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کاربرد نوع شرط:
- جایگاه : پژوهشی
- مجله: Iranian Journal of Medical Sciences
- نوع مقاله: Journal Article
- کلمات کلیدی: HIV,biopsy,Acquired immunodeficiency syndrome,Mycobacterium tuberculosis (MTB),Spindle cell
- چکیده:
- چکیده انگلیسی: Pseudotumour is a benign inflammatory lesion. Mycobacterial spindle cell pseudotumour (MSP) is a rare pseudotumour. It is a benign proliferation of spindle-shaped histiocytes containing acid-fast mycobacterium, commonly reported in immunocompromised patients. MSP is usually associated with mycobacterium avium complex (MAC). Here, we present the case of a 38-year-old gentleman with acquired immune deficiency syndrome (AIDS) who presented with low-grade fever for 1-month duration. Clinically, he had generalised lymphadenopathy. Chest X-ray showed miliary infiltration in bilateral lung fields. Lymph nodal biopsy showed spindle-shaped histiocytes filled with acid-fast bacilli on Ziehl-Neelsen (ZN) stain, suggestive of MSP. Immunohistochemical (IHC) stains were positive for CD68, S-100 and negative for CD31, which are consistent with MSP. Polymerase chain reaction (PCR) of the biopsy tissue was positive for MTB. Highly active antiretroviral therapy (HAART) was continued and anti-tubercular therapy (ATT) was started. The fever resolved within two weeks and there was a resolution of lymph nodal swelling by 6 weeks. The diagnosis of MSP associated with mycobacterium tuberculosis (MTB) makes our case interesting. It is of utmost importance to differentiate MSP from Kaposi’s sarcoma (KS) and other pseudotumours and to know whether it is of tubercular or non-tubercular origin, as the treatment is entirely different.
- انتشار مقاله: 23-04-1395
- نویسندگان: Deba Prasad Dhibar,Kamal Kant Sahu,Surjit Singh,Amanjit Bal,Abhijit Chougale,Varun Dhir
- مشاهده
- جایگاه : پژوهشی
- مجله: Asia Pacific Journal of Medical Toxicology
- نوع مقاله: Journal Article
- کلمات کلیدی: Organophosphate Poisoning,Pralidoxime Compounds,Oximes,Comparative Effectiveness Research
- چکیده:
- چکیده انگلیسی: Organophosphate (OP) compounds are frequently used agorchemicals for deliberate self-harm in some parts of the world resulting in high mortality and morbidity. Pralidoxime (2PAM) is the most widely used and trialed oxime for treatment of OP poisoning. There have been variations over the results of trials using 2PAM for OP poisoning. 2PAM therapy has led to favorable outcomes in some studies, whereas it has been associated with unfavorable outcomes or without benefit in the others. Why 2PAM works in some trials and why it does not in the others, has been a key question for medical toxicologists with no definite answer. In this systematic review, we sought to investigate possibilities of the variations in the results of different studies conducted on the effectiveness of 2PAM therapy for OP poisoning and we tried to provide solutions for future studies.
- انتشار مقاله: 17-05-1394
- نویسندگان: Ashish Bhalla,Surjit Singh
- مشاهده
- جایگاه : پژوهشی
- مجله: Asia Pacific Journal of Medical Toxicology
- نوع مقاله: Journal Article
- کلمات کلیدی: India,Artificial Respiration,Bungarus,Neurotoxicity Syndromes,Snake Bites
- چکیده:
- چکیده انگلیسی: Background: Bungarus caeruleus (common krait) bite during monsoon season is common in northwest India. Respiratory failure is responsible for high mortality in the victims. In this study we report our experience with manual ventilation using bag valve mask (BVM) in patients with neuroparalysis due to common krait bite.
Methods:This prospective study was conducted between June 2009 and December 2009. All consecutive patients with diagnosis of common krait bite who were manually ventilated by BVM were studied. The duration of ventilation and complications associated with ventilation were noted. Polyvalent anti snake venom was administered as per the "national snake bite protocol" and patients were followed up until final outcome.
Results: Thirty-four patients (70.6% men) were studied. All patients except two came from rural areas and they were hospitalized between June and September. Majority of patients were bitten during the night while sleeping on the floor. The mean time interval between bite and arrival to hospital was 4.4 hours. Ptosis (100%) was he most common clinical finding followed by ophtalmoplegia (80%) and limb muscle weakness (74%). Twenty-four patients (70%) developed respiratory symptoms and 20 (59%) were intubated and manually ventilated by BVM. Mean duration of assisted ventilation was 34.6 ± 12.8 hours. Hoarseness of voice and throat pain were noted in all intubated patients following extubation, which responded to conservative therapeutic measures. The mean duration of hospitalization was 6 ± 1.6 days. All patients except one survived.
Conclusion: Manual ventilation with BVM in patients with neuroparalysis due to common krait bite is a safe and effective modality in resource constraint settings.- انتشار مقاله: 16-11-1392
- نویسندگان: Ashish Bhalla,Vikas Suri,Navneet Sharma,Surjit Singh
- مشاهده
- جایگاه : پژوهشی
- مجله: Asia Pacific Journal of Medical Toxicology
- نوع مقاله: Journal Article
- کلمات کلیدی: toxicology,Poison Control Centers,India
- چکیده:
- چکیده انگلیسی: In the editorial by Dr. Reza Afshari “Empowerment of Medical Toxicology in Asia Pacific Region” published in the Asia Pacific Journal of Medical Toxicology (APJMT) (1), the role of Asia Pacific Association of Medical Toxicology (APAMT) in promoting medical toxicology has been discussed and some suggestions have been made regarding how to promote this field of medical sciences in the region. The stated goal of APAMT is to promote chemical safety, poison control and treatment in the region and to some extent the organization has been successful in achieving these objectives. In the editorial, a few suggestions have been put forward to further achieve these objectives. As far as India is concerned, poison control and treatment centers do not practically exist and most of the acutely poisoned patients are being managed either in general medical departments or intensive care units. The clinical toxicologists are practically non-existent and toxicology is still a part of forensic medicine in undergraduate curriculum and emergency medicine is not developed. There is no society of medical toxicology and the Indian society of toxicology is mostly membered by forensic specialists. A few poison information centers exist in major cities. Most of the research has been done in few centers by interested clinicians as supportive structure is lacking. Hence, a national society of medical toxicology which promotes the objectives of APAMT is needed. We also need to develop poison control and treatment centers and not only information centers as poisonings are more often due to chemicals and require specialized care. In most parts of South East Asia, majority of population lives in rural areas and is involved with agriculture. We also need to extend facilities to rural and semi-urban areas. These centers can play an important role in further promoting of public health, poison control and disaster control and also can assist in informing public about dangers of poisons and collection of harmonized data. To achieve these objectives, we need funding which has to be absorbed from government and non-governmental organizations. There is also a need to start educational activities such as post-doctoral fellowships in management of acute poisonings (2,3). This will go in a long way to promote and empower the medical toxicology in the region as India can help several developing countries in fulfilling the objectives of APAMT.
- انتشار مقاله: 02-06-1392
- نویسندگان: Surjit Singh,Surjit Singh,Surjit Singh
- مشاهده
- جایگاه : پژوهشی
- مجله: Asia Pacific Journal of Medical Toxicology
- نوع مقاله: Journal Article
- کلمات کلیدی: Poisoning,Argemone mexicana,Dihydrosanguinarine,Dropsy,Sanguinarine
- چکیده:
- چکیده انگلیسی: Background:Epidemic dropsy occurs due to ingestion of mustard oil contaminated with oil from Argemone mexicana, leading to edema and tenderness of the abdomen, upper and lower limbs. In this study, clinical profiles of patients presented with epidemic dropsy in north India are described.
Methods: This was a prospective study of patients presented with epidemic dropsy to the emergency department of Nehru Hospital, during the period from March 2004 to December 2011. Inclusion criteria were patients presenting with tender bilateral pitting leg edema and dermal telangiectasia. Clinical and laboratory data of patients were entered into case record forms at the time of presentation until discharge from the hospital.
Results: Leg edema was the principal symptom in our series, and was in concurrence with current literature. Erythema has only been reported in 35-82% of published series, though it was present in all of our patients. Similarly, features such as diarrhea, hepatomegaly and anemia were more frequent in our cases compared to the literature. Furthermore, pancytopenia which was documented on peripheral blood counts in 54% of our cases has never been reported before.
Conclusion: Epidemic dropsy should be considered in patients presenting with progressive erythema, edema, and tenderness of the limbs who had a history of consumption of mustard oil and confirmation of Argemone oil contamination according to laboratory tests.
- انتشار مقاله: 12-02-1392
- نویسندگان: Navneet Sharma,Naina Mohan,Ashish Bhalla,Aman Sharma,Surjit Singh
- مشاهده
- جایگاه : پژوهشی
- مجله: Asia Pacific Journal of Medical Toxicology
- نوع مقاله: Journal Article
- کلمات کلیدی: Research,Acute poisoning,Developing countries,Medical toxicology
- چکیده:
- چکیده انگلیسی: In the editorial by Dr. Reza Afshari “What is the best research for low income countries” (1), some important issues have been raised, highly relevant to developing countries. In most developing countries including India, emergency medicine is not well established and clinical toxicology is even further a low priority in view of both research and clinical management. The number of poison control and treatment centers is few and if they exist, they are mainly in metro cities. Moreover, we are faced with lack of required resources for such research. Dr. Afshari’s suggestion about the need for epidemiological studies should be regarded as highly important (1). These studies should be prospective and community-based rather than hospital or poison centre based. Unless we know the pattern of poisonings, it will not be possible to formulate the guidelines for treatment and research as poisonings vary in different countries and in different areas of a country (2). Depending on pattern, the treatment and research guidelines can be devised and scarce resources can be allocated. The acute poisonings in developing countries are very often due to toxic chemicals. This is because there is a lack of control on availability of chemicals as laws do exist but implementation is lacking (2). Although specific antidote is available for majority of them, mortality remains high because treatment is often delayed due to non-availability of proper centres and lack of antidotes. Therefore, it is necessary to train health care professionals and to provide better awareness in general public regarding risks of poisonings. Furthermore, not only resources are lacking, western textbooks or literature is only available for management of poisonings and local guidelines are limited. In high income countries, both knowledge and money are available but poisoned patients are in limited number while in developing countries it is other way round. We must pay the most careful attention to the role of gastric lavage which due to legal reasons in some countries such as India, it is mandatory (3). It is also crucial to carefully investigate the venomous snakes where more species are required to be identified and antivenoms should be developed. There is a great need to develop low-priced diagnostic kits and cheaper analytic methods for poisons. More access to information in developing world and South-South collaboration is a highly welcomed idea. We need a standardized format to record, uniform protocols to manage poisonings and low cost healthcare technologies such as self-inflating bag in saving patients with respiratory arrest following snakebite or OPC poisoning or where short term ventilation is required.
- انتشار مقاله: 28-12-1391
- نویسندگان: Surjit Singh,Surjit Singh,Surjit Singh
- مشاهده
- جایگاه : پژوهشی
- مجله: Asia Pacific Journal of Medical Toxicology
- نوع مقاله: Journal Article
- کلمات کلیدی: Systemic capillary leak syndrome,Endothelial dysfunction,Phosphine gas,Aluminum phosphide,Polyserositis
- چکیده:
- چکیده انگلیسی:
Background: Aluminum phosphide is the common cause of poisoning in adults in India, with a very high case fatality ratio. We studied five patients of aluminum phosphide poisoning with polyserositis.
Methods: We enrolled all patients with aluminum phosphide poisoning presenting to emergency medical department, at a tertiary care hospital in northwestern India from January to July 2006. These patients were managed according to a standard treatment protocol and their complications were recorded.
Results: During the study period, total of 35 patients were admitted with 57.5% mortality in the first 12 hours. Among the rest, 5 patients were found to develop polyserositis. All these patients had severe hypotension at presentation and developed respiratory distress requiring mechanical ventilation after an average stay of 3.8 days post-ingestion. They were managed conservatively and four of them were discharged from the hospital after the average stay of 10 days.
Conclusion: In this case series, features of polyserositis (pleural effusion, ascites and pericardial effusion) were found in 15% patients of severe aluminum phosphide poisoning. We postulate systemic capillary leak syndrome, secondary to mitochondrial damage in the endothelium, as a possible mechanism.
- انتشار مقاله: 22-05-1391
- نویسندگان: Ashish Bhalla,Sushil Mahi,Navneet Sharma,Surjit Singh
- مشاهده