Malabar Medical College

Kerala, India

Malabar Medical College

Kerala, India
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Kazim M.,Malabar Medical College | Kothari V.,SMS Medical College | Priyadarshi S.,SMS Medical College | Mistry T.,AIIMS | And 2 more authors.
Anaesthesia, Pain and Intensive Care | Year: 2017

Aims and Background: To prolong postoperative analgesia many adjuvants has been used opioids and alpha-2 agonists are very popular among them. This study was aimed at comparing the sensory, motor, hemodynamic, sedative and analgesic properties of epidural administration of fentanyl and dexmedetomidine as an adjuvant to ropivacaine. Methodology: With Institutional ethical committee clearance this study was conducted at our hospital. After obtaining informed and written consent, a total of 60 patients scheduled for elective percutaneous nephrolithotomy (PCNL) were randomly allocated into two groups of 30 each. Patients of both genders, aged 21-60 y, ASA physical status I and II were enrolled. Group RD received 28 ml of inj ropivacaine 0.5%+dexmedetomidine 1 ug/kg and Group RF received 28 ml of ropivacaine 0.5%+inj fentanyl 1 ug/kg epidurally. Hemodynamic parameters, sedation scores, and time to onset of sensory loss, complete motor blockade, two segmental dermatomal regression and time of first rescue analgesic were recorded. Data were compiled systematically and analyzed using unpaired t-test, Chi-square and Mann-Whitney U test. P<0.05 was considered significant. Results: The demographic profile of patients was comparable in both groups. Onset of sensory analgesia up to T10 was 6.8±2.8 min vs. 8.7±2.7 min and time to reach maximum motor block was 19.8±5.8 min vs. 23.9±4.9 min in Group RD and Group RF respectively, which was significantly less in the Group RD. Postoperative analgesia was significantly prolonged in the Group RF as compared to Group RD, e.g. 394.5±36.5 vs. 268.5±28.3 min respectively. Sedation scores were better in the Group RD and highly significant on statistical comparison (P<0.001). Incidence of hypotension, nausea and vomiting was high in the Group RF, while incidence of dry mouth was higher in the Group RD. Conclusion: Dexmedetomidine is a better adjuvant than fentanyl when added to epidural ropivacaine in terms of early onset of sensory and motor block, prolonged postoperative analgesia and better sedation with less side effects.


Khader A.,Government Medical College | Vineetha M.,Government Medical College | George M.,Malabar Medical College | Manakkad S.P.,Government Medical College | And 2 more authors.
Indian Journal of Dermatology | Year: 2017

Neurolymphomatosis (NL) refers to nerve infiltration by neurotropic neoplastic cells in the setting of a known or an unknown hematological malignancy. It typically presents as painful or painless peripheral mononeuropathy, mononeuritis multiplex, polyneuropathy, polyradiculopathy, or cranial neuropathy. A 32-year-old male presented with a hyperpigmented hypoesthetic plaque over the anterolateral aspect of the right leg with thickening of the right common peroneal nerve and foot drop clinically diagnosed as Hansen's disease. Biopsy taken from skin showed infiltrates of pleomorphic small and medium sized lymphocytes in the dermis and subcutis. On immunohistochemistry, the cells were positive for CD3, CD4 and negative for CD8, CD20, and CD30. Ultrasonography-guided fine-needle aspiration of the thickened nerve showed infiltrates of atypical lymphoid cells. Based on these findings, a diagnosis of NL in primary cutaneous CD4+ pleomorphic small/medium-sized T-cell lymphoma was made. The disease responded to systemic chemotherapy and localized radiotherapy with no evidence of relapse during 3 years follow-up. NL in primary cutaneous CD4+ pleomorphic small/medium-sized T-cell lymphoma presenting with manifestations redolent of Hansen's disease is not described in available literature. This case also demonstrates the utility of fine needle aspiration of nerve, a minimally invasive procedure in the diagnosis of NL.


PubMed | Co operative Hospital and Malabar Medical College
Type: Journal Article | Journal: Journal of orthopaedic case reports | Year: 2016

Anterior dislocation of hip associated with fracture of proximal femur is an uncommon injury. Only very few cases are reported in the literature. We report such an unusual and previously not described case of anterior dislocation of hip associated with fracture of trochanter and neck of the femur in an elderly lady.A 60 year old lady was presented to our casualty following a fall at home. She complained of pain in the left hip with deformity and inability to move the limb. The hip was externally rotated and clinical examination revealed anterior dislocation of the hip. X-ray showed associated fracture of the proximal femur extending between base of greater trochanter and head of the femur. Cemented Hemiarthroplasty was done under regional anesthesia.Anterior dislocation of hip with extensive fracture of proximal femur, though a rare condition may present because of associated twisting force at the time of the fall. If operated with cemented prosthetic replacement of the head, patient can be mobilized early.


Meenakshi S.R.,Malabar Medical College | Agarwal R.,M S Ramaiah Medical College
Journal of Clinical and Diagnostic Research | Year: 2013

Background and Objectives: Nitric Oxide (NO), the L-arginine derivative, is tonically synthesised by the endothelium within the kidney and it plays a crucial role in the regulation of the blood pressure and the renal blood flow. NO regulates the renal function through the modulation of the vascular tone and sodium handling. With the progressive development of the renal insufficiency, it remains unclear whether the endogenous NO production is increased or decreased in the kidney. This study was carried out to determine whether there were any changes in the levels of NO and teir correlation with the routine parameters of the renal dysfunction in the patients of Chronic Renal Failure (CRF), as the disease progresses in conjunction with poor renal functions. Methods: Thirty patients with chronic renal disease which was caused by chronic glomerulonephritis and hypertension, who were on Maintenance Haemodialysis (MHD) with serum creatinine levels of > 2.5 mg/dl, were included in this study. Thirty healthy voluntary blood donors were taken as the controls. NO was estimated by a spectrophotometric method by using cadmium reduction. The routine renal function tests, BUN and Creatinine were performed by the standard clinical chemistry procedures. Results: The serum NO levels were found to be significantly increased (p < 0.01) in the CRF on MHD (98.77 ± 35.40 μmol/l) as compared to the controls (22.03 ± 7.23 μmol/l). The NO output correlated with the serum creatinine (r = 0.8123, p < 0.01) and the urea concentration (r = 0.5166, p = <0.01) in the CRF group. Conclusion: The NO levels were markedly enhanced in the CRF patients who were on MHD. This was due to the dialysis procedure itself, which led to the stimulation of cytokine induced NO synthase and also due to the platelets which generated more NO due to uraemia. At high concentrations, NO is a cytotoxic molecule which is responsible for the complications of dialysis and it results in Nitrosative Stress in these patients, as it is a highly reactive free radical. Since the no output correlated with the serum creatinine and urea concentrations, a higher no production probably indicated insufficient blood purification, due to the common effect on their elimination pathways via the renal tract. Therefore, the alterations of the renal function, that are reflected in the changes of the creatinine concentration, will be accompanied by the changes in the serum NO. Thus, the determination of the NO levels in the peripheral blood may be useful in the assessment of the dialysis and they can also be used as markers in the follow up and the prognosis in these type of patients.


Ekambaramgnanadesigan,Annamalai University | Balumahendran K.,Annamalai University | Gnanagurudasan E.,Malabar Medical College | Santhosh Kumar N.,Shridevi Institute of Medical science and Research Hospital
International Journal of Pharma and Bio Sciences | Year: 2013

Selenium (Se) is considered to be one of the most controversial trace elements. Se deficiency is a global health problem related to an increased susceptibility to various diseases of animals and humans particularly male infertility. This review covers particularly the current knowledge of selenium in the reproductive system. Nowadays, infertility is one of the most stressful conditions amongst married couples. Male factor infertility is implicated in almost half of these cases. Recent advances in the field of reproductive medicine have focused the role of selenium concentration in relation with male fertility. The main aim of the present review was to provide further data on the distribution of this metal throughout the human male reproductive tract.


Pandit D.,Malabar Medical College
Indian Journal of Rheumatology | Year: 2011

Brucellosis commonly presents as pyrexia of unknown origin. However, it can also present with the involvement of reticular-endothelial or skeletal system wherein sacroilitis, spondylitis, arthritis, and osteomyelitis are the common presentations. Osteoarticular manifestations are often under diagnosed due to a low index of suspicion, and temporary response to symptomatic treatment. This can lead to a chronic incapacitating disease. Being treatable, it is important to identify them early and institute appropriate therapy. Diagnosis can be achieved by bacterial isolation and/or serology. New culture methods and molecular techniques can be useful whenever available. Treatment with antibiotics and surgery when indicated can help prevent the incapacitation and crippling, which otherwise results due to progressive disease. Elimination of animal brucellosis is the only way of prevention of human brucellosis. A safe and effective vaccine for human use is the future hope. © 2011 Indian Rheumatology Association.


Naik G.,Malabar Medical College | Deshpande S.R.,Malabar Medical College
Journal of Clinical and Diagnostic Research | Year: 2011

The Human immunodeficiency virus infection is essentially an infection of the immune system, with progressive and profound defects in the cell mediated immune response. The pathogenesis of the Human immunodeficiency virus infection is a multifactorial process, consisting of aberrant cellular activation and the disregulation of nearly every aspect of the immune system. The lentivirus subverts the immune system by infecting the CD4+Tcells that normally orchestrate immune responses and by activating the immune system and inducing a cytokine milieu that the virus uses to its own replication advantage. The disease outcome depends on the innate immune response, the adaptive immune response, the host genetic factors and the differences in viral pathogenicity.


Naik G.,Malabar Medical College | Deshpande S.R.,Malabar Medical College
Journal of Clinical and Diagnostic Research | Year: 2011

Objective: To study the prevalence of Staphylococcus aureus and Methicillin-Resistant Staphylococcus Aureus (MRSA) in surgical site infections (SSIs) in referral hospitals at the coastal city of Mangalore, India. Materials and Methods: This study was conducted on 300 patients who underwent surgery in the obstetrics and gynaecology, orthopaedic and surgical departments which were attached to the referral hospitals which were attached to Kasturba Medical College, Mangalore. Pus samples were collected with two sterile swabs and processed in the Microbiology department. Results: Of the 300 pus samples, 216(72%) showed growth. 258 aerobic bacteria were isolated. The most common organism which was isolated was Staphylococcus aureus, with 83(32.2%) isolates. Of these, 8 (9.6%) were Methicillin Resistant Staphylococcus Aureus (MRSA). Conclusions: Indian clinicians and infectious disease specialists in the coastal areas are facing formidable challenges from Methicillin Resistant Staphylococcus aureus. Despite the best surgical practices, nearly a tenth of all the SSIs cases could be caused by MRSA. Routine screening for these multidrug resistant organisms in the hospital staff, especially in the surgical departments and pre-surgical screening of the patients could help in reducing the incidence of MRSA.


Kashinatha Shenoy M.,Malabar Medical College
Research Journal of Pharmaceutical, Biological and Chemical Sciences | Year: 2013

Epidemic keratoconjunctivitis is commonly associated with type 8 & 9 strains of adenovirus which are responsible for epidemics in India and elsewhere [1]. The patients are highly contagious for up to 2 weeks and the incubation period for the virus is 2-14 days, the affected person being infectious for 10-14 days after symptoms [2,3]. Epidemic keratoconjunctivitis (EKC) is characterized by conjunctivitis with acute onset of watering, redness, foreign body sensation, discharge and discomfort. Both eyes are affected in 60% of the cases [4]. Ophthalmic examination shows lid oedema, a follicular response which is frequently associated with a preauricular adenopathy; subconjunctival hemorrhages' and pseudo membranes may rarely develop in unusual instances. Corneal involvement causes intense photophobia due to punctate epithelial lesions. Later, sub epithelial infiltrates appear at the level of Bowman membrane as a hypersensitivity reaction to viral antigen [3,4]. We herewith report a rare case of pseudo membrane covering both eyes, attended by difficulty to open both the eyes.


Liji K.,Malabar Medical College | Warrier P.K.,MES Medical College | Deshpande S.R.,Malabar Medical College
Research Journal of Pharmaceutical, Biological and Chemical Sciences | Year: 2013

To study the acid-base status of the malayalee patients admitted in Medical Intensive care Unit with metabolic encephalopathy, to know about the most common underlying disease, to understand the prevalent metabolic disorder among nonvegetarian patients in the Malappuram region of Kerala state, India. Estimation of acid base parameters and electrolytes (Na+, K+, and Cl-) in intensive care unit patients with metabolic encephalopathy were done in a total of 43 adults admitted with metabolic encephalopathy. Simultaneously, age and sex matched 25 non vegetarian malayalee of control group were also studied. Most of the ICU admitted nonvegetarian malayalee patients showed significant acid base and electrolyte balance disorders. Most cases of metabolic encephalopathy had an identifiable precipitating factor. Disorders like Hyponatremia require timely recognition and can often be reversed with appropriate intervention and treatment of underlying predisposing factors. Early diagnosis of hyponatremia, and electrolyte imbalances, in the ICU admitted patient may prove life saving in a nonvegetarian malayalee patient.

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