Kaushik Ghosh - Academia.edu (original) (raw)
Papers by Kaushik Ghosh
Asian Journal of Medical Sciences
Background: Direct laryngoscopy and endotracheal intubation elicit hemodynamic pressor responses ... more Background: Direct laryngoscopy and endotracheal intubation elicit hemodynamic pressor responses which may be hazardous in high risk patients. Fentanyl, a low cost synthetic opioid, when used judiciously, may be a good option to attenuate this stress response. Aims and Objectives: The present study has been conducted to compare the efficacy of three different doses of intravenous fentanyl in attenuation of hemodynamic pressor response to laryngoscopy and endotracheal intubation in elective surgery under general anesthesia. Materials and Methods: It was a double-blinded randomized controlled trial. A total of 90 patients of American Society of Anesthesiologists physical status I and II, 55 male and 35 female, aged between 20 and 55 years, were randomized into three groups receiving 2, 3, and 4 μg/kg of injection fentanyl, respectively, administered intravenously 5 min before direct laryngoscopy and endotracheal intubation. Results: There were significant differences in hemodynamic va...
Oxford medical case reports, 2016
Cutaneous metastases of the breast carcinomas can present clinically as nodules, plaques and tumo... more Cutaneous metastases of the breast carcinomas can present clinically as nodules, plaques and tumors (most commonly as nodules) as well as 'erysipelas-like' lesions are known as 'carcinoma erysipeloides'. We want to share our experience in diagnosing a middle-aged lady with carcinoma erysipeloides secondary to breast carcinoma and her management as this is commonly misdiagnosed as cellulitis or scleroderma in general practice. Unfortunately, the patient had presented to us at a late stage with wide-spread metastasis, and as such, chemotherapy was the only available option. She expired after her third cycle of chemotherapy.
Annals of Indian Academy of Neurology, 2015
stenosis can reduce the risk of stroke to 0.34%. [5] On the other hand, ischemic stroke patients ... more stenosis can reduce the risk of stroke to 0.34%. [5] On the other hand, ischemic stroke patients have a higher likelihood of having carotid stenosis. However, the site of stroke is not clearly related to the degree and site of the carotid stenosis. The incidence of intracranial atherosclerosis is high in Asians. Outcome of stroke is poor in this group, with a mortality of 101-125 per 100,000 patients. [1] Recent studies have shown that the outcome of stroke deteriorates and risk of recurrent stroke increases with intracranial atherosclerosis. [6] Stenosis of the major intracranial vessels progresses at the rate of 9-12% over six months and a patient with more than 50% stenosis has approximately 40% risk of suffering a vascular event over the next two years. [7] Intracranial atherosclerosis has been shown to correlate well with atherosclerosis at other sites like carotid arteries and the aorta. [8] Materials and Methods A cross-sectional descriptive study was conducted at multiple tertiary care centers during a period of two years between 2009 and 2011. The institutional ethics committee approved
AJIM, 2013
This cross sectional study was designed to document sequential changes in serum as well as urinar... more This cross sectional study was designed to document sequential changes in serum as well as urinary sodium and potassium levels in cerebrovascular accident (CVA) patients, in relation to a control group, in an attempt to precise the role of these electrolytes in occurrence of CVA.
Asian J Med Sci, 2014
Swine flu is caused by antigenic shift of influenza A virus with clinical features similar to sea... more Swine flu is caused by antigenic shift of influenza A virus with clinical features similar to seasonal influenza virus. Majority of the morbidity and mortality due to swine flu are attributable to pneumonia and the acute respiratory distress syndrome (ARDS). Bacterial superinfection can occur, though it is rare in adults. Here we report a case of swine flu superinfected with carbapenem resistant Klebsiella, which is often coined as Klebsiella 'superbug'.
Journal of Neurosciences in Rural Practice, 2014
ABSTRACTCerebellar ataxia is a rare manifestation of neuropsychiatric systemic lupus erythematosu... more ABSTRACTCerebellar ataxia is a rare manifestation of neuropsychiatric systemic lupus erythematosus (SLE). Development of vasculitic infarcts in the cerebellum is the most plausible reason of this manifestation. We report the case of a patient who presented with characteristic skin rashes of lupus along with cerebellar signs. Imaging of brain in this patient revealed prominent cerebellar atrophy. She was treated with mycophenolate mofetil and oral corticosteroid, and there was no further progression of her neurological signs after the initiation of therapy. In the clinical context of varied presentations of neurolupus, this is one of the rare sightings and our treatment protocol holds promise as first-line therapy in future.
Endocrinology, Diabetes and Metabolism Case Reports, 2014
Summary Motor neuron disease (MND) is a progressive devastating neurodegenerative disease, which ... more Summary Motor neuron disease (MND) is a progressive devastating neurodegenerative disease, which universally progresses towards death. Hence, every attempt should be made to find out if there are any treatable conditions, which can mimic MND. Herein, we describe a case of hypercalcaemia due to primary hyperparathyroidism confused as MND and subsequently cured with parathyroid surgery. Learning points Any patient with neurological disorder should have a screening of all the common electrolytes including calcium as electrolyte imbalance can present with paralysis (e.g. hypokalaemia) to amyotrophic lateral sclerosis (e.g. hypercalcaemia). No patient should be stamped as having MND without having a proper work-up of all its differentials as there might be a treatable condition masquerading as MND.
A 35 years old male patient presented with a chop wound in posterior neck between C2 and C3 inter... more A 35 years old male patient presented with a chop wound in posterior neck between C2 and C3 interspace. After initial resuscitation this patient was put for surgery and general anesthesia was induced in left lateral position. Our experience suggested that a proper size ILMA (intubating laryngeal mask airway) is useful in managing difficult airway in left lateral position. Blind intubation attempt via ILMA is generally successful. We recommend routine use of ILMA as a backup plan in managing anticipated difficult intubation in nonconventional position.
Asian J Med Sci, 2014
Background: Though local anesthetic agents are widely used to provide postoperative analgesia in ... more Background: Though local anesthetic agents are widely used to provide postoperative analgesia in intra-articular route, their efficacy is not accepted universally. Objective: The present study has been conducted to compare the analgesic effects of intra-articular ropivacaine between two different doses following arthroscopic knee surgery. Study design: Double-blinded randomized controlled trial. Total 60 patients of ASA (American Society of Anesthesiologists) physical status I and II, 34 male and 26 female, aged between 18 to 60 years, were randomized into 3 groups receiving 10 ml normal saline, 10 ml 0.5% ropivacaine and 10 ml 0.75% ropivacaine respectively, administered in intra-articular space at the end of operation. Results: Ropivacaine groups had significantly delayed first post-operative rescue analgesic request with significantly lesser requirement of rescue analgesia in first 24 hours (p<0.001 in both cases). Except 6th post-operative hours, ropivacaine groups also showed significantly less VAS scores (Visual Analogue Scale) up to 12 hours post-operatively (p<0.05). Conclusion: In our double-blinded randomized controlled trial, administration of intra-articular 0.75% ropivacaine showed superior analgesic efficacy following arthroscopic knee surgery. Further, larger trials are needed to confirm our findings.
Annals of Indian Academy of Neurology, 2012
Henoch-Schonlein purpura (HSP) is a small vessel vasculitis that is rare in adults. Here, we pres... more Henoch-Schonlein purpura (HSP) is a small vessel vasculitis that is rare in adults. Here, we present a case of a woman who presented with palpable purpura, abdominal pain, arthritis and ischemic stroke. The patient met the diagnostic criteria of HSP. However, cerebrovascular disease is reported as an uncommon, yet fatal, complication of HSP. The patient responded to aggressive immunosuppression with pulses of corticosteroids and cyclophosphamide. In the absence of an established protocol of treatment of such neurologic emergency in HSP patients, this report demonstrates a successful outcome.
Annals of Indian Academy of Neurology, 2013
Several mutations of the GATA3 gene lead to the HDR phenotype. [3] Therefore, HDR patients exhibi... more Several mutations of the GATA3 gene lead to the HDR phenotype. [3] Therefore, HDR patients exhibit a spectrum of phenotypes. The severity of sensorineural deafness varies and is symmetrical in majority of HDR patients. The term "renal dysplasia" represents various abnormalities such as agenesis, hypoplasia, pelvicalyceal deformity, and renal scarring. Most patients present with symptoms related to hypocalcemia; however, some patients have normal calcium levels or show asymptomatic hypocalcemia. [2] The familial forms of hypoparathyroidism can follow an autosomal dominant, autosomal recessive, or X-linked recessive pattern. Hypoparathyroidism can present as an isolated disorder or may be associated with other congenital abnormalities such as DiGeorge Syndrome. Here, we report the case of a patient who presented with seizure, extensive intracranial calcification, and hypocalcemia, and who was subsequently diagnosed with HDR syndrome.
Clinical Medicine & Research, 2014
ABSTRACT Introduction: Cervical lymphadenoparthy is a common presentation of many diseases, thoug... more ABSTRACT Introduction: Cervical lymphadenoparthy is a common presentation of many diseases, though it is mostly tubercular in origin in developing countries. This cross sectional study was done to corroborate fine needle aspiration cytology (FNAC) findings with histopathological examinations (HPE) in cervical lymphadenopathy. Materials and methods: 120 patients of both sexes attending the FNAC unit of Nilratan Sircar Medical College and Hospital, Kolkata were enrolled in this study. They were evaluated by thorough clinical examination followed by routine investigations, FNAC and histopathological examination (HPE). Results: There was maximum corroboration of FNAC and HPE reports in tubercular lymphadenitis (76 v/s 76) and Hodgkin’s disease (2 v/s 2) followed by metastatic carcinoma (20 v/s 16) and non specific lymphadenitis (14 v/s 5) respectively. Overall correlation was 88.4% (excluding 8 cases where FNAC results were inconclusive due to unsatisfactory smear). The sensitivity, specificity, positive predictive value and negative predictive value of FNAC to diagnose tubercular lymphadenopathies were 86.36%. 100.0%, 100.0% and 72.73% respectively. In case of metastatic CA, these were 100.0%, 96.15%, 80.0% and 100.0% respectively. Conclusion: FNAC is simple, safe, quick, cheap, acceptable yet accurate method of establishing the etiology in cases of cervical lymphadenopathy.
Asian Journal of Medical Sciences
Background: Direct laryngoscopy and endotracheal intubation elicit hemodynamic pressor responses ... more Background: Direct laryngoscopy and endotracheal intubation elicit hemodynamic pressor responses which may be hazardous in high risk patients. Fentanyl, a low cost synthetic opioid, when used judiciously, may be a good option to attenuate this stress response. Aims and Objectives: The present study has been conducted to compare the efficacy of three different doses of intravenous fentanyl in attenuation of hemodynamic pressor response to laryngoscopy and endotracheal intubation in elective surgery under general anesthesia. Materials and Methods: It was a double-blinded randomized controlled trial. A total of 90 patients of American Society of Anesthesiologists physical status I and II, 55 male and 35 female, aged between 20 and 55 years, were randomized into three groups receiving 2, 3, and 4 μg/kg of injection fentanyl, respectively, administered intravenously 5 min before direct laryngoscopy and endotracheal intubation. Results: There were significant differences in hemodynamic va...
Oxford medical case reports, 2016
Cutaneous metastases of the breast carcinomas can present clinically as nodules, plaques and tumo... more Cutaneous metastases of the breast carcinomas can present clinically as nodules, plaques and tumors (most commonly as nodules) as well as 'erysipelas-like' lesions are known as 'carcinoma erysipeloides'. We want to share our experience in diagnosing a middle-aged lady with carcinoma erysipeloides secondary to breast carcinoma and her management as this is commonly misdiagnosed as cellulitis or scleroderma in general practice. Unfortunately, the patient had presented to us at a late stage with wide-spread metastasis, and as such, chemotherapy was the only available option. She expired after her third cycle of chemotherapy.
Annals of Indian Academy of Neurology, 2015
stenosis can reduce the risk of stroke to 0.34%. [5] On the other hand, ischemic stroke patients ... more stenosis can reduce the risk of stroke to 0.34%. [5] On the other hand, ischemic stroke patients have a higher likelihood of having carotid stenosis. However, the site of stroke is not clearly related to the degree and site of the carotid stenosis. The incidence of intracranial atherosclerosis is high in Asians. Outcome of stroke is poor in this group, with a mortality of 101-125 per 100,000 patients. [1] Recent studies have shown that the outcome of stroke deteriorates and risk of recurrent stroke increases with intracranial atherosclerosis. [6] Stenosis of the major intracranial vessels progresses at the rate of 9-12% over six months and a patient with more than 50% stenosis has approximately 40% risk of suffering a vascular event over the next two years. [7] Intracranial atherosclerosis has been shown to correlate well with atherosclerosis at other sites like carotid arteries and the aorta. [8] Materials and Methods A cross-sectional descriptive study was conducted at multiple tertiary care centers during a period of two years between 2009 and 2011. The institutional ethics committee approved
AJIM, 2013
This cross sectional study was designed to document sequential changes in serum as well as urinar... more This cross sectional study was designed to document sequential changes in serum as well as urinary sodium and potassium levels in cerebrovascular accident (CVA) patients, in relation to a control group, in an attempt to precise the role of these electrolytes in occurrence of CVA.
Asian J Med Sci, 2014
Swine flu is caused by antigenic shift of influenza A virus with clinical features similar to sea... more Swine flu is caused by antigenic shift of influenza A virus with clinical features similar to seasonal influenza virus. Majority of the morbidity and mortality due to swine flu are attributable to pneumonia and the acute respiratory distress syndrome (ARDS). Bacterial superinfection can occur, though it is rare in adults. Here we report a case of swine flu superinfected with carbapenem resistant Klebsiella, which is often coined as Klebsiella 'superbug'.
Journal of Neurosciences in Rural Practice, 2014
ABSTRACTCerebellar ataxia is a rare manifestation of neuropsychiatric systemic lupus erythematosu... more ABSTRACTCerebellar ataxia is a rare manifestation of neuropsychiatric systemic lupus erythematosus (SLE). Development of vasculitic infarcts in the cerebellum is the most plausible reason of this manifestation. We report the case of a patient who presented with characteristic skin rashes of lupus along with cerebellar signs. Imaging of brain in this patient revealed prominent cerebellar atrophy. She was treated with mycophenolate mofetil and oral corticosteroid, and there was no further progression of her neurological signs after the initiation of therapy. In the clinical context of varied presentations of neurolupus, this is one of the rare sightings and our treatment protocol holds promise as first-line therapy in future.
Endocrinology, Diabetes and Metabolism Case Reports, 2014
Summary Motor neuron disease (MND) is a progressive devastating neurodegenerative disease, which ... more Summary Motor neuron disease (MND) is a progressive devastating neurodegenerative disease, which universally progresses towards death. Hence, every attempt should be made to find out if there are any treatable conditions, which can mimic MND. Herein, we describe a case of hypercalcaemia due to primary hyperparathyroidism confused as MND and subsequently cured with parathyroid surgery. Learning points Any patient with neurological disorder should have a screening of all the common electrolytes including calcium as electrolyte imbalance can present with paralysis (e.g. hypokalaemia) to amyotrophic lateral sclerosis (e.g. hypercalcaemia). No patient should be stamped as having MND without having a proper work-up of all its differentials as there might be a treatable condition masquerading as MND.
A 35 years old male patient presented with a chop wound in posterior neck between C2 and C3 inter... more A 35 years old male patient presented with a chop wound in posterior neck between C2 and C3 interspace. After initial resuscitation this patient was put for surgery and general anesthesia was induced in left lateral position. Our experience suggested that a proper size ILMA (intubating laryngeal mask airway) is useful in managing difficult airway in left lateral position. Blind intubation attempt via ILMA is generally successful. We recommend routine use of ILMA as a backup plan in managing anticipated difficult intubation in nonconventional position.
Asian J Med Sci, 2014
Background: Though local anesthetic agents are widely used to provide postoperative analgesia in ... more Background: Though local anesthetic agents are widely used to provide postoperative analgesia in intra-articular route, their efficacy is not accepted universally. Objective: The present study has been conducted to compare the analgesic effects of intra-articular ropivacaine between two different doses following arthroscopic knee surgery. Study design: Double-blinded randomized controlled trial. Total 60 patients of ASA (American Society of Anesthesiologists) physical status I and II, 34 male and 26 female, aged between 18 to 60 years, were randomized into 3 groups receiving 10 ml normal saline, 10 ml 0.5% ropivacaine and 10 ml 0.75% ropivacaine respectively, administered in intra-articular space at the end of operation. Results: Ropivacaine groups had significantly delayed first post-operative rescue analgesic request with significantly lesser requirement of rescue analgesia in first 24 hours (p<0.001 in both cases). Except 6th post-operative hours, ropivacaine groups also showed significantly less VAS scores (Visual Analogue Scale) up to 12 hours post-operatively (p<0.05). Conclusion: In our double-blinded randomized controlled trial, administration of intra-articular 0.75% ropivacaine showed superior analgesic efficacy following arthroscopic knee surgery. Further, larger trials are needed to confirm our findings.
Annals of Indian Academy of Neurology, 2012
Henoch-Schonlein purpura (HSP) is a small vessel vasculitis that is rare in adults. Here, we pres... more Henoch-Schonlein purpura (HSP) is a small vessel vasculitis that is rare in adults. Here, we present a case of a woman who presented with palpable purpura, abdominal pain, arthritis and ischemic stroke. The patient met the diagnostic criteria of HSP. However, cerebrovascular disease is reported as an uncommon, yet fatal, complication of HSP. The patient responded to aggressive immunosuppression with pulses of corticosteroids and cyclophosphamide. In the absence of an established protocol of treatment of such neurologic emergency in HSP patients, this report demonstrates a successful outcome.
Annals of Indian Academy of Neurology, 2013
Several mutations of the GATA3 gene lead to the HDR phenotype. [3] Therefore, HDR patients exhibi... more Several mutations of the GATA3 gene lead to the HDR phenotype. [3] Therefore, HDR patients exhibit a spectrum of phenotypes. The severity of sensorineural deafness varies and is symmetrical in majority of HDR patients. The term "renal dysplasia" represents various abnormalities such as agenesis, hypoplasia, pelvicalyceal deformity, and renal scarring. Most patients present with symptoms related to hypocalcemia; however, some patients have normal calcium levels or show asymptomatic hypocalcemia. [2] The familial forms of hypoparathyroidism can follow an autosomal dominant, autosomal recessive, or X-linked recessive pattern. Hypoparathyroidism can present as an isolated disorder or may be associated with other congenital abnormalities such as DiGeorge Syndrome. Here, we report the case of a patient who presented with seizure, extensive intracranial calcification, and hypocalcemia, and who was subsequently diagnosed with HDR syndrome.
Clinical Medicine & Research, 2014
ABSTRACT Introduction: Cervical lymphadenoparthy is a common presentation of many diseases, thoug... more ABSTRACT Introduction: Cervical lymphadenoparthy is a common presentation of many diseases, though it is mostly tubercular in origin in developing countries. This cross sectional study was done to corroborate fine needle aspiration cytology (FNAC) findings with histopathological examinations (HPE) in cervical lymphadenopathy. Materials and methods: 120 patients of both sexes attending the FNAC unit of Nilratan Sircar Medical College and Hospital, Kolkata were enrolled in this study. They were evaluated by thorough clinical examination followed by routine investigations, FNAC and histopathological examination (HPE). Results: There was maximum corroboration of FNAC and HPE reports in tubercular lymphadenitis (76 v/s 76) and Hodgkin’s disease (2 v/s 2) followed by metastatic carcinoma (20 v/s 16) and non specific lymphadenitis (14 v/s 5) respectively. Overall correlation was 88.4% (excluding 8 cases where FNAC results were inconclusive due to unsatisfactory smear). The sensitivity, specificity, positive predictive value and negative predictive value of FNAC to diagnose tubercular lymphadenopathies were 86.36%. 100.0%, 100.0% and 72.73% respectively. In case of metastatic CA, these were 100.0%, 96.15%, 80.0% and 100.0% respectively. Conclusion: FNAC is simple, safe, quick, cheap, acceptable yet accurate method of establishing the etiology in cases of cervical lymphadenopathy.