International Journal of Advances in Medicine

Outcome of intensive care unit admitted COVID-19 patients with co-morbid conditions requiring ventilator support

2022-12-19T02:15:03+00:00

Background: The characterization of intensive care unit (ICU) admitted COVID-19 patients with co-morbid conditions requiring ventilator support can help investigators worldwide to prepare for emergency situation arising at the time of spread of disease. The objective of our study is to analyse the outcome of ICU admitted COVID-19 patients with co-morbid conditions.

Methods: Post ethics committee approval for multiple centers, data of 212 consecutive discharged and death COVID-19 confirmed ICU patients were included and analyzed. These patients of all age groups and genders were admitted in Bhaktivedanta Hospital and Research Institute, Mira Road, Mumbai, Maharashtra, India which is a dedicated COVID hospital from March 2020 to November 2020.

Results: Of the total 212 ICU patients, 17 (9%) cases were moderate, 195 (91%) were severe cases as per CT severity score grading, median duration of stay in the hospital was 9 (37%) days. Diabetes mellitus was the leading co-morbid condition with frequency of 27.8% followed by ischemic heart disease (IHD) (5.6%), chronic kidney disease (CKD) (5.1%), asthma (3.77%) and chronic obstructive pulmonary disorder (COPD) (0.94%).

Conclusions: Not all patients with co-morbid conditions progress towards poor lung function. IHD is the worst prognostic indicator for progressing towards poor lung function as compared to diabetes, CKD and COPD.

Serum creatine phosphokinase as a marker of severity and prognosis in organophosphorus compound poisoning

2022-11-30T23:15:02+00:00

Background: Various newer biomarkers for organophosphorus (OP) compound poisoning are being looked at from diagnostic and prognostic perspectives. The present study was conducted to observe if serum creatine phosphokinase (CPK) can be used as a marker to assess the severity and monitor prognosis in patients of OP compound poisoning.

Methods: In this hospital based prospective, observational study, 100 duly screened patients presenting with OP compound were classified as per severity grade according to POP scale. Serum cholinesterase and serum CPK levels were assessed twice, on day 1 and on day 4; apart from requirements as per standard management protocol; and the levels were compared across severity grades of OP compound poisoning. Outcomes such as intermediate syndrome and need of intubation and chances of mortality were studied for correlation.

Results: There was statistically significant positive correlation between serum CPK level on day 1 as well as on day 4 with the severity of poisoning. The day 1 mean serum cholinesterase level also increased with the increase in severity of poisoning, but not the day 4 level. Significantly positive correlation was observed between serum CPK levels and development of intermediate syndrome, need of intubation and chances of mortality amongst cases.

Conclusions: Serum CPK can be used as an efficient marker of severity in the patients of OP compound poisoning and will be useful to predict prognosis and outcome.

Application of artificial intelligence in medical care: review of current status

2022-12-02T22:19:13+00:00

Artificial intelligence (AI) has transformed almost all spheres of our life and has the potential to radically alter the field of health care. The increasing availability of healthcare data and rapid development of big data analytic methods has made possible the recent successful applications of AI in healthcare. Guided by relevant clinical questions, powerful AI techniques can unlock clinically relevant information hidden in the massive amount of data, which in turn can assist clinical decision making. To date, many AI systems have been developed in healthcare, but use and adoption in clinical practice has been limited. In this article, we tried to review few of promising AI techniques and tools, which can have a great impact on our health care system and in turn on quality of life.

Anaphylaxis should be recognized early and managed appropriately

2022-12-10T03:57:28+00:00

Anaphylaxis is a severe, systemic hypersensitivity reaction characterized by rapid in onset with potentially life-threatening. The prevalence of anaphylaxis has been estimated at 1.6% to 5.1% and increasing nowadays. Drug-Induce-Anaphylaxis is one the most cause of fatal anaphylaxis. A 26-year-old male with anaphylaxis shock due to drug-induced with total IgE as a diagnostic support test. Anaphylaxis is a multisystem allergic emergency. Early recognition and prompt administration of epinephrine remain the cornerstone of management due to its rapid progression.

Myocardial bridging manifested as acute coronary syndrome: an unusual presentation of the so-called benign coronary anatomy variant

2022-12-06T08:37:35+00:00

Myocardial bridging is an anatomical variant characterized by a coronary artery that tunneled through the myocardium. Often asymptomatic, myocardial bridging could also go to a further extent, presenting as myocardial ischemia in the form of stable angina pectoris, acute coronary syndrome, arrhythmias, or even sudden cardiac death. Although these are uncommon manifestations, it is still a challenge for physicians when encountering such cases. Additional imaging techniques are often required to diagnose myocardial bridging. This report is about a unique case of a 72-year-old man presenting with acute coronary syndrome (ACS) in the form of unstable angina pectoris (UAP), which was later found to be caused by myocardial bridging on coronary angiography. Following administration of beta-blocker, antiplatelet, and statin, the angina symptoms, as well as ischemic sign on electrocardiography (ECG), were completely resolved.

Fractured penis with concomitant urethral injury: a challenging presentation at a tertiary hospital in north-central Nigeria-case report and literature review

2022-12-12T01:04:24+00:00

Fractured penis is reported as a traumatic rupture of the tunica albuginea by following blunt injury to an upright penis. Though a rare urological emergency due to blunt trauma to a turgid penis. The rupture of the tunica albuginea is often single involving either of the two corpora cavernosa; however concomitant urethral injury is an exceptionally infrequent condition requiring primary urethral anastomosis. Many of the patients are likely to have urethral strictures following surgery. Buccal mucosal graft is repeatedly used for substitution urethroplasty in urethral stricture management; however, its use is not commonly reported for immediate treatment in the background of fractured penis. Herewith is the report of a 33-year-old male with rupture of both corpora cavernosa, as well urethral rupture, after coitus. The urethral injury was repaired using buccal mucosal graft. At follow-up, patient did not encounter erectile or voiding issues. The implementation of this technique would go a long way at ameliorating the occurrence of urethral strictures in these subsets of patients, however there is still room for larger sample-sized prospective studies in the future. Consistent with our index case, surgery for the fractured penis is expedient with a view to conserving urethral and sexual function.

Early imaging to detect bone metastatic disease of a 54-year-old woman with history of breast cancer: a case report

2022-12-11T07:37:58+00:00

The World Health Organization (WHO) has predicted a global amount of 19 million cancer case in 2025. After the lungs and liver, bone is the third most common site of tumour spread. The bone is a dynamic tissue that plays a critical role not only in structural support and movement, a reservoir for minerals and energy, but also houses of the bone marrow, which is the main site of postnatal hematopoiesis. A 54-year-old Indonesian woman presented to orthopaedist with complaints of sudden left hip pain and progressive difficulty in walking for three weeks. She reported severe pain that is exacerbated by any physical activity and movement. She has a medical history of breast cancer (pathologically confirmed in Sanglah General Hospital) which had undergone radiotherapy and chemotherapy a year ago. Outpatient left hip X-rays revealed lytic lesions at left acetabulum to left ilium, suggestive of metastatic disease. The established imaging techniques projectional radiography, skeletal scintigraphy, computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) have undergone further development, with a resulting improvement in their diagnostic yield.

Nephrotic range of proteinuria in long standing rheumatoid arthritis: a diagnostic challenge

2022-11-29T20:43:19+00:00

A 54-year-old male, a sero positive rheumatoid arthritis on treatment for 5 years, switched over to native drugs for 6 months. He was admitted with features suggestive of nephrotic range of proteinuria (Urine PCR- 8.32). A differential diagnosis of drug induced rheumatoid arthritis-amyloidosis was entertained. He underwent renal biopsy showed Membranous nephropathy (MN) (anti-phospholipase A2 receptor antibody PLA2R-positive). He was treated with high dose steroids, angiotensin receptor blockers and leflunomide as DMARD for rheumatoid arthritis. Nephrologist did not want to start mycophenolate mofetil/ rituximab since it was 1^oMN. The proteinuria even after 1 month of steroids did not show any reduction; though anti-phospholipase A2 receptor antibody positive is a negative predictor for other secondary causes, considering his age and being a chronic smoker, we did a PET scan to rule out an internal malignancy. It revealed a metabolically active lesion in right upper lobe of the lung; Bronchoalveolar lavage (BAL) was done in that CBNAAT showed Mycobacterium tuberculosis positive. ATT was started and steroids tapered; a month into ATT, then Urine PCR reduced to 2 and at 3^rd month of ATT, PCR was <1 and disease is under remission.

A variant of Kounis syndrome due to diclofenac sodium

2023-01-16T06:36:50+00:00

Kounis syndrome is an acute coronary syndrome of varying degrees induced by allergic or anaphylactic reaction leading to coronary vasospasm or atheromatous plaque erosion or rupture or global myocardial hypoperfusion occurring as a result of systemic vasodilation and decreased venous return in context of anaphylaxis. We reported a case of 33-year-old female who presented to emergency department in an irritable state with complaints of nausea, vomiting, abdominal pain, breathlessness and generalized itching which developed secondary to administration of diclofenac injection by intra muscular (IM) route. On evaluation, echocardiography revealed global LV systolic dysfunction. The patient was successfully treated with continuous noradrenaline infusion, fluid resuscitation and other supportive measures with repeat echocardiography revealing normal LV systolic function.

A rare variant of thalamic stroke- artery of Percheron infarct

2022-12-05T20:14:14+00:00

The thalamus is a walnut-sized structure that is located in the brain which receives rich blood supply from posterior cerebral artery and its communicating branches. One of the unusual presentations is the infarction of artery of percheron. Hereby reporting a case of 68-year-old female with no known co-morbidities who presented to the emergency department with complaints of sudden onset loss of consciousness in the morning. On further investigation, was found to have infarction of one of the variants of thalamic perforating arteries.

An interesting case of pyrexia of unknown origin

2022-12-12T22:58:40+00:00

Pyrexia of unknown origin (PUO) is defined as fever≥101°F on at least two occasions, illness duration of ≥3 weeks. Brucellosis is a bacterial infection caused by brucella species that includes Brucella canis, Brucella abortus, Brucella melitensis, and Brucella suis. They are gram-negative coccobacilli. They are non-motile, non-spore-forming, and facultative intracellular organisms. Kikuchi disease is a benign self-limiting disease, also referred to as histiocytic necrotizing lymphadenitis. Kikuchi disease mainly affects young women and usually presents as fever, lymphadenopathy and leucopenia. The manifestations are similar to brucellosis. Both coexist in a patient, which can be challenging for the treating physician. Here, we presented a case of brucellosis with coexisting Kikuchi disease.

A case of dysferlinopathy (Miyoshi distal myopathy limb-girdle muscular dystrophy type 2b phenotype) from a tertiary care hospital

2022-12-05T23:42:53+00:00

Limb girdle muscular dystrophy type 2B (LGMD2B) and Miyoshi myopathy are caused by similar mutations in the dysferlin gene. The phenotype of these allelic disease variants can vary considerably. We report a young male with severe and rapidly progressing muscle disorder with increased creatine phosphokinase (CPK) and confirmatory muscle biopsy findings. Genetic testing was done. A homozygous nonsense variation in exon 23 of the DYSF gene, which was consistent with the patient’s clinical reports of dysferlinopathy. Clinical phenomenology and preferential muscle involvement lead one to the gold standard genetic testing in heritable myopathies, which was well established in this report.

Lemmel syndrome: a rare condition causing cholangitis due to duodenal diverticulum

2022-12-19T23:31:39+00:00

Lemmel syndrome, rare condition occurs when there is one or more diverticulum causes cholangitis and obstructive jaundice due to compression of common bile duct (CBD) by mechanical obstruction. And are commonly recognized as an incidental finding at cross-sectional imaging. There may be also added pathophysiologic mechanisms that also contribute to the process to the development of this syndrome like duodenal diverticula leading to sphincter of Oddi dysfunction and pressure compression of CBD by diverticula. Inflammation of these duodenal diverticula is very rare. Patients undergoing routine gastrointestinal tract (upper GI) evaluation, duodenal diverticulum presents up to 27% of patients mostly periampullary diverticulum. There may be multiple diverticula leading to compression of CBD causing cholangitis.

An interesting case of seronegative neuro myelitis optica spectrum disorder

2022-12-23T20:49:03+00:00

Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune disease that causes severe demyelination, especially in the optic nerve and spinal cord with typical clinical manifestations of acute optic neuritis and transverse myelitis. Seventy to ninety percent of the cases of NMOSD test positive for aquaporin 4 IgG Antibodies (AQP4 IgG Ab). Here we report a case of 22-year-old female who presented with history of diffuse headache since 1 week, history of double vision since1 week and excessive day time sleepiness since2 months. Patient had a past history of bilateral and simultaneous optic neuritis 9 months back. On further evaluation patient was diagnosed as seronegative NMOSD (AQP4 IgG Ab–negative).

Non-dengue related febrile thrombocytopenia in HIV patient: a case report

2022-12-10T03:40:19+00:00

In tropical areas, febrile thrombocytopenia is often caused by infectious diseases, especially dengue. Thrombocytopenia is common in Human Immunedeficiency Virus (HIV) patients at any stage or as a complication of the illness. Here we presented a case report of a 38-year-old female initially diagnosed with dengue fever but turn out to be thrombocytopenia due to HIV infection with pneumocystis carini pneumonia (PCP). Febrile thrombocytopenia in people living with HIV should be observed carefully. It may be caused by a new opportunistic infection or as the natural progression of HIV disease.

Sickle cell anemia: a mimicker of rheumatoid arthritis

2022-12-20T21:43:22+00:00

Sickle cell disease (SCD) is a genetic disorder characterized by presence of abnormal hemoglobin S, leading to sickling of RBCs. The prevalence of sickle cell carriers among different tribal groups varies from 1-40%. Rheumatoid arthritis closely mimics the bone crisis symptoms in sickle cell anemia hence prompt diagnosis should be made to commence correct choice of treatment. We reported an 18 year old female with sickle cell disease who presented multiple intermittent joint pain of both limbs for 6 years with acute worsening of pain for the past 7 days. Diagnosis of sickle cell anemia becomes important as musculoskeletal manifestations of the disease can mirror the symptoms of inflammatory arthritis and the treatment given for rheumatoid arthritis can potentially worsen the condition in patients with sickle cell anemia.