Indian Journal of Clinical Practice

Permanent URI for this collection

https://imsear.searo.who.int/handle/123456789/150289

Editor: Dr. KK Aggarwal
ISSN: 0971– 0876

Frequency: Monthly

Language: English

Open Access Peer-reviewed journal

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

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Now showing 1 - 20 of 667

Arrhythmia in Adult Congenital Heart Disease
(IJCP Group, 2023-06) Bisht, Devendra Singh; Kishor, Kamal; Jaidka, Mohit
This case report highlights the significance of a multidisciplinary approach in the management of patients with repaired membranous ventricular septal defect (VSD) who develop postoperative arrhythmias. We present the case of a young female who experienced symptomatic episodes of supraventricular tachycardia following VSD repair. Through electrophysiological study and radiofrequency ablation, multiple tachycardia substrates were identified and successfully ablated. This report underscores the importance of combining surgical repair, electrophysiological evaluation and intervention to achieve optimal outcomes in this specific patient population.
Heart Smart Diabetes Care
(IJCP Group, 2023-01) Sheohare, Raka; Agrawal, Navneet; Saxena, Ashish; Kalra, Sanjay
The world is growing smarter day by day, and so is health care. In spite of innumerable inventions and tech-tools, however, we struggle to contain chronic illnesses like diabetes and heart disease. We need to work together and design a rational, scientific and socially sustainable Heart Smart diabetes care ecosystem, with Heart Smart management strategies, to ensure happiness and harmony in persons who live with diabetes.
Minimal Intubating Dose of Succinylcholine: A Comparative Study of 0.4, 0.5 and 0.6 mg/kg Dose
(IJCP Group, 2023-07) Gupta, Ajit; Shekhar, Saurav; Ankesh; Kumar, Rajesh; Prakash, Jay
Muscle relaxants are integral part of modern balanced anesthesia and succinylcholine, a depolarizing drug, is in use despite its adverse effects. The excellent intubating condition, fastest onset and shortest duration of action make it an excellent choice for anesthesiologists. The conventional dose of 1.5-2 mg/kg is commonly used for obtaining relaxation for intubation. This study was conducted with much smaller dose of succinylcholine as 0.4, 0.5 and 0.6 mg/kg to evaluate the acceptable intubating dose at 60 seconds, which was unlikely to have any untoward/side effects.
Pleomorphic Adenoma of the Hard Palate: A Multidisciplinary Approach
(IJCP Group, 2023-07) Dharmashala, Ganapati L; E, S Vinayak; Bhimsen, Padmini; Hegde, Mamta
Pleomorphic adenoma is the most common salivary gland tumor accounting for 80% of all major salivary gland tumors. It is a benign salivary gland neoplasm that constitutes 3% to 10% of the neoplasms in the head and neck region.1 Salivary gland neoplasms represents less than 1% of all tumors. This article is being showcased as a special case due to the fact it was done at a Taluk Hospital and also because ENT and oromaxillofacial surgeons were involved during the surgery.
Ghost of Medical Gaslighting
(IJCP Group, 2023-06) Kishor, Kamal; Bisht, Devendra Singh; Kalra, Sanjay
Medical gaslighting is when the actual symptoms of patients are dismissed or downplayed by medical professionals. It occurs frequently among patients suffering from chronic illnesses for which medical science gives no authoritative diagnostic protocol or effective treatment and those from populations underrepresented in clinical trials such as the female gender, specific races and ethnicity, third gender and patients with disability. Gaps in scientific knowledge and missing empathy have been cited as possible reasons. Respecting patient symptoms, accepting epistemic humility and investing in research may be possible solutions for this disharmony.
An Open-labeled Clinical Study to Evaluate the Safety and Efficacy of “Anuloma DS” in Improving Constipation
(IJCP Group, 2023-07) BG, Varuni
Background: Constipation is a common gastrointestinal problem in the general population. Despite a plethora of well-established and safe treatment options, the improvement is not satisfactory for many patients. This has prompted interest in alternative therapeutic strategies for constipation. Methods: This open-label, non-comparative single-arm clinical study evaluated the efficacy and safety of the polyherbal formulation “Anuloma DS”, 1 tablet daily at bedtime, in improving bowel movements in 30 adult patients with functional constipation. Patients were evaluated at baseline (Visit 1, Day 0) and follow-ups during Visit 2 (Day 7 ± 2), Visit 3 (Day 14 ± 2) and Visit 4 (End of the Study) at Day 30 ± 2. Results: There was a significant increase in the mean of spontaneous bowel movement every week from day 7 to days 14 and 30. All constipation symptoms such as abdominal bloating (aadmana), abdominal pain/discomfort (aanaha), feeling of incomplete evacuation and straining during passing stool improved significantly as did the SGA and the PGA scores. Conclusion: Anuloma DS is highly effective for the treatment of chronic functional constipation. No treatment-related side effects were reported by the study participants.
Invasive Monitoring in the Intensive Care Unit
(IJCP Group, 2023-07) Doradla, LP Saikumar; Vadivelan, M
The purpose of monitoring of the patient in an intensive care unit (ICU) is to improve patient care, like bringing about a change in the treatment or transfer of the patient to a step-down unit. Monitoring also shows the extent of compliance with a formulated standard of care or the degree of deviation from the expected standard of care. The monitoring used for a patient admitted to an ICU can be invasive or noninvasive. Invasive monitoring in an ICU includes arterial blood pressure, transesophageal Doppler, central venous pressure (CVP) measurement, pulmonary artery catheterization, arterial blood gas (ABG) analysis and measurement of intracranial pressure (ICP) and intra-abdominal pressure (IAP). Monitoring of the physiologic parameters depends on the underlying illness of the patient and the availability of equipment in the ICU.
Etiology of Chronic Kidney Disease in Nigeria and Management Challenges
(IJCP Group, 2023-02) O, Sotubosotomiwa; Jacob, Awobusuyi Olugbenga; Sharma, Sourabh
The prevalence of chronic kidney disease (CKD) is increasing globally and is one of the noncommunicable diseases associated with increase mortality globally in the last two decades. The prevalence of CKD in Nigeria, it is 1.6% to 12.4%. Ninety percent of end-stage renal disease (ESRD) patients are said to die within 3 months of commencing dialysis. Indices are even worse in resource poor countries like Nigeria where prevention and adequate intervention are usually hampered by funds. In regions like Nigeria, it will be cheaper to prevent CKD than treating its complications. Hence, it is important to identify the common etiologies of CKD in Nigeria and prevent or promptly address them before causing irreversible damage to the kidneys. The most common cause of CKD in Nigeria includes hypertension, glomerulonephritis and diabetes mellitus. Many of these etiologies are preventable/treatable and should be looked for as a major way to reduce the incidence of CKD in Nigeria. Challenges identified in Nigeria, propagating CKD include westernization, inadequate manpower, late presentation, diagnostic challenge and poorly equipped facilities. Interventions like encouraging healthy lifestyle, making available essential drugs, training of health personnel, subsidized cost of treatment, legislation and policies to curb drug abuse. Therefore, resource-poor settings should focus on creating more awareness and making legislations and/or policies focused on these preventable causes of CKD as this is more realistic and effective in these settings.
Glucometric Guardianship
(IJCP Group, 2023-01) Kalra, Sanjay; Agrawal, Navneet; Kapoor, Nitin; Kalhan, Atul; Teelucksingh, Joel; Sahay, Rakesh
This communication conceptualizes, defines and describes glucometric guardianship, as a means of ensuring optimal glycemic management. We define glucometric guardianship as the process of ensuring appropriate measurement, monitoring and analysis of glucose levels, so as to ensure alertness in glycemic management, and agility in anticipating and detecting suboptimal glycemic parameters, and responding to them. This paper hopes to draw attention to the need for glucometric science, encourage debate and discussion and facilitate research on the topic.
A Rare Case of an Intratonsillar Abscess
(IJCP Group, 2023-06) Easweran, S Vinayak; Bhimsen, Padmini; Hegde, Mamta
The case describes the anatomy and pathophysiology of the palatine tonsils and the development of intratonsillar abscess. The abscess can be caused by a suppurative focus that arises in acute tonsillitis when outward drainage is prevented, leading to pus accumulation in the tonsillar tissue. Dehydration or a history of peritonsillar abscess can also lead to intratonsillar abscess. The condition can be mistaken for tonsillolith or malignancy, such as lymphoma. A computed tomography (CT) scan is recommended for diagnosis, showing a low-density and ring enhancement. Aspiration using a large bore needle is the preferred mode of treatment, but if repeated aspirations fail, tonsillectomy may be necessary. Intratonsillar abscess is rare and so far only 29 cases have been reported.1 The differential diagnoses include lymphoma, which usually presents as unilateral enlargement of the tonsil, tonsillolith due to its appearance and peritonsillar abscess again due to the unilateral enlargement of the tonsil. This case is different as compared to other reported cases we did not do a CT scan as recommended by most of the studies (cost being a concern). Also, in this case, we resorted to surgery as the main modality unlike other cases wherein the surgeons opted to do an aspiration of the pus mainly keeping the intraoperative complications in mind.
The Pyramid of Transgender Health Therapeutics
(IJCP Group, 2023-07) Kalra, Sanjay; Sharma, Sanjay; Sanyal, Debmalya; Kalra, Pramila; Sukumar, Suja P; Rohilla, Ashok K; Shenoy, Mohan T
Transgender care needs a multidisciplinary team approach. The awareness about transgender health has increased over the past few years in India. The pyramid of transgender health helps to demystify the care of transgender individuals. The 7 S's of lifestyle modification need to be followed in the routine clinical care of transgender individuals. The individuals also need psychological care and support, metabolic and medical care, endocrine management, and later surgery in some cases. The policy makers can use the pyramid to decide about financial help to the community for their holistic care. The physicians involved in the care of transgender individuals can also take guidance about comprehensive care and management of transgender and gender diverse individuals.
A Pilot Study to Evaluate the Effects of Cerebroprotein Hydrolysate on Neurological Outcomes and Hospital Stay in Patients Admitted for Ischemic and Hemorrhagic Stroke
(IJCP Group, 2023-02) Ashraf, M Uwais; Parveen, Nikhat; Ashraf, M Uzair; Bharadwaj, Divyashsish; Bharadwaj, Devashsish; Abbasi, Areeb
Introduction: Neurological stroke is the most common cause of disability and leaves nearly 65% of survivors with sensory, motor and coordinative disabilities. At present, there are no therapies to prevent long-term neurological deficits after stroke. Many neuroprotective drugs are being tested with the aim to ensure these effects. Preclinical studies have shown a modulatory effect of cerebroprotein hydrolysate on synaptic remodeling and facilitated synaptic transmission. Material and methods: This was a hospital-based, open-label pilot study conducted in a tertiary care hospital of North India. All patients admitted with a diagnosis of stroke both ischemic and hemorrhagic, were included in the study. Patients were randomized into two groups. The test group was given cerebroprotein hydrolysate, along with standard treatment for stroke, whereas the other group was kept on standard treatment for stroke as per the latest guidelines, without cerebroprotein. Results: A total of 50 patients of stroke, admitted in a tertiary care center were included in the study. The mean age of the patients was 65.7 ± 11.86 years. Twenty-six (52%) were males and 24 (48%) were females. Out of the total 50 patients, 23 (46%) had ischemic stroke and 27 (54%) had hemorrhagic stroke. Twenty (40%) had diabetes, 37 (74%) had hypertension, 8 (16%) were known cases of coronary artery disease, 28 (56%) had dyslipidemia, 22 (44%) were smokers, 7 (14%) had a history of ethanol consumption and 13 (26%) were obese. Mean Barthel score at admission was 21.2 ± 11.3 and mean Rankin score at admission was 3.6 ± 1.37. Mean Barthel score at end of treatment was 53.9 ± 28.72 and mean Rankin score at end of treatment was 2.6 ± 1.65. The mean duration of admission was 6.8 ± 3.57 days. Conclusion: The current study highlights the role of cerebroprotein hydrolysate in improving the neurological scores and reducing hospital stay among patients hospitalized with stroke.
An Interesting Endocrine Cause of Pyrexia of Unknown Origin: A Case Report and Review of Literature
(IJCP Group, 2023-06) Kumar, C Vijai; Alex, Neetu Mariam
Pyrexia of unknown origin (PUO) is one of the most challenging medical problems. Endocrine causes of PUO are rare. Fever is common in a few endocrine disorders (e.g., thyroid storm, adrenal crisis and pheochromocytoma). However, PUO as the sole presenting feature is very rare with only a few reported cases in the literature. We present the case of a middle-aged male who came to us with PUO, weight loss and loss of appetite. The unusual symptomatology like loss of appetite, altered bowel habits made diagnosis difficult. This case highlights the importance of considering thyroid disorder in the differential diagnosis of PUO. Abnormal thyroid function may be an early clue for diagnosis.
The Efficacy and Safety of a Combination of Amino Acids, Vitamins and Probiotics in PROM and PPROM
(IJCP Group, 2023-02) Kant, Anita
The prevalence and severity of prelabor rupture of the membranes (PROM)/preterm PROM (PPROM) are a worldwide public health concern. PROM is the result of a cascade of events involving matrix metalloproteinase (MMP)-9, tissue inhibitor of metalloproteinases 1 (TIMP1), cytokines and proapoptotic genes, which is initiated by several factors such as infection, genotoxic agents or some unknown etiology. In PROM, there is an increased expression and activation of MMP-2, MMP-3 and MMP-9 and a reduction of TIMP1. p53 and tumor necrosis factor (TNF)-? mediate the major apoptotic pathway of PROM. p53 can transactivate some MMP genes, resulting in the overexpression of MMPs. This leads to apoptosis. MMP-2 and MMP-9 degrades type-IV collagen, which is the major structural component of chorioamnion. Understanding the fundamental pathology at the molecular level, it appears necessary to adjust the biologically protective mechanism to prevent spontaneous preterm labor. Our findings show that the novel combination of arginine, ascorbic acid, folic acid, glutamine, glutathione, thiamine, lactic acid bacillus spores, vitamin E acetate and pyridoxine is safe and effectively prevents PROM and PPROM (97% patients) and prolongs pregnancy term.
Motivational Techniques and Hacks for Treating Childhood Obesity
(IJCP Group, 2023-01) Verma, Meenakshi; Verma, Suneet Kumar
Treating obesity in children and adolescents is not a cakewalk. Asking them directly to get up and run, or just serving them a four-quadrant plate won’t serve the purpose at all. An obese child is already under the repercussions of oppressive remarks by the society. If at home as well, their mental milieu is not taken care of, there are chances of them being trapped in the shackles of depression. To avoid such drastic consequences, one must be prudent enough, while conversing with their children/patients regarding their weight. Motivation enhancement is very crucial in childhood obesity management, as the required changes in diet, behavior and physical activity are difficult to carry out with an insufficient level of motivation.1 The motivational hacks presented here might be helpful for parents and health care professionals in convincing their children/patients to stride through the road to health.
Vascular Calcification in Chronic Kidney Disease Patients on Hemodialysis: Prevalence and Correlation with Vascular Disease Events
(IJCP Group, 2023-06) War, Fayaz Ahmad; Aggarwal, Manju; Sharma, Sourabh
Introduction: With declining kidney function, the prevalence of vascular calcifications increases and calcification occurs years earlier and is more severe in chronic kidney disease (CKD) patients than in general population. We did this study to find the prevalence of vascular calcification in patients on maintenance hemodialysis using simple and inexpensive radiological method and to find out the correlation of vascular calcification score with vascular disease events, cardiovascular and all-cause mortality over a follow-up period of 1 year. Materials and methods: This prospective, observational, comparative, follow-up, single-center study of maintenance hemodialysis patients was performed at a tertiary care center in Haryana. Seventy-one patients on maintenance hemodialysis for more than 3 months were included in the study. Patients who were 18 years of age or below, CKD stage 5 patients not on dialysis and those who had previous history of parathyroidectomy were excluded. Adragao score for vascular calcification was calculated by evaluating bilateral iliac, femoral and radial arteries in plain radiographic films of pelvis and hands. Statistical analyses were performed with the SPSS System 10.0. Results: Seventy-one patients were enrolled in this study out of which, 45 were male and 26 were female. Mean age of patients was 61.92 ± 10.77 years. Majority of patients were elderly (age group ?60 years). Out of 71 patients, 66 (92.9%) were hypertensive and 26 (36.6%) patients were diabetic. Twenty-two (30.9%) patients had cardiovascular disease (CVD) at baseline. Coronary artery disease (CAD) was present in 20 (28.1%) patients, cerebrovascular disease was present in 2 (2.8%) patients and peripheral artery disease (PAD) was present in only 1 patient at baseline. Average dialysis duration received by patients was 21.35 ± 21.17 months. Out of 71 patients, 16 (22.5%) received calcium-containing phosphate binder, 51 (71.8%) received noncalcium-containing phosphate binder and 4 patients received no phosphate binder. Fifty-five (77.4%) patients received therapeutic or prophylactic vitamin D3 therapy during the study period. Vascular calcification detected with plain X-ray of pelvis and both wrists was found in 56.3% of patients on maintenance hemodialysis. The prevalence and severity of vascular calcification was higher with increasing age. Diabetes was found to be significantly associated with the presence of vascular calcification (p < 0.0005). CAD at the time of enrollment was significantly associated with vascular calcification (p = 0.009). Serum levels of calcium, phosphate, vitamin D3, intact parathyroid hormone (PTH), calcium-phosphate product or use of phosphate binders or the types or vitamin D therapy did not correlate clinically with presence of vascular calcification. Hemodialysis duration did not correlate with the presence of vascular calcification (p = 0.113). Presence of vascular calcifications in hemodialysis patients predicted future vascular disease events over 1 year follow-up (p = 0.013) but did not correlate with cardiovascular and all-cause mortality. Conclusion: There is a high prevalence of vascular calcification in maintenance hemodialysis patients in our center. The risk factors of vascular calcification were higher age, diabetes and CAD. These patients should be followed-up regularly for vascular events. We also want to reiterate with this study that plain X-ray is sufficient to rule out vascular calcification in CKD patients and should be employed regularly in dialysis clinics.
Safety and Efficacy of a Combination of Amino Acids in Insufficient Lactating Mothers
(IJCP Group, 2023-01) Kalra, Bharti
Milk production of the mammary gland is mainly determined by the milk synthesis and proliferation abilities of mammary epithelial cells (MECs). The availability of amino acids is critical for the production of milk. Amino acids enhance milk protein synthesis and mammary gland development through the mechanistic target of rapamycin (mTOR) pathway. Taurine enhances lactation by increasing prolactin secretion. Vitamins such as Thiamine and Pyridoxine are essential for maintaining and growing maternal and child health. However, there is a paucity of data regarding the safety and efficacy of amino acids and vitamins combination in lactating mothers with insufficient lactation. Hence, a prospective study was conducted to assess the safety and efficacy of a novel amino acids and vitamins combination. The results showed that with the intervention of this combination, 62% of participants showed onset of lactation within 45 minutes to 2 hours. The study suggests clinicians should consider this novel combination to improve lactation in insufficient lactating mothers
An Open-label Prospective Noncomparative Clinical Study to Evaluate the Efficacy and Safety of Beliv: An Ayurvedic Medicine in Improving Liver Function
(IJCP Group, 2023-04) Samudrala, Naresh
An open-label prospective noncomparative study was conducted to examine the efficacy and safety of Beliv tablet, a polyherbal Ayurvedic medicine, in 30 adult patients suffering from liver disorders. Two tablets were administered daily for 56 days. Patients were evaluated at Day 0, Day 21, Day 42 and at Day 56. The primary end point of the study was a change in liver function test parameters measured by the levels of serum glutamic-oxaloacetic transaminase (SGOT), serum glutamic-pyruvic transaminase (SGPT) and total bilirubin at all assessment points. Results showed a significant reduction in the serum levels of SGOT, SGPT and total bilirubin from baseline to 21 days, 42 days and 56 days. The total icterus symptom score was also significantly reduced from 5.17 ± 2.26 (baseline) to 2.6 ± 1.48, 1.37 ± 1.13 and 0.77 ± 0.73 at Days 21, 42 and 56, respectively. The Subjective Global Assessment (SGA) decreased significantly from 3.33 ± 1.16 (Day 21) to 2.33 ± 1.16 and 1.80 ± 0.76 at Days 42 and 56, respectively. The Physician Global Assessment (PGA) score was also significantly reduced from 3.0 ± 1.02 (Day 21) to 2.07 ± 0.83 and 1.70 ± 0.79 at Days 42 and 56, respectively. A significant reduction in serum creatinine level was observed at Day 56. No adverse effects or serious adverse effects were observed during the study period. The study concluded that Beliv tablet was highly effective for the treatment of liver disorders, as evidenced by the reduction in serum levels of SGOT, SGPT, total bilirubin, icterus symptoms and PGA and SGA scores. No treatment-related side effects were reported by any of the study participants suggesting that it was safe for clinical use in humans for the treatment of liver disorders.
Clinical Efficacy of Piracetam in the Management of Acute Stroke and Post-Stroke Sequelae: An Expert Panel Review and Opinion
(IJCP Group, 2023-06) Sharma, Vikram; Choudhary, Sanjay Kumar; Y, Sunil Kumar Yadav; Muchhala, Snehal; Mane, Amey; Kotak, Bhavesh
Stroke is a major cause of death worldwide. Prompt treatment and decision-making is essential for good outcomes. The two major therapeutic approaches for acute ischemic stroke are thrombolytics and neuroprotectants. Piracetam, a nootropic drug aims to increase cerebral blood flow, enhance oxygen extraction, restore membrane fluidity and modulate neurotransmission. Likewise, citicoline has been shown to positively influence cerebral plasticity and neurorepair processes. The present article aims to offer insights on the current management of acute stroke and to position piracetam and its combination with citicoline in the management of acute stroke and post-stroke sequelae based on an expert panel discussion.
Milk-Alkali Syndrome: A Century Old Cause of Resurgence of Severe Hypercalcemia Due to Excessive Use of Calcium Supplements
(IJCP Group, 2023-04) Sahu, Utsav
The milk-alkali syndrome (MAS) is characterized by a triad of elevated calcium levels, metabolic alkalosis and acute kidney injury that commonly occurs due to the combined intake of large amounts of calcium and absorbable alkali. The syndrome can have an acute onset with the rapid development of hypercalcemia and, if left untreated, may result in acute renal failure and metastatic calcification. An increased number of cases of MAS have recently been reported. This is likely due to the common use of over the counter (OTC) preparations of calcium for preventing and treating osteoporosis in postmenopausal women. Herein, we report a case of severe hypercalcemia due to prolonged intake of calcium carbonate supplements in the absence of any alkali.

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