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Biomedical subjects

S K Sharma

Publications and source records attributed to S K Sharma.

At least 739 records · Page 41Linked to original sources
PubMedDate not supplied

Domestic cooking fuel and lung functions in healthy non-smoking women.

OBJECTIVE: The objective of this study was to compare the pulmonary functions in healthy non-smoking women who used either biomass or liquified petroleum gas (LPG) as their sole cooking fuel. The effects of passive smoking, ventilation, over crowding and cooking index were also taken into account. METHODOLOGY: The study was conducted over a period of two years from January 1994. One hundred healthy non-smoking women were included 50 cooked solely with biomass and 50 cooked with LPG. A standardised respiratory symptoms questionnaire was administered to all the subjects and spirometry was carried out. RESULTS: Passive smoking showed no significant difference between the two groups. No statistically significant differences was found in lung functions in the two groups except for the PEFR, which was significantly lower (P < 0.01) in women using biomass. No correlation was observed between different variables and pulmonary functions. The step-wise multivariate linear regression analysis showed no correlation between cooking fuel and the pulmonary functions. CONCLUSION: The absence of the expected adverse effects of biomass on pulmonary functions was possibly due to better ventilation in the kitchens of subjects in the biomass group compared to previous studies.

Adult↗
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Tracheobronchial amyloidosis masquerading as bronchial asthma.

A case of localized tracheobronchial primary amyloidosis masquerading as "bronchial asthma" is presented. Computed tomography of the chest and fiberoptic bronchoscopy image are included. Tracheobronchial primary amyloidosis is a rare, but potentially curable cause of airway obstruction mimicking asthma.

Amyloidosis↗
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Comparison of single breath and steady state methods for the measurement of pulmonary diffusing capacity for carbon monoxide in normal subjects, patients with bronchial asthma and chronic obstructive airway disease.

The results of pulmonary diffusing capacity (DLCO) measurements by the steady state (DLCOss) and single breath (DLCOsb) methods were compared in 50 normal subjects (Group A), 50 patients with bronchial asthma (Group B) and 50 patients with chronic obstructive lung disease (COAD) (Group C). A significant correlation was observed between DLCOss and DLCOsb in all the three groups of subjects. This relationship was stronger in Groups A and B as compared to Group C. Both DLCOsb and DLCOss were significantly correlated to parameters of air-flow obstruction. Both measurements of DLCO appear valid in normal subjects and in patients with bronchial asthma. In patients with COAD, on the other hand, DLCOsb may be valid measurement, since it is less likely to be influenced by airways obstruction.

Adult↗
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DOTS centre at a tertiary care teaching hospital: lessons learned and future directions.

BACKGROUND: In 1993, Government of India started the Revised National Tuberculosis Control Programme (RNTCP). A model Directly Observed Therapy, Short-Course (DOTS) centre was established at the All India Institute of Medical Sciences (AIIMS) to (i) identify the challenges and opportunities in establishing DOTS centres at tertiary care facilities, (ii) to teach the strategies of RNTCP to medical and paramedical staff, and (iii) to undertake relevant operational research connected with tuberculosis (TB) treatment and control. In this communication, we describe the experience of establishing a DOTS centre at India's premier medical institute and discuss the lessons learned. METHODS: Since September 2001 through November 2002 AIIMS employees and their dependants diagnosed with tuberculosis were enrolled for treatment at AIIMS DOTS centre. One hundred sixty-eight patients were diagnosed as suffering from tuberculosis. Of these 49 patients were referred out and remaining 119 patients were treated at AIIMS DOTS centre. RESULTS: Treatment success was achieved in 80% (20/25) of new smear positive cases and the DOTS centre achieved other targets set up by the RNTCP. As the results of the pilot study at AIIMS DOTS centre were favourable, the facilities of AIIMS DOTS centre were extended to the general public from September 2002 onwards. CONCLUSION: Despite tremendous patient load at tertiary care facilities, it is possible to achieve targets established by the RNTCP. However, additional research needs to be conducted especially relating to drug resistance and surrogate markers of failure under RNTCP.

Adult↗
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Lymphangioleiomyomatosis: a rare cause of breathlessness.

A 24-year-old female presented with complaints of cough with scanty expectoration, breathlessness on exertion and chest pain for the last three years. These symptoms had appeared during the 12th week of her third pregnancy. She was given anti-tuberculosis treatment at another hospital for nine months without any improvement in symptoms. Four years ago she had been diagnosed to have leprosy of borderline variety for which she had received treatment. On examination, she was tachypnoeic with a respiratory rate of 33 breaths per minute. She had clubbing and small, discrete and firm lymph nodes in the anterior cervical region. Chest examination revealed wheezing with bibasilar end-inspiratory crepitations.

Adult↗
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Triple A syndrome.

Triple A syndrome (Allgrove syndrome) is an autosomal recessive disorder consisting of achalasia, alacrima and Addison insufficiency. We report an 11-year-old girl with predominant symptom of achalasia who was diagnosed as Triple A syndrome almost 3 years after initial presentation.

Addison Disease↗
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Intra abdominal abscess presenting as a thigh abscess.

Secondary thigh abscesses are rare, and their cause is often obscure. We report a case of an elderly diabetic who presented with thigh abscess secondary to tuberculous sacroilitis. Key words: Secondary thigh abscess, retroperitoneal abscess, tuberculous sacroilitis.

Abdominal Abscess↗
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Total thyroidectomy: the treatment of choice in differentiated thyroid carcinoma.

INTRODUCTION: Clinically detectable thyroid carcinoma constitutes less than 1% of human cancers. Ninety percent of all thyroid malignancies are differentiated papillary and follicular carcinoma. Surgery plays a key role in differentiated thyroid carcinoma as it carries excellent prognosis, lower recurrence rate and low mortality rate but controversy persists for extent of surgery and optimal surgical management of lymph node metastasis. PATIENT AND METHOD: A retrospective analysis was done for the cases that underwent total thyroidectomy with lymph node dissection for differentiated carcinoma of thyroid in Kathmandu Medical College during two year periods (Oct 2001 to Oct 2003). RESULT: In our experience with 18 cases of Differentiated Thyroid Carcinoma (DTC) treated with total thyroidectomies and lymph node dissection, papillary carcinoma was predominant with 83% incidence. Disease was prevalent in 50 to 60 year age group. Except two cases of transient hypocalcaemia and few wound related complications, there have been no other complications. CONCLUSION: Total thyroidectomy with lymph node dissection is safe and effective, so, the treatment of choice in cases of differentiated thyroid carcinoma.

Adult↗
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Upper GI endoscopy in children- in an adult suite.

UNLABELLED: Although Upper GI endoscopy is commonly performed in adults, paediatric endoscopy is not available in many of our referral centres. The efficacy and safety of upper GI endoscopy in paediatric age group performed in adult suite of Kathmandu Medical College is reviewed. PATIENTS AND METHOD: A retrospective study of endoscopies performed on children aged up to 15 years in an adult endoscopy suite of Kathmandu medical college over last one year is presented. All cases were the referred cases from paediatric unit for various problems. RESULTS: Endoscopy in paediatric group comprises only 6% of total upper GI endoscopies performed during the same year. Sex ratio was almost equal. Most cases (87%) were performed under local anaesthetic and well tolerated by the patients. Recurrent abdominal pain (RAP) was the commonest indication and among them one third of cases had significant positive finding. CONCLUSION: Upper GI endoscopy is a useful diagnostic tool in children. Where specialized paediatric endoscopy units are not feasible i.e. developing countries, endoscopic services to children can be safely provided in adult endoscopy suite with or without sedation. Upper GI endoscopy is well tolerated by children even without sedation.

Abdominal Pain↗
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Omental torsion: a case report.

Omental torsion is a rare cause of acute abdomen. Most often it presents with sign and symptoms of acute appendicitis. It is seldom considered in the differential diagnosis preoperatively based on clinical findings and the diagnosis is only established during surgery. We present a case of omental torsion in a middle aged male patient who presented with findings suggestive of appendicular perforation and underwent emergency laparotomy.

Adult↗
PubMedDate not supplied

Antimicrobial utilization pattern in out patient services of ENT department of tertiary care hospital of Eastern Nepal.

OBJECTIVE: The objective of this study was to monitor the antimicrobial utilization in ENT out patient services in a tertiary care hospital of Nepal. MATERIALS & METHODS: A total of 191 prescriptions were randomly audited at varying time interval from the department of ENT in the year 2003. The data was collected in customized Performa in the form of antibacterial audit questionnaires. It also contained Patient particulars, diagnosis, investigations, drug details and information from the prescriber regarding the indication for prescribing antimicrobial agent, suspecting organism underlying infection, duration of therapy and details of any concomitant medications. RESULTS: The incidence of use of antimicrobial agents (AMA) in 191 prescriptions was analyzed from the enrolled prescriptions, a total of 218 antimicrobials i.e.1.4 antimicrobial agent per patient were prescribed. . The AMAs were indicated therapeutically in 73.29% of patients & 19.37% patients for prophylaxis. The AMAs were advised for more than 72 hours for prophylaxis in 86.48%. In the concomitant medications antihistaminic were prescribed in 32.62% and NSAIDS in 21.98% cases. Most of patients reported with upper respiratory tract infections (URTI-32.56%), Chronic Suppurative otitis Media (CSOM-18.3%), sinusitis (6.28%), tonsillitis (5.75%),. Pharyngitis (3.66%), Acute Suppurative Otitis Media (ASOM-2.61%) and others. The diagnosis was established clinically in 42.40% and confirmative in 35.60%. In 21.46% the diagnosis was not disclosed. Out of 191 patients, culture sensitivity tests were performed for only 31 patients and 13 patients depicted a positive culture sensitivity tests. The common microbes isolated from the culture were staphylococcus aureus (69.2%). Streptococcus (7.7%), Enterobacteriacae (7.7%), Pseudomonas auroginosa (7.7%) & psendomanas mirabilis (7.7%). Clinically suspected organism were mentioned in only 32 prescriptions and most prescriber presumed the infections due to staphylococci & pseudomonas (43.75%), streptococci (21.8%),Gram negative organisms (12.5%) and H influenza (9.3%). The use of a single drug was abundant (89.52%), two drugs (9.94%), and three drugs (0.52% )prescriptions. Ciprofloxacin (23.85%) was preferred, followed by amoxycillin (20.06%), combination of ampicillin + cloxacillin( 9.17%), doxycyclin (5.96%). Erythromycin (4.58%) and cotimoxazole (4.58%). Expensive drugs i.e azithromycin (2.75%), roxithromycin (1.37%) and cephalosporins (3.21%) were also prescribed. The causative microbes were sensitive to amoxycillin (53.84%), cloxacillin (53.84%) ciprofloxacin (46.15%), gentamicin (46.15%), and cephalosporin (46.15%). But resistant to erythromycin, tetracycline, cotrimoxazole and norfloxacin) CONCLUSIONS: Majority of patients were prescribed drugs irrationally with misleading indications without confirming the bacteriological culture and sensitivity.

Ambulatory Care↗
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Idiopathic pulmonary haemosiderosis: two case reports.

Idiopathic pulmonary haemosiderosis (IPH) is a rare disorder and is characterised by the occurrence of episodes of diffuse alveolar haemorrhage (DAH). The patients usually present with a history of recurrent haemoptysis, anaemia and alveolar opacities on chest radiograph. The radiographic features are very characteristic and reveal alveolar opacities in middle and lower zones with selective sparing of the upper zones. An extensive diagnostic work-up is needed to exclude other causes of DAH. We report two cases of idiopathic pulmonary haemosiderosis who responded well to treatment with oral glucocorticoids.

Adolescent↗
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Bronchial adenoma--an eleven-year experience.

Thirteen patients with bronchial adenoma were investigated. Most of these were young males and had recurrent hemoptysis and chest infection. Radiographs of the chest were abnormal in 11 patients. The tumor was visualized by fiberoptic bronchoscopy in all but one patient. The procedure was safe and none of the patients had massive hemoptysis following bronchoscopic biopsy. Limited follow-up revealed good results following surgery.

Adult↗