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Chandra Gude D.,Princess Durru Shehvar Childrens and General Hospital | Chennamsetty S.,Medwin Hospital | Pal Bansal D.,Medwin Hospital | Jha R.,Medwin Hospital
Journal of the Indian Medical Association | Year: 2013

Acute transverse myelitis is a well known neurological complication occurring in systemic lupus erythematosus. Many prior studies have shown a link between transverse myelitis and the presence of antiphospholipid antibodies. Earlier theories have linked thrombotic tendency to be the culprit in such manifestations but currently there is evidence to support other causative mechanisms. A case of a young female diagnosed as systemic lupus erythematosus has been reported who presented with acute transverse myelitis and was found to be seronegative for antiphospholipid antibody. It is important to pay heed to and accordingly treat complications like acute transverse myelitis that occur regardless of antiphospholipid antibody positivity in a systemic lupus erythematosus setting.

Gude D.,Princess Durru Shehvar Childrens and General Hospital | Abbas A.,Princess Durru Shehvar Childrens and General Hospital | Mohiuddin H.,Princess Durru Shehvar Childrens and General Hospital
Annals of Cardiac Anaesthesia | Year: 2013

Antagonists of vitamin K dependant clotting factors are commonly used as treatment/prophylaxis for anticoagulation. Due to their narrow therapeutic window, a wide range of complications including death may occur. International normalized ratio (INR) is monitored to measure adequacy/excess of anticoagulation. There is a plethora of risk factors that may contribute to the uncontrollably high INR values. We describe our experience of a case of deep venous thrombosis wherein the patient had an overshoot of INR during anticoagulation therapy. We review the literature and discuss management in such scenarios.

Gude D.,Princess Durru Shehvar Childrens and General Hospital | Mohiuddin H.,Princess Durru Shehvar Childrens and General Hospital | Abbas A.,Princess Durru Shehvar Childrens and General Hospital
International Journal of Pharma and Bio Sciences | Year: 2013

Complications following traumatic intubations are devastating and could prove fatal. Extremely demanding, they necessitate that the intensivists' team possess the adequate skill and presence of mind to tackle such complications. We discuss our experience with one such case and review the literature discerning the probable causes and prevention strategies.A 62 yr old female presented with endotracheal (ET) tube in-situ from another center where she was intubated and mechanically ventilated for 5 days for severe shortness of breath and altered sensorium secondary to gastrointestinal sepsis and right lower lobe-pneumonia. Upon admission she was hemodynamically stable and mechanical ventilatory support was continued. Her electrolyte disturbances and metabolic acidosis were corrected, along with adequate broad spectrum antibiotic coverage. There was a past history of bronchial asthma and inhaled and occasional oral corticosteroid use. Over the next 2 days she responded well and was weaned off the ventilator whilst continuing continuous positive airway pressure (CPAP) support. The next day post-extubation she developed respiratory distress that was refractory to CPAP warranting invasive ventilation again. During intubation, a 7.5mm endotracheal tube with a stylet, was advanced. Air entry was equal in bilateral apices but feeble which was interpreted as secondary to thick (obese) chest wall. Auscultation of abdomen over gastric fundus did not reflect the ambu-bag ventilation. Patient began developing rapid subcutaneous swelling beginning from the neck to face upwards and chest and trunk downwards including both the upper limbs. Due to the swelling and protrusion of tongue it was virtually impossible to advance the laryngoscope to re-guide the ET tube. Emergency tracheostomy was planned but before the procedure could start, patient developed cardiac arrest necessitating advanced cardiac-life-support protocol of cardiopulmonary resuscitation (CPR). Due to massive subcutaneous emphysema, the tracheostomy procedure failed and the patient could not be revived despite aggressive CPR. Post-humous fibreoptic bronchoscopy confirmed the tracheal tear (level II degree as per classification described below).

Komala K.,Princess Durru Shehvar Childrens and General Hospital | Reddy M.,Princess Durru Shehvar Childrens and General Hospital | Jehan Quadri I.,Princess Durru Shehvar Childrens and General Hospital | Suneetha B.,Princess Durru Shehvar Childrens and General Hospital | Ramya V.,Princess Durru Shehvar Childrens and General Hospital
Journal of Clinical and Diagnostic Research | Year: 2013

Background: Misoprostol is a new promising agent for cervical ripening and induction of labour. The ideal dose, route and frequency of administration of misoprostol are still under investigation. Although, vaginal application of misoprostol has been validated as a reasonable mean of induction, there is a patient resistance to digital examination and there is a risk of ascending infection. For this reason, oral administration of misoprostol for cervical ripening and labour induction has been tried. Aims and Objectives: To compare 50μg of oral misoprostol versus 25μg of intravaginal misoprostol for induction of labour at term and maternal, foetal outcomes. Methods: 200 women who were at term, with indication for induction of labour and Bishop scores of ≤5 were randomly assigned to receive misoprostol 50μg or 25μg intravaginal, every 4-6 hours, for a maximum of 5 doses. In either group, pregnant females with inadequate uterine contractions despite being given maximum 5 doses of misoprostol, were augmented using oxytocin. The primary outcome measure was time-interval from induction to vaginal delivery and vaginal delivery rate within 24 hours. Results: The median induction to vaginal delivery time in oral group (12.92h) and vaginal group (14.04 h) was not significant. Oral misoprostol resulted in more number of vaginal deliveries as compared to vaginal misoprostol (94% as compared to 86%), which was not significant. There was a significantly higher incidence of uterine tachysystole in the vaginal group, as compared to oral group. There were no significant differences between the groups with respect to oxytocin augmentation, caesarean section rate, analgesic requirement and neonatal outcome. Conclusion: Oral misoprostol is as efficacious as vaginal misoprostol because of shorter induction delivery interval, lower caesarean section rates, and lower incidence of failed induction rates. Lower incidence of foetal distress and easy intake are observed if the drug is administered orally.

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