Kauverian Medical Journal

Antibiogram: A clinical audit

T. Rajarajan — 2024-11-20

An antibiogram is a valuable tool in clinical microbiology that provides a summary of antimicrobial susceptibility patterns for various bacterial pathogens within a healthcare facility or region. A clinical audit of antibiograms involves systematically reviewing and analyzing these susceptibility reports to assess the effectiveness of current antibiotic prescribing practices and guide future treatment decisions. This process typically includes collecting data on bacterial isolates, their sources, and their susceptibility to different antibiotics over a specified period. The audit may evaluate trends in resistance patterns, identify emerging multidrug-resistant organisms, and compare local susceptibility data with national or international benchmarks. By conducting regular antibiogram audits, healthcare institutions can optimize antimicrobial stewardship programs, update empiric therapy guidelines, and ultimately improve patient outcomes by ensuring the most appropriate and effective antibiotic choices are made based on local resistance patterns.

ICD implant in 6-year-old with Jervell and Lange-Nielsen (JLN) syndrome

T. Joseph Theodore — 2024-11-20

Jervell and Lange-Nielsen syndrome (JLNS), a rare autosomal recessive subtype of long QT syndrome (LQTS) caused by potassium channel gene mutations, is characterized by congenital bilateral sensorineural hearing loss and prolonged QT interval, predisposing patients to life-threatening cardiac arrhythmias. A 6-year-old girl with congenital bilateral sensorineural hearing loss (right cochlear implant at age 3 years) experienced six emotion- and exercise-triggered syncope episodes since the age of 3 years. Her electrocardiogram (ECG) revealed a corrected QT interval (QTc) of 600 ms and T-wave alternans, indicative of JLNS, which was confirmed by genetic testing. Despite beta-blocker treatment, her symptoms persisted, necessitating the successful placement of a subpectoral transvenous implantable cardioverter-defibrillator (ICD) to prevent sudden cardiac death, despite the challenges posed by her thin chest wall and age. ICD pacing has been employed to reduce QTc, and left cardiac sympathetic denervation is planned if the symptoms recur.

Myotonia congenita: A case series

Bhuvaneshwari Rajendran — 2024-11-20

This study examines five patients with confirmed CLCN1 gene mutations associated with myotonia congenita, a rare neuromuscular disorder causing muscle stiffness. Four patients presented milder symptoms with early onset, while one exhibited severe phenotype affecting facial muscles. All patients maintained ambulatory function, though the severe case required a walking stick. Notably, none reported family history, suggesting de novo mutations or incomplete penetrance. The study highlights the phenotypic variability in CLCN1-related myotonia, emphasizing the importance of genetic testing for accurate diagnosis and counseling. The findings contribute to understanding genotype-phenotype relationships in myotonia congenita and stress the need for comprehensive clinical assessments in suspected cases.

Retroperitoneal sarcoma: A report of two cases

SKS. Patne — 2024-11-20

Retroperitoneal sarcomas are rare tumors, with the potential for late presentation due to their location, lack of significant symptoms at an early stage and availability of space for expansion. For the same reason, along with their proximity to vital structures, the majority of such tumors are deemed inoperable. Surgery offers the only hope of cure in such patients, at times with the addition of adjuvant therapy. We present here two cases of large retroperitoneal sarcomas where complete resection was possible, with potential for cure.

Saccular abdominal aortic aneurysms: A case series

Arunagiri Viruthagiri — 2024-11-20

This case report describes a 44-year-old male presenting with acute abdominal pain due to multiple saccular abdominal aortic aneurysms. The patient had a history of left-leg ischemia and tuberculous lymphadenopathy. Despite previous advice for open repair, the patient deferred treatment. Upon admission, CT angiography revealed multiple saccular aneurysms in the infrarenal aorta and the right common iliac artery. Due to the unsuitable anatomy and suspected inflammatory etiology, endovascular repair was not considered. Open aneurysm repair was performed using a Rifampicin-soaked Dacron graft followed by omentoplasty. A ruptured saccular aneurysm was observed intraoperatively. The patient's postoperative recovery was uneventful, and he was discharged on day 7. Histopathology of the sac and thrombus revealed nonspecific changes. The patient was maintained on oral penicillin post-surgery and was doing well at the weeks follow-up. This case highlights the importance of timely intervention in the management of complex aortic aneurysms and the potential complications associated with delayed treatment.