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Biomedical subjects

N Kakkar

Publications and source records attributed to N Kakkar.

At least 19 recordsLinked to original sources
PubMed2005

An outbreak of dengue fever in periurban slums of Chandigarh, India, with special reference to entomological and climatic factors.

BACKGROUND: Dengue viral infection is one of the most important public health problem in tropical countries. AIM: An outbreak of dengue fever was investigated in a periurban slum area of Chandigarh, India, during September to December, 2002. MATERIALS AND METHODS: Blood samples from 218 patients and 30 apparently healthy contacts were tested for dengue-specific immunoglobulin M (IgM) and IgG antibodies including 80 acute samples collected within 5 days of illness were subjected for virus isolation in newborn mice. The average temperature, rainfall, and humidity of the epidemic year were compared with the number of dengue cases. STATISTICAL ANALYSIS: statistical significance was found out using c2-test. RESULTS: A total of 76 cases were positive by either dengue IgM capture assay (n = 57) or virus isolation (n = 17) or both (n = 2). Fifteen of nineteen viral isolates subjected for typing by type-specific multiplex reverse transcription-polymerase chain reaction were found to be of dengue virus. High rainfall and humidity with the temperature range from 21 degrees C to 33 degrees C during the months of August and September might have favored the breeding of mosquitoes, thus leading to an increase in the number of dengue cases in October and November, 2002. CONCLUSION: The present outbreak thus emphasizes the need for continuous sero epidemiological and entomological surveillance for the timely implementation of effective dengue control programme.

Adolescent↗
PubMed2005

Outpatient oral anticoagulant management--an audit of 82 patients.

OBJECTIVE: Use of oral anticoagulants for thrombotic diseases has been increasing steadily over the years. Management practices however, are far from uniform. We conducted a retrospective audit among outpatients on oral anticoagulant therapy to assess treatment practices and overall control of anticoagulation. METHODS: Case records of 82 patients who were on anticoagulant therapy for a minimum duration of three months were reviewed. Information on pre-therapeutic assessment of patients, therapeutic control and complications seen during the course of treatment was recorded. RESULTS: Case notes of 43 males and 39 females with a mean age of 47.5 +/- 14.6 years, on oral anticoagulant treatment were evaluated. Treatment duration ranged from 3 months to 7 years for a total of 258.7 patient treatment years. Pre-therapeutic assessment of patients was inadequate with only baseline hematological and renal parameters available for most patients. Of a total of 1631 prothrombin time ratios and International Normalized Ratios recorded, only 17.8% were in the therapeutic range with 73% being sub-therapeutic. Sixteen (19.5%) patients had treatment related complications. The number of thrombotic and hemorrhagic events per 100 patient treatment years was 3.4 and 2.7 respectively. CONCLUSIONS: Pre-therapeutic assessment of patients was inadequate. The overall therapeutic control was poor with patients in a state of underanticoagulation for most period of anticoagulant treatment. The complication rate was also unacceptably high. There is a need to reassess management practices of patients on long term oral anticoagulation with strict adherence to standard accepted guidelines to make this therapy more effective and safer for patients.

Administration, Oral↗
PubMed2004

Multilocular cystic renal cell carcinoma in a child.

Multilocular cystic renal cell carcinoma is an extremely rare condition in adults with no previous case reports in the pediatric age group. The authors report on an 8-year-old girl who underwent nephrectomy for a right-sided renal cystic disease because of extensive involvement of the kidney. Subsequent histopathologic examination findings showed presence of renal cell carcinoma in all the cysts. Awareness of this malignancy in a child is extremely important in the background of recent reports advocating conservative wait and watch management in unilateral renal cystic disease, which has similar clinical and imaging findings.

Carcinoma, Renal Cell↗
PubMed2004

Improvement in fresh frozen plasma transfusion practice: results of an outcome audit.

Blood components have been in use in clinical practice for many decades now. In spite of fairly clear guidelines regarding their use, inappropriate prescriptions for components are still rampant. We undertook this work to assess the appropriateness of fresh frozen plasma (FFP) transfusions in our hospital. A prospective audit of 504 transfusion orders for 1761 FFP units was conducted over a 6-month period which was followed by a re-audit of 294 FFP prescriptions for 961 units. In the initial audit, we identified 304 (60.3%) prescriptions which were inappropriate according to the British Committee for Standardization in Hematology (BCSH) guidelines. The re-audit performed after an educational campaign among clinicians showed a reduction in inappropriate requests by 26.6%. The specific areas of misuse were FFP transfusions in patients with hypoproteinaemic states (40.5%), anaemia (36.5%), bleeding without coagulation factor deficiency (10.2%) and volume depletion (9.2%). A significant 50.3% of requests in the initial audit and 38.4% in the re-audit were for single- or two-unit transfusions, which were subtherapeutic. FFP transfusions carry the same risks to the patients as any other blood component. Prescribers of these transfusions need to be aware of the clinical setting where their use is appropriate. Local hospital transfusion committees can play a vital role in overseeing transfusion practices to ensure optimal use of blood/component therapy.

Anemia↗
PubMed2004

An audit of splenectomies in a teaching hospital in North India. Are postsplenectomy guidelines being complied with?

AIMS: Patients with an absent or dysfunctional spleen are at risk of infection by encapsulated and other bacteria. Overwhelming postsplenectomy infection (OPSI) causes most concern because it can result in significant mortality. A retrospective review of splenectomised patients in a tertiary care setting over an eight year period was carried out to determine whether current postsplenectomy guidelines were being followed. METHODS: The cases were identified from the medical records and pathology files and data such as the reason for splenectomy, the preventive measures taken regarding vaccination, and antibiotic prophylaxis, together with their documentation in the discharge notes were assessed. RESULTS: Fifty six patients were studied. Trauma, both blunt and penetrating, was the most common reason for splenectomy. Thirty six patients received pneumococcal vaccination, with 20 patients having no mention of vaccination in their case notes. The discharge notes of 50 patients mentioned their splenectomised status; however, documentation of vaccination details in the discharge summary was poor, with only three patients having the relevant information recorded. Documentation of the need for future vaccination and precautions required in the asplenic condition was also lacking. Nine patients had postsplenectomy complications, although there were no cases of OPSI. CONCLUSIONS: Adherence to standard guidelines for the management of splenectomised patients was unsatisfactory. There is a need for an improvement of the vaccination rate and careful documentation of this important health risk in the discharge summaries. Maintenance of a splenectomy registry could aid in optimising the management of these patients.

Adolescent↗
PubMed2004

Spurious rise in the automated platelet count because of bacteria.

The era of automation in haematology, although improving the accuracy and precision of results, has also introduced the laboratory haematologist to a vast array of spurious parameters. The identification of these results is important so that inappropriate management decisions are avoided. The case presented here illustrates a spuriously raised automated platelet count resulting from bacterial overgrowth in the blood sample.

Adult↗
PubMed2004

Botryomycosis--a series of six integumentary or visceral cases from India.

Botryomycosis is characterized by a chronic suppurative lesion with distinctive fungus-like grains that resemble the sulphur granules of actinomycosis. Both integumentary and visceral forms of the disease are recognized. The visceral involvement occurs predominantly in the lungs. Botryomycosis may develop in apparently healthy individuals as well as the immunologically compromised. Six cases of botryomycosis, affecting various sites in the bodies of immunocompetent individuals, are described. In each of the six cases, the initial clinical diagnosis was of an abscess or malignancy.

Abscess↗
PubMed2004

Knowledge base of clinicians regarding oral anticoagulant therapy in a teaching institution--a questionnaire survey.

AIMS: Maintaining international normalized ratios (INRs) within the therapeutic range for patients on oral anticoagulant therapy is a tough task. Physician practices have a vital bearing on safe management in these patients. We sought to assess the knowledge base of clinicians in our hospital regarding oral anticoagulant treatment. METHODS: A retrospective review of 3152 consecutive INRs in patients on outpatient oral anticoagulant treatment (OAT) was carried out over a 16 month period. To assess clinician practices, we performed a questionnaire survey (20 questions) on various aspects of OAT among 65 clinicians (response rate--89%). RESULTS: 76.3% of the INRs were in the sub-therapeutic range, 19.1% in the therapeutic range while 4.6% INRs were beyond therapeutic range. Fifty five completed questionnaires were returned by 24 consultants and 35 residents. Knowledge of clinicians regarding the loading dose of the oral anticoagulant, target INR range, the colour of the tablet was not adequate with 21, 28 and 23 correct responses respectively. Documentation of dietary and drug history was inadequate with 13 and 38 responses respectively. Patient education was limited to only verbal information to patients on anticoagulation. Most clinicians performed baseline screens before starting therapy. Although majority of clinicians (41) reported haemorrhagic complications in patients, just under one-third (28.8%) clinicians encountered thrombosis more often. Significant differences between the knowledge of consultants and residents was only found in responses for the correct loading dose (p < 0.0007) and the laboratory methodology in use for PT/INR determination (p < 0.04). CONCLUSIONS: Knowledge base of clinicians regarding oral anticoagulant management was unsatisfactory. A tendency to under-dose patients was observed. There is need for stricter adherence to accepted guidelines of anticoagulant therapy with particular emphasis on patient education.

Administration, Oral↗
PubMed2003

Celiac crisis.

Celiac crisis is a life-threatening cause of acute diarrhea and multiple metabolic emergencies. It is extremely rare these days. We successfully managed a 5-year old girl with celiac crisis for multiple metabolic problems viz., hyponatremia, hypokalemia, metabolic acidosis, hyperglycemia and polyuria in Pediatric Intensive Care Unit. Steroid therapy was life saving. The case may serve as a reminder of the condition, which presents a difficult therapeutic challenge.

Acidosis↗
PubMed2003

Subependymomas in children: a report of five cases including two with osseous metaplasia.

Subependymomas are highly differentiated slow growing gliomas. They are one of the few gliomas which are biologically benign. They are extremely rare in children. However, after going through the histopathology records of our department of fourteen years (1983-1997) we found that five (20%) cases of subependymomas have been diagnosed in children out of a total of twenty-six subependymomas. Two of our cases showed the presence of osseous metaplasia, a hitherto undescribed finding.

Brain Neoplasms↗