1993 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-8333642

RESUMO

We report the use of centrally administered tissue-type plasminogen activator for three patients who presented with massive pulmonary embolism to the emergency department. In all patients, rapid improvement of pulmonary arterial pressures ensued by the end of the drug infusion, while the presenting symptoms of chest pain and shortness of breath subsided.


Assuntos
Embolia Pulmonar/tratamento farmacológico , Ativador de Plasminogênio Tecidual/uso terapêutico , Adolescente , Adulto , Idoso , Emergências , Feminino , Humanos , Masculino , Embolia Pulmonar/fisiopatologia
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