International Journal of Advances in Medicine

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:


Recent Submissions

Now showing 1 - 20 of 1151
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    Lateral medullary syndrome: an unwanted ischemia to identify early
    (Medip Academy, 2022-12) Prajjwal, Priyadarshi; Inban, Pugazhendi; Nagre, Abhijit; Shah, Mujtaba Hussain; Chaudhary, Ansh; Ranjan, Raunak; Chaudhary, Bhupendra
    Lateral medullary syndrome also referred to asWallenberg syndrome, posterior inferior cerebellar artery (PICA) syndrome, orvertebral artery syndrome is a cluster of neurological symptoms and signs brought on by obstructions in the blood vessels supplying the medulla, which causes ischemia or infarction of the brainstem. The vertebral artery or the posterior inferior cerebellar artery are the arteries most frequently affected with lateral medullary syndrome. The most prevalent symptom istransient ischemic attack (TIA) with dizziness or vertigo andatherosclerosis in the posterior cerebral circulationbeingthe most common cause. Lateral Medullary Syndrome patients sufferfrom strokes or infarction and alsopresentwith vomiting,nausea, gait impairment, instability, hoarseness, and swallowing difficulties. Depending on the particular nuclei and fibersinvolved, different indications will appear. CT/MRI imaging is used to diagnose conditions. The majority of management is supportive, including risk factor reduction for additional ischemia events as well as speech and occupational therapy following an acute intervention. In this review article, we discuss the etiopathogenesis and factors leading to lateral medullary syndrome along with a comprehensive discussion on its clinical features, challenges in diagnosis, and treatment.
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    A rare case of adolescent tuberculous pericardial effusion: a case report
    (Medip Academy, 2022-09) Primanelza, Dewi Hanifa; Pramudita, Arvin; Mansyoer, Riza
    Tuberculous pericarditis (TBP) is a rare case of extrapulmonary TB (EPTB) especially in the developed countries. This may cause serious and deadly impact if not diagnosed and treated properly. A-15-year-old girl was admitted with tightness of breath, weight loss, a productive cough and fatigue. Severe malnutrition, bronchial rales and anemia are present in patient. Chest x-ray showed pleural effusion with cardiomegaly. On three days later, Thoracic multi-slice spiral (MSCT) confirmed pericardial effusion, following pericardiocentesis on the fifth day. Tuberculous was confirmed by analysis of pericardial fluid. This patient was diagnosed as tuberculosis pericardial effusion showed complete recovery after pericardiocentesis and anti-tuberculosis drugs administration. Tuberculous is an endemic disease and its extrapulmonary forms should be included as a differential diagnosis. Early and adequate treatment decreases the risk of developing into a potentially fatal disease.
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    Cirrhosis-related ascites with right heart failure and pulmonary tuberculosis
    (Medip Academy, 2022-09) Putra, Agus Dody Pranata Suadi; Dewi, Dewa Ayu Rina Wiana; Wirawan, I. Made Suma
    Ascites is defined as an excess of fluid within the peritoneal cavity. Causes of ascites may be classified into two pathophysiologic categories: associated with the normal peritoneum and occur due to a diseased peritoneum. Ascites is clinically apparent when the patient presents either symptomatically with abdominal distension, thus leading to further testing, or asymptomatically when radiological imaging shows unexpected peritoneal fluid accumulation. The serum ascites-albumin gradient (SAAG) and total protein levels from ascitic fluid are useful to distinguish the etiology of ascites.We report a case of a 30-years-old man with shortness of breath, the stomach has been getting bigger, nausea, and cough which was subsequently diagnosed with cirrhosis-related ascites accompanied with right heart failure and pulmonary tuberculosis.
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    Duchenne muscular dystrophy: case series of rare inherited muscular disorder
    (Medip Academy, 2022-12) Dewi, I. Gusti Ayu Sri Mahendra; Seputra, Desak Made Cittarasmi Saraswati
    Duchenne muscular dystrophy (DMD) is a rare muscular disordercaused by mutation of gene encoding dystrophin protein which required for maintaining muscle stability during contraction. DMD occurs in 1 in 5000 male live births and characterized by progressive muscular weakness associated with motor development delay, loss of independent ambulation, respiratory failure, and cardiomyopathy. We present a case series of 3 DMD patients who were diagnosed at Prof. dr. I.G.N.G. Ngoerah general hospital,Denpasar over a period of four years (2019-2022). Clinical manifestation of patients includes progressive weakness of lower extremities and difficulty to stand up from sitting position. Physical examination revealed pseudohypertrophy of calf, winged scapula, positive Gower抯 sign, and waddling gait in all three cases. Supporting examination showed an increase of alanine transaminaseand aspartate transaminase5.6 times and 6.1 times the upper limit of normal, respectively. Definitive diagnosis of all patient was made based on immunohistochemistry staining which revealed an absent of dystrophin protein around muscle membrane
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    Neuromyelitis optica presenting as neurogenic bladder
    (Medip Academy, 2022-12) Aryadevi, C. P.; Pradeep, Geethika; Bhargavan, P. V.; P. V., Shiji
    Neuromyelitis optica(NMO) is an immune mediated disease of central nervous system primarily affecting optic nerves, spinal cord and brain stem. This case report describes a 24-year-old male with no comorbidities presented with high grade fever followed by proximal lower limbweakness and bilateral hydrouretero nephrosis without any lower urinary tract obstruction. He had clinical features of conus-cauda lesion with MRI spine showing features of longitudinally extensive transverse myelitis (LETM) and brain MRI showing involvement of splenium of corpus callosum. He improved with steroid therapy with in a period of 2 weeks and oral steroid was tapered of and stopped within a period of two months. There wasno relapse of symptoms so far.
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    Congestive hepatopathy secondary to graves� disease: acase report
    (Medip Academy, 2022-09) Adrian, Steven Johanes; Wirawan, I.Made Suma
    Graves� disease is a common cause of hyperthyroidism in iodine-sufficient parts of the world. Excessive thyroid hormone is known to have multiple effects on various organs, including the liver. We reported a case of 49-year old male patient with worsening jaundice, ascites, tremor, and palpitation, with previous history of uncontrolled Graves� disease. Findings from examination reveals signs of congestive hepatopathy, such as positive hepatojugular reflux and dilated hepatic vein. Treatment options for hyperthyroidism in patients with liver dysfunction includes methimazole and radioactive iodine-131. Liver dysfunction in patients with thyrotoxicosis is commonly found in daily practice, but establishing the cause of liver dysfunction can be a challenge because of the multiple cause of liver injury in hyperthyroidism.
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    Expression of DOG 1 and correlation with Ki-67 and tumor characteristics in GIST: case series analysis in a tertiary care center
    (Medip Academy, 2022-12) Edwin, Danita G. S.; K., Nithin Diwagar; Sekhar, Ganthimathy
    Gastrointestinal stromal tumours (GISTs) are the most common non epithelial, mesenchymal tumours of the gastrointestinal tract and amount to 1 to 3% of all gastrointestinal tumours. Histologically, GISTs demonstrate considerable morphologic variation.The aim of the study was to evaluate the histo-morphological features of GIST and the expression of DOG1 and KI-67 in these tumours. Eleven cases of GISTs received during a five-year period at a tertiary care centre were analysed for their demographic parameters, morphology and risk stratification. Immunohistochemistry for DOG1 and Ki67 was performed for all the eleven cases.Inthis study there was a female preponderance with the mid -fifties being the median age of presentation. The stomach and small intestine were the common sites of involvement. The histologic type was predominantly spindle cell with a few cases of mixed tumours. DOG 1 was positive in all the tumours and Ki-67 index was markedly elevated in the epithelioid cell type and in the high-risk category of tumours.DOG 1 holds good as an important marker for clinically suspected GIST diagnosis and Ki-67 expression correlates with the risk stratification of the tumour and can be a good prognostic factor
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    Data bias in precision medicine
    (Medip Academy, 2022-12) Laishram, Indira Singha
    Precision medicine is poised to increasingly improve health outcomes for more people in the near future. In contrast to the more traditional reactive methods of disease treatment, precision medicine is a customizable treatment and disease prevention approach that is tailored for the individual. Artificial intelligence (AI) using sophisticated algorithms and machine learning(ML)tools powers these precision medicine processes. These algorithms analyze big data collected from multiple sources over the past decades to aid physicians to make data-backed critical clinical decisions. However, studies have shown that unintentional biases in the source data and in the process can affect these precision medicine efforts.
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    A confounding case of pancytopenia
    (Medip Academy, 2022-12) C., Vignesh; K., Mahendra Kumar
    Tuberculosis is one of the major health problems in the developing countries like India. Due to its nonspecific presentation, extra pulmonary TB is diagnosed at later stages.It is an important differential diagnosis for pyrexia of unknown origin (PUO). A 54-year-old male came to hospital with complaints of fever, pain abdomen (on and off), easy fatiguability, reduced appetite, weight loss, breathlessness on exertion for 8 months who completely recovered after starting anti-tubercular therapy.
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    A rare case of traumatic intramural hematoma in pediatricage group successfully managed with expectant approach
    (Medip Academy, 2022-12) Kurian, Elizabeth; Joseph, Jijo; Thomas, Geido Davis; Anand, Rajeev
    Acute colonic intramural hematoma is a rare clinical entity. In most cases reported in literature a surgical management is used. Here we present a case of an 8-year-old boy who was found to have a colonic intramural hematoma following a fall from bicycle. Considering the age of the child and hemodynamic stability a conservative management wasadopted and the child was successfully managed
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    An interesting case of melioidosis: a mimicry of pulmonary tuberculosis
    (Medip Academy, 2022-12) Sivasamy, Manoj|R., Shreenidhi; M. K., Nishaanth; M., Jagadeesan; S., Prasanna Karthik
    Melioidosis is caused by Burkholderia pseudomalleiwhich is a soil-dwelling aerobic bacterium reported mostly in tropical and subtropical areas, especiallyinAsia (Southeast) andAustralia (Northern part). Melioidosis is a severe infection that can manifest as chronic debilitating pneumonia mimics pulmonary tuberculosis. Here, we reporteda case of melioidosis, in 51-year-old menwith poorly controlled type 2 diabetes mellitus. The patient recovered with appropriate intravenous antibiotics and supportive medications.
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    Molluscum contagiosum could become an early sign of HIV infection
    (Medip Academy, 2022-12) Hardiani, Ni Luh Raka M.; Suryana, Ketut; Suhardinata, Kadek A.
    HIV is a type of virus that attack the immune system, causing it unable to function normally and putting the person in a condition called immunocompromised and is vulnerable to lots of infection. People living with HIV are prone to complications if there is persisting infection and inflammation. One of the inflammation markers is theneutrophil-lymphocyte ratio(NLR). Complication on the skin is one of the frequently happened. One of it is Molluscum contagiosum. Molluscum contagiosum caused by virus infection which target the epidermal layer of the skin that result in formation of round, umbilicated, painless papule or nodule. In this case report, we present a male, 49 years old which has complained of persistent fatigue and diarrhea. There is multiple rounds, skin-colored, painless papules on his face and neck since 6 month ago which keep increasing. Laboratory result show decrease in hemoglobin and high neutrophil lymphocyte ratio. In HIV, the NLR value has a significant negative correlation with the CD4 amount. The existence of molluscum contagiosum in an adult with unknown HIV status need to be considered as a possibility of an immunocompromised especially if accompanied with other conditions. In the patient with HIV, with the existence of Molluscum contagiosum, the possibility of decreasing CD4 and increasing viral load need to be suspected. The patient抯 obedience in consuming ARV also needs a careful attention.
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    Double chambered right ventricle with ruptured sinus of Valsalva: rare entity
    (Medip Academy, 2022-12) Lalwani, Jaya; Kumar, Lokesh; Rameshwar; M., Jagadeesan
    Valsalva sinus aneurysm (SVAs) and double-chambered right ventricle (DCRV)is an uncommon congenitalheart defect and are usually associated with ventricular septal defect (VSD) in 50% to 60% of patient抯 population. The current case report had documented a 59 years old hypertensive asymptomatic male with a known case of SVAs presented to our hospital following device closure for 6 months. On examination, the patient was diagnosed to have DCRV induced by SVAs prior to the closure along with other factors. However, to the best of our knowledge, this is the first case report on DCRV induced by SVAs in synergy with other associated multifactors and without VSD among the Indian population.
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    Hoffman抯 syndrome-a rare neurological presentation of hypothyroid myopathy
    (Medip Academy, 2022-12) Sriharsha, Tirumalasetty; Kumar, A. Arun; J., Raghav Raj; Reddy, N. Monika; V., Vikrannth; Raghavan, Vinod; Rajendran, Kannan
    Hoffman's syndrome is a rare form of hypothyroid myopathy, which causes proximal muscle weakness and pseudohypertrophy of muscles.Itis a complication of untreated or uncontrolled Hypothyroidism.The neurological manifestations of hypothyroidism usually occur late in the course of disease. It is quite rare to present with neurological manifestations in the earlier stage of disease. Very few cases of Hoffman抯 syndrome were reported from India. Here we report a case of 27-year-old male who presented to the medicine OPD with initial symptoms of proximal muscle weakness, fatigue and calf muscle hypertrophy. On further evaluation patient was found to have hypothyroid myopathy in the form of Hoffman抯 syndrome.
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    Safety of oral graded challenges as a diagnostic approach hypersensitivity reaction to anti-tuberculosis drugs: a case report
    (Medip Academy, 2022-12) Dwipayana, Putu Aditya; Suryana, Ketut
    Tuberculosis (TB) still becomes a significant health problem in developing countries, especially in Indonesia. Allergy to antitubercular drugs is a real hindrance to the management of TB. The first-line anti-TB drug (ATD) is still the most effective TB drug, but it can have some side effects. One of these side effects is drug hypersensitivity reactions (DHR) which can affect a patient's compliance. The recommended diagnostic approach to DHR is a graded challenge by introducing drugs safely and optimally under a threshold dose until the usual daily dose is reached. We present a case of DHR to ATB drug and oral graded challenge as the diagnosis approach.
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    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
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    Characteristic of cardiac and neurological forms of non-polio enterovirus infection
    (Medip Academy, 2022-12) Sadadiwala, Mehul Hitesh; A. L., Potapchik; N. V., Matsiyeuskaya
    Enterovirus infections (EVI) are ubiquitous and generally present with mild symptoms and have a favorableprognosis with full recovery. But sometimes it can be challenging to diagnose mixed forms of EVI which can result in fatal outcomes. An interesting case report on a patient admitted to the Grodno Regional infectious diseases clinical hospital. The patientwas diagnosed with enteroviral infection. Histological slides of the brain, heart, lung and other systemic organs were prepared on autopsy and are presented in this scientific paper. Generalized EVI in mixed form can cause primary lesions of the brain (destructive edema), the heart (necrotizing cardiomyopathy), and sepsis while also affecting other organ systems. This can lead to unfavorable outcomes similar to that in our case report. Mixed form EVI (meningitis, myocarditis, and sepsis) can progress rapidly towards an adverse course, with the development of severe life-threatening complications. We strongly suggest that mandatory PCR screening for EVI should be carried out in young individuals with sepsis-like diseases and with a fever of unexplained origin at the time of presentation.
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    Granulicatella adiacensinfective endocarditis
    (Medip Academy, 2022-12) Alagesan, Arun Kumar; Sriharsha, Tirumalasetty; J., Raghav; V., Vikrannth; R., Kannan; K., Meenakshi
    Infective endocarditis is an unconventional infectious disease nonetheless life-threatening. A roundabout of 3% to 5% cases of Streptococcalinfective endocarditis is caused by nutritionally variant Streptococci (NVS). Granulicatella species is one of the atypical causes of infective endocarditis. In this context, the authors are disclosing a case of infective endocarditis in an underlying rheumatic heart disease patient, caused by Granulicatella adiacens. The patient had breathlessness for the past four months, on and off fever for two months anew and mid-diastolic murmur with vegetation in aortic valve as appeared by echocardiogram. The blood cultures were tested positive for Granulicatella adiacens. The patient was successfully treated with intravenous vancomycin for a period of six weeks.
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    Systemic review through published clinical trials of artavakshaya
    (Medip Academy, 2022-09) Patel, Jalpa D.; Patel, Akshay M.; Donga, Shilpa B.
    Menstrual irregularity is one of the most frequent gynaecologic disorders among women in reproductive age. In modern science, the treatment is based on mostly hormone therapy. Due to the need of an era for alternative medicine in field of gynecology, present study was tried to overview oral medicine used to treat Artavakshayaaccording Ayurveda classics. This systematic review was designed in order to gather information regarding oral medications for Artavakshayain Ayurveda.This study had several steps assearching only randomised clinical trials in Ayurveda medicine literature, extracting them and finding evidences. To search Ayurveda medicine digital library was used, which includes several ancient traditional medical references. There quire data was gathered using data base such as Google scholar, PubMed, Dhara, Medknow, OMICS, Scopus, J-gate for knowledge. This paper explores different research articles related reviews and overall analysis about oral therapy which can be applied in the treatment of Artavakshaya.
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    Risk of progression to overt hypothyroidism in Indian patients with subclinical hypothyroidism: a prospective observational study
    (Medip Academy, 2022-12) Singh, Shailendra Kumar; Singh, Rina; Singh, Santosh Kumar; Iquebal, Mir Asif; Jaiswal, Sarika; Rai, Pradeep Kumar
    Background:Subclinical hypothyroidism (SCH) is a common endocrine disorder but spontaneous course of SCH in India is lacking. The aim of the study is to determine the spontaneous course of SCH and to identify the risk factors, which enhances the occurrence of overt hypothyroidism (OH).Method: This is a real world prospective observational study. 58 SCH were followed up six monthly for one year to determine the course of SCH.Results: After one year of follow up 11 (18.97%) patients progressed to OH. 37 (63.79%) remained in subclinical hypothyroid category. In 10 (17.29%) patients TSH (thyrotropin) normalized. Rate of progression (odds ratio: 4.58; 95% CI: 1.14, 18.28) was significantly more in anti-thyroid peroxidase (TPO) positive group as compared to anti-TPO negative group. Conclusions: This first data from India clearly shows that SCH has a variable course. Rate of progression to OH is high (18.97%) in Indian SCH patients. In a cohort of 58 patients followed for one year only the presence of anti-TPO antibody waspredictive of OH. The initial risk stratification can identify patients with SCH at greatest risk for progression to OH in which treatment is mandatory.