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Biomedical subjects

K R Sethuraman

Publications and source records attributed to K R Sethuraman.

At least 19 recordsLinked to original sources
PubMed2002

Infective endocarditis: report of a prospective study in an Indian hospital.

Forty-six patients who fulfilled the Duke's clinical diagnostic criteria for infective endocarditis (IE) were evaluated. Thirty-five (76%) patients were below 40 years of age with rheumatic heart disease being the most common underlying heart lesion affecting 26 (56%). An obvious predisposing cardiac lesion could not be ascertained in 22%. Blood culture positivity was 44% with streptococcus heading the list. The incidence of the staphylococcal (25%) and gram negative bacillary endocarditis (15%) were found to be increasing. Streptococci were susceptible to penicillin with minimum bactericidal concentration: minimum inhibitory concentration within acceptable limits. However, the appearance of methicillin resistant staphylococcus aureus and high level gentamicin resistant enterococcus as aetiological agents of infective endocarditis were found to add to the complexity of the problem. With the emergence of drug-resistant organisms as causative agents of IE, whenever medical therapy is the primary method of treatment of this condition, the selection of antibiotics should depend upon extensive in vitro testing and in vivo monitoring of clinical efficacy.

Adolescent↗
PubMed2002

Unexpected presentations--four cases of lead poisoning.

OBJECTIVE: To describe the clinical presentation and response to treatment of four patients who presented with abdominal pain and were diagnosed to have lead poisoning. METHODS: After ruling out the more obvious causes of abdominal pain by barium studies, gastrointestinal endoscopies, and biochemical studies, blood lead levels were estimated by atomic absorption spectrophotometry. The patients were treated with oral d-penicillamine. RESULTS: The four patients had blood lead levels from 79 microg/dL to 365 microg/dL. All four of them showed marked improvement in their clinical condition and lowering of blood lead levels on follow up. CONCLUSIONS: Clinicians need to develop a high index of suspicion of lead poisoning as a possible cause of unexplained abdominal pain or altered sensorium, especially against a background of environmental lead contamination in India.

Abdominal Pain↗
PubMed2001

Angioplasty of membranous obstruction of inferior vena cava.

Membranous obstruction of vena cava (MOVC) is a common cause of hepatic venous outflow obstruction. Surgical procedures utilized to relieve symptoms carry a high morbidity and mortality. A patient who presented with gradual onset ascites and dilated, tortuous veins over the anterior abdominal wall and the back was found to have MOVC by inferior vena cavogram. Balloon dilatation of the obstruction was done successfully through a transvenous approach. Following this, the patient improved remarkably. The procedure is safe, effective and easy to perform. This balloon angioplasty provides alternative method for treatment of membranous obstruction of vena cava.

Adult↗
PubMed2001

Streptococcus agalactiae endocarditis.

Streptococcus agalactiae (S. agalactiae) is a rare cause of infective endocarditis, which is associated with a high mortality rate. Endocarditis in adults is generally related to immunocompromised states. We hereby report the case of a 35 year old man who presented with fever and delirium in whom aortic valve endocarditis due to S. agalactiae was detected. Though most patients with S. agalactiae endocarditis need surgical intervention along with antibiotics, our patient improved with medical therapy alone.

Adult↗
PubMed1999

Scorpion envenomation as a risk factor for development of dilated cardiomyopathy.

OBJECTIVES: Though scorpion envenomation is known to lead to acute myocarditis and a reversible decrease in left ventricular function, it has not been implicated as an etiological factor in idiopathic dilated cardiomyopathy. We studied the association of idiopathic dilated cardiomyopathy with a history of scorpion sting as well as with socio-economic status, history of smoking and alcoholism, rural habitation, and history of snake bites. METHODS: Consecutive cases of idiopathic dilated cardiomyopathy were recruited for this study: The association with putative risk factors was studied using a case-control study design with two sets of controls. One set of controls were age and sex matched inpatients selected at random, the other set of controls were spouse, or if not available, a close relative, ordinarily resident with the patient. RESULTS: On analysis, none of the factors except scorpion envenomation had a significant association. A past history of scorpion envenomation had an adjusted odds ratio of 8.01 (3.55-18.06) when compared to one set of controls and an odds ratio of 8.33 (6.55-10.59) when compared to the second group of controls. CONCLUSIONS: Our study indicates that a history of scorpion envenomation acts as a risk factor for the subsequent development of idiopathic dilated cardiomyopathy. Despite an apparently complete recovery from a scorpion sting, many patients probably retain sub-clinical deficits that predispose to the development of cardiomyopathy later in life, when other factors get added on. The known association of cardiomyopathy with catecholamine excess in experimental situations in animal studies, and in other disease states in humans, supports this hypothesis.

Adolescent↗
PubMed1995

Cardiac involvement and scorpion envenomation in children.

Cardiac complications of 32 children with scorpion envenomation, during a 1-year period from August 1990 to August 1991 were studied. Sixteen children (50 per cent) were diagnosed as having myocarditis; of these in four children the presentation was subclinical. ECG changes were seen in 63 per cent of children envenomed and was a sensitive indicator of myocarditis. Sixty-nine per cent of children with myocarditis had left ventricular dysfunction as shown by echocardiography. Though statistically not significant, there was a correlation between prolonged QTc and LV dysfunction, which needs to be studied further. In those children who came for follow-up, the left ventricular function reversed to normal.

Animals↗
PubMed1995

Scorpion envenomation in children in southern India.

The clinical presentation of 32 children with scorpion envenomation was analysed. The most common presentation was cold, clammy extremities with normal blood pressure. Myocarditis was present in 16 children (50%) and encephalopathy in four (12.5%). Two children died. ECG was a sensitive indicator of myocarditis which was subclinical in four children. Left ventricular dysfunction was a transient phenomenon. Myocarditis and encephalopathy were the two lethal complications observed. Serum free fatty acid levels were elevated two to three-fold in all symptomatic patients. Blood glucose levels were only mildly elevated and serum amylase levels and electrolytes were normal in all the children. No specific antivenom was given. In the absence of specific antivenom, early and active supportive treatment reduces the morbidity and mortality due to scorpion envenomation.

Animals↗
PubMed1993

The use of objective structured clinical examination (OSCE) for detecting and correcting teaching-learning errors in physical examination.

The innovative use of Objective Structured Clinical Examination (OSCE) to detect and correct teaching-learning (T-L) errors in clinical skills is described. The group performance errors could be classified as Type I (faulty performance or omission of a step), Type II (failure to recognize or correctly interpret a clinical sign) or combined (Type I & II) errors. Type I errors were due to ineffective or absent T-L experiences. Type II errors were due to poor concept attainment or inability to discriminate between the differences in a clinical sign. Clinical demonstration during feedback was effective in eliminating Type I errors. Correcting Type II errors of the group needed more time and effort and was only partially effective.

Clinical Competence↗
PubMed1987

Salivary paracetamol elimination in patients with congestive cardiac failure.

1. Salivary paracetamol elimination was studied in nine patients with congestive cardiac failure (CCF). Six healthy volunteers served as the control group. 2. Paracetamol elimination t1/2 and apparent volume of distribution were significantly higher in patients with CCF compared with controls. There was no significant change in the clearance rate. 3. Drug therapy of failure for a period of 15 days returned the t1/2 and V values to normality.

Acetaminophen↗
PubMed1985

Biplane measurement of mitral valve orifice size by two-dimensional echocardiography.

We used a new method of imaging the mitral valve orifice in two planes to assess 187 cases of mitral stenosis. By ensuring that the diastolic antero-posterior diameter of the mitral valve orifice in the short-axis view was the same as that obtained in the long-axis view, imaging of the true mitral valve orifice could be confirmed in 173 cases. This objective method proved to be accurate and could eliminate observer variation noted in other methods of current usage.

Diastole↗
PubMed1984

Left ventricular false tendons: echocardiographic incidence in India and clinical importance.

In a prospective study of 1012 patients above the age of 12 years, we detected 4 (0.4%) cases of left ventricular false tendon (LVFT) by echocardiography. Two patients had significant heart disease and LVFT was perhaps a chance occurrence; two others had no significant heart disease and LVFT probably had a causal association with S3 gallop in one and systolic murmur in the other. Diagnosis of LVFT may help to explain cardiac findings of uncertain origin.

Adolescent↗
PubMed1984

Atrial septal motion in obligatory right to left shunt.

An adult patient with a hypoplastic right heart with intact ventricular septum, pulmonary atresia, secundum ASD and a PDA was studied by 2-D echocardiography. A striking flap valve motion of the primum portion of the interatrial septum was observed. This is perhaps the first report of its kind in an adult.

Adult↗