International Journal of Advances in Medicine

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https://imsear.searo.who.int/handle/123456789/156150

Editor-in-Chief: Dr. K.N. Shah
ISSN: 2349-3925 (Print); 2349-3933 (Online)

Frequency: Quarterly

Language: English

Open Access Peer-reviewed journal

Web site: https://www.ijmedicine.com/

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Now showing 1 - 20 of 1334

A 3-month-old child with miliary tuberculosis: a case report
(Medip Academy, 2022-11) Primanelza, Dewi Hanifa; Tangguh, Leonard; Mansyoer, Riza
Miliary tuberculosis (TB) is a severe form of disseminated TBthat could be fatal without treatment. It remains a significant health problem in endemic countries such as Indonesia. A-3-month-old child was admitted to the hospital with chief complain of shortness of breath, cough,and intermittent low-grade fever. Significant clinical findings were lack of weight gain, previous contact with confirmed cases of TB, and severe malnutrition. Significant laboratory findings were anemia, elevated CRP, and hypoalbuminemia. Radiological findings were suggestive of miliary TBwith bilateral diffuse reticulonodular lung lesion on chest CT-scan. Diagnosis of miliary TB is difficult because of nonspecific, atypical symptoms and varied clinical signs. It is needed multiple diagnostic approach, especially for children. Miliary TBremain to be a difficult case that require an early intervention despite difficulties in its diagnosis, to prevent morbidity and mortality of patient.
Abdominal tuberculosis: a surgical perplexity
(Medip Academy, 2018-09) Vagholkar, Ketan R.; Chandrashekhar, Shantanu; Vagholkar, Suvarna
Abdominal tuberculosis is one of the most challenging forms of extra pulmonary tuberculosis. The diagnosis of the disease itself poses the greatest challenge due to the variability of presentation. Clinical presentations in various forms with conflicting results on a multitude of haematological, immunological and radiological tests causes a lot of confusion in interpreting and correlating the symptoms to arrive at a diagnosis. This adds to the perplexity in surgical management of this complex disease especially in an era where AIDS has added to the problems. Having arrived at a diagnosis, chemotherapy is the mainstay of treatment. Surgery is indicated when the response to medical therapy is poor or complications supervene. Deciding the optimum procedure is again a major issue. Understanding the pathophysiology therefore is pivotal in making a value decision. The article briefly outlines the approach to this surgical perplexity.
Aberrant phenotypes in acute myeloid leukemia in India
(Medip Academy, 2018-03) Aparna, Suresh Kumar; Sharmila, Murugesan
Background: Acute myeloid leukemia (AML) is a heterogeneous disease, associated with a high diversity of phenotypes. The study was done with the aim to study about the aberrant phenotypes in acute myeloid leukemia cases and the correlation among the aberrant phenotypes and poor prognostic factors in acute myeloid leukemia.Methods: This cross sectional study was conducted on 35 cases of newly diagnosed AML according to the selection criteria at Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai for a period of 6 months. Immunophenotyping analysis by flow cytometry was done on fresh bone marrow aspirate or peripheral blood sample by applying Acute Leukemia Panel. The co-expression of different antigen markers on lymphocytes was analyzed.Results: Aberrant lymphoid markers were seen in 17 (49%) cases. 5 (14%) cases had lymphoid associated antigen expression alone. 3 (8%) cases had asynchronous antigen expression alone. 9 (27%) cases had both asynchronous antigen expression and lymphoid associated antigen expression which is of cases . In total, lymphoid associated antigen expression is seen in 41% of cases and asynchronous antigen expression in 35% of cases. CD3, CD19 (lymphoid associated antigen) and CD34+ CD15+ (asynchronous aberrant phenotype) were the most common equally expressed aberrant phenotypes, each in 7 cases. CD 3 was significantly more common in males (P=0.021) but in general there were no statistically significant association between adverse prognostic factors and aberrant phenotypic AML.Conclusions: CD19 and CD3 were the most commonly expressed lymphoid associated antigen. Most common asynchronous aberrant phenotype was CD34+CD15+. None of the aberrant phenotypic expression was not associated with poor risk factors in acute myeloid leukemia except for common expression of CD3 in males.
Accuracy of imaging findings compared with that of histopathological findings of the ovarian lesions
(Medip Academy, 2019-03) Kumar, Ponnam Bharath; Reddy, Prem Sai
Background: Newer imaging techniques have emerged, and it is necessary to study their accuracy in comparison to the gold standard of histopathology for increasing accuracy of diagnosis. Ovarian tumors are difficult to diagnose when they are of small size. But their diagnosis should be done at an earlier stage for effective outcome of the management of these tumors. The objective was to study accuracy of imaging findings compared with that of histopathological findings of the ovarian lesions.Methods: This study was done for a period of two years from December 2010 to May 2012. A total of 30 patients who were clinically suspected to have ovarian pathology were referred to us for ultrasonography. In 30 patients, who were referred for sonography a total of 36 ovarian masses was found? Each patient was examined by Trans abdominal sonography / Trans vaginal sonography, MRI (Pre and Post contrast) and CT when required.Results: Sonography could detect the origin of mass accurately in 29 (80.5 %) masses and MRI could detect the origin accurately in 34 (94.4%) masses. Sonography characterized 33/36 (91.6%) masses correctly. MRI correctly characterized 34/36 (94.5%) cases and tissue content was identified correctly. The sensitivity of imaging findings for correctly identifying malignant lesions was 100% and sensitivity for correctly making a benign diagnosis was 92.5%. The specificity of imaging findings for correctly identifying malignant lesion was 92% and specificity for correctly making a benign diagnosis was 84.6 %.Conclusions: MRI is significantly superior to US in all respects due to the excellent soft tissue contrast and organ-specific information generated in the pelvis.
Acid based disorders in intensive care unit: a hospital-based study
(Medip Academy, 2019-01) Rajendran, Babu; Mallampati, Seetha Rami Reddy; J., Sheju Jonathan Jha
Background: Acid base disorders are common in the ICU patients and pose a great burden in the management of the underlying condition.Methods: Identifying the type of acid-base disorders in ICU patients using arterial blood gas analysis This was a retrospective case-controlled comparative study. 46 patients in intensive care unit of a reputed institution and comparing the type of acid-base disorder amongst infectious (10) and non-infectious (36) diseases.Results: Of the study population, 70% had mixed acid base disorders and 30% had simple type of acid base disorders. It was found that sepsis is associated with mixed type of acid-base disorders with most common being metabolic acidosis with respiratory alkalosis. Non-infectious diseases were mostly associated with metabolic alkalosis with respiratory acidosis. Analysis of individual acid base disorders revealed metabolic acidosis as the most common disturbance.Conclusions: These results projected the probability of acid bases disorders in various conditions and help in the efficient management. Mixed acid base disorders are the most common disturbances in the intensive care setup which is metabolic acidosis with respiratory alkalosis in infectious diseases and metabolic acidosis is the most common simple type of acid base disorder.
Acne vulgaris management: what’s new and what’s still true.
(2015-02) Seth, Vikas; Mishra, Anuj
Acne vulgaris is one of the commonest skin disorders that can affect individuals from childhood to adulthood, most often occurring in the teenage years. Regarding its management, what’s still true is that a wide range of treatment options are available, ranging from the commonly used topical treatments like benzoyl peroxide, azelaic acid, sulfur, antibiotics, retinoids and superficial chemical peels while the systemic treatments available include the use of systemic antibiotics, retinoids, and antiandrogens. What’s new in the management of acne vulgaris is the use of laser and light devices and other newer technologies. The present article reviews the use of above mentioned agents in the current scenario.
Actinomycotic lacrimal canaliculitis: a rare case report
(Medip Academy, 2019-05) Bashir, Humaira; Nazir, Asifa
Actinomyces israelii is a gram-positive anaerobic organism commonly associated with canaliculitis in adults. Actinomyces are normal commensal bacteria in humans and primarily cause opportunistic infections during immunosuppressive state or when loss of continuity of epithelial lining in mucosa occurs. Lacrimal canaliculitis is a relatively rare condition and is undiagnosed for long periods of time. Being a relatively rare condition, it is commonly overlooked and undiagnosed for long periods of time. Primary chronic canaliculitis is an uncommon problem and Actinomycosis may form in up to 2% of all lacrimal disease. Here present study reports a case of lacrimal canaliculitis caused by Actinomyces israelii.
Active surveillance culture in a critical care unit of a tertiary care hospital of West Bengal, India: a prospective study
(Medip Academy, 2019-01) Thakur, Leelavati; Dash, Chinmaya; Sinha, Sulekha
Background: Hospital-acquired infections are a common and serious public health problem and their management and control are essential to minimize hospital-related morbidity and mortality. The aim was to acquire the base line data regarding prevalence of Multi Drug Resistant (MDR) organism in a tertiary care institution and to help in ensuring proper practice guidelines like contact isolation, cohorting and sterile barrier precaution. The study design was an observational descriptive hospital based cross sectional study.Methods: The study was conducted in a critical care unit of a tertiary care hospital for a duration of 6months. Patients with the age more than 18yrs, duration of stay more than 48hrs were included in the study. Categorical data are expressed in percentages.Results: In the study 111 patients more than 18 yrs of age were enrolled of which 68 were male and 43 females. The sample collected from the axillary site were 110, nasal site 108, urine 96 and respiratory site 95. The culture positivity for pathogenic organisms were maximum for axillary site (95.5%) followed by nasal site (83.33%), respiratory site (36.8%) and urine (26%). Of all the organisms isolated multidrug resistance were as follows: MRSA 63% and MSSA 37% (of all S. aureus), MR CoNS 41.32% (of all CoNS), ESBL producer 22.2% and carbapenemase producer 22.2% (of all Klebsiella species), ESBL producer 37.5% and carbapenemase producer 31.26% (of all E. coli), non albicans Candida 57.14% (of all Candida species).Conclusions: Early identification of the causative pathogen in nosocomial and community-acquired infection is crucial for initiating the correct antibiotics as well as preventing further spread.
An acute case of herpes zoster ophthalmicus with post-herpetic neuralgia and cranial nerve neuropathies
(Medip Academy, 2022-09) Dadu, Fahad; Kumar, Sathish; R., Sadhana; M., Ram kumar; Kumar, Magesh
Herpes zoster is a common diagnosis in the emergency department which is caused by reactivation of varicella zoster virus (VZV). Reactivation in ophthalmic division of trigeminal nerve causes Herpes zoster ophthalmicus. It is associated with a rash in the distribution of the trigeminal nerve dermatomes especially in ophthalmic and maxillary divisions. The most often complications of HZO are episcleritis, keratitis, glaucoma, and cataracts. HZO with cranial neuropathy is a very rare condition. So herewith wereport a case 51years old female with swelling, redness in right eye and drooping of eyelids on the right side. She had tearing and double vision. She was diagnosed with herpes zoster ophthalmicus with neuropathy of 3rd,4thand 6th cranial nerves. The patient was treated and discharged in a healthy condition. Timely diagnosis and treatment can decrease morbidity and prevent the complication.
Acute exacerbations of asthma occurring frequently time to check your techniques
(Medip Academy, 2019-11) Bonapelli, Vijaysagar Reddy; D. J., Sujay; J., Prakruthi; A. S., Sathiqali
Background: Asthmatics form a predominant section of patients in OPD. If poorly controlled the frequency of attacks requiring an emergency department visit adds to the burden. It was noticed that the patients who were on inhalational therapy had poor control despite the absence of other factors which could lead to exacerbations. Hence author evaluated the inhalational techniques.Methods: A prospective study undertaken in the department of medicine in tertiary care hospital in Dakshina Kannada District, Karnataka enlisting 25 patients admitted with acute exacerbation of bronchial asthma. The patients were assessed for their symptoms, signs and recurrent attacks along with their cough severity index and inhaler scores and the observations were tabulated.Results: Of the twenty-five, 15 were on inhalation therapy with various modes of deliveries. There were 15 males and 10 females from ages 20 to 50years. The number of attacks of asthma was higher in those not on inhalation therapies than those using inhalation therapies. Also, the level/severity of cough, measured as Cough Severity Index, was assessed among the two groups. Those on inhalation therapy had a lower grade of cough than those not on therapy . Mean AEC was 94 among those on inhalation therapy and 209 among those not on therapy. Inhalational score was calculated for each patient. There is a strong negative correlation of -0.709 between inhalation score and recurrent attacks, which is statistically significant (p=0.003). Lower inhalation scores were associated with recurrent attacks.Conclusions: Recurrent exacerbations in an asthmatic patient on inhalation therapy are due to improper inhalational technique. It was suggested that it is wise to spend time with the patients in authors OPD set up and teach them the correct techniques of using inhalational therapy hence reducing frequency of attacks and cost of health care in such patients.
Acute kidney injury in patient with acute gastroenteritis and history of consuming energy drink
(Medip Academy, 2024-10) Pauliana; Sunaka, IW.
An abrupt decline in kidney function is a characteristic of acute kidney injury (AKI), a disorder that affects the structure and function of the kidneys. Hypovolemia from gastroenteritis is known as one of the causes from prerenal AKI. Energy drinks, which are consumed a lot by workers and young people are also known can decrease kidney function and liver function even without having any pre-existing diseases. There were two reported cases of consumption energy drink that worsening kidney and liver function in gastroenteritis patient with mild-moderate dehydration state.
Acute liver failure secondary to chronic lymphocytic leukemia
(Medip Academy, 2019-05) Saini, Rohin; Mishra, Arvind; Gupta, Kamlesh; Anand, Rohit; Tripathi, Umesh; Hashim, M.
Chronic lymphocytic leukemia is an indolent malignancy of lymphocytes commonly seen in elderly. Dissemination of malignancy is a rare cause of acute liver failure and has rarely been reported. Here we describe the case of a sixty five year old male presenting with acute liver failure. He is a diabetic with no known history of seropositive hepatitis, drug intake or any addictions. Bone marrow and liver biopsy suggestive of chronic lymphocytic leukemia. He eventually succumbed to his illness.
Acute mercury poisoning complicated by gastrointestinal bleeding
(Medip Academy, 2024-06) Bhattacharjee, M; Mahawar, AK; Paghdar, H.
Mercury poisoning is a rare but potentially serious condition that can result from environmental exposure to elemental mercury. We present a case of a 22-year-young male who presented to the emergency department (ED) with symptoms of mercury poisoning after his family members brought home a vial of elemental mercury. The patient experienced nausea, anxiety, abdominal pain, diarrhea, and fever. Despite normal initial laboratory tests and imaging studies, a presumptive diagnosis of mercury poisoning was made based on the patient's history of exposure and clinical presentation. Although his hospital stay was complicated by passage of blood in stool, possibly lower GI bleed, but treatment with N-acetylcysteine (NAC) was initiated empirically, leading to resolution of symptoms and a favorable outcome. This case highlights the importance of considering mercury poisoning in patients with appropriate exposure history and the effectiveness of NAC in the treatment of acute mercury poisoning. Public education on the hazards of mercury and the importance of prompt recognition and treatment are essential in preventing severe complications associated with mercury exposure.
Acute pancreatitis as first presentation of primary hyperparathyroidism: an observational study attertiary care centreJammu and Kashmir, India
(Medip Academy, 2022-02) Mushfiq, Syed; Gazala, Sheenam; Imran, Ali
Metabolic causes of acute pancreatitis though uncommon, are important as early recognition helps in the management and prevention of recurrent episodes. Among the uncommon etiologies, Primary hyperparathyroidism (PHPT) is one of the important causes of acute pancreatitis. We studied nine patients with acute or recurrent acute pancreatitis with etiology of PHPT. All patients had elevated serum calcium on admission and high levels of circulating parathyroid hormone. Ultrasonography, 4D CT and Sestamibi scan was used to localize parathyroid adenoma. These patients underwent parathyroidectomy and post-operative histology was consistent with parathyroid adenoma.
Acute pulmonary embolism in a patient with neuroleptic malignant syndrome
(Medip Academy, 2022-03) Jaison, Pyari; Kurian, Abraham; Gladson, Nikhil; Abraham, Merin V.
Neuroleptic malignant syndrome (NMS)is a life-threatening complication seen in psychiatric patients exposed to antipsychotic medications. NMSis associated with medication with dopamine antagonist action. The typical tetrad of symptoms of NMS includes fever, muscle rigidity, altered mental status and autonomic dysfunction. Acute pulmonary embolism is one of the major complications seen in patients diagnosed with neuroleptic malignant symptoms. Here we present a case report of a 64 years old female with a history of psychiatric illness, presented with fever, rigidity andaltered mental status and diagnosed to haveNMS. Later her condition was complicated by pulmonary embolism. She was treated with bromocriptine and heparin infusion and improved symptomatically.
Acute rheumatic fever in young adult patients: a case report
(Medip Academy, 2025-02) Kinasih, KVNR; Dewi, AAISK
Acute rheumatic fever (ARF) is an inflammatory response to group A Streptococcus (GAS) infection. The incidence ranges from 8 to 51 per 100.000 children and young adults worldwide. A 19-year-old male patient admitted with complaint of abdominal pain and joint pain of knee in both legs and elbow in both hands. Multiple erythematous macules, round in shape, elevated of white blood cells and anti-streptolysin O titer (ASOT) are present in this case. The diagnosis of ARF is made using the Jones criteria. Intramuscular benzathine penicillin G as a single dose is recommended for management of ARF and as secondary prophylaxis to prevent recurrences. Comprehensive treatment was needed for patient with rheumatic fever to prevent reoccurrence and also complication which may arise.
An adaptive clinical trial on patients with non variceal upper gastrointestinal bleed with the help of endoscopy
(Medip Academy, 2020-03) Singh, Prem; Singh, Gaurav; Kumar, Vinay; Chawla, Gaurav
Background: Acute upper gastrointestinal hemorrhage (UGIH) is a common condition worldwide frequently leads to hospital admission also has a significant associated morbidity and mortality, especially in the elderly. A systematic diagnostic and definite therapeutic approach is essential to establish a diagnosis, relevant to specific investigations for appropriate treatment in tertiary medical care center.Methods: A comparative trial was done on n=109 cases with an objective to find out the different causes of UGI bleed in population, to assess the requirement of blood transfusion in patients with massive GI Bleed and to compare the treatment outcome of Proton pump inhibitors over Tranexamic acid and Octreotide in non-variceal UGI bleed. The cases were assigned to three different groups by lottery system. Proton pump inhibitors (Omeprazole), Somatostatin (Octreotide), Anti-fibrinolytic (Tranexamic acid), outcome was assessed after complete treatment and follow up.Results: Out of 150 cases, 109 were diagnosed with non-variceal GI bleed, 35 cases were treated with Omeprazole out of which 11.42% cases received blood transfusion, and 4 had history of re bleeding, Mean Duration of stay in hospital was 4.4±1.75, when compared to the other two group the duration of hospitalization was least as the P value was <0.0001.Conclusions: In this study it was demonstrated the use of PPI in case of Non-Variceal Bleeding significantly reduces the need of blood transfusion. Even it reduces the cases of re bleeding and duration of hospital stay.
Admission HbA1c value as a prognostic marker in patients admitted with COVID-19
(Medip Academy, 2022-12) Jain, Vaibhav; Hegde, Suraj S.
Background:Diabetes mellitus has been firmly established as a risk factor for the prognosis of COVID-19. However, the impact of pre-COVID-19 glycemic control on prognosis is yet to be fully understood. Our study aimedto establish the effect of HbA1c at admission on the outcome of patients admitted with COVID-19.Methods:It was a prospective observational study of admitted adult patients with confirmed SARS-CoV-2 infection in a tertiary care centre based on data collected from the medical record section using the patient data registry between April 2021 to June 2021. Information regarding demographic and clinical features, laboratory values, and hospital outcomes was collected and analysed.Results:182 patients admitted to the hospital with COVID-19 during the study period were included, their mean age was 48.75 years, the mean HbA1c was 6.1. Males accounted for 69.8% (127) of the sample population. 41.2% (75) were known diabetics. 44.8% (81) were known hypertensives. The mortality rate overall was 25.3% (46). 63.7% (116) had HbA1c values >6.5.High HbA1c values was associated with longer duration of hospital stay (p=0.032), higher levels of inflammatory markers, increased need for mechanical ventilation (p=0.001), higher mortality rate (p=0.001).Conclusions:Patients with COVID-19 with poor glycemiccontrol as evidenced by admission HbA1c levels were found to have more severe disease course with increased level of inflammatory markers, longer duration of hospital stay and higher risk of mortality
Adrenomyeloneuropathy in a subacute combined degeneration suspect: a diagnostic dilemma
(Medip Academy, 2022-09) Saxena, Sumanyu; Khalid, Atahar
Adrenomyeloneuropathy(AMN) is a variant of adrenoleukodystrophy (ALD) which is a peroxisomal disorder of beta-oxidation that results in accumulation of very long-chain fatty acids (VLCFAs) in plasma, central and peripheral nervous systems, adrenal glands and testes leading totheir dysfunction. These conditions are known as the ALD/AMN complex. In this article we discuss a case of AMN with respect to clinical presentation, diagnosis and treatment.
Adult hemophagocytic lymphohistiocytosis triggered by disseminated tuberculosis and Klebsiella pneumoniaeco-infection in an immunocompetent individual-a diagnostic challenge
(Medip Academy, 2022-10) Kondam, Alekya; Prabhu, Mukhyaprana; N., Shreesha; Vidarshan, Madhavan; Lakshmi, Sindhura
Here in we report a diagnostically challenging case of adult hemophagocytic lymphohistiocytosis (HLH) triggered by disseminated tuberculosis and Klebsiella pneumoniaeco-infection in an immunocompetent Individual. She was a young female presented with complaints of fever, abdominal pain and jaundice. Her evaluation showed cytopenias, hyperbilirubinemia, transaminitis, and hepatosplenomegaly. She progressed to have multi-organ involvement in the form of myocarditis, pleural effusion. Provisional diagnosis of fever with unknown origin and sepsis with multiple-organ dysfunction was made and evaluated for the same. Rapid clinical deterioration with evaluation for sepsis being normal prompted for considering HLH in the differential diagnoses, bone marrow and other criteria have been met resulting in confirmation of the same. Without prior past or family history of HLH, secondary HLH was suspected and substantial evaluation for possible triggers was made, and concomitantly immune suppression was started with corticosteroids. Disseminated tuberculosis was diagnosed and concomitantly Klebsiella pneumoniaewas isolated from the bronchioalveolar lavage cultures. As there was no significant immune response culmination, intravenous immunoglobulins were added along with the treatment for possible triggers-tuberculosis and Klebsiellasimultaneously. Patient showed significant improvement with this approach. In conclusion management of HLH is different from conventional sepsis and the treatment for each cause of HLH also varies. Furthermore, this case report stresses on the importance for initiating treatment rapidly and tailored approach of management therapy for each case.

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