The National medical journal of India最新文献

Methaemoglobinaemia and a Heinz-body haemolytic anaemia are uncommon but potentially treatable complications of aniline poisoning. Management of aniline poisoning is mainly removing the source of aniline exposure and management of methaemoglobinaemia. Management of methaemoglobinaemia is guided by blood methaemoglobin levels and patient symptoms. Blood methaemoglobin level <30% requires only supplemental oxygen while for methaemoglobin level >30%, intravenous methylene blue is the mainstay of treatment. All patients treated with methylene blue should be observed for delayed haemolysis, acute renal failure and cardiac complications. In patients with contraindication to methylene blue, exchange transfusion can be used while haemodialysis is reserved for complicated cases. We successfully managed 6 patients of methaemoglobinaemia due to aniline poisoning by methylene blue. Two of these patients who developed Heinz-body haemolytic anaemia with acute renal failure as a complication also required exchange transfusion.

Background The challenge faced by an undergraduate medical student to draw factually correct histology diagrams needs to be addressed by the use of innovative teaching strategies. We introduced a new method to teach drawing of histology diagrams and compared its outcome with two preexisting methods. We obtained feedback from the students and faculty. Methods We introduced an innovation (method 3): A validated hand-drawn pencil sketch of a histology diagram was provided to the students. Students drew on the pencil sketch with haematoxylin and eosin (H&E) pencils and coloured it. They then drew the same diagram afresh. Three diagrams of systemic histology were chosen and the evaluation criteria shared with students. The students drew all three diagrams once, each by a different method. The scores of method 3 were compared with the other two methods, copying from standard atlas (method 1) and from hand-drawn colour chart made by teacher (method 2). Feedback was sought from students and faculty by means of a google form. Results A total of 112 students (of 167 who volunteered) completed the study. The mean (SD) score obtained by method 3 (4.83 [0.298]) was higher than the mean score by method 1 (3.91 [0.95]) and method 2 (4.82 [0.27]). There was a statistically significant difference between method 3 and method 1 (p<0.01), and method 2 and method 1 (p<0.01). However, the difference in scores between methods 3 and 2 was not statistically significant (p>0.05). Conclusion We found method 3 (the innovation) to be better than one of the pre-existing methods (method 1) but not better than method 2. The quality of diagrams produced by methods 2 and 3 were better than those by method 1, and equally so. The ease of drawing and time taken to draw were the best for method 2. Hence, overall, method 2 may be adjudged the best method.

Background Autologous stem cell transplantation (ASCT) is potentially beneficial for patients with myeloma-related renal impairment but is associated with high rates of complications in dialysis-dependent patients and requires specific precautions. Methods Patients diagnosed with myeloma and concomitant dialysis-dependent renal dysfunction were admitted for ASCT after achieving at least partial response with bortezomib-based induction therapy. For both patients, mobilization consisted of granulocyte colony stimulating factor for 5 days and CD34 directed Plerixafor on Day 1. Melphalan was administered at a dose of 140 mg/m2 and a pre-emptive session of haemodialysis was planned 24 hours after melphalan. Peripheral blood stem cell infusion was done after 24 hours. A central venous sample for blood gas analysis was obtained daily and ad hoc dialysis was planned at the earliest sign of metabolic acidosis (pH <7.35, HCO3 <15 or K >6 mEq/L). Results Two patients with biopsy proven cast nephropathy and dialysis dependence (twice a week) were taken for ASCT with the above protocol. No variation from usual stem cell yield or engraftment kinetics was noted. Patient 1 (M, 49 years) achieved very good partial response post-transplant and has been dialysis free for 18 months post-ASCT. Patient 2 (M, 48 years) achieved negative immunofixation post-ASCT and was dialysis free for 9 months post-transplant, following which he requires one session of dialysis every 3-4 weeks for onset of uraemic symptoms. Conclusions ASCT in dialysis-dependent patients is associated with a higher risk of drug toxicity, infections and transplant-related mortality. Use of reduced dose melphalan, pre-emptive dialysis after 24 hours and monitoring for acidosis and symptoms of uraemia to identify acidosis at an early stage allows safe administration of high dose chemotherapy. A major proportion of patients can potentially achieve reduction or freedom from dialysis support post-transplant.

Vasant Ramji Khanolkar was the first Indian pathologist and a pioneering researcher who was at the forefront of the diverse fields of cancer research, blood group genetics, epidemiology and leprosy research, etc. in the mid-twentieth century. All his cutting-edge research took place after he joined Tata Memorial Hospital, Bombay (now Mumbai), as Director of Laboratories. There is little evidence of his research in the first 17 years of his career in India, at J.J. Hospital and K.E.M. Hospital, Bombay. We tried to address this gap by attempting to obtain information on Khanolkar's papers from PubMed, prior to his having joined Tata Memorial Hospital. We evaluated the abstracts of the presentations that he made at the meetings of the Teaching Pathologists Association, Bombay. Finally, we extracted from the autopsy registers at the two hospitals, any useful information about the autopsies that he had performed. Khanolkar performed preliminary laboratory research in anaemia as well as some experimental pathology in his stint at K.E.M. Hospital. Further, surprisingly, histology was not performed on most autopsies at J.J. Hospital for the period that he was Professor, but was done at K.E.M. Hospital. Why Khanolkar was a late bloomer and did not perform much research or publish in the first two institutions that he was Professor at, remains a mystery.