Natl Med J India
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Kala-azar has re-emerged from near eradication. The annual estimate for the incidence and prevalence of kala-azar cases worldwide is 0.5 million and 2.5 million, respectively. Of these, 90% of the confirmed cases occur in India, Nepal, Bangladesh and Sudan. ⋯ Phase III Trials with a first-generation vaccine (killed Leishmania organism mixed with a low concentration of BCG as an adjuvant) have also yielded promising results. Preliminary studies using autoclaved Leishmania major mixed with BCG have been successful in preventing infection with Leishmania donovani. Until a safe and effective vaccine is developed, a combination of sandfly control, detection and treatment of patients and prevention of drug resistance is the best approach for controlling kala-azar.
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Survival after cardiopulmonary resuscitation depends upon the quality of pre-hospital support, availability of resuscitation equipment and the competence of the resuscitator. There are few data on the prognosis of patients undergoing such resuscitation in India. ⋯ With 5.5 resuscitation attempts needed for one live discharge after in-hospital cardiorespiratory arrest and 17 attempts to save a life after pre-hospital events, our outcomes are comparable to those reported from developed nations. A return of pulse after shorter durations of cardiopulmonary resuscitation, ventricular fibrillation or tachycardia as the abnormal presenting rhythm, in-hospital location of cardiorespiratory (CR) arrest and female sex were independent predictors of live discharge. Age and aetiology of CR arrest did not influence the outcome.
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Mechanical ventilation under anaesthesia needs to be controlled to maintain normal oxygen and carbon dioxide tensions in the blood and to economize on fresh gas flows. Various ventilation nomograms such as Radford's nomogram and Nunn's CO2 predictor are based on data from studies, some of which do not mimic the conditions which prevail under anaesthesia. We, therefore, planned a study to formulate nomograms for normocapnic ventilation for anaesthetized adult subjects. ⋯ The differences obtained in our nomograms are probably because the earlier ones were based on minute carbon dioxide production and physiological dead space data obtained from widely differing studies, some of which did not resemble conditions prevailing under anaesthesia. None of these used strict inclusion criteria such as pulmonary function tests. These may also be due to a difference in body structure between the subjects studied. Therefore, minute volume requirements calculated based on available western nomograms should not be applied to Indian subjects for normocapnic ventilation under anaesthesia.
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Comparative Study
The Bologna Hospital-at-Home: a model for cost-effective care of advanced cancer patients in developing countries.
There are two options for India, if it intends to build up an adequate level of assistance for advanced cancer patients: increase the number of hospital beds (including hospice care); or introduce home care. We have used the home care approach in Italy and found it to be cost-effective. ⋯ Hospital-at-Home care merits consideration in the palliative care of advanced cancer patients in developing countries. Detailed quality of life studies and cost-benefit assessments would need to be done before such a strategy is implemented. The BHH could be a model adaptable to developing countries. Our first experiences with such a model in Albania and India were encouraging.
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Post-traumatic vasospasm after severe head injury is now a well known entity. However, all studies available in the literature have evaluated only the anterior cerebral circulation. We evaluated the incidence of basilar artery vasospasm in patients with severe head injury. ⋯ Basilar artery blood flow velocity is higher in patients with severe head injury. Patients with diffuse brain injury have a particularly high velocity. Thus, it may be an easy method to assess the severity of head injury. The temporal profile of basilar artery vasospasm needs to be established in severely head-injured patients to assess its clinical utility.