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Das S.K.,ESI Post graduate Institute of Medical Science and Research | Mukherjee S.,Amrita Institute of Medical science | Vasudevan D.M.,Amrita Institute of Medical science | Balakrishnan V.,Amrita Institute of Medical science
Singapore Medical Journal | Year: 2011

Introduction: Readily available laboratory tests are extremely useful in achieving a better understanding of diseases, and thereby, allow thoughtful management decisions to be made. The examination of peripheral blood smears usually provides excellent clues to the cause of the disease. The main objective of this study was to compare the haematological parameters of patients with non-alcoholic fatty liver disease (NAFLD) and alcoholic liver disease (ALD), and assess whether these tests have any discriminant value between the two conditions. Methods: The haematological parameters were investigated in 105 NAFLD patients, 40 ALD patients, 32 alcoholics and 77 normal participants. Results: The haemoglobin, red blood cell, haematocrit, lymphocyte count and platelet count were significantly reduced, while the mean corpuscular volume, mean corpuscular haemoglobin and prothrombin time expressed as an international normalised ratio (PT/INR) were significantly elevated in ALD patients compared to the other groups. The platelet count was significantly reduced, while the PT/INR and erythrocyte sedimentation rate (ESR) were significantly elevated in alcoholics compared to normal participants. ESR was also significantly elevated in ALD patients compared to normal participants and NAFLD patients. Compared to the control group, the NAFLD patients have significantly higher haematocrit and significantly lower platelet count. Conclusion: Chronic alcoholism is associated with inflammation and haematotoxic effects, while NAFLD has limited effect on haematological parameters. Source

Gothi D.,ESI Post graduate Institute of Medical Science and Research | Gupta S.S.,Eras Lucknow Medical College | Kumar N.,Sanjay Gandhi Post Graduate Institute of Medical Sciences | Sood K.,National Institute of Tuberculosis and Respiratory Disease
Lung India | Year: 2015

Background: The severity of exacerbation in chronic obstructive pulmonary disease (COPD) due to the overlap of obstructive sleep apnea syndrome (OSAS) is not known. Aims: To find out the 1) severity of acute exacerbation of COPD (AECOPD) in patients with overlap syndrome compared to only COPD, 2) prevalence of overlap syndrome in AECOPD, and 3) clinical characteristics of COPD compared to overlap syndrome. Materials and Methods: Fifty-one patients admitted with AECOPD were classified into; Mild exacerbation: Normal arterial blood gases (ABG) treated with antibiotics, Moderate: Normal ABG treated with parenteral corticosteroids, Severe: Type 1 respiratory failure, Very severe: Type 2 respiratory failure with normal pH and Life-threatening: Type 2 respiratory failure with pH <7.35. They were evaluated for OSAS with full polysomnography after the exacerbation subsided and analysed depending on presence or absence of overlap syndrome. Results: The majority of only COPD cases (26/38) had mild and moderate exacerbations whereas majority of overlap patients (9/13) had severe, very severe and life-threatening exacerbations (statistically significant, P = 0.021). Of 51 patients, 13 had OSAS i.e. the prevalence of overlap in AECOPD was 25.5%. The mean BMI in only COPD and overlap syndrome was 20.70 ± 8.03 kg/m2 and 31.82 ± 5.80 kg/m2 (P < 0.001), respectively. Metabolic syndrome was recorded in 2/36 (5.3%) patients in only COPD and 6/13 (46.2%) patients in overlap (P < 0.001). Conclusion: Overlap syndromes are more likely have respiratory failure compared to only COPD during AECOPD. AECOPD have a high prevalence of OSAS. Overlap syndrome have significantly higher likelihood of obesity and metabolic syndrome compared to only COPD. Source

Biswas B.K.,ESI Post graduate Institute of Medical Science and Research | Agarwal B.,Pain and Hyperbaric Medicine | Bhattarai B.,Bp Koirala Institute Of Health And Medical Science Bpkihs | Dey S.,North Eastern Indira gandhi Regional Institute of health and Medical science NEIgRIhMS | Bhattacharyya P.,North Eastern Indira gandhi Regional Institute of health and Medical science NEIgRIhMS
Indian Journal of Anaesthesia | Year: 2012

Purpose: It is sometimes difficult for our patients to acquire recommended flexion of their back to perform subarachnoid block upon them. The aim of this study was to find out the degree of procedural success and patient preference when subarachnoid blocks were performed on patients with suboptimal flexion of the back. Methods: Subarachnoid blocks were performed on 160 adult patients from both sexes without any spinal deformity. Procedures were performed with patients in the lateral or seated position with the back either straight or flexed. This approach divided the study population into 4 equal groups: Lateral with back straight (LS) or flexed (LF) and seated with back straight (SS) or flexed (SF). The primary endpoint was correct needle placement. Numbers of attempts, needle redirections and patients' preferred posture were determined to compare the outcome in different groups. Results: For both positions, the overall success rates were 95% and 100% in patients who had straight or flexed back, respectively (P=0.81). In the lateral position, significantly more patients of the LF group (40) than those of the LS group (32) had successful placement of spinal needle at first attempt (P=0.03). Altogether, 34 and 21 patients in the SS and SF groups, respectively, required cephalad redirections of the needle (P=0.003). Most patients preferred the straight back position (69.7-88%). Conclusion: With a higher preference by patients for the straight back posture, the overall success rate of correct spinal needle placement was comparable among the groups who had their back placed in a straight or in a flexed posture for subarachnoid block. Source

Chaturbhuj D.N.,National AIDS Research Institute Indian Council of Medical Research | Hingankar N.K.,National AIDS Research Institute Indian Council of Medical Research | Srikantiah P.,World Health Organization | Garg R.,World Health Organization | And 12 more authors.
AIDS Research and Human Retroviruses | Year: 2010

A survey for transmitted HIV drug resistance (HIVDR) was conducted according to WHO guidelines among clients newly diagnosed with HIV-1 infection at two voluntary counseling and testing centers (VCTC) in Mumbai. HIVDR testing was performed using the ViroSeq RT-PCR method (Abbott). Out of 50 successfully amplified and sequenced specimens, analysis of the first 34 consecutively collected specimens revealed no nucleoside reverse transcriptase inhibitor, nonnucleoside reverse transcriptase inhibitor, or protease inhibitor mutations from the 2007 WHO list of mutations for surveillance of transmitted HIVDR, indicating that the prevalence of transmitted HIVDR to all three drug classes was <5% among recently infected VCTC clients in Mumbai. The phylogenetic analysis revealed that all samples belonged to HIV-1 subtype C. Continued ART program monitoring and further evaluation of transmitted HIV drug resistance in coming years are essential in Mumbai as well as in other regions of the country in which ART is being scaled up rapidly. Copyright 2010, Mary Ann Liebert, Inc. Source

Pokharel K.,BP Koirala Institute of Health science | Biswas B.K.,ESI Post graduate Institute of Medical Science and Research | Tripathi M.,Sanjay Gandhi Post Graduate Institute of Medical Sciences | Subedi A.,BP Koirala Institute of Health science
Critical Care Medicine | Year: 2015

Objective: The inadvertent loss of an entire guide wire during central venous catheterization can lead to serious patient harm and require additional investigations as well as retrieval procedures. We aimed to analyze globally published reports of lost wires during central venous catheterization to understand its possible etiology, presentation, treatment, and outcomes with an objective of finding solutions to make the procedure safer. Data Sources: MEDLINE, Scopus, and CINAHL, supplemented by scanning the reference lists of relevant publications. Study Selection: All reports describing an inadvertent intravascular loss of a complete guide wire during placement of central venous catheters published up to December 2014 were included. Reports exclusively describing the 1) retrieval method, 2) partially retained guide wires, and 3) entrapped guide wires during withdrawal were excluded. Data Extraction: In each instance, we collected data about the method of the missed guide wire detection, the time interval between the procedure and detection, the supplementary investigations performed to confirm the diagnosis, and the risk factors associated with such events as well as the complications, the final outcome, and the wire retrieval methods used. Data Synthesis: A systematic analysis of the accessed publications was performed. Conclusions: Over the last decade, the number of reported instances of lost guide wires during central venous catheterization has increased rapidly. Unsupervised or improperly supervised insertions of the central catheters by trainees, distractions during insertions, and high workload are the main risk factors. A retained guide wire increases the risk and cost of additional diagnostic and therapeutic interventions, as well as imposing many minor-to-serious life-threatening complications. Continuing education along with simulator-based skill development, vigilant supervision, and a shared workload during out of hours working are likely to prevent such occurrences. © 2015 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved. Source

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