Vidarbha Journal of Internal Medicine最新文献

{"title":"Snakebite","authors":"Deepanshu Asudani, A. Aher","doi":"10.25259/vjim_26_2021","DOIUrl":"https://doi.org/10.25259/vjim_26_2021","url":null,"abstract":"Snakebite is a prevalent cause of morbidity and mortality in rural India. There is a great unawareness among the general public about this important occupational hazard and timely intervention like anti-snake venom. Furthermore, there is a confusion among primary health centre workers about the management due to various Western guidelines which are difficult to follow in the Indian setting. Knowledge about its prevention, avoiding harmful first aid measures, and having proper guidelines for its management can help in timely proper intervention and saving lives. Hence, here, we present a short review on types of snakes, clinical features, guidelines of management (based on Indian protocols), and its prevention.","PeriodicalId":232453,"journal":{"name":"Vidarbha Journal of Internal Medicine","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125460593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Predictors of Success of Non-invasive Positive Pressure Ventilation in Hypercapnic Respiratory Failure","authors":"Tilottama Parate, Gayatri Dhote, R. Parate","doi":"10.25259/vjim_23_2021","DOIUrl":"https://doi.org/10.25259/vjim_23_2021","url":null,"abstract":"\u0000\u0000To study the indication of NIPPV in patients with hypercapnic respiratory failure. To evaluate the clinical, laboratory and ventilatory parameters with respect to improvement or deterioration in general condition of the patient. To predict the outcome in the form of weaning from NIPPV or requirement of invasive ventilation. To compare APACHE II score with outcome.\u0000\u0000\u0000\u0000Non-invasive ventilation (NIV) is now being considered more as the respiratory support of choice for acute respiratory failure. In some patients, with acute hypercapnic respiratory failure, NIV is inadequate and invasive ventilation is required for the management of respiratory failure. Thus, the determination of early predictors of the success of non-invasive positive pressure ventilation (NIPPV) is important to identify the patients who are likely to benefit from it. This study was done to determine the early predictors of the success of NIPPV in hypercapnic respiratory failure.\u0000\u0000\u0000\u0000In the current hospital-based prospective observational study, 100 patients admitted with hypercapnic respiratory failure requiring ventilation therapy are included in the study. Baseline clinical (heart rate [HR] and respiratory rate [RR]), arterial blood gas (ABG) parameters (pH, pO2, and pCO2), and ventilatory parameters were recorded before the initiation of NIPPV. The above parameters were re-evaluated at 1, 4, and 24 h after initiation of NIPPV. Acute Physiology and Chronic Health Evaluation II (APACHE II) score was also calculated on admission and at the end of 24 h to compare with the outcome.\u0000\u0000\u0000\u0000Of the 100 patients, 73% of patients showed improvement in clinical and laboratory parameters. There was an improvement in HR, RR, pH, pCO2, and pO2 within the 1st hour and continued to improve even after 1 h, 4 h, and 24 h of NIPPV in the success group. About 27% of patients who failed to improve required intubation. The optimum cutoff value for APACHE II score on admission for predicting the outcome of NIPPV was found to be 33 in this study. Therefore, a score above 33 predicts failure of NIV.\u0000\u0000\u0000\u0000This study demonstrated that the clinical and laboratory parameters predict the success of NIPPV in patients with hypercapnic respiratory failure averting the need for mechanical ventilation.\u0000","PeriodicalId":232453,"journal":{"name":"Vidarbha Journal of Internal Medicine","volume":"7 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114034844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimation of Elevated Systolic Pulmonary Artery Pressure Using Right Ventricular Isovolumic Relaxation Time","authors":"A. Arke, P. M. Babu, A. Borkar","doi":"10.25259/vjim_21_2021","DOIUrl":"https://doi.org/10.25259/vjim_21_2021","url":null,"abstract":"\u0000\u0000Echocardiographic estimation of pulmonary hypertension (PH) in absence of tricuspid regurgitation (TR) remains a challenge. Isovolumic relaxation time (IVRT) measured by Doppler tissue imaging (DTI) can be a useful method to estimate PH. This study was designed to evaluate the feasibility and accuracy of the right ventricle (RV) IVRT for predicting PH.\u0000\u0000\u0000\u0000We conducted an analytical cross-sectional study in 90 consecutive patients suspected or known to have pulmonary hypertension (PH). sPAP was assessed using TR jet velocity using a Bernoulli’s equation. RV IVRT was calculated using tissue Doppler imaging.\u0000\u0000\u0000\u0000Out of the 90 consecutive patients [49 (54.4%) were female, mean age was 48 +/- 14 years and mean systolic pulmonary aretry pressure (sPAP) was 68.25+/- 29.15 mmHg. Mean RV IVRT was 67.29 ± 22.2 msec. We found a strong correlation between IVRT and systolic pulmonary pressure (r = 0.69, P < 0.0001) and a cutoff of 43 ms showed a sensitivity and specificity of 89% and 93%, respectively, for the prediction of elevated sPAP (≥39 mm Hg). However, this correlation reduces in the presence of RV dysfunction and elevated mean RA pressure.\u0000\u0000\u0000\u0000The calculation of IVRT by DTI is a simple and feasible method. It correlates well with sPAP. It is a useful echocardiographic parameter as a screening in patients at risk for PH, monitoring the disease progression and the effect of the treatment for PH, especially in patients with absent TR.\u0000","PeriodicalId":232453,"journal":{"name":"Vidarbha Journal of Internal Medicine","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130297378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Digoxin Holiday","authors":"M. Mardikar, N. Khandekar","doi":"10.25259/vjim_20_2021","DOIUrl":"https://doi.org/10.25259/vjim_20_2021","url":null,"abstract":"Digoxin is used in clinical practice for two major purposes: To improve ventricular performance in heart failure with reduced ejection fraction and to control the ventricular rate in atrial fibrillation. It is a cardiac glycoside with a positive inotropic effect and causes atrioventricular nodal inhibition through vagomimetic effect. It also decreases the sympathetic drive generated by the failing circulation, which provides a rational in using the drug in congestive heart failure (CHF) with sinus rhythm. The use of this drug is a standard therapy in the treatment of CHF with atrial fibrillation. However, the dose adjustment of this drug is difficult because of the variation in its pharmacokinetic characteristics, the variability in its clearance, and the lack of a good relationship between the dose and the desired effect and its narrow therapeutic range. This creates difficulty for clinicians to choose the appropriate dosage of the drug to get the desired benefit without the risk of toxicity. In many countries, serum concentration monitoring is not always possible, so it is common in clinical practice to drop the medication for 1 or 2 days a week, giving the drug a ‘holiday,’ to avoid the risk of toxicity. This is contrary to the use of this drug without interruption in countries where routine serum concentration monitoring is possible. This review provides a summary of the evidence relating to the rationale behind using digoxin holiday and the therapeutic implications of digoxin holiday. Much of the information is available from prospective crossover clinical trials. There are no randomised control trials of digoxin holiday in patients with heart failure and/or atrial fibrillation.","PeriodicalId":232453,"journal":{"name":"Vidarbha Journal of Internal Medicine","volume":"68 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121555269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Study of Clinical Profile and Treatment Pattern of Scrub Typhus Patients in Tertiary Care Hospital","authors":"Shubham Ingle, Atul Rajkondwar","doi":"10.25259/vjim_12_2021","DOIUrl":"https://doi.org/10.25259/vjim_12_2021","url":null,"abstract":"\u0000\u0000To assess the clinical features, complications and treatment of scrub typhus patients in tertiary care hospital.\u0000\u0000\u0000\u0000A total of 100 patients with scrub typhus, aged >12 years admitted in medicine wards and intensive care units of Government Medical College, Nagpur, were included in the study. A detailed history was taken; clinical examination, all relevant investigations, and IgM ELISA test were done for the diagnosis of scrub typhus.\u0000\u0000\u0000\u0000The most common presenting symptoms were high-grade fever with chills (80%). The most common complication was lung involvement (35%), liver damage (28%), and acute kidney injury (27%) with six cases requiring renal replacement therapy. Multisystem organ dysfunction syndrome was seen in 19% of cases. About 27% of patients had acute respiratory distress syndrome of which 16 cases needed mechanical ventilation. Of 100 patients included, 82 (82%) cases survived and were discharged, while 18 (18%) patients succumbed during hospital admission. Among the risk factor studied, systemic hypertension was associated with an increase in mortality (P = 0.014). There was a statistically significant increase in mortality (P = 0.006) in patients having electrocardiogram abnormalities in the forms of low-voltage complexes and tachycardia. Early diagnosis and rapid treatment with doxycycline (93.90%) and ceftriaxone (87.80%) were found to be associated with more survival rate.\u0000\u0000\u0000\u0000Scrub typhus is a significant disease in this part of the country; therefore, it should be kept in mind as a possible diagnosis in undifferentiated fevers even though an eschar is not found. An early diagnosis and timely antibiotic therapy may prevent further complications.\u0000","PeriodicalId":232453,"journal":{"name":"Vidarbha Journal of Internal Medicine","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121773108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complete Ophthalmoplegia: A Rare Presentation of Idiopathic Intracranial Hypertension","authors":"R. Agrawal, Vinod Khandait","doi":"10.25259/vjim_25_2021","DOIUrl":"https://doi.org/10.25259/vjim_25_2021","url":null,"abstract":"Idiopathic intracranial hypertension (IIH) is a disorder defined by clinical criteria that include signs and symptoms produced by raised intracranial tension (headache, papilloedema and vision loss), raised intracranial tension and normal CSF composition with no other cause of intracranial hypertension evident on neuroimaging. The most common symptom of IIH is headache; the most common sign is papilloedema and visual field loss. Here, we report a case of IIH which presented without headache, with visual loss and complete ophthalmoplegia in one eye and sixth cranial nerve palsy in other eye. There was no improvement in vision of patient on medical management and she was planned for a CSF diversion procedure. We highlight the various treatment options available for IIH and the importance of timely diagnosis and urgent treatment.","PeriodicalId":232453,"journal":{"name":"Vidarbha Journal of Internal Medicine","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130340373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neuropsychiatric Manifestation of Acute Intermittent Porphyria: A Case Report","authors":"Tilottama Parate, Tony K S, Rahul Bhiwgade, Faisal Pathan","doi":"10.25259/vjim_10_2021","DOIUrl":"https://doi.org/10.25259/vjim_10_2021","url":null,"abstract":"Acute intermittent porphyria is a rare hereditary metabolic disorder with heme biosynthesis. Because of the wide and non-specific symptomatology of porphyria, diagnosis of porphyria is often missed or usually misdiagnosed as polyneuropathy or encephalopathy, or psychiatric disease. This case report is a reminder to physicians regarding porphyric neuropathy and psychiatric involvement associated with porphyria.","PeriodicalId":232453,"journal":{"name":"Vidarbha Journal of Internal Medicine","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131246205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medical Oxygen – The National Stewardship Programme","authors":"Dipti Chand","doi":"10.25259/vjim_27_2021","DOIUrl":"https://doi.org/10.25259/vjim_27_2021","url":null,"abstract":"","PeriodicalId":232453,"journal":{"name":"Vidarbha Journal of Internal Medicine","volume":"267 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116050056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}