In view of high incidence of mortality with Ethylene dibromide poisoning, a retrospective study was conducted, with objectives to compare demographic, toxicological & clinical outcome in patients treated conservatively and those who underwent therapeutic plasmapheresis. Records of Forty patients from central India region, with ingestion of ethylene dibromide admitted over last six years were reviewed .The majority of patients were less than 30 years (77.5%). Gastrointestinal symptoms (87.5%) were predominant at presentation. Amongst biochemical parameters hepatotoxicity was seen in 26 (65%), cardio toxicity in 19 (47.5%) and renotoxicity was seen in 4 (10%). Fourteen patients (35%) had normal biochemical parameters. Out of 26 patients with hepatotoxicity, 13 were treated conservatively whereas 13 underwent plasmapheresis. In conservative group the mean liver enzymes level were 937.6 I.U./ml (range 96-3717) ,while in plasmapheresis group it was 2587.6 I.U./ml (126-11700). The mortality rate was 5/13(38.4%) in conservatively treated patients as compared to 3/13(23%) in plasmapheresis group. Mean length of hospital stay was 5.4 days (range 2-20 days).Best outcome was when the patient presented to the hospital within six hours of ingestion. Death occurred anywhere between twenty hours and five days. Ethylene dibromide is highly toxic substance with a reported mortality rates as high as 30-60%.In our study we found a 15.4% decrease in mortality in plasmapheresis group as compared to conservative. Thus plasmapheresis may be considered an important treatment modality for ethylene di bromide poisoning.
The prospectively designed study was conducted to determine adequacy of AVF in 130 patients over a period of two years. Adequacy of AVF was graded if the blood flow rate was higher or equal to 300 ml/ min on at least fifty percent of dialysis sessions in one month. AV-fistula adequacy was correlated with clinical and demographic factors like age, gender, diabetic status, smoking status, body mass index (BMI), serum calcium, serum phosphorus and Ca×P product, serum albumin and an evaluation for peripheral vascular disease (PVD). RESULTS: The study included 130 patients (68 males and 42 females). Early adequacy rate of 110 fistulas was 66% and 51% at end of 3 rd and 6 th months respectively. Diabetes was present in 41%, 32% were hypertensive and 27% of the patients were overweight (BMI ≥27 kg/m 2). The adequacy rate was lower in older (age ≥ 65) patients (34.0 vs. 57.6%, P = 0.028), in overweight (BMI ≥ 27 kg/m 2) patients (33.3 vs. 57.5%, P = 0.026). It was also marginally lower in diabetics versus nondiabetics (40.0 vs. 58%, P = 0.058) and the presence of peripheral vascular disease and increase calcium phosphorus product adversely affected AVF adequacy. The adequacy rate was not affected by patient smoking status and serum albumin. The adequacy rate was substantially lower for forearm versus upper arm fistulas (40.0 vs. 64%, P = 0.0131). The adequacy of forearm fistulas was particularly poor in women (13%), patients age 65 or older (12.5%), and diabetics (24%). In contrast, upper arm fistulas were adequate in
Takayasu arteritis is a rare granulomatous systemic disease characterized by stenosis or obliteration of large & medium sized arteries mainly aorta and its main branches as well as pulmonary artery. Although this disease has variable presentation, but its presentation as Dilated cardiomyopathy is rare. Renal involvement is also less frequently reported in young males. We report a case of 20 yr old male who presented with features of congestive heart failure, renal failure and incidentally detected with absent right radial pulse and hypertension .His CT angiography revealed occlusion of right subclavian artery, superior mesenteric artery & bilateral renal arteries with splenic infarct suggestive of Takayasu arteritis. This case report illustrates a rare case of dilated cardiomyopathy and renovascular hypertension with renal failure secondary to Takayasu Arteritis which responded with systemic corticosteroids.
BACKGROUND: Pleural effusion is one of the common manifestations of tuberculosis and malignancy in our country. If it is not diagnosed early it can increase the morbidity and mortality. Pleural fluid analysis and blind pleural biopsy may not be helpful always .With this background we started our study to assess undiagnosed cases of pleural effusion by rigid medical thoracoscopy. AIM: As only few studies are published regarding the use of rigid medical thoracoscopy in the evaluation of undiagnosed pleural effusion, our present study aims to assess its significance in it. MATERIAL AND METHOD: In our study 22 cases were selected who came to our OPD with undiagnosed pleural effusion from January 2010 to January 2011 including both sexes and different age groups. Rigid medical Thoracoscopy were done in all of them. RESULTS: Out of 22 cases, 16 were diagnosed as malignant, 3 as tubercular, 1 as chronic inflammation, 1 as non specific and in 1 case procedure was not successful. CONCLUSION: With this study we found that rigid medical Thoracoscopy is an efficient procedure for diagnosing undiagnosed pleural effusion.
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