The Journal of the Association of Physicians of India
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Diagnosis and management of acid-base disorders ranks high among the medical problems that intimidate many physicians. In practice, acid-base disorders can be approached very systematically as they can be easily diagnosed when certain rules are applied. Using a four step process including, 1) determination the serum pH, 2) calculation of the serum anion gap, 3) estimating the degree of compensation, 4) calculation of the excess anion gap, the reader will be able solve any complex acid-base problem. In this review we describe a practical stepwise approach to identify and resolve issues involving acid-base disorders.
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J Assoc Physicians India · Aug 2006
Pregnancy outcomes in pre-gestational and gestational diabetic women in comparison to non-diabetic women--A prospective study in Asian Indian mothers (CURES-35).
Diabetes can complicate pregnancy but it is not the major complication of pregnancy. Though prevalence of diabetes is alarmingly high among Indians there have been very few studies assessing the effect of diabetes on pregnancy outcomes, particularly comparing pre-gestational diabetes mellitus [PGDM] and gestational diabetes [GDM] with non-diabetic mothers. ⋯ Women with diabetes have worse pregnancy outcomes compared to non-diabetic mothers with and those with pre-gestational diabetes fare worse than those with gestational diabetes. The study emphasizes the fact that strict glycemic control is extremely important during pregnancy.
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J Assoc Physicians India · Jul 2006
Comparative StudyHealth problems and disability of elderly individuals in two population groups from same geographical location.
To compare morbidity, disability (ADL-IADL disability) along with behavioral and biological correlates of diseases and disability of two elderly population groups (tea garden workers and urban dwellers) living in same geographical location. ⋯ This study highlights the physical dimension of health problems of elderly individuals. Social circumstances and health risk behaviours play important role in the variation of health and functional status between the two groups. Life-style modification is warranted to prevent onset of chronic diseases. To improve quality of life, rectification of poor health status through affordable health service for disease screening and better management of illness, nutritional improvement and greater health awareness are necessary particularly among low socio-economic group. Low-cost intervention like cataract surgery could make a difference in the quality of life of elderly Indian.
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J Assoc Physicians India · Jun 2006
Review Practice GuidelineAPI expert consensus document on management of ischemic heart disease.
The incidence of coronary artery disease (CAD) has dramatically increased in India during the recent years. There are two facets of CAD: stable CAD and unstable CAD which includes patients with acute coronary syndrome (unstable angina, non-ST elevation myocardial infarction, ST elevation myocardial infarction). The treatment of stable CAD (stable angina) includes anti-anginal medication, medication to modify atherosclerosis and aggressive treatment of causative risk factors. ⋯ This document is an expert consensus document which has been prepared by going through the available guidelines and other relevant literature on the subject. The experts have performed a formal review of the literature and have weighed the strength of evidence for or against a particular therapy as it can be applied in Indian scenario. The consensus document deals with the management of ischemic heart disease (IHD) under following sections: 1) Stable Angina 2) Non ST Elevation Acute Coronary Syndrome (NSTE-ACS) 3) ST Elevation Acute Coronary Syndrome (STE-ACS) or Acute Myocardial Infarction (AMI).
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Ionotropic agents are frequently used in vasodilatory shock like conditions of septic or nonseptic origin. Conventional catecholamines such as norepinephrine are used at a very high dose with possibility of adverse effects in many patients. ⋯ Vasopressin has been found to be superior to epinephrine in animal models and some human trials, especially in patients with resistant ventricular fibrillation (VF) while doing cardiopulmonary resuscitation (CPR). Analogues of VP have also been used for diuresis in patients of hepatorenal syndrome.