Purpose: To study the hemodynamic parameters in ophthalmic artery (OA) using color Doppler imaging in subjects with primary open-angle glaucoma (POAG), normal-tension glaucoma (NTG) and age matched normals. Methods: Sixty-eight eyes of 68 subjects (41 males and 27 females) constituted material for this prospective observational study. They were divided into three groups; Group A had 24 patients with POAG, Group B had 18 patients with NTG and Group C had 26 normal subjects. They underwent CDI of OA. The outcome variables were peak systolic velocity (PSV), end diastolic velocity (EDV), resistivity index (RI) and pulsatility index (PI). Data were compiled and analyzed using one-way ANOVA analysis. Results: The mean ± SD age of POAG patients, NTG patient and normal subjects was 59.

A 48-year-old man was brought to the emergency room after ingesting an unknown amount of carbamazepine. He was unconscious and not responding to the noxious stimuli. He was intubated and was placed on mechanical ventilation because of respiratory insufficiency. Primary detoxification was performed with a gastric lavage and charcoal instillation. His serum carbamazepine level was 25.6 mcg/mL at the time of admission. His computed tomography of the brain was normal. He was managed conservatively but there was no improvement in his neurological status in the next 24 hours. Serum carbamazepine level was repeated and reported to be 28.3 mcg/mL. As there was no improvement in his sensorium and the serum carbamazepine levels remained persistently high, extracorporeal removal of carbamazepine was attempted. As the facility to carry out hemoperfusion was not available immediately, the decision to initiate hemodialysis was taken. After 3 sessions of hemodialysis, his sensorium improved markedly and the carbamazepine level at this time was within the therapeutic range. He was discharged after psychiatry consultation and counseling. We review the literature regarding extra corporeal techniques for the removal of carbamazepine and discuss them in this article.

Abstract

Background: Poisoning constitutes about 60% of deliberate self-harm in rural Asia. OPCs account for 80% of pesticide poisoning. Ravi et al reported the incidence of organophosphorous poisoning as around 1.26 lakhs in India. Patients will be required ventilator support for management in most of cases and hence study is being done to find the association of factors in patients with prolonged ventilator support.Methods: Statistical analysis was carried out for 50 patients after categorizing each variable like age, sex, type of compound, quantity, serum pseudo cholinesterase levels, respiratory failure, intermediate syndrome and other clinical signs.Results: Out of 50 patients 74% of patients required more than 10 days of ventilation and methyl parathion was the frequent compound associated with prolonged ventilation and 60% of patients who required 4-8 days of atropinisation and also patients who had low pseudocholinesterase levels at the onset had required prolonged ventilation.Conclusions: The results show that outcome of patients with OPC   poisoning is associated with type of compound, period of atropinisation, quantity, pseudocholinesterase levels. So immediate treatment is most important to improve mortality in OPC poisoning.

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BACKGROUND Elevated serum uric acid (UA) level strongly reflects and may even cause oxidative stress, metabolic syndrome and insulin resistance which are risk factors for progression of liver disease. Hepatic injury is associated with distortion of the metabolic function. Hepatic disease/Cirrhosis of liver can be evaluated by biochemical analysis of serum tests, includes levels of serum alanine and aspartate amino transferases, alkaline phosphatase, and also by uric acid estimation. In chronic liver disease, high serum uric acid is associated with more severe disease. However, there are limited numbers of studies showing the association of uric acid with different parameters of liver dysfunction. METHODS In this study a total of 66 patients of known chronic liver disease of different causes were included. All patients were above 18 years of age. Patients with factors that influence the serum uric acid level were excluded. A thorough history was obtained, and physical examination was done. Various laboratory data including serum uric acid level and liver function test were measured. Using different parameters, Child Turcotte Pugh (CTP) score was calculated for each patient. Using suitable statistical method, data was analysed for any association between serum uric acid level and different causes of chronic liver disease and disease severity using Child Turcotte Pugh (CTP) grading. RESULTS In our study, out of 66 patients suffering from chronic liver disease, 48 (72.7%) were male. Alcohol was the most common cause (69.7%) of CLD followed by chronic hepatitis C (15.2%). A higher serum uric acid level was observed among patients with non-alcoholic fatty liver disease (NAFLD) (7.04±1.61) and patients with CTP class C (8.26±1.75). CONCLUSIONS From our study, we can conclude that uric acid is higher in patients with NAFLD as hyperuricemia is associated with many risk factors for NAFLD such as obesity, insulin resistance and metabolic syndrome. Serum uric acid is also higher with higher CTP score which is an oxidative marker for liver damage.

Acute liver failure (ALF) is a condition with rapid deterioration of liver function resulting in hepatic encephalopathy and/or coagulopathy in patients with previously normal liver. Acute liver failure (ALF) is an uncommon condition associated with high morbidity and mortality. The prognosis is poor for untreated cases of Acute liver failure, so early recognition and management of patients with acute liver failure is crucial. A cause for acute liver failure can be identified in 60 to 80 percent of patients. Identifying the underlying cause of the liver failure is important because it influences the approach to management and provides prognostic information. Aims and Objectives: The aim of our study is to identify the clinical features, etiology and outcome of acute liver failure in a tertiary care hospital. Materials and Methods: This study is an observational study where patients with Acute Liver Failure admitted in ICU in our institution after meeting the diagnostic criteria for Acute liver failure were included in the study. Details of history, relevant symptoms and baseline investigations included, complete blood count, blood glucose, renal function test, serum electrolytes, liver function test (LFT), prothrombin time, international normalized ratio (INR), lactate dehydrogenase (LDH), creatine kinase (CK)], arterial blood gas analysis, arterial lactate, arterial ammonia, amylase and lipase level and pregnancy test (if female) and ultrasonography (USG) abdomen were recorded, MRI brain and other investigations relevant to the admission diagnosis, co morbidities and aetiology if needed were recorded. All the patients received standard supportive treatment for ALF. Results: In this study of 57 patients, majority of the patients were from the age group 41 to 50 years (17 patients) and 31 to 40 years (13 patients). 36 patients were male and 21 patients were females. Jaundice and encephalopathy was observed in all 57 (100%) patients, 24 (42%) patients had INR >2.5, 27 (47%) patients had serum creatinine >1.2 mg/dl and 18 (31.5%) patients had serum ammonia levels >100 micromol/L. The lowest value for serum aminotranferase was observed in infections (other than viral hepatitis) and maximum value was observed in drugs leading to ALF.In 20 (35%) patients viral hepatitis was the cause for ALD, followed by drugs and toxins which was the cause of ALD in 18 (31.5%) patients. Infections other viral hepatitis as the aetiology for ALF was observed in 16 (28%) of patients. Ischemic hepatitis was observed in 1 and Wilson’s disease was noted in 2 patients. Total 6 (10.5%) patients out of 57 patients had died, 4 patients with hepatitis B infection, 1 patient with paracetamol over dosage and 1 patient with dengue fever had died. Conclusion: Viral hepatitis and drugs are the commonest cause for acute liver failure. The aetiology of ALF varies significantly worldwide. Determining the etiology of acute liver failure requires a combination of detailed history taking and investigations. A broad evaluation is required to identify a cause of the acute liver failure, as the prognosis is poor in untreated cases of acute liver failure, so early recognition and management of patients with acute liver failure is crucial.

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