International Journal of Advances in Medicine

Unveiling Bowen’s disease on lower limb: a case report of long-term misdiagnosis as dermatitis

2025-08-22T06:37:36+0530

Bowen’s disease (BD) is a pre-cancerous condition classified as in-situ cutaneous squamous cell carcinoma (CSCC) of the epidermis. Several studies have shown that the condition requires prompt diagnosis and treatment due to its progressive nature. Despite the urgency of treatment, misdiagnoses are common due to similarities to dermatitis or psoriasis. Therefore, this report presents the case of a 69-year-old man with a hyperpigmented erythematous plaque on the right lower leg, which was misdiagnosed as nummular dermatitis for over 10 years. The patient reported the long-term use of corticosteroids, but the lesion persisted. Physical examination showed a 35×40 mm irregular plaque with excoriation. A skin biopsy showed full-thickness epidermal atypia, confirming BD. The lesion was surgically removed with a 4 mm margin, and an O-Z flap was used for closure. After the treatment, no recurrence was observed at 6 months of follow-up. BD often mimics other dermatological conditions, leading to delayed diagnosis. This case underscores the importance of biopsy in chronic skin lesions, especially when treatments fail. Surgical excision remains the most reliable treatment, offering a high success rate and low recurrence. Non-surgical options, such as photodynamic therapy and topical agents, have lower efficacy. In this case, the surgical approach with a 4 mm safety margin ensured complete removal while minimizing recurrence risk. This report showed the significance of early and accurate diagnosis of BD to prevent progression to invasive CSCC. Surgical excision was the preferred treatment for BD, offering high cure rates and minimizing complications.

A case report: Cleistanthus collinus (Oduvan) poisoning

2025-08-22T06:37:33+0530

Cleistanthus collinus-an extremely toxic plant has been reported to be used for deliberate self-harm in different parts of the country, notably South India. Toxins contained include Cleistanthin A and B arediphyllin derivatives and are known to cause neuromuscular blockade, type 2 respiratory failure, type 2 renal tubular acidosis, hypokalaemia, cardiac arrhythmias. We are presenting a case report where the poisoning was associated with type 2 respiratory failure, acute kidney injury, type 2 renal tubular acidosis, hypokalaemia, acute respiratory distress syndrome. The patient was managed with intravenous N-acetylcysteine, ventilatory support and multiple sessions of dialysis following which the patient after a prolonged stay of 29 days was discharged from the hospital.

Transthoracic echocardiography as a diagnostic tool in the identification of saddle pulmonary thromboembolism

2025-08-22T06:37:36+0530

Pulmonary thromboembolism (PTE) is a common and potentially fatal emergency that results from thrombi mostly originating from deep veins of lower limbs. It is the third most frequent cause of death after myocardial infarction and stroke, with wide clinical spectrum ranging from asymptomatic emboli to sudden death. A particularly severe variant is saddling pulmonary embolism, defined by large thrombus lodges at bifurcation of main pulmonary trunk. Computed tomography pulmonary angiography (CTPA) remains the gold standard for diagnosing PTE. However, its use may be limited by hemodynamic instability, contrast allergies, renal impairment, or unavailability in resource-limited settings. In such scenarios a reliable bedside diagnostic alternative becomes essential. Given the urgency of diagnosis in saddle PTE and limitations of CTPA in critical care settings, echocardiography may serve as an important adjunct in early detection and triage.

Intersecting emergencies: acute adrenal crisis in a patient with acute coronary syndrome

2025-08-22T06:37:34+0530

Acute adrenal crisis is a rare but life-threatening endocrine emergency that can present with non-specific symptoms and may mimic or coexist with other critical conditions such as acute coronary syndrome (ACS). We report a case of 48-year-old male with no known comorbidities who presented with left-sided chest pain, restlessness, and gastrointestinal symptoms. He was initially diagnosed with Non-ST Elevation Myocardial Infarction (NSTEMI) and managed for Acute coronary syndrome (ACS) and dyselectrolytemia. Upon referral to our tertiary care centre, the patient was found to have complete heart block, severe hyperkalemia, hyponatremia, and hypotension. Despite correction of hyperkalemia and initiation of standard therapy for ACS with cardiogenic shock, the patient’s condition failed to improve. Further evaluation revealed critically low serum cortisol (1.9 µg/dl) and elevated plasma adrenocorticotropic hormone (ACTH-630 pg/ml), confirming a diagnosis of primary adrenal insufficiency (Addison’s disease) with acute adrenal crisis. Initiation of intravenous hydrocortisone and fludrocortisone led to rapid clinical stabilization, normalization of electrolytes, and improvement in hemodynamic status of the patient. The patient was discharged in stable condition on maintenance corticosteroid therapy. This case highlights the importance of considering adrenal insufficiency in patients with persistent hypotension and dyselectrolytemia, particularly when presenting atypically in the context of acute coronary syndrome.

Diagnostic uncertainty between cystic fibrosis and allergic bronchopulmonary aspergillosis in a young adult male: a case report

2025-08-22T06:37:32+0530

A 23-year-old male presented with persistent respiratory issues and HRCT findings indicating bronchiectasis. Both cystic fibrosis (CF) and allergic bronchopulmonary aspergillosis (ABPA) were considered due to overlapping clinical and radiological features. Notably, elevated Aspergillus-specific IgE levels supported ABPA, while systemic and reproductive features pointed towards CF. This case exemplifies the diagnostic complexity when two conditions with converging presentations must be carefully distinguished.

Multiple myeloma masquerading as ascites: a rare case report

2025-08-22T06:37:30+0530

A 45-year-old woman with progressive abdominal distension was diagnosed with multiple myeloma after presenting with unexplained ascites. Investigations revealed anemia, hypercalcemia, renal dysfunction, lytic bone lesions, and 62% atypical plasma cells in bone marrow. Liver biopsy showed amyloid deposition, suggesting amyloidosis-induced hepatic dysfunction as the cause of ascites. Other causes, including portal hypertension and malignancy, were ruled out. Myelomatous ascites is rare and requires high suspicion for diagnosis. This case highlights the importance of considering multiple myeloma in unexplained ascites, as early recognition and treatment can significantly improve patient outcomes.

Incidental extra cystic findings in autosomal dominant polycystic kidney disease: beyond the liver and kidney

2025-08-22T06:37:28+0530

Autosomal dominant polycystic kidney disease (ADPKD) is a genetic disorder primarily affecting the kidneys and liver, but its systemic nature can lead to unexpected extrarenal findings. This report describes a 55-year-old woman with ADPKD who presented with hypertension and abdominal discomfort. Diagnostic imaging uncovered not only typical renal and hepatic cysts but also rare incidental lesions-a caecal lipoma, ovarian dermoid, and diverticulum. Surprisingly, she later developed synchronous bilateral breast cancer, suggesting a possible link between ADPKD and malignancy. These findings highlight the need for comprehensive evaluation in ADPKD patients, as extrarenal manifestations may signal underlying comorbidities. A multidisciplinary approach is essential for early detection and management of such complex presentations, emphasizing the importance of regular surveillance beyond renal and hepatic involvement.

Rare case of congenital tracheal diverticulum presenting as tubercular diverticulitis: a case report

2025-08-22T06:37:27+0530

Congenital tracheal diverticulum (DV) is often discovered incidentally during imaging unless the patient becomes symptomatic. We report the case of a young female who presented with a 10-week history of cough accompanied by minimal sputum production and weight loss. Due to a mismatch between chest X-ray findings and sputum results, a high-resolution CT scan of the chest was performed, which revealed normal lung parenchyma but demonstrated a multiloculated tracheal DV. Bronchoscopic evaluation identified a small opening of the DV in the central portion of the trachea. Microbiological analysis of the bronchial wash tested positive for Mycobacterium tuberculosis (MTB) on both CBNAAT and MGIT. The patient made a complete clinical and radiological recovery in response to standard antitubercular treatment. Based on clinical presentation, imaging, and microbiological evidence, a diagnosis of congenital tracheal DV with tubercular diverticulitis was made-an extremely rare presentation that, to the best of our knowledge, has not been previously reported.

Von Hippel-Lindau syndrome: a rare case report from a tertiary care hospital

2025-08-22T06:37:26+0530

Von Hippel-Lindau (VHL) is a diagnostic challenge due to the fact that it is rare and as stated above, presentation is also not typical in all cases. It is quite rare as prevalence ranges from 1 per every 30,000-50,000 population per year. Present case is unique in the sense of difficulty in the diagnosis at previous clinics. She had retinal angioma, left renal mass, infertility. Thus, multiple presentations make the diagnosis difficulty and thereby treatment. Hence, it is necessary to present all possible cases which come across during the routine clinical care so that the physicians and surgeons bear this differential in mind.

Study of diastolic dysfunction in diabetic patients and its correlation with microalbuminuria

2025-08-22T06:37:34+0530

Background: Diabetes mellitus (DM) increases cardiovascular risk, with diastolic dysfunction (DD) affecting 60% of asymptomatic type 2 DM patients. Microalbuminuria, a marker of endothelial dysfunction, may predict cardiac complications.

Methods: A cross-sectional study was conducted on 250 diabetic adults at the Department of General Medicine, Ganesh Shankar Vidyarthi Memorial Medical College (GSVMMC), Kanpur, from August 2023 to February 2025. Diastolic dysfunction was assessed via echocardiography; microalbuminuria via urine ACR. Statistical analysis (Chi-square, ANOVA, Pearson’s correlation) was performed using SPSS, with p <0.05 considered significant.

Results: Among 250 diabetic patients, 72% had diastolic dysfunction-most commonly Grade I (45.2%). Microalbuminuria was present in 88% and increased significantly with worsening diastolic grade, peaking in Grade III dysfunction (ACR 1250.55 mg/g). Type 2 diabetes patients had higher prevalence of both diastolic dysfunction (81.2%) and microalbuminuria (86.7%) compared to Type 1 patients, who showed lower rates (diastolic dysfunction: 23.4%; microalbuminuria: 93.6%). A strong correlation existed between urine ACR, serum creatinine, and diastolic dysfunction severity (p<0.001).

Conclusion: Microalbuminuria is prevalent in DM and strongly linked to DD severity, supporting its role in cardiovascular risk stratification. Routine screening and targeted therapies (e.g., SGLT2 inhibitors) may improve outcomes.

Association of nephrotoxic medication exposure and nephrotoxic medication induced acute kidney injury in hospitalised non-critically ill children: single centre study

2025-08-22T06:37:29+0530

Background: Acute kidney injury (AKI) in children is increasingly linked to nephrotoxic medication exposure, particularly in hospitalized patients. Although nephrotoxic drugs contribute substantially to AKI incidence, especially with multiple-agent exposure, data on their prevalence and associated AKI risk in non-critically ill pediatric populations remain limited. This study assessed the prevalence of nephrotoxic medication exposure in non-critically ill children per 1000 patient-days of hospitalization, and the prevalence of nephrotoxic AKI among these patients.

Methods: This prospective study evaluated nephrotoxic medication exposure and the development of nephrotoxic AKI in non-critically ill hospitalized children aged 1 month to 12 years. Baseline kidney function was assessed and serum creatinine levels were monitored during and after the exposure period. AKI was defined according to KDIGO criteria. Upon AKI occurrence, nephrotoxic medications are substituted with less harmful alternatives.

Results: The study included 3,264 children with bronchopneumonia (29.4%), acute gastroenteritis (26%), and tropical fever (22.4%) as common hospitalization causes. Nephrotoxic medication exposure was identified in 3.1% of cases, yielding a prevalence rate of 5.02 per 1000 patient days. Most exposed children were aged 3 to 12 years (58.4%), with a nearly equal gender distribution (males: 51.5%). Among those exposed, 70.3% received one nephrotoxic medication, while 29.7% received two, resulting in an AKI prevalence of 5.94%. AKI resolved within an average of 11±4 days following the substitution of non-nephrotoxic drugs. The most frequently administered nephrotoxic drugs were vancomycin (38.6%), acyclovir (26.7%), and amikacin (17.8%).

Conclusions: The findings indicate that nephrotoxic medication exposure among non-critically ill children was minimal, with a low prevalence rate of nephrotoxic AKI. Vancomycin, acyclovir, and amikacin are the most commonly used nephrotoxic drugs.

The prevalence of asymptomatic Cryptococcal antigenemia in people living with human immunodeficiency virus with severe immunosuppression

2025-08-22T06:37:25+0530

Background: Cryptococcal meningitis is a life-threatening disease among human immunodeficiency virus (HIV) patients specially with severe immunosuppression. Cryptococcal antigen (CrAg) can be detected well before the development of disease as CrAg circulates before the progressing to meningitis so if serum CrAg positive in asymptomatic patients the patients may develop cryptococcal meningitis in future so treatment in asymptomatic patients who are positive for CrAg can reduce the mortality.

Methods: This was cross-sectional study in which CrAg was tested among 84 PLHIV patient with CD4 count of less than 200/mm³ using latex agglutination test. Age, gender, World Health Organization (WHO) staging, ART regimen, haemoglobin level and presence of other opportunistic infection were added as determinants of CrAg positivity.

Results: Mean age among the study subjects was 39.19 years. 72.6% were males and 27.4% were females. 77.4% belong stage 1 of WHO,6% to stage 2,15.4% to stage 3, and 1.2% to stage 4. Mean CD4 count of subjects was 94.70 cells/mm³. 54.7% of the subjects had CD4 count of less than 100cells/mm³ and 45.3% subjects had CD4 count of more than 100 cells/mm³ subjects were tested positive for CrAg with prevalence being 6%. Mean CD4 count in subjects who tested positive was 34.20 cells/mm3 and in subjects who tested negative was 98.53 cells/mm³.

Conclusions: Prevalence of asymptomatic cryptococcal antigenemia was found to be 6% in PLHIV with CD4 count less than 200 cells/mm³ and prevalence was about 10.8% in subjects with CD4 count of less than 100 cells/mm³ compared to 0% in subjects with CD4 count of 100-200 cells/mm³. As the mortality of cryptococcal meningitis is very high and testing CrAg is cost effective if done in large scale.

Comparing the performance of ChatGPT and Chatsonic on PLAB-style questions: a cross-sectional study

2025-08-22T06:37:35+0530

Background: Artificial Intelligence (AI), particularly large language models like ChatGPT and Chatsonic, has garnered significant attention. These models, trained on massive datasets, generate human-like responses. Studies have assessed their performance on professional and licensing examinations, as well as medical examinations, with varying levels of competency. Assessment of ChatGPT and ChatSonic's competence in addressing PLAB-oriented queries.

Method: We conducted an independent cross-sectional study in May 2023 to evaluate the performance of ChatGPT and Chatsonic on the PLAB-1 Exam. The study used 180 multiple-choice questions from a mock test on the 'Pastest' platform and excluded questions with images, tables, or unanswered by AI. The responses of the two AI models, correct answers, and question difficulty statistics were recorded and compared. The performance of the two AI software packages was assessed based on the recorded metrics.

Results: Out of 180 questions, 141 were included and 39 excluded. ChatGPT outperformed Chatsonic, answering 78% of questions correctly compared to the latter's 66%. ChatGPT achieved 85% accuracy in answering easy questions, while Chatsonic performed poorly across all levels, answering 75% of easy questions, 64% of average questions, and only 38% of difficult questions.

Conclusions: ChatGPT outperformed Chatsonic in all dataset categories and showed non-statistically significant superior performance across difficulty levels. Both AI models' accuracy decreased with increasing question difficulty.

A single centre experience in challenging diagnosis and management of osseous and extraosseous Ewing sarcoma: a case series

2025-08-22T06:37:31+0530

Ewing sarcoma (ES) predominantly affects adolescents and young adults, commonly involving the pelvis, femur, and chest wall. This case series analysed the clinicopathological features and treatment profiles of 12 pediatric and adolescent ES patients treated at Tirunelveli Medical College Hospital, Tamil Nadu, from 2019 to 2023. The peak incidence occurred in the 6–15-year age group, with a female predominance. Osseous ES was the most common subtype, with most patients presenting with localised disease or lung metastases. Treatment included chemotherapy, surgery, and radiotherapy, delivered through a multidisciplinary approach. Survival outcomes varied based on disease extent and response to treatment. Advances in radiotherapy and surgical management of oligometastatic disease, along with multiple chemotherapy cycles, may enhance prognosis. The study highlights the importance of early detection, increased awareness, and structured follow-up protocols in improving outcomes. Tailored, comprehensive management strategies are crucial for addressing the clinical challenges of ES in resource-limited settings.

Antitoxic effect of herbal drugs mentioned in Ashtang Hridaya in the context of insect bites

2025-08-22T06:37:28+0530

There is an immense variety of species, such as flies, bees, wasps, ants, lice, butterflies, dragonflies, and mosquitoes. These insects make up more than half of all known living organisms and could potentially account for over 90% of the distinct life forms on Earth. Insects frequently come into contact with humans, and their bites can trigger various symptoms due to their poisonous effects. Out of eight branches of Ayurveda, Agada tantra has the centre of interest in the description of various types of poison and the treatments dealing with poison, i.e., Agad (antidotes/antitoxic formulation). The Acharyas have documented various medicinal plants and Agad formulations specifically designed to treat Keet Visha (Insect bite poison) and its associated symptoms in their Samhitas. In a group of antitoxic drugs (Vishaghna Mahakashay), the drugs which are mentioned are used in various combinations or individually for the cure of poisoning or the symptoms related to poisoning. In these studies, we aim to offer an evidence-based approach to the choice of anti-toxic effect of herbal drugs, which is mentioned in the Ashtanga Hriday in the context of insect bites like Tagara, Nagkeshar, Haridra, Daruharidra, Manjishtha, and Patang. The data was sourced from Ayurvedic treatises and various textbooks on Agadatantra. Research papers published online were accessed using search engines like PubMed, Scopus, Google Scholar, AYUSH Research Portal, and DHARA. The reviewed Antitoxic drugs Haridra, Daruharidra, Patang, Manjishtha, Tagar and Nagkeshar all have antimicrobial and antibacterial activity, which may help to prevent the infection by killing the bacteria and can promote healing. Reviewed studies show most of the drugs are blood purifiers, some having antioxidant, anti-inflammatory, anti-pyretic, anti-virulence, analgesic, antihistaminic, and anti-microbial properties. The diverse pharmacological properties and actions of these ingredients make them valuable not only for treating insect bites but also for other conditions such as pain, inflammation, skin issues, gastroenteritis, and fever. Further research is essential to fully understand their efficacy in treating poisoning and related symptomatic conditions. This review aims to compile comprehensive knowledge of all antitoxic drugs with its constituents, highlighting their therapeutic, pharmacological and medicinal uses.