The Journal of the Association of Physicians of India
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J Assoc Physicians India · Oct 2015
Observational StudyClinical Profile of Patients Requiring Prolonged Mechanical Ventilation and their Outcome in a Tertiary Care Medical ICU.
An increasing number of patients require mechanical ventilation and there has been a proportional increase in patients needing prolonged mechanical ventilation (ventilated for ≥ 21 days, for atleast 6 hours per day). It accounts for about 10% of all mechanically ventilated patients. Although these patients represent a smaller proportion of intensive care unit (ICU) patients, they consume substantial ICU resources. We studied etiology, metabolic and clinical profile, complications and outcome of these patients. ⋯ The incidence of prolonged mechanical ventilation in our study was 3.91% of total 1150 ICU admissions and 11.3% of the 397 patients requiring invasive mechanical ventilation. AIDP, CVA, tetanus and ARDS were the most common diagnoses. Survival in the study population was 57.75%. VAP was the most common complication. High incidence of hypocalcaemia, hypomagnesaemia, hypokalemia and hypophosphatemia was noted in patients requiring prolonged mechanical ventilation.
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J Assoc Physicians India · Sep 2015
Asymptomatic Unilateral Hyperlucent Lung in a Prospective Kidney Donor.
A 50 year old lady, prospective kidney donor was referred to our department for opinion in view of abnormal clinical findings during preoperative evaluation. She was asymptomatic from respiratory point of view. Her vital parameters were normal and on auscultation found to have decreased breath sounds and fine crackles throughout left hemithorax. ⋯ Hence other causes of unilateral hyperlucent lung like pneumothorax, idiopathic giant bullae, congenital lobar emphysema, pulmonary artery hypoplasia, pulmonary embolism and bronchial obstruction due to foreign body or mucus plugs should be considered. Treatment is supportive with early control of super-added infections along with influenza and pneumococcal vaccination. Bronchodilators can be useful, especially if the spirometry shows obstructive abnormality.
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Stiff-person syndrome or Moersch-Woltmann is a very rare and disabling neurologic disorder characterized by muscle rigidity and episodic spasms involving axial and limb musculature. It is an autoimmune disorder resulting in a malfunction of aminobutyric acid mediated inhibitory networks in the central nervous system. We describe a patient of stiff person syndrome.
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J Assoc Physicians India · Jul 2015
Rethinking the Postgraduate Teaching Program and Examinations in Today's India.
Postgraduate medical education has undergone drastic changes in the developed and developing countries on par with advancements in technology. The Indian examination system which we imbibed from the British requires a rethinking and restructuring to keep pace with the changing trends shown by the Federation of the Royal Colleges of UK. ⋯ We suggest changes in the theory examination which should be objectively based rather than the outdated essay and short notes. We discuss positive and proactive changes to reform our clinical examination system to enable a just and fair assessment of the candidate in a strictly time bound fashion.
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J Assoc Physicians India · Jul 2015
Treatment and Outcome of Carbapenem-Resistant Gram-Negative Bacilli Blood-Stream Infections in a Tertiary Care Hospital.
Infections caused by carbapenem-resistant bacteria constitute a major challenge for current medical practice. ⋯ High incidences of bacteremia by carbapenem-resistant GNB including Enterobacteriaceae is a worrisome trend. Treatment options are compromised and only available option is colistin which has its own limitation. Colistin monotherapy may be non-inferior compared to combination therapy for treating BSIs caused by isolates with minimum inhibitory concentration (MIC) for colistin as ≤0.5 mg/l. Combined use of the colistin and carbapenem may provide good therapeutic options for BSI caused by carbapenem-resistant GNB and warrants further investigations.