A B C D E F G H I J K L M N O P Q R S T U V W X Y Z All
Moulick, N. D.
- Congenital Cardiomyopathies and Structural Defects
Authors
Source
The Indian Practitioner, Vol 66, No 9 (2013), Pagination: 529-530Abstract
No Abstract.
- Risk Factors and Outcome of Patients with Diabetic Foot Ulcers
Authors
1 Dept of Medicine, 1st floor college building LTMGH, Sion, Mumbai, IN
2 SMO, Dept of Medicine, LTMGH, Sion, IN
3 Dept of Medicine, LTMGH, Sion, IN
Source
The Indian Practitioner, Vol 68, No 11 (2015), Pagination: 20-25Abstract
Background and objective
Diabetic foot ulcers result from a combination of vasculopathy, neuropathy and infections. The present study was aimed at identifying the demographics, clinical and biochemical risk factors for development of foot ulcer in diabetic subjects and their association with the macro and micro-vascular complications of Diabetes.The outcomes with respect to healing and requirement of amputation were also studied.
Methods
This was a cross sectional study conducted at a charitable tertiary care centre over a period of 18 months. Patients witha diabetic foot ulcer that had not healed for more than 14 days (n=106) were included in the study. Diabetic patients with pressure sores (bed ridden patients) and with major trauma causing ulcers were excluded from the study. Patients who failed to follow up were also excluded from the analysis. All patients were initially examined in detail clinically and evaluated for micro and macro vascular complications of diabetes and followed up for wound outcomes.
Results
In this study, diabetic foot ulcers were found in the 5th decade and men were affected more often than women. Ischemic heart disease and Cerebro-vascular accidents were present in 36.7% and 18.9 % and Retinopathy and Nephropathy were present in 19.8 % and 43.4% patients respectively. Deep, infected ulcers were associated with increased incidence of non-healing, greater number of amputations and higher mortality. The highest mortality (53.8%) was seen in smokers and alcoholics. Increased WBC count, raised creatinine, proteinurea and high HbA1c were associated with amputations and mortality. On Binary multiple logistic regression analysis it was found that duration of diabetes, stage of diabetic ulcer, diabetic nephropathy and diabetic retinopathy were independent predictors of ulcer healing and mortality.
- Evaluation of Cardiac Dysfunctions in Patients with HIV
Authors
1 Department of Medicine, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai-400 022, IN
Source
The Indian Practitioner, Vol 69, No 4 (2016), Pagination: 37-40Abstract
Objectives: HIV compromises the immunity of a person to such a level that the person affected becomes highly vulnerable to variety of infectious and non-infectious diseases. For many years the infectious diseases were focused upon as they carried the major proportion of HIV/AIDS related mortality. Infection with HIV is one of the causes of acquired heart disease. Thus cardiac involvement in HIV affected patients is becoming more prevalent as therapy and longevity improve. With this view in mind we undertook the study of cardiac manifestations in patients with HIV.Methods: This was an observational study, conducted in a tertiary care centre with an aim to study cardiac parameters in patients who have HIV.
Results: 151 HIV positive cases were studied over a period of 18 months. Majority of our patients were middle aged with average age of 38.7 years. 59.7% were males and 40.3% were females. Out of the 151 cases included 52(34.4%) had CD4 count < 200, 58(38.4%) had CD4 between 200-350 and 41(27.2%) had CD4 count > 350. 116(76.8%) patients had normal LVEF (> 60%) and 35(23.2%) had low LVEF (<60%). 11.9% patients had pericardial effusion. 26.4% patients had diastolic dysfunction and 15.9% of our patients had Pulmonary Arterial Hypertension.
Conclusion: Cardiac complications of HIV infection tend to occur late in the disease or are associated with related therapies. Cardiac involvement is common among HIV patients with 35.7% of our patients having cardiac involvement. 25.7% patients had some abnormal 2D echo findings which was associated with low CD4 count (< 350).
Keywords
HIV, Cardiac Dysfunctions, Pericardial Effusion.- Invasive Fungal Infections in Diabetes Mellitus
Authors
1 Dept of Medicine, 1st Floor College Building, LTMGH, Sion, Mumbai, IN
2 LTMGH, Sion, Mumbai, IN
3 Department of Medicine, LTMGH, Sion, Mumbai, IN
Source
The Indian Practitioner, Vol 69, No 7 (2016), Pagination: 17-22Abstract
Background and objective: Invasive fungal infections (IFI) are increasingly diagnosed in the immunocompromised patients due to improved diagnostic modalities. Major risk factors for IFI are diabetes mellitus, HIV infection, neutropenia, prolonged use of corticosteroids; recipients of bone marrow or solid organ transplant, haematological malignancies and inherited immunodeficiency disorders. In systemic fungal infections the outcome of the disease depends more on the host factors rather than the fungal virulence. Zygomycosis (Mucor) is the most lethal opportunistic fungal infection particularly among patients with diabetes mellitus and haematological malignancies. Rhino cerebral zygomycosis most common and fulminant type of zygomycosis leads to fatal consequences within a week of onset. Diagnosis of fungal infection include routine microscopy, cultures and advanced serological methods. Management of fungal infections depending on the type of infection and aetiologic agents. Antifungal agents have varying spectrum of activity, dosing, safety profiles and costs. Common antifungal agents used are polyene (AmphotericinB), Azole (Fluconazole, Itraconazole, and Voriconazole etc), Echinocandins (caspofungin, anidulafungin etc). Along with antifungal drugs treatment of co-morbid disease is important for better outcomes.
Methods: This was a prospective observational study performed in hospitalised patients. Patients hospitalised with suspected fungal infection or the patients hospitalised for any illness and suspected to have fungal illness during course of stay were screened and worked up in detail for fungal aetiology. Radiologicaly suspected fungal infection cases were worked up and specific samples collected for microbiology. Patient who were diagnosed to have definitive invasive fungal disease were included in the study.
Results: In present study 34 patients of conformed IFI were included and observed. 15 patients were diabetic with IFI. Male patients 19(55.9%) in age group12 to 70 years with the average age being 47.15 years were predominantly affected. Most common risk factor in the present study was diabetes mellitus which was noted in 15 out of 34 cases(44.11%). Mucor is commonest fungus in diabetic patients(60%) followed by aspergillus (26.66%).Naso-orbital infection was most common site of affection. Mortality was 46.7% in diabetic patients with fungal infections. Better outcomes observed in patients treated with combined medical and surgical treatment (64.3%) than medical treatment 45% alone.
References
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- Fever With Rash – A diagnostic Conundrum!
Authors
1 Terna Medical College, Navi Mumbai, IN
2 Infectious Diseases, Fortis Hospital, Mulund, Mumbai, IN
Source
The Indian Practitioner, Vol 71, No 7 (2018), Pagination: 24-29Abstract
The differential diagnosis of fever and rash in an adult is varied and includes a variety of infectious and non-infectious causes. When confronted with a patient having fever with rash, making a timely and specific diagnosis can be very important not only from an individual patient perspective but also from a public health perspective. An accurate characterization of the skin lesions and a detailed history can help narrow the differential diagnosis in a specific patient. The approach to the patient with fever and rash will cover the common etiologies for this presentation with focus on infectious etiologies in the adult patient. Non-infectious etiologies will be discussed as part of the differential diagnosis of each presentation.References
- Todd WTA., Lockwood DNJ. Sundar S: Infectious Diseases. in Davidson’s Principle and Practice of medicine chapter 13, 20th ededs : Boon AN., Colledge NR Walkar BR Hunter JA Churchill Livingstone London 2006 283 -376.