FATAL PROGNOSIS OF H1N1 INFLUENZA IN LATE TRIMESTER OF PREGNANCY: DESCRIPTIVE ANALYSIS OF FOUR CASES

Influenza infection in late trimester associated with complications is attributable risk factors for critical illness among pregnant women. We have analyzed the medical records of four pregnant women retrospectively who were admitted in a medical intensive care unit of tertiary care center with influenza-like symptoms of breathlessness, fever, headache, myalgia and cough. Their mean age was 26.5 (19-30). They were confirmed to have H1N1infection by real-time reverse transcriptase polymerase chain reaction assay. Chest x-ray of all patients showed abnormalities like pulmonary edema and suggestive of acute respiratory distress syndrome. Arterial blood gas analysis of all four patients shown severe hypoxia and all of them was mechanically ventilated. Oseltemivir was started for all four from the day of admission. Pipracillin-tazobactum combination along with other antibiotics was given as prophylaxis and treatment of different infections. Midazolam and morphine were given together to reduce the restlessness and ventilator-associated distress. Furosemide was given to all for breathing problems and pulmonary edema. Despite of all the management provided none of the patients survived due to the progression of H1N1 into septic shock and multiple organs dysfunction syndromes.Â

Phonophoresis in Physiotherapy: Mechanisms, Applications, and Emerging Trends for Enhanced Drug Delivery and Therapeutic Efficacy

Phonophoresis, a widely utilized treatment in physiotherapy, combines topically applied gel or cream-based medications with ultrasonic therapy to enhance percutaneous absorption of pharmacological agents. The procedure employs ultrasound frequencies of 0.7 to 1.1 MHz with intensities ranging from 0.0 to 3.0 Watts per cm². Indications for phonophoresis span various inflammatory, deformative, dermatological, and rheumatic/neurological conditions. Recent studies suggest its clinical efficacy in pain relief and improved function, especially in conditions like lateral epicondylitis and osteoarthritis. The mechanism of action involves both thermal and non-thermal effects, with cavitation playing a key role in enhancing transdermal transport. Phonophoresis offers a non-invasive alternative for drug delivery, bypassing hepatic metabolism and minimizing systemic side effects. Various medicinal gels, particularly diclofenac, are used for transdermal drug delivery through phonophoresis. Low frequency phonophoresis has gained attention for enhancing transdermal transport, especially for macromolecules. Its applications extend beyond physiotherapy to include ocular drug delivery, nail therapy, gene therapy, and sports sciences. Clinical studies demonstrate the effectiveness of phonophoresis in conditions like anterior knee pain, tuberculous lymphadenitis, acute low back pain, and latent myofascial trigger points. Dosage considerations emphasize optimizing thermal effects without causing tissue damage. Studies highlight the potential of phonophoresis in relieving pain and improving function, particularly in knee osteoarthritis. Additionally, phonophoresis with Phyllanthus amarus nanoparticle gel shows promise in reducing pain and enhancing functional capacity in symptomatic knee osteoarthritis. In summary, phonophoresis stands as a valuable modality in physiotherapy, showcasing diverse applications and demonstrating clinical efficacy in various musculoskeletal and inflammatory conditions. Further research is warranted to explore its full potential and optimize treatment protocols

Pediatric Renovascular Hypertension: A Pediatric Interventional Radiologist's Perspective

Renovascular hypertension (RVH) contributes close to one-fourth of the secondary etiologies of hypertension in children and a delay in diagnosis can result in adverse clinical outcomes. RVH in children is clinically silent with elevations in blood pressure measurements sometimes as its sole manifestation. Only a high index of suspicion by the clinician can prompt its detection. Despite the availability of other imaging modalities like ultrasound, computed tomography, and magnetic resonance imaging, digital subtraction angiography is still considered the gold standard to make a diagnosis of RVH. Angioplasty is considered the treatment of choice in appropriately selected patients. In this article, we shall focus on the various imaging findings, and management of RVH in children, which requires a multidisciplinary approach with a special focus on the role of interventional radiology

Predictors and patterns of empirical antibiotic therapy and associated outcomes in COVID-19 patients: a retrospective study in a tertiary care facility in South India

The coronavirus disease (COVID-19) led to a global health crisis. Inappropriate use of antibiotics in COVID-19 patients has been a concern, leading to antimicrobial resistance. This study evaluated the patterns and predictors of empirical antibiotic therapy in COVID-19 patients and associated outcomes. A hospital-based retrospective study was conducted with 525 patients admitted to Kasturba Hospital, Manipal, India, with moderate and severe COVID-19 from 1 March to 1 August 2021. They were divided based on empirical therapy, and predictors of antibiotic usage were assessed by logistic regression. Four hundred and eighty (91.4%) COVID-19 patients received at least one course of antibiotics, with 440 (83.8%) initiating empirical therapy. Patients with severe COVID-19 manifestations were more likely to be prescribed empirical antibiotics. Multivariable analysis showed that patients initiated on empirical antibiotics had significantly elevated levels of procalcitonin [OR: 3.91 (95% CI: 1.66–9.16) (p = 0.001)], invasive ventilation [OR: 3.93 (95% CI: 1.70–9.09) (p = 0.001)], shortness of breath [OR: 2.25 (95% CI: 1.30–3.89) (p = 0.003)] and higher CRP levels [OR: 1.01 (95% CI: 1.00–1.01) (p = 0.005)]. Most antibiotics (65.9%) were prescribed from the ‘Watch’ group, the highest being ceftriaxone. Only 23.8% of the patients had microbiologically confirmed infections. The study identified predictors for initiating empirical antibacterial therapy in our setting.</p