Guntupalli K.K.,Ben Taub General Hospital |
Karnad D.R.,Jupiter Hospital |
Bandi V.,Ben Taub General Hospital |
Hall N.,Texas Childrens Hospital Pavilion for Women |
And 2 more authors.
Chest | Year: 2015
The first of this two-part series on critical illness in pregnancy dealt with obstetric disorders. In Part II, medical conditions that commonly aff ect pregnant women or worsen during pregnancy are discussed. ARDS occurs more frequently in pregnancy. Strategies commonly used in nonpregnant patients, including permissive hypercapnia, limits for plateau pressure, and prone positioning, may not be acceptable, especially in late pregnancy. Genital tract infections unique to pregnancy include chorioamnionitis, group A streptococcal infection causing toxic shock syndrome, and polymicrobial infection with streptococci, staphylococci, and Clostridium perfringens causing necrotizing vulvitis or fasciitis. Pregnancy predisposes to VTE; D-dimer levels have low specifi city in pregnancy. A ventilation-perfusion scan is preferred over CT pulmonary angiography in some situations to reduce radiation to the mother's breasts. Low-molecular-weight or unfractionated heparins form the mainstay of treatment; vitamin K antagonists, oral factor Xa inhibitors, and direct thrombin inhibitors are not recommended in pregnancy. The physiologic hyperdynamic circulation in pregnancy worsens many cardiovascular disorders. It increases risk of pulmonary edema or arrhythmias in mitral stenosis, heart failure in pulmonary hypertension or aortic stenosis, aortic dissection in Marfan syndrome, or valve thrombosis in mechanical heart valves. Common neurologic problems in pregnancy include seizures, altered mental status, visual symptoms, and strokes. Other common conditions discussed are aspiration of gastric contents, OSA, thyroid disorders, diabetic ketoacidosis, and cardiopulmonary arrest in pregnancy. Studies confi ned to pregnant women are available for only a few of these conditions. We have, therefore, reviewed pregnancy-specifi c adjustments in the management of these disorders. © 2015 American College of Chest Physicians.
Manikandan A.,Narayana Hrudayalaya |
Sarkar B.,AMRI Hospitals |
Holla R.,Narayana Hrudayalaya |
Vivek T.R.,Jupiter Hospital |
Sujatha N.,Government General Hospital
British Journal of Radiology | Year: 2012
Objectives: The purpose of this study was to demonstrate quality assurance checks for accuracy of gantry speed and position, dose rate and multileaf collimator (MLC) speed and position for a volumetric modulated arc treatment (VMAT) modality (Synergy® S; Elekta, Stockholm, Sweden), and to check that all the necessary variables and parameters were synchronous. Methods: Three tests (for gantry position-dose delivery synchronisation, gantry speed-dose delivery synchronisation and MLC leaf speed and positions) were performed. Results: The average error in gantry position was 0.5° and the average difference was 3 MU for a linear and a parabolic relationship between gantry position and delivered dose. In the third part of this test (sawtooth variation), the maximum difference was 9.3 MU, with a gantry position difference of 1.2°. In the sweeping field method test, a linear relationship was observed between recorded doses and distance from the central axis, as expected. In the open field method, errors were encountered at the beginning and at the end of the delivery arc, termed the "beginning" and "end" errors. For MLC position verification, the maximum error was -2.46 mm and the mean error was 0.0153±0.4668 mm, and 3.4% of leaves analysed showed errors of >±1 mm. Conclusion: This experiment demonstrates that the variables and parameters of the Synergy® S are synchronous and that the system is suitable for delivering VMAT using a dynamic MLC. © 2012 The British Institute of Radiology.
Das N.T.,Jupiter Hospital |
Deshpande C.,TNMC and BYL Nair Charitable Hospital
Journal of Clinical and Diagnostic Research | Year: 2017
Introduction: Laparoscopic Cholecystectomy (LC) is the most frequently performed elective daycare surgery and provision of postoperative pain relief is of importance. After laparoscopic cholecystectomy shoulder and abdominal pain causes considerable distress. Visceral pain during coughing, respiration and mobilization increases morbidity, hospital stay and costs. Aim: To compare the analgesic efficacy of intraperitoneally instilled equipotent concentrations of bupivacaine and ropivacaine versus placebo in relieving postoperative pain after laparoscopic cholecystectomy when used as a part of multimodal analgesia. Materials and Methods: In this randomised, prospective, double blind, placebo controlled study, 90 ASA Class I or II patients were randomly divided into three groups of 30 each. Group S received intraperitoneal infiltration with 35 ml of 0.9% normal saline, Group B with 35 ml of 0.25% bupivacaine and Group R with 35 ml of 0.375% ropivacaine. All groups received standard general endotracheal anaesthesia and analgesia with IV paracetamol 15 mg/kg and diclofenac 1.5 mg/kg. Numerical Rating Scale (NRS) score of analgesia at rest and on cough/movement, duration of analgesia, haemodynamic parameters, need for a rescue analgesic (IV tramadol 1 mg/kg) was recorded and adverse effects of procedure and drugs if any were monitored. Data was analysed with SPSS statistical software version 21.0. One way ANOVA or the Kruskal–Wallis test was used to compare continuous data across all three groups as appropriate. Subsequent analysis of continuous data between two groups was achieved by Tukey’s post hoc test. Significance was accepted as p<0.05. Results: The mean NRS was <5 till only four hours in Group S, till eight hours in Group B and till 16 hours in Group R. The duration of analgesia was 13.47+1.38 hours in Group R, 7.93+1.44 hours in Group B and 4.47+0.86 hours in Group S. Conclusion: Intraperitoneal infiltration of LA significantly reduces pain intensity scores in the early postoperative period after LC surgery and helps in improving the postoperative recovery profile and outcome. This makes LC surgery more amenable to day care surgical setup. Ropivacaine (0.375%) is more efficacious, longer acting with a higher intensity of postoperative analgesia than bupivacaine (0.25%). © 2017, Journal of Clinical and Diagnostic Research. All rights reserved.
Deshpande A.A.,BSES MG Global Hospital andheri |
Dalvi A.N.,Jupiter Hospital
Journal of Minimal Access Surgery | Year: 2012
A 42-year-old patient presented with right-sided abdominal discomfort. Investigations revealed a 19 21 centimetres large cystic lesion occupying nearly the entire right side of the abdomen. It was situated between ascending colon and right kidney and extended from the liver to the pelvic inlet supero-inferiorly. Laparoscopic excision was planned. The cyst was aspirated completely and dissected from the surrounding structures. It was eventually found to be arising from the right free edge of the greater omentum. Due to its size and weight it was lodged behind the ascending colon. Post-operative course was uneventful. Histology revealed a mesothelial omental cyst. Omental cysts are rare abdominal tumours. Complete excision is the treatment advised to prevent recurrence. Laparoscopic excision can be safely performed taking care to ascertain diagnosis and not to damage any structures intra-operatively.
Guntupalli K.K.,Baylor College of Medicine |
Hall N.,Baylor College of Medicine |
Hall N.,Texas Childrens Hospital Pavilion for Women |
Karnad D.R.,Jupiter Hospital |
And 3 more authors.
Chest | Year: 2015
Managing critically ill obstetric patients in the ICU is a challenge because of their altered physiology, different normal ranges for laboratory and clinical parameters in pregnancy, and potentially harmful effects of drugs and interventions on the fetus. About 200 to 700 women per 100,000 deliveries require ICU admission. A systematic five-step approach is recommended to enhance maternal and fetal outcomes: (1) differentiate between medical and obstetric disorders with similar manifestations, (2) identify and treat organ dysfunction, (3) assess maternal and fetal risk from continuing pregnancy and decide if delivery/termination of pregnancy will improve outcome, (4) choose an appropriate mode of delivery if necessary, and (5) optimize organ functions for safe delivery. A multidisciplinary team including the intensivist, obstetrician, maternal-fetal medicine specialist, anesthesiologist, neonatologist, nursing specialist, and transfusion medicine expert is key to optimize outcomes. Severe preeclampsia and its complications, HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome, and amniotic fluid embolism, which cause significant organ failure, are reviewed. Obstetric conditions that were not so common in the past are increasingly seen in the ICU. Thrombotic thrombocytopenic purpura of pregnancy is being diagnosed more frequently. Massive hemorrhage from adherent placenta is increasing because of the large number of pregnant women with scars from previous cesarean section. With more complex fetal surgical interventions being performed for congenital disorders, maternal complications are increasing. Ovarian hyperstimulation syndrome is also becoming common because of treatment of infertility with assisted reproduction techniques. Part II will deal with common medical disorders and their management in critically ill pregnant women. © 2015 American College of Chest Physicians.
Viswanathan V.,Jupiter Hospital
Indian Journal of Rheumatology | Year: 2012
Acute rheumatic fever (ARF) and its sequelae rheumatic heart disease (RHD) are systemic inflammatory conditions following group A beta haemolytic streptococcal (GABHS) pharyngitis. The condition primarily affects children between 5 years and 15 years of age mainly in developing countries and in indigenous populations of developed countries. Pathogenesis of the disease remains an enigma and specific treatment is not available; hence there is a lot of emphasis on prevention of initial and recurrent attacks. With protean manifestations, a high index of suspicion along with precise interpretation of clinical criteria (modified Jones criteria) is needed for the diagnosis. Clinical guidelines on the management of this condition with reference to the Indian scenario have been formulated. Antiinflammatory agents such as aspirin and steroids are the mainstay of symptomatic treatment of rheumatic fever. Primary prevention of ARF is accomplished by proper identification and adequate antibiotic treatment of GABHS tonsillopharyngitis. The most effective approach for control of ARF and RHD is secondary prophylaxis. © 2012 Indian Rheumatology Association.
Puri V.,KEM Hospital |
Venkateshwaran N.,Jupiter Hospital |
Khare N.,KEM Hospital
Indian Journal of Plastic Surgery | Year: 2012
The management of patients with trophic ulcers and their consequences is difficult not only because it is a recurrent and recalcitrant problem but also because the pathogenesis of the ulcer maybe different in each case. Methodically and systematically evaluating and ruling out concomitant pathologies helps to address each patient's specific needs and hence bring down devastating complications like amputation. With incidence of diabetes being high in our country, and leprosy being endemic too the consequences of neuropathy and angiopathy are faced by most wound care specialists. This article presents a review of current English literature available on this subject. The search words were entered in PubMed central and appropriate abstracts reviewed. Relevant full text articles were retrieved and perused. Cross references from these articles were also reviewed. Based on these articles and the authors' experiences algorithms for management have been presented to facilitate easier understanding. It is hoped that the information presented in this article will help in management of this recalcitrant problem.
Rokade M.L.,Jupiter Hospital
Journal of Medical Ultrasound | Year: 2013
Background: The urinary bladder has many inherent characteristics that make it an ideal structure for evaluating with three-dimensional (3D) volume ultrasound (US). The purpose of this study was to evaluate the application of 3D sonography in assessing bladder pathologies. Materials and methods: One hundred patients were evaluated in this study. The cases were taken from the pool referred for the evaluation of the renal system (kidney, ureter, and bladder), abbreviated as US KUB at our hospital. The examination was performed with the bladder filled up to 250-350ml, or whenever adequate distension was noted with wide separation of the bladder walls. Routine (two-dimensional) 2D scanning was followed with the acquisition of 3D volume using abdominal and endocavitary probes. Results: Application of surface rendering algorithm on obtained 3D data sets yielded near cystoscopy-like images of the urinary bladder. The anatomy of the trigonal region of the bladder and the ureteric orifices was obtained in detail. Various bladder pathologies, notably bladder mass, diverticuli and ectopic ureteric openings, were noted. Conclusion: 3D virtual cystoscopy is a promising technique for evaluating bladder pathologies. Its multiplanar capabilities and surface rendering capabilities are helpful for further characterizing the lesions seen on 2D US. It can serve as a good road map prior to cystoscopy. © 2013.
Gadkar N.,Jupiter Hospital
Indian heart journal | Year: 2011
Transradial coronary angiography was performed using a novel sheathless 4 French system. The incidence of radial artery spasm, radial artery occlusion, and local vascular complications were lesser as compared to the conventional approach using a sheath.
Shete M.M.,Jupiter Hospital |
Shete M.M.,Apex Kidney Care Pvt Ltd
Journal of Association of Physicians of India | Year: 2016
Hypertension is one of the most common conditions seen in primary care and a major public health problem in India. It can lead to various complications if not detected early and treated appropriately. As per the latest Eighth Joint National Committee (JNC 8) the goal BP in most hypertensive patients age <60 years should be <140/90 mmHg and treatment can be started by selecting drugs from among 4 specific medication classes i.e. angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB), calcium channel blocker (CCB) or diuretics. CCB is one of the first line drugs in the management of hypertension. Among CCB, Cilnidipine is a unique Ca2+ channel blocker as it has inhibitory action on the sympathetic N-type Ca2+ channels along with its effect on L-type Ca2+ channels. This article focuses on the current status of cilnidipine in the management of hypertension and co-morbidities. Cilnidipine by attenuating norepinephrine release from sympathetic nerve endings leads to vasodilatation, decreases heart rate and increases renal blood flow. Cilnidipine has an advantage of causing less reflex tachycardia, less pedal edema and better control of proteinuria in comparison to L-type CCB. By causing dilatation of efferent arteriole, it causes less damage to glomeruli and suppresses podocyte injury. Cilnidipine also increases insulin sensitivity. Therefore, cilnidipine as CCB can be a good choice in hypertensive patients with diabetes, chronic kidney disease and in patients developing pedal edema with other CCB. © 2016, Journal of Association of Physicians of India. All rights reserved.