1Dialysis And Renal Transplantation, Madras Medical Mission, CHENNAI/INDIA, 2Nephrology, Sri Ramachandra University, 600137/INDIA, 3Nephrology, Sri Ramachandra University, Chennai/INDIA, 4Chennai/Tamil Nadu/INDIA
Of 55 patients with testicular cancer, treated by combination chemotherapy including cisplatin, 21 (mean age 35 [21-51] years) were reexamined for late sequelae of the chemotherapy 1-9 years later. No patient had a recurrence or second malignancy. They all had normal renal function (renal sequence scintigraphy; creatinine clearance). Seven of 20 patients had a polyneuropathy, nine of 18 had high-tone hearing loss. Two patients became fathers after treatment. In nine of 20 patients the serum concentration of follicle-stimulating hormone was raised to above 20 mU/ml, evidence of germ-cell damage. Six of 13 patients had an abnormal ejaculation following retroperitoneal lymphadenectomy or excision of a residual tumour. There was no evidence of any life-limiting toxicity of the chemotherapy.
Depression is ranked fourth among the disabling diseases affecting people worldwide and is the most common psychological problem in patients with End Stage Renal Disease (ESRD). The aim of this study is to assess the physical and emotional health status of renal dialysis patients, based on the SF-36 scale in relation to their economic status. Sixty maintenance hemodialysis patients, with a mean age of 40±13 years were included in this cross-sectional study using the SF-36 scale. It comprises 36 questions regarding physical and mental functions, body pain, vitality, etc. An SF-36 score of 50 or less was considered as moderate to severe depression and 51-100 as mild depression to good health. 56.81% of the patients who are below poverty line under dialysis had moderate to severe depression with regard to their health status. A physical health score of up to 50 was seen in 63.63% of patients below poverty line 63.63% (P= 0.16). A mental health score of 0-50 was observed in 61.63% of the cohort studied (P = 0.22). Among the patient with diabetes (28.33%) 55.56% had depression. Dialysis duration was directly associated with deteriorating physical health status and inversely proportional to their mental health status (P<0.05). There are problems in other regular activities due to depressed physical and mental health. The factors that were identified in this study that influence depression such as poverty status, increasing age, vintage and frequency of dialysis and treatment with erythropoietin dosage should be addressed and treated accordingly to improve the quality of life. Improving self-esteem with fruitful employment opportunities, concerted rehabilitation by professionals and easing of economic burden by private-public partnership is an achievable goal.
The study was conducted in twelve female dogs of different breeds, randomly divided into two groups of six dogs each. All dogs underwent a comprehensive pre-anaesthetic evaluation prior to surgery. One hour before the procedure, the dogs received firocoxib orally. Pre-anaesthetic medication included injections of xylazine and buprenorphine, followed by induction with ketamine and midazolam. In Group I, lignocaine was administered during induction followed by a constant rate infusion (CRI), while in Group II, lignocaine was applied directly to the peritoneal cavity and viscera during surgery. Anaesthesia was maintained with isoflurane in both the groups. The quality of sedation, induction and recovery from anaesthesia was noted as excellent in both groups. Haematological and serum biochemical parameters varied within normal acceptable ranges and showed no significant differences between the groups. Electrocardiographic parameters, blood pressure values and blood gas parameters also remained within normal limits, without significant differences between the groups. Pain scores were lower in Group II compared to Group I, although the difference was not statistically significant. Both multimodal anaesthetic protocols proved effective in managing postoperative pain in dogs. Keywords: Pain, multimodal anaesthesia, multimodal analgesia, OHE, GCMPS
A Fifteen years girl belonging to a low socioeconomic status was admitted with peritonsillar abscess caused by methicillin resistant Staphylococcus aureus (MRSA), high fever, diarrhoea and septicaemic shock. Initial blood cultures and widal test, stool cultures and routine stool examination were non-contributory to the diagnosis. A bone marrow culture in the second week confirmed the diagnosis of Salmonella typhi infection. Examination of a fresh stool sample showed cysts of Entamoeba histolytica. She was treated with ciprofloxacin, metronidazole, augmentin and ceftriaxone. She had no clinical evidence of immunosuppression prior to this episode and her HIV test was negative. This case report highlights the presence of community acquired MRSA infection causing perititonsillar abscess, and the diagnostic dilemma of fever and diarrhoea due to coinfection with Salmonella typhi and Entamobea histolytica.
Aim: We did this prospective study to compare cystatin C, creatinine and GFR in live related or spousal renal donors to assess recipient graft function at the end of 2 weeks. Materials and methods: Our study cohort comprised 39 patients (19 Males, 20 females) with a mean age of 38.3+9.3. Donor details such as age, sex, nationality, serum creatinine, serum cystatin C, GFR by isotope renogram and renal angiogram were collected in addition to recipient details such as BMI, serum creatinine, diabetic status and immunosuppression particularly tacrolimus (Pangraf). All donors were related or spousal. All recipients received initial immunosuppression with 0.5mg/kg body weight of prednisolone, mycophenolate mofetil (mycept) 750mg - 1000mg bid, and tacrolimus at 0.1mg/kg body weight or cyclosporine at a dose of 8mg/kg body weight in 2 divided doses. Analysis was done using PASW Statistics 18 with chi-square test and one way Anova with post-hoc Tukey. Result: Of the 39 patients, 14 were Indian and 25 were of African origin. The incidence of double renal artery was 10.3% and this was noted in only left sided harvested kidneys. The harvested kidneys were left sided in 29 patients and right sided in 10 patients. Five percent of patients were mildly hypertensive but were on adequate anti-hypertensive therapy. While creatinine was found to be significantly different between race (p=0.19) and gender (p< 0.001), cystatin C was not, indicating that cystatin C may be a more stable reference value across race and gender. In the 12 patients who received cyclosporine, the levels were 301+67.5ng/mL and in the 26 patients on tacrolimus, the levels were 12.3±7.3ng/mL. One patient had graft thrombosis with anuria after 5 days and his graft was removed. One patient had recurrence of FSGS underwent plasmapheresis and her renal function improved. One patient suffered from tacrolimus toxicity.Table: [Donor details]Table: [Recipient parameters]Conclusion: Our study shows that cystatin C is a superior marker of GFR as its value is independent of gender and race. The mean serum creatinine in the recipients was 1.5±1.3mg/dL at the end of 2 weeks after donor surgery with adequate trough level with the use of the generic tacrolimus and mycophenolate mofetil.
'%3e%3ccircle r='20' fill='%23008'/%3e%3ccircle r='17.5' fill='%23fff'/%3e%3ccircle r='3.5' fill='%23008'/%3e%3cg id='d'%3e%3cg id='c'%3e%3cg id='b'%3e%3cg id='a' fill='%23008'%3e%3ccircle r='.875' transform='rotate(7.5 -8.75 133.5)'/%3e%3cpath d='M0 17.5.6 7 0 2l-.6 5L0 17.5z'/%3e%3c/g%3e%3cuse xlink:href='%23a' transform='rotate(15)'/%3e%3c/g%3e%3cuse xlink:href='%23b' transform='rotate(30)'/%3e%3c/g%3e%3cuse xlink:href='%23c' transform='rotate(60)'/%3e%3c/g%3e%3cuse xlink:href='%23d' transform='rotate(120)'/%3e%3cuse xlink:href='%23d' transform='rotate(-120)'/%3e%3c/g%3e%3c/svg%3e)
'%3e%3ccircle r='9'/%3e%3cg id='d'%3e%3cg id='c'%3e%3cg id='b'%3e%3cpath d='m-19 0 1.169 1.169L0 0l-17.831-1.169z'/%3e%3cpath id='a' d='m-.884.116.05.05L0 0z' transform='scale(19.2381)'/%3e%3cuse xlink:href='%23a' transform='scale(1 -1)'/%3e%3c/g%3e%3cuse xlink:href='%23b' transform='rotate(45)'/%3e%3c/g%3e%3cuse xlink:href='%23c' transform='rotate(90)'/%3e%3c/g%3e%3cuse xlink:href='%23d' transform='rotate(180)'/%3e%3cg transform='translate(-2.02)'%3e%3cg id='f' transform='translate(37.962)'%3e%3cpath id='e' d='M5 0 1.618 1.176l-.073 3.58-2.163-2.854-3.427 1.037L-2 0z'/%3e%3cuse xlink:href='%23e' transform='scale(1 -1)'/%3e%3c/g%3e%3cuse xlink:href='%23f' transform='rotate(120)'/%3e%3cuse xlink:href='%23f' transform='rotate(-120)'/%3e%3c/g%3e%3c/g%3e%3c/svg%3e)