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Pandey R, Garg R, Darlong V, Punj J, Chandralekha, Kumar A. Unpredicted neurological complications after robotic laparoscopic radical cystectomy and ileal conduit formation in steep trendelenburg position: two case reports. Acta Anaesthesiol Belg 2010; 61:163-6. [PMID: 21268573 DOI: pmid/21268573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Robotic surgery is becoming popular for minimally invasive surgical evolution as robotic devices allow unprecedented control and precision in minimally invasive procedures. Two cases of robotic radical cystectomy with ileal conduit urinary diversion surgeries having perioperative neurologic complications related to prolonged surgery in steep head down position are presented. In these patients, neurological deterioration occurred after extubation probably due to cerebral edema. We suggest the duration and positioning should be optimized for such prolonged surgery in steep head down position and some recommendations should be made. Moreover, in such surgeries a great vigilance has to be observed in the perioperative period.
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Affiliation(s)
- R Pandey
- Department of Anaesthesiology and Intensive Care, All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110029, India
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Garg R, McGuinness S. Trends in Coronary Artery Bypass Surgery at Auckland City Hospital. Heart Lung Circ 2010. [DOI: 10.1016/j.hlc.2010.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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153
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Agarwal A, Garg R, Joshi A, Verma S. Combined spinal epidural anesthesia with epidural volume extension technique for hysterectomy in patient with unpalliated cyanotic heart disease--a case-report. Acta Anaesthesiol Belg 2010; 61:159-61. [PMID: 21268572 DOI: pmid/21268572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Adults with unrepaired cyanotic heart disease scheduled for a non-cardiac surgery present serious concerns for the anesthesiologists. Both general and regional anesthetic techniques have been safely reported in Eisenmenger's syndrome and adults with Tetralogy of Fallot (TOF) for non-cardiac surgery. The safety of low-dose sequential combined spinal epidural (CSE) technique in high-risk cardiac cases has recently been emphasized in obstetric anesthetic practice but to our knowledge, this technique has not been reported for hysterectomy in cyanotic heart disease patients in anesthetic literature. We report the successful management of hysterectomy in a patient with ventricular septal defect and pulmonary atresia (VSD-PA) using CSE anesthesia with epidural volume extension (EVE) technique.
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Affiliation(s)
- A Agarwal
- Department of Anesthesiology and Intensive Care, All India Institute of Medical Sciences, New Delhi, India
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154
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Garg R, McGuinness S. Trends in Coronary Artery Bypass Graft Surgery and Combined Aortic Valve Surgery at Auckland City Hospital. Heart Lung Circ 2010. [DOI: 10.1016/j.hlc.2010.06.582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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155
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Khanna P, Garg R, Sunder RA. Rosai-Dorfman disease--perianaesthetic concerns. Acta Anaesthesiol Belg 2010; 61:1-3. [PMID: 20593637 DOI: pmid/20593637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Rosai-Dorfman Disease (RDD) may be challenging for anesthesiologist in view of its multisystem involvement, specially the airway. We present a patient with RDD scheduled for bilateral rhinotomy and bilateral neck dissection for nasal obstruction and gross bilateral lymphadenopathy. Care should be taken in airway management because of the distortion of airway anatomy by the soft tissue mass with possible intracheal extension of mass. Central venous catheterization should be guided by ultrasonography.
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Affiliation(s)
- P Khanna
- Department of Anaesthesiology and Intensive Care, All India Institute of Medical Sciences, Ansari Nagar, New Delhi
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Alzahrani AZ, Srivastava GP, Garg R, Migliorato MA. An ab initio study of electronic and structural properties of Mn in a GaAs environment. J Phys Condens Matter 2009; 21:485504. [PMID: 21832523 DOI: 10.1088/0953-8984/21/48/485504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Based on ab initio calculations, we have investigated the atomic geometry, electronic properties and magnetic properties of Mn incorporation in GaAs. The inclusion of the Hubbard potential U in the calculation (namely with the σGGA+U scheme) results in the optimized geometry being contracted by approximately 2% relative to the relaxed geometry obtained by the (σGGA) method. Within both the σGGA and σGGA+U schemes the Mn impurity in bulk GaAs behaves like a d-hole with the majority spin state lying at 0.25 eV above the Fermi level. Theoretically simulated STM images for Mn/GaAs(110) indicate round protrusions at As sites and Ga sites, the latter being dependent on the Mn adsorption site (i.e. in different atomic layers). These results are supportive of a previous experimental STM image obtained with a very low Mn concentration.
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Affiliation(s)
- A Z Alzahrani
- School of Physics, University of Exeter, Stocker Road, Exeter EX4 4QL, UK
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Abstract
OBJECTIVES To evaluate the role of smoking as a risk factor for the development of pulmonary tuberculosis. MATERIALS AND METHODS A total of 111 sputum smear-positive patients of pulmonary tuberculosis and 333 controls matched for age and sex were interviewed according to a predesigned questionnaire. RESULTS The adjusted odd ratio of the association between tobacco smoking and pulmonary tuberculosis was 3.8 (95% confidence interval, 2.0 to 7.0; P value, < 0001). A positive relationship between pack years, body mass index and socioeconomic class was also observed. CONCLUSION There is a positive association between tobacco smoking and pulmonary tuberculosis.
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Affiliation(s)
- R Prasad
- Department of Pulmonary Medicine, Chhatrapati Sahuji Maharaj Medical University (Erstwhile K. G. Medical University), Lucknow, India.
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160
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Garg R, Faderl S, Garcia-Manero G, Cortes J, Koller C, Huang X, York S, Pierce S, Brandt M, Beran M, Borthakur G, Kantarjian H, Ravandi F. Phase II study of rabbit anti-thymocyte globulin, cyclosporine and granulocyte colony-stimulating factor in patients with aplastic anemia and myelodysplastic syndrome. Leukemia 2009; 23:1297-302. [PMID: 19242494 PMCID: PMC4217203 DOI: 10.1038/leu.2009.28] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2008] [Revised: 01/09/2009] [Accepted: 01/26/2009] [Indexed: 11/09/2022]
Abstract
We investigated efficacy and safety of rabbit anti-thymocyte globulin (rATG), cyclosporine and granulocyte colony-stimulating factor (G-CSF) as first-line therapy for patients with aplastic anemia (AA) and low or intermediate-1 or hypoplastic myelodysplastic syndrome (MDS). rATG 3.5 mg/kg (or 2.5 mg/kg per day for patients >or=55 years with MDS) was given for 5 days. Cyclosporine (5 mg/kg) and G-CSF (5 microg/kg) were given daily and continued for up to 6 months or longer. Responses were assessed about 3 and 6 months after therapy. Thirty-six patients have been enrolled on study and 32 patients treated; 25 were evaluable for a response (13 with AA, 12 with MDS); the rest are too early. The median age was 62 years (range, 20-83) for patients with AA and 63 (range, 42-80) for patients with MDS. Of 13 patients, 12 (92%) patients with AA responded (5 complete response (CR), 7 partial response (PR)), whereas of 12 patients, 4 (33%) patients with MDS responded (1 CR, 3 PR). For patients with AA, the median time to response (TTR) was 93 days (range, 79-623), whereas in the MDS group the median TTR was 111 days (range, 77-139). Grade III/IV toxicities were mainly cytopenias and neutropenic fever. Combination of rATG, cyclosporine and G-CSF is safe and effective as first-line treatment of AA and has significant activity in low-risk MDS.
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Affiliation(s)
- R Garg
- Department of Leukemia, The University of Texas, MD Anderson Cancer Center, Houston, TX 77030, USA
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Garg R, Gupta A, Gupta N, Sharma R. The optimal technique of tracheal intubation in an immobilized cervical spine. Acta Anaesthesiol Scand 2009; 53:690-1. [PMID: 19419374 DOI: 10.1111/j.1399-6576.2009.01923.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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164
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Mehndiratta M, Mishra S, Khwaja G, Pandey S, Batla A, Garg R. PO1.12 Comparative Study of Nerve Conduction Parameters in Healthy Indian Males and Females. Clin Neurophysiol 2009. [DOI: 10.1016/s1388-2457(09)60101-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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165
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Mehndiratta M, Mishra S, Khwaja G, Pandey S, Batla A, Garg R. PO1.11 Normative Data of Nerve Conduction Studies in 440 Nerves (220 Healthy Indian Subjects) from University Hospital, North India. Clin Neurophysiol 2009. [DOI: 10.1016/s1388-2457(09)60100-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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166
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Garg R. The Rendell Baker Soucek paediatric mask in adult difficult airways. Anaesth Intensive Care 2009; 37:328. [PMID: 19400509 DOI: pmid/19400509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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167
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Garg R, Giridhar KK. Fibreoptic bronchoscope guided tracheal intubation via facemask in apnoeic patients. Anaesth Intensive Care 2009; 37:330-331. [PMID: 19400511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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168
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Agarwal AK, Garg R, Kauser SA. When neurological deficit is not a stroke. Case Reports 2009; 2009:bcr2006043448. [DOI: 10.1136/bcr.2006.043448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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169
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Agarwal AK, Garg R, Simon M. Ring enhancing lesion on CT scan: metastases or a brain abscess? Case Reports 2009; 2009:bcr2006041913. [DOI: 10.1136/bcr.2006.041913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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170
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Pandey R, Garg R, Kumar A, Darlong V, Punj J, Singh SA. Case report: Airway management of a patient with popping pedunculated subglottic laryngeal polyp. Acta Anaesthesiol Belg 2009; 60:251-3. [PMID: 20187489 DOI: pmid/20187489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Management of airway is a great challenge to anesthesiologists. Sometimes though airway is apparently normal but lesion around it may give a concern for securing airway. Patient, 52 years, ASA grade I presented to otolaryngology clinic with important complaints of stridor and dyspnoea. There was no comorbidity. Routine investigations were normal. Indirect laryngoscopic examination revealed pedunculated mass (polyp) arising from subglottic region, with a size of 0.7 x 0.5 cm and its pedicle was around 1.5 cm long delicate structure. This polyp was not visible during inspiration but it popped out of the vocal cords during expiration. Microlaryngeal surgery was planned to remove this polyp. Intubation of trachea was a great challenge as polyp was visible only during expiration. Tracheal intubation under controlled ventilation and neuromuscular blockade might have caused rupture of polyp pedicle or dislodgement of polyp in the trachea (as its pedicle was quite thin and delicate) which would have resulted in respiratory obstruction in the patient. Fiberoptic guided awake intubation was planned during expiratory phase of spontaneous respiration in order to avoid any injury or damage to the polyp or its pedicle.
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Affiliation(s)
- R Pandey
- Department of Anesthesiology and Intensive Care, All India Institute of Medical Sciences, New Delhi, India.
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171
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Abstract
We present a rare but potentially harmful adverse reaction of propofol. A 50-year-old patient was posted for laparoscopic cholecystectomy, developed generalized convulsions after few seconds of propofol administration at anesthesia induction. Convulsions subsided with intravenous administrations of thiopentone and midazolam. Patient remained hemodynamically stable and surgery was uneventful. Blood sugar, serum electrolytes and arterial blood gas analysis were normal. Postoperatively, there was no evidence of postictal phase, serum electrolytes and postoperative computerized tomographic scanning of the head were normal. Patient had uneventful recovery. The administration of propofol has been associated with abnormal movements collectively termed as seizure-like phenomenon. Despite the claims that propofol may have proconvalsant activity, there is significant amount of evidence to the contrary also. The pathophysiological mechanisms behind the neuroexcitatory symptoms with propofol are unknown. Propofol alters the conscious state, the transition from the conscious state to anesthesia or vice versa may be a particularly vulnerable period and may be prolonged after the end of propofol administration.
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Affiliation(s)
- R Garg
- Department of Anesthesiology and Intensive Care, All India Institute of Medical Sciences, Ansari Nagar, New Delhi -110 029, India.
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172
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Ratnayake M, Garg R, Greaves S, Gerber I, Webster M. Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy: The Auckland Experience. Heart Lung Circ 2009. [DOI: 10.1016/j.hlc.2009.04.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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173
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Garg R, Mehra S, Prasad R. Isoniazid induced gynaecomastia: a case report. Indian J Tuberc 2009; 56:51-54. [PMID: 19402273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Gynaecomastia due to anti-tubercular chemotherapy is a rare side effect. Isoniazid causing breast tissue enlargement has been very rarely reported. We report a 60-year old, male patient of Pulmonary Tuberculosis who was started on antituberculous treatment (ATT) with rifampicin (R), isoniazid (H), ethambutol (E) and pyrazinamide (Z) together for initial two months and R, H & E thereon. After five months of initiation of treatment, while receiving RHE, he developed painful bilateral gynaecomastia. Isoniazid was stopped and patient was continued on R & E till completion of the treatment up to nine months. After stopping isoniazid, his breast swelling subsided to some extent and became non-tender. Follow up, at six months, after stopping the course of treatment, patient was asymptomatic except for slight bilateral non-tender breast enlargement.
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Affiliation(s)
- R Garg
- Department of Pulmonary Medicine, Chhatrapati Sahuji Maharaj Medical University, Lucknow, Uttar Pradesh.
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174
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Gupta V, Garg R, Chander J. Detection of AmpC Beta-lactamases in Gram Negative Bacilli - A Study from North India. Int J Infect Dis 2008. [DOI: 10.1016/j.ijid.2008.05.301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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175
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Garg R. Precautions with a modified stimulating Touhy needle. Anaesth Intensive Care 2008; 36:912. [PMID: 19115663 DOI: pmid/19115663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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176
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Narang S, Dali JS, Agarwal M, Garg R. Evaluation of the efficacy of magnesium sulphate as an adjuvant to lignocaine for intravenous regional anaesthesia for upper limb surgery. Anaesth Intensive Care 2008; 36:840-4. [PMID: 19115654 DOI: 10.1177/0310057x0803600614] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Several additives have been combined with local anaesthetics for intravenous regional anaesthesia to improve block quality, analgesia and to decrease tourniquet pain. Magnesium sulphate is one potential additive. This prospective, randomised, double-blinded study was conducted in 30 ASA physical status I or II patients undergoing upper limb surgery under tourniquet. In group L, patients received intravenous regional anaesthesia with lignocaine alone (9 ml of 2% lignocaine diluted with normal saline to total volume of 36 ml). Patients in group M received intravenous regional anaesthesia with lignocaine plus magnesium sulphate (6 ml of 25% magnesium sulphate plus 9 ml of 2% lignocaine diluted with normal saline to total volume of 36 ml). Assessment was by observing the response to injection of drug; sensory and motor block and tourniquet pain. The mean time of onset of sensory block was 12.40 and 3.47 minutes in groups L and M respectively (P < 0.001). The average times of onset of motor block in groups L and M were 17 and six minutes respectively (P < 0.001). Of the patients in group M, 66.7% reported moderate to severe pain while the drug was being injected, compared to 20% in group L (P=0.011). There was a statistically significant difference in visual analogue scale for tourniquet pain at 10 and 30 minutes after tourniquet inflation (lower in group M). These findings indicate that magnesium sulphate added as an adjuvant to lignocaine hastens the onset of sensory and motor block and decreases tourniquet pain. However there is increased incidence of transient pain on injection if magnesium sulphate is added.
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Affiliation(s)
- S Narang
- Department of Anaesthesiology and Intensive Care, Maulana Azad Medical College and associated Lok Nayak Hospital, New Delhi, India
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179
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Garg R, Zahra F, Chandra JA, Vatsal P. A comparative study of injection placentrex and conventional therapy in treatment of pelvic inflammatory disease. J Indian Med Assoc 2008; 106:463-467. [PMID: 18975504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
To compare the effect of placentrex injection given along with conventional therapy, with conventional treatment alone on the symptoms and signs of pelvic inflammatory disease (PID) ie, abdominal pain, dysmenorrhoea and adnexal tenderness, 50 out of 100 women with PID were randomly assigned to receive intramuscular placentrex injection along with two-week conventional therapy and 50 received conventional treatment only. Abdominal pain, dysmenorrhoea and adnexal tenderness were evaluated at the end of 2 months. There was marked reduction in the sign of adnexal tenderness in the placentrex group as compared to conventional treatment group (p < 0.001). Subjective symptoms of lower abdominal pain and dysmenorrhoea were also relieved better in placentrex group (p < 0.01 and 0.05 respectively). This study showed significant and persistent improvement of signs and symptoms of PID in women who received injection placentrex.
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Affiliation(s)
- R Garg
- Department of Obstetrics and Gynaecology, Era's Lucknow Medical College, Lucknow 226003
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180
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Mehta M, Garg R, Rath GP, Prabhakar H. Beware kinking of disposable plastic circuit tubing during anaesthesia. Anaesth Intensive Care 2008; 36:624. [PMID: 18714639 DOI: pmid/18714639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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181
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Garg R, Sinha R. Preoperative atropine treatment and fever in children. Anaesth Intensive Care 2008; 36:619. [PMID: 18714635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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182
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Garg R, Bhalotra A, Arya M, Bhadoria P, Manchanda G. Congenital cystic adenomatoid malformation of lung--differential diagnosis and management. Anaesth Intensive Care 2008; 36:464-5. [PMID: 18564819 DOI: pmid/18564819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
MESH Headings
- Cystic Adenomatoid Malformation of Lung, Congenital/diagnosis
- Cystic Adenomatoid Malformation of Lung, Congenital/diagnostic imaging
- Cystic Adenomatoid Malformation of Lung, Congenital/surgery
- Diagnosis, Differential
- Hernia, Diaphragmatic/diagnosis
- Hernias, Diaphragmatic, Congenital
- Humans
- Infant, Newborn
- Intensive Care Units, Neonatal
- Intubation, Gastrointestinal
- Laparotomy
- Lung/surgery
- Male
- Radiography
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Abstract
This report describes anaesthesia for consanguineous siblings with the rare genetic condition hyperekplexia. This condition is also known as 'stiff baby syndrome' or 'startle disease'. Hyperekplexia can present in major and minor forms and is caused by a mutation in chromosome 5 which results in a defect in the alpha-1 subunit of the inhibitory glycine receptors in the caudal pontine reticular formation leading to neuronal hyperexcitability. The patients present with a potentially life-threatening exaggerated startle reflex. Life-threatening spasms may be terminated by forced flexion of the head and legs towards the trunk. Anaesthesia management should avoid stimuli which trigger the reflex. Clonazepam and diazepam are used to prevent and control the spasms. Propofol and other agents with the ability to potentiate both GABA-ergic and glycinergic transmission may be appropriate choices for anaesthesia. Reaction to neuromuscular blockers may be unpredictable. Both our patients had relatively prolonged but otherwise uneventful recovery.
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Affiliation(s)
- R Garg
- Department ofAnaesthesia, All India Institute of Medical Sciences, Delhi, India
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184
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Sarna A, Pujari S, Sengar AK, Garg R, Gupta I, Dam JV. Adherence to antiretroviral therapy & its determinants amongst HIV patients in India. Indian J Med Res 2008; 127:28-36. [PMID: 18316850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND & OBJECTIVE Very high levels of adherence are required for ART to be effective. There is limited information available from India on adherence to ART and its predictors. We carried out this study to examine adherence levels and to explore the factors associated with adherence among PLHA receiving ART in India. METHODS Using a cross-sectional study design 310 HIV+ patients receiving ART (252 paying out-of-pocket; 58 free via employee-insurance programme) were interviewed from Pune and Delhi health facilities, using a semi-structural questionnaire. RESULTS The median age for patients was 36 yr. The median time from diagnosis of HIV-infection was 34.5 months, median time on ART was 16 months and median CD4 cell count at start of ART was 110 cells/microl. 98 per cent of the respondents were using a non protease inhibitor (PI) treatment regimen. Mean 4-day adherence was 93 per cent. Adherence was lower over longer periods of recall: 20 per cent reported missed does over the past 7 days; 33 per cent reported ever missing a full day's medications and 16 per cent had a treatment interruption of more than 7-days at least once. On univariate analysis less than university education, being unemployed, obtaining free treatment, severe depression, baseline CD4 count>200/microl, hospitalization >2 times, having moderate to severe side-effects and taking 4 or more medicines were associated with lower adherence (<90%). However, only obtaining free treatment (adjusted OR, 4.05, 95% CI 1.42-11.54, P=0.009) and severe depression (adjusted OR 4.48, 95% CI 1.64-12.27, P=0.003) were associated with lower adherence in multivariate analysis. INTERPRETATION & CONCLUSION Although the overall adherence was high, lower levels of adherence were documented among patients receiving free ART. Provision of free treatment without adequate patient preparation and adherence support may compromise the success of ART scale up programmes. Early diagnosis and management of depression need special focus.
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Affiliation(s)
- A Sarna
- Horizons/Population Council, New Delhi, India.
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Abstract
Postural orthostatic tachycardia syndrome (POTS) is an autonomic disturbance which has become better understood in recent years. It is now thought to encompass a group of disorders that have similar clinical features, such as orthostatic intolerance, but individual distinguishing parameters--for example, blood pressure and pulse rate. The clinical picture, diagnosis, and management of POTS are discussed.
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186
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Agarwal AK, Garg R, Kauser SA. When neurological deficit is not a stroke. Arch Emerg Med 2007; 24:751. [DOI: 10.1136/emj.2006.043448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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187
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Zhou J, Goenka A, Garg R, Richardson M, Forastiere A, Califano J, Koch W, Farrag T, Tufano R, Bajaj G. Optimal Management of the Neck in Patients With Locoregionally Advanced Oropharyngeal Carcinoma: Comparison of Pre-Radiotherapy Neck Dissection, Post-Radiotherapy Neck Dissection or Observation. Int J Radiat Oncol Biol Phys 2007. [DOI: 10.1016/j.ijrobp.2007.07.1554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Goenka A, Zhou J, Rudra S, Garg R, Farrag T, Koch W, Califano J, Forastiere A, Tufano R, Bajaj G. Contemporary Multidisciplinary Management of Tonsillar Squamous Cell Carcinoma With Surgery and Radiation Therapy: 12 Year Experience of the Johns Hopkins Hospital. Int J Radiat Oncol Biol Phys 2007. [DOI: 10.1016/j.ijrobp.2007.07.1605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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189
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Garg R, Fahmi N, Singh RV. Coordination chemistry of oxovanadium(V) complexes with active Schiff bases: synthetic, spectral, and antimicrobial approach. RUSS J COORD CHEM+ 2007. [DOI: 10.1134/s1070328407100089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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190
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Prasad R, Garg R, Dua R. Concomitant allergic bronchopulmonary aspergillosis and allergic fungal sinusitis. Indian J Med Sci 2007; 61:532-4. [PMID: 17785891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
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191
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Narain JP, Lal S, Garg R. Implementing the revised International Health Regulations in India. Natl Med J India 2007; 20:221-224. [PMID: 18254515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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192
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Affiliation(s)
- R Garg
- Diabetes Unit, Russells Hall Hospital, Dudley, West Midlands.
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193
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Abstract
Some patients with type 2 diabetes mellitus (T2DM) have severe insulin resistance. Their insulin requirements are significantly greater. These patients need to take 2-3 injections at the same time to take the correct insulin dose or to redial the insulin pen. When daily insulin requirements are in excess of 300 units/day, the volume of the injected insulin becomes an issue. Large-volume injection can cause discomfort and lead to poor concordance with treatment. Using high-strength insulin e.g. U-500 insulin can reduce the volume of the injected insulin. Despite publications of small case reports or case series, no universal guidelines exist on the use of U-500 insulin. We discuss common sense approaches when considering the use of U-500 insulin in clinical practice.
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Affiliation(s)
- R Garg
- Department of Diabetes and Endocrinology, Institution of Origin, Leicester Royal Infirmary, Infirmary Squire, Leicester, UK.
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194
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Garg R, Kumar RR, Yadav CL, Banerjee PS. Duration of anthelmintic effect of three formulations of ivermectin (oral, injectable and pour-on) against multiple anthelmintic-resistant haemonchus contortus in sheep. Vet Res Commun 2007; 31:749-55. [PMID: 17237985 DOI: 10.1007/s11259-007-0054-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2006] [Indexed: 11/24/2022]
Abstract
We report the results of investigations that were conducted in a sheep flock in Uttaranchal, India where repeated failure of anthelmintic medication was noted. The study revealed that Haemonchus contortus in sheep had developed resistance to benzimidazoles (fenbendazole, mebendazole and albendazole), imidazothiazole (levamisole) and salicylanide (rafoxanide), while it was fully susceptible to avermectins (ivermectin). Further, the suppression of nematode egg output in faeces of sheep naturally infected with multiple anthelmintic-resistant H. contortus following treatment with ivermectin tablet (0.4 mg/kg body weight (bw), orally), ivermectin injection (1% w/v, 0.2 mg/kg bw, subcutaneously) and ivermectin pour-on (0.5 w/v, 0.5 mg/kg bw) was also studied over a period of 10 weeks post treatment. It was noted that ivermectin tablet after initial clearance of infection (faecal egg count reduction 100%), could not prevent establishment of new patent natural infection for even a single day, while ivermectin pour-on and injection prevented the establishment of new infection for 7 and 14 days post treatment, respectively. Maximum protection period (duration for which mean faecal egg count of sheep reaches 500 eggs per gram of faeces or more) of 68 days was recorded in sheep treated with injectable ivermectin, followed by pour-on (60 days) and oral (53 days) preparations.
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Affiliation(s)
- R Garg
- Department of Veterinary Parasitology, College of Veterinary and Animal Sciences, G.B. P.U.A.& T., Pantnagar-263145, Uttaranchal, India.
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195
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Prasad R, Rout A, Garg R, Kushwaha R, Ahuja RC. An open randomized controlled trial of noninvasive positive pressure ventilation in patients of acute on chronic hypercapnic respiratory failure in a general respiratory ward setting. Lung India 2007. [DOI: 10.4103/0970-2113.44377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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196
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Vijay K, Sharma R, Rao S, John C, Garg R, Arun R, Shah S, Marwah A, Suresh PV, Maheshwari S, Shetty DP. Fontan failure in the current era. Indian J Thorac Cardiovasc Surg 2006. [DOI: 10.1007/s12055-006-0547-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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198
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Abstract
The three Rnd proteins, Rnd1, Rnd2 and RhoE/Rnd3, are a subset of Rho family proteins that are unusual in that they bind but do not hydrolyse GTP, and are therefore not regulated by the classical GTP/GDP conformational switch of small GTPases. Increased expression of each Rnd protein induces loss of stress fibres in cultured fibroblasts and epithelial cells, acting antagonistically to RhoA, which stimulates stress fibre formation. RhoE is farnesylated and localizes partly on membranes, including the Golgi and plasma membrane, and in the cytosol. RhoE inhibits RhoA signalling in part by binding to the RhoA-activated serine/threonine kinase ROCK I (Rho-associated kinase I), thereby preventing it from phosphorylating its targets. RhoE activity is itself regulated by phosphorylation by ROCK I on multiple sites. RhoE phosphorylation enhances its stability, leading to an increase in RhoE levels. In addition, phosphorylation reduces its association with membranes and correlates with its ability to induce loss of stress fibres. RhoE also acts independently of ROCK to inhibit cell cycle progression, in part by preventing translation of cyclin D1, and to inhibit transformation of fibroblasts by oncogenic H-Ras. RhoE is therefore a multifunctional protein whose localization and actions are regulated by phosphorylation.
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Affiliation(s)
- K Riento
- Ludwig Institute for Cancer Research, Royal Free and University College School of Medicine, 91 Riding House Street, London W1W 7BS, UK
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199
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Garg R, Gupta SK, Tripathi P, Naik S, Sundar S, Dube A. Immunostimulatory cellular responses of cured Leishmania-infected patients and hamsters against the integral membrane proteins and non-membranous soluble proteins of a recent clinical isolate of Leishmania donovani. Clin Exp Immunol 2005; 140:149-56. [PMID: 15762886 PMCID: PMC1809348 DOI: 10.1111/j.1365-2249.2005.02745.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Development of an effective immunoprophylactic agent for visceral leishmaniasis (VL) has become imperative due to the increasing number of cases of drug resistance and relapse. Live and killed whole parasites as well as fractionated and recombinant preparations have been evaluated for vaccine potential. However, a successful vaccine against the disease has been elusive. Because protective immunity in human and experimental leishmaniasis is predominantly of the Th1 type, immunogens with Th1 stimulatory potential would make good vaccine candidates. In the present study, the integral membrane proteins (IMPs) and non-membranous soluble proteins (NSPs), purified from promastigotes of a recent field isolate, Leishmania donovani stain 2001, were evaluated for their ability to induce cellular responses in cured patients (n = 9), endemic controls (n = 5) of visceral leishmaniasis (VL) and treated hamsters (n = 10). IMPs and NSPs induced significant proliferative responses (SI 6.3 +/- 4.1 and 5.6 +/- 2.3, respectively; P < 0.01) and IFN-gamma production (356.3 +/- 213.4 and 294.29 +/- 107.6 pg/ml, respectively) in lymphocytes isolated from cured VL patients. Significant lymphoproliferative responses against IMPs and NSPs were also noticed in cured Leishmania animals (SI 7.2 +/- 4.7 & 6.4 +/- 4.1, respectively; P < 0.01). In addition, significant NO production in response both IMPs and NSPs was also noticed in macrophages of hamsters and different cell lines (J774A-1 and THP1). These results suggest that protective, immunostimulatory molecules are present in the IMP and NSP fractions, which may be exploited for development of a subunit vaccine for VL.
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Affiliation(s)
- R Garg
- Division of Parasitology, Central Drug Research Institute, Lucknow, India
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200
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Abstract
BACKGROUND Clostridium difficile (C. difficile) is recognized as a frequent cause of antibiotic-associated diarrhea and colitis. OBJECTIVES The aim of this review is to establish the efficacy of antibiotic therapy for C. difficile-associated diarrhea (CDAD), to identify the most effective antibiotic treatment for CDAD in adults and to determine the need for stopping the causative antibiotic during therapy. SEARCH STRATEGY MEDLINE (1966 to 2003), EMBASE (1980 to 2003), Cochrane Central Database of Controlled Trials and the Cochrane IBD Review Group Specialized Trials Register were searched using the following search terms: "pseudomembranous colitis and randomized trial"; "Clostridium difficile and randomized trial"; "antibiotic associated diarrhea and randomized trial". SELECTION CRITERIA Only randomized, controlled trials assessing antibiotic treatment for CDAD were included in the review. Probiotic trials are excluded. The following outcomes were sought: initial resolution of diarrhea; initial conversion of stool to C. difficile cytotoxin and/or stool culture negative; recurrence of diarrhea; recurrence of fecal C. difficile cytotoxin and/or positive stool culture; patient response to cessation of prior antibiotic therapy; sepsis; emergent surgery: fecal diversion or colectomy; and death. DATA COLLECTION AND ANALYSIS Data were analyzed using the MetaView statistical package in Review Manager. For dichotomous outcomes, relative risks (RR) and 95% confidence intervals (CI) were derived from each study. When appropriate, the results of included studies were combined for each outcome. For dichotomous outcomes, pooled RR and 95% CI were calculated using a fixed effect model, except where significant heterogeneity was detected, at which time the random effects model was used. Data heterogeneity was calculated using MetaView. MAIN RESULTS Of eleven studies identified, two were subsequently excluded because patients were stool positive for C. difficile, but did not have diarrhea or because the study was not a randomized controlled trial. All of the remaining nine studies involved patients with diarrhea who recently received antibiotics for an infection other than C. difficile. The definition of diarrhea ranged from at least two loose stools per day with an associated symptom such as rectal temperature > 38(o)C, to at least six loose stools in 36 hours. In terms of symptomatic cure, metronidazole, bacitracin and fusidic acid were not shown to be less effective than vancomycin. Teicoplanin may be slightly more effective than vancomycin with a relative risk of 1.21 [95% CI 1.00 to 1.46] and a p-value of 0.06. In terms of initial symptomatic resolution, vancomycin is more effective than placebo with a relative risk of 6.75 [95% CI 1.16 to 48.43] and a p-value of 0.03. This result should be interpreted with caution given the small number of patients in this comparison (12 in the vancomycin group and nine in the placebo group) and the poor methodological quality of the trial. Metronidazole, bacitracin, teicoplanin, fusidic acid and rifaximine are as effective as vancomycin for initial symptomatic resolution. The other secondary outcomes measured in this review: surgery, sepsis and death occurred infrequently in all of the studies. AUTHORS' CONCLUSIONS Current evidence leads to uncertainty whether mild CDAD needs to be treated. Patients with mild CDAD may resolve their symptoms as quickly without treatment. The only placebo-controlled study shows vancomycin's superior efficacy. However, this result should be treated with caution due to the small number of patients enrolled and the poor methodological quality of the trial. The Johnson study of asymptomatic carriers also shows that placebo is better than vancomycin or metronidazole for eliminating C. difficile in stool during follow-up. If one does decide to treat, then two goals of therapy need to be kept in mind: improvement of the patient's clinical condition and prevention of spread of C. difficile infection to other patients. Given these two considerations, one should choose the antibiotic that brings both symptomatic cure and bacteriologic cure. In this regard, teicoplanin appears to be the best choice because the available evidence suggests that it is better than vancomycin for bacteriologic cure and has borderline superior effectiveness in terms of symptomatic cure. Teicoplanin is not readily available in the United States, which must be taken into account when making treatment decisions in that country.
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