Muralidhar Varma - Academia.edu (original) (raw)

Papers by Muralidhar Varma

Journal of Investigative Medicine High Impact Case Reports, 2016

Pyogenic liver abscesses are rare with an incidence of 0.5% to 0.8% and are mostly due to hepatob... more Pyogenic liver abscesses are rare with an incidence of 0.5% to 0.8% and are mostly due to hepatobiliary causes (40% to 60%). Most are polymicrobial with less than 10% being caused by Staphylococcus aureus. Of these, few are caused by methicillin-resistant Staphylococcus aureus (MRSA) and fewer still by a community-acquired strain. Here we present a case study of a patient with a community-acquired MRSA liver abscess. The patient presented with fever since 1 month and tender hepatomegaly. Blood tests revealed elevated levels of alkaline phosphatase, C-reactive protein, erythrocyte sedimentation rate, and neutrophilic leukocytosis. Blood cultures were sterile. Ultrasound of the abdomen showed multiple abscesses, from which pus was drained and MRSA isolated. Computed tomography of the abdomen did not show any source of infection, and an amebic serology was negative. The patient was started on vancomycin for 2 weeks, following which he became afebrile and was discharged on oral linezolid for 4 more weeks. Normally a liver abscess is treated empirically with ceftriaxone for pyogenic liver abscess and metronidazole for amebic liver abscess. However, if the patient has risk factors for a Staphylococcal infection, it is imperative that antibiotics covering gram-positive organisms be added while waiting for culture reports.

Journal of cardiothoracic surgery, Jan 16, 2015

The Korean journal of internal medicine, 2012

An unusual case of spontaneous cerebrospinal fluid (CSF) rhinorrhea with a pneumocephalus is desc... more An unusual case of spontaneous cerebrospinal fluid (CSF) rhinorrhea with a pneumocephalus is described in a middle-aged woman who presented with a watery nasal discharge for 1 week and headache, vomiting, and fever for 1 day. The neurological examination revealed meningeal signs and bilateral papilledema. The CSF picture suggested pyogenic meningitis, and computed tomography of the brain revealed pneumocephalus. Diagnostic nasal endoscopy showed outpouching of the dura from the left olfactory cleft with a CSF leak and granular nasal mucosa. The defect was repaired surgically, and a biopsy of that area revealed granulomatous changes suggestive of tuberculosis. The patient recovered completely with standard four-drug antitubercular therapy. To our knowledge spontaneous CSF rhinorrhea with pneumocephalus occurring secondary to nasal tuberculosis has not been previously reported.

Canadian journal of gastroenterology = Journal canadien de gastroenterologie, 2008

To study the value of platelet count to spleen diameter ratio as a noninvasive parameter for diag... more To study the value of platelet count to spleen diameter ratio as a noninvasive parameter for diagnosing esophageal varices (EVs) in liver cirrhosis. The laboratory and ultrasonographic variables were prospectively evaluated in 150 patients with liver cirrhosis. Only stable patients were included in the study. Patients with active gastrointestinal bleeding at the time of admission were excluded. All patients underwent screening upper gastrointestinal endoscopy. The platelet count, spleen diameter and platelet count to spleen diameter ratio in patients with EVs were significantly different from patients without EVs. The platelet count to spleen diameter ratio had the highest accuracy among the three parameters. By applying receiver operating characteristic curves, a platelet count to spleen diameter ratio cut-off value of 1014 was obtained, which gave positive and negative predictive values of 95.4% and 95.1%, respectively. The accuracy of this cut-off value as evaluated by applying r...

Case Reports, 2014

A 65-year-old woman, treated for non-ST segment elevation myocardial infarction and unexplained t... more A 65-year-old woman, treated for non-ST segment elevation myocardial infarction and unexplained type 2 respiratory failure, was referred to our hospital in view of difficulty in weaning off the ventilator. She was evaluated in detail for persistent hypercapnia. Ultrasound of the diaphragm showed minimal excursion of diaphragm while she was off the ventilator and fluoroscopy confirmed bilateral diaphragmatic palsy. As extensive radiological, immunological and microbiological workup ruled out other possible aetiologies, a diagnosis of idiopathic Bell&amp;amp;amp;amp;amp;#39;s palsy of the diaphragm was made. She was treated with valacyclovir and steroids after which she gradually recovered and was weaned off the ventilator.

Toxicology International, 2014

Herbicide poisoning is most common method of suicide in India and it is associated with high morb... more Herbicide poisoning is most common method of suicide in India and it is associated with high morbidity and mortality. Among different herbicidal poisonings the most predominantly found poisonings are paraquat and glyphosate. These compounds are highly toxic and their poisonings require proper management techniques. High fatality is seen in these cases which are mainly due to its inherent toxicity and lack of effective treatment. Common symptoms of these poisonings includes gastrointestinal corrosive effects with mouth and throat, epigastric pain and dysphagia, acid-base imbalance, pulmonary edema, shock and arrhythmia. Long term health effects include pulmonary fibrosis, renal failure, hepatic failure, heart failure, multi-organ failure or death. No proven antidote exists for these poisonings. So the treatment is mainly supportive. Initially gastric lavage or whole-gut irrigation using adsorbents such as Fuller&amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s earth, bentonite or activated charcoal is recommended. In case of renal failure hemodialysis or hemoperfusion may be considered. However novel approaches like treatment with N-acetylcysteine, vitamin C, vitamin E, cyclophosphamide may also be helpful.

Background: India along with other South Asian countries significantly contributes to the global ... more Background: India along with other South Asian countries significantly contributes to the global burden of cardiovascular diseases. Studies have shown Indians to exhibit higher prevalence of Coronary Artery Disease and coronary risk factors as compared with Caucasians. These risk factors are compounded by behavioural risk factors such as regular tobacco use, low physical activity as well as a high saturated fat intake and this places a need for effective behavioural modification.

F1000posters, Oct 4, 2012

This paper is available online at www.jprhc.com ABSTRACT Aspirin resistance may be biochemical or... more This paper is available online at www.jprhc.com ABSTRACT Aspirin resistance may be biochemical or clinical. Data related to the presence of aspirin resistance in the Indian population is scarce. We conducted a cross sectional study to address the issue of clinical aspirin non responsiveness and to assess the association between inhibition of platelet aggregation, clinical risk factors and occurrence of vascular events. We studied platelet aggregation by optical aggregometry in 20 patients on aspirin.

Journal of Clinical Research in HIV AIDS and Prevention, 2013

The Journal of the Association of Physicians of India

Gram negative bacilli are the commonest cause of infections at all sites in the Indian setting. T... more Gram negative bacilli are the commonest cause of infections at all sites in the Indian setting. There is a considerable degree of resistance to both first line and second line gram negative agents. Resistance to gram positive cocci is less of a problem than that of gram negative bacilli. MRSA prevalence though is not insignificant.

Background: Septic shock is a leading cause of mortality in hospitals. Appropriate timely empiric... more Background: Septic shock is a leading cause of mortality in hospitals. Appropriate timely empirical antibiotics are vital for outcome for septic shock. This study aimed to see the impact of appropriateness of empirical antibiotics in patients who presented with septic shock. Methods: : We have conducted a prospective observational study from March 2012 to May 2012. During this period, patients diagnosed as Septic Shock as per the Surviving Sepsis Campaign Guidelines 2012 were divided into two groups: 1) Those treated with appropriate antibiotics; 2) Those treated with inappropriate antibiotics. Inappropriateness is defined as microbiological documentation of an infection that is not being effectively treated at the time of administration, absence of antibiotic against a specific class of microorganisms or the administration of an antimicrobial agent to which the microorganism was resistant. Results were analyzed using SPSS version 16. P.Value of >0.05 was considered as significan...

Background: Scrub typhus is a common cause of acute febrile illness in the tropical countries, of... more Background: Scrub typhus is a common cause of acute febrile illness in the tropical countries, often presenting with respiratory manifestations including Acute Respiratory Distress Syndrome (ARDS). The study was aimed to analyze the respiratory manifestations in patients with scrub typhus. Methods: A prospective observational study was conducted between August 2010 and July 2012. During this period, a total of 358 patients were diagnosed with scrub typhus. Out of which 92 presented with respiratory symptoms. Diagnosis of scrub typhus was made based on serology and presence of eschar. Results: In the study conducted, majority of the patients were male 58 (63%) and were mostly agriculturist 43 (46.7%). Cough 36 (39%) and breathlessness 32(34.8%) were the predominant symptoms. Wheeze 3(3.3%) and upper respiratory tract 1(1.1%) symptoms were some of the other manifestatons. Eschar was seen in 29(31.5%) cases, predominant site being neck. On imaging, 24( 22.6%) had bilateral infiltrates,...

Objective: To assess awareness of pharmacovigilance among the healthcare professionals and to eva... more Objective: To assess awareness of pharmacovigilance among the healthcare professionals and to evaluate the impact of an educational intervention for improving awareness of pharmacovigilance among physician, pharmacist and nurses in an Indian tertiary care teaching hospital. Material &Methods: A suitable self-administered Knowledge, attitude, practice (KAP) survey questionnaire was designed, validated using a method developed by Lynn M and survey was conducted among physician, nurses, pharmacist of kasturba hospital, where local hospital based ADR reporting system exist. An interactive educational intervention was designed for all participants of Pre-KAP questionnaire survey. The impact of effectiveness of educational intervention among health care professionals was evaluated by means of post-KAP questionnaire survey. The chi-square test and One-way Analysis of variance was used for statistical calculations. Results: In our study a total of 255 health care professionals were responde...

AbstractA 20-year-old male presented with mildacute exacerbation of bronchial asthma withretroste... more AbstractA 20-year-old male presented with mildacute exacerbation of bronchial asthma withretrosternal chest pain. On examination,apart from bilateral polyphonic wheezing,the patient had subcutaneous emphysemain the supraclavicular region and Hamman’ssign on auscultation. The suspicion ofpneumomediastinum was confirmed bychest X-ray and computerized tomographyscan (CT scan) of thorax. Patient made anuneventful recovery.Spontaneous pneumomediastinum shouldbe suspected in young patients with ahistory of asthma presenting with chest pain.In most cases, the outcome is benign, butrarely, it can be life threatening that mightrequire surgical intervention.

Microbiology and Immunology, 2015

Clinical diagnosis of scrub typhus is often difficult because the symptoms are very similar to th... more Clinical diagnosis of scrub typhus is often difficult because the symptoms are very similar to those of other febrile illness such as dengue, leptospirosis, malaria and other viral hemorrhagic fevers. Though better diagnostic tests are available for rickettsial diseases and scrub typhus elsewhere, the Weil-Felix test is still commonly used in India, mainly because microimmunofluorescence assays (M-IFA) were not available in India till recently and relevant staff had insufficient training. The present study was performed to investigate the performance of M-IFA, IgM ELISA, and Weil-Felix test on 546 non-repeated serum samples from subjects suspected of having scrub typhus. One hundred and forty-three of these 546 samples were positive by M-IFA; these cases were also confirmed clinically to have scrub typhus based on their dramatic responses to doxycycline therapy. IgM ELISA was positive in 122 of the 143 M-IFA positive cases and the Weil-Felix test in 96. Though the Weil-Felix test is a heterophile agglutination test, it was found in this study to have good specificity but far too little sensitivity to use as a routine diagnostic test. IgM ELISA can be a good substitute for M-IFA. Incorporation of multiple prototype antigens on M-IFA slides is likely one of the reasons for its superior performance. As newer and better diagnostic assays become available for scrub typhus diagnosis in developed countries, it will be imperative to also use such tests in other endemic countries to prevent over- or under-diagnosis of scrub typhus.

Clinical Epidemiology and Global Health, 2015

The Journal of the Association of Physicians of India, 2013

The objective of this study was to detect C. difficile in patients presenting with Antibiotic Ass... more The objective of this study was to detect C. difficile in patients presenting with Antibiotic Associated Diarrhoea. Stool samples from twenty-five patients collected over a period of four months were processed for C. difficile by culture and the isolates were identified following standard methods. C. difficile toxins A and B and C. perfringens enterotoxin were detected by ELISA performed directly on stool specimens. Four patients (16%) were found positive for C. difficile infection. All patients with C. difficile infection received prior treatment with third-generation cephalosporins or beta-lactam/beta-lactamase inhibitor antibiotics. C. perfringens enterotoxin was found in two (8%) patients. Severe colitis was seen in one (25%) of the four patients who had co-infection with C. difficile and C. perfringens. This study demonstrated a significant occurrence of C. difficile infection in this hospital population. There is a need to further evaluate the role of C. perfringens in causing...