International Journal of Advances in Medicine

Endocarditis: a case series with review on atypical presentations of infective endocarditis

Danish E. — 2023-02-22

Infective endocarditis is a well-known clinical entity. However, despite improved diagnostic techniques and advances in treatment options, clinical heterogeneity of infective endocarditis sometimes prevents rapid recognition, correct diagnosis and timely treatment which are very essential to reduce morbidity and mortality associated with this disease. We herein present a case series of seven patients who presented to Government Medical College, Kozhikode during the period 2018-2022 with atypical presentations of infective endocarditis.

A case series of clinical profile in patients with cerebral venous thrombosis

Shreenidhi R. — 2023-02-22

Thrombosis of the venous system in the brain is a cause of cerebral infarction, second only to arterial disease, but is associated with high levels of morbidity and mortality. The clinical picture of cerebral venous thrombosis is highly variable and often presents a source of confusion to physicians. This study aimed to establish the clinical picture of cerebral venous thrombosis in patients in a tertiary healthcare center. We collected and analysed the case records of 23 patients with CVT. The most predominant presenting complaint was headache (47.8%) followed by vomiting (26%). The most common site of involvement was found to be the superior sagittal sinus (34.8%). Multiple sites of involvement were more common than a single site.

Avascular necrosis of femoral head: a rare case as a symptom of the chronic phase in adult chronic myelogenous leukemia patients on nilotinib therapy

Ni Kadek Seri Mahayanti — 2023-02-22

Chronic myelogenous leukemia (CML) is a malignant clonal disorder of hematopoietic stem cells characterized by abnormal proliferation and accumulation of immature granulocytes. Avascular necrosis (AVN) is a rare case in CML patients where a systematic review reported only 21 cases from 1984 to 2021 of which 17 cases were AVN of the femoral head (AVNFH) and 3 cases were associated with treatment with tyrosine kinase inhibitors, namely imatinib, desatinib and nilotinib. We report a 51-year-old male patient with complaints of hip joint pain. The patient was diagnosed with CML from bone marrow examination with hypercellular results and PCR examination which detected the presence of BCR-ABL transcription in the form of b2a2 fusion. The patient received nilotinib 200 mg every 12 hours. The diagnosis of AVN was established from clinical symptoms and radiological examination. The patient was planned to undergo a total hip replacement.

A case of Alport syndrome

Sai Indraneel Kaluvai — 2023-02-22

Alport syndrome is an inherited disease characterized by progressive renal failure, hearing loss and ocular abnormalities. It usually manifests as progressive form of glomerular disease that is often associated with sensorineural hearing loss and ocular abnormalities. The defects are caused by mutations in the genes that code for type IV collagen's alpha chains, which are the most important structural elements of basement membranes, including those in the kidney, cochlea, and eye. We present a 37-year-old female known case of chronic kidney disease on medical management came with complaints of shortness of breath and loss of appetite. Her 2 children are also affected. Her renal biopsy showed glomerulosclerosis, splitting, lamination of basement membrane. Pure tone audiometry revealed bilateral sensorineural hearing loss. Slit lamp examination showed bilateral lenticonus and distant direct ophthalmoscopy revealed oil droplet sign which confirms lenticonus with dot and fleck retinopathy. Hence diagnosed as a previously undetected case of Alport syndrome.

Balantidium coli causing acute diarrheal disease in a diabetic

Sharan Bose — 2023-02-22

Balantidium coli is a rare, free-living protozoan causing an acute diarrheal disease in human beings similar to amoebic dysentery. It is found in tropical and subtropical regions but is very rare in the Indian subcontinent. It is an exceedingly rare infection and only a handful of case reports have been published worldwide on this infection. Here, we report a case of a Balantidium coli infection presenting as an acute diarrheal disease from South India.

A case report on palatally positioned single mesiodens: common supernumerary tooth

Sanjeev Kumar — 2023-02-22

Mesiodens is one of the commonest dental anomalies in children. It may be present in primary or early mixed dentition. It can also be found in permanent dentition. It affects dental as well as facial aesthetics. The reported prevalence of mesiodens is about 0.15% to 1.9%. It is one of the etiologic factors causing malocclusion in children. Therefore, dentists can make the parents aware about the possibilities of malocclusion and convince for the treatment as soon as possible.

An unusual manifestation of scrub typhus presenting with splenic infarct: a case report

Anuj Arora — 2023-02-22

Scrub typhus has a wide range of clinical presentation varying from mild symptoms like fever, chills, headaches, myalgias, gastric ulcerations and hepatitis to more fatal conditions like pneumonia and encephalopathy caused by disseminated vasculitis with splenic infarct being a rare complication. We report a case of 50-years old male with scrub typhus who presented as multiple splenic infarcts.

Intracranial tuberculoma in human immunodeficiency virus-infected patient: a case report

Desak M. C. S. Seputra — 2023-02-22

Intracranial tuberculoma is one of the most devastating forms of Mycobacterium tuberculosis infection, presenting in 1% of all tuberculosis cases. This condition is significantly associated with high morbidity and mortality and frequently occurs in immunocompromised patients such as patient with human immunodeficiency virus (HIV) infection. Symptoms of intracranial tuberculoma include headache, nausea, vomiting, ataxia, diplopia, hemiparesis, and seizure. We reported a 34-years-old male patient presented with progressive left side weakness for 1 month prior to admission. Patient also complained of intermittent fever, headache, productive cough, night sweats, and unintentional weight loss. On neurological examination, power of left upper and lower limb was 3. Patient had a positive test result for HIV serologic examination. Chest X-ray showed infiltrate in the apical segment of right lower lobe of the lung. Mycobacterium tuberculosis was found on sputum gene expert examination. Head computed tomography (CT) scan showed multiple hypodense lesions with contrast enhancement in right caudate nucleus and right lentiform nucleus, suggestive for tuberculoma. Patient was treated with fixed-dose combination of antituberculosis, corticosteroid, and other symptomatic medication and showed a significant clinical improvement.

A rare presentation of primary apla and pulmonary thrombolism

Vignesh Chinnasamy — 2023-02-22

Antiphospholipid syndrome (APS) is a state of hypercoagulation, causing thrombus in artery, vein and capillaries, with or without obstetrical events with the presence of autoantibodies, which includes lupus anticoagulant, anticardiolipin antibodies and anti-β2-glycoprotein 1 antibodies. It has variable clinical presentations such as vascular thrombosis and obstetrical complications, pulmonary thromboembolism (PTE), pulmonary hypertension, and acute respiratory distress syndrome. Hereby we presented a case of young male who came to our hospital with hemoptysis and isolated pulmonary embolism, with the background of APS which is rare. Hemoptysis and pulmonary thromboembolism both being fatal emergencies requiring completely different management methods.

A rare case of tumour lysis syndrome in multiple myeloma

Lakshmipriya Kalidindi — 2023-02-22

Tumour lysis syndrome (TLS) is a serious life-threatening complication of cancer chemotherapy which is a constellation of metabolic disturbances that typically occurs during therapy of bulky, rapidly proliferative tumours. TLS is an oncological emergency that causes a significant release of phosphate, potassium, uric acid, and nucleic acids into the blood stream. Incidence of TLS in multiple myeloma is rare. Here we present a case of multiple myeloma who later developed tumour lysis syndrome in its due course which was rare. A 67-year-old male was diagnosed with Multiple myeloma on the basis of M spike, osteolytic lesions and bone marrow analysis. First cycle of chemotherapy with lenalidomide, bortezomib and denosumab was initiated. During the course of follow up he presented to our casualty with complaints of chills and rigor. Based on the biochemical abnormalities a diagnosis of tumour lysis syndrome was made. He received I.V fluids, anti-hyperkalemic measures, allopurinol. He had neutropenic sepsis and went into septic shock and died after multiple resuscitative efforts.

Inferior vena caval web causing Budd Chiari syndrome

Shilpa M. Manuel — 2023-02-22

Budd Chiari syndrome (BCS) is a condition resulting from obstruction of hepatic venous outflow at various levels, regardless of the cause of obstruction. Manifestations can range from asymptomatic state to fulminant hepatic failure or cirrhosis depending on how acutely the obstruction developed. IVC web is an unusual yet potentially treatable cause of BCS. This case report throws light on a rare cause of BCS, which is an IVC web and how endovascular technique helped in patient recovery.

Cerebral venous thrombosis in polycythemia rubra vera: a rare case report

Lokesh Kumar A. — 2023-02-22

Polycythemia rubra vera (PV) is a disease characterised by increased production of red blood cells due to genetic mutation which leads to increase in RBC mass and increased viscocity of blood. Myeloproliferative neoplasms have been implicated in the causation of cerebral venous thrombosis (CVT). Here we presented a 34 year old male who present with headache and diplopia. Fundus examination revealed bilateral papilledema. MRI brain with venogram was done which revealed right transverse and sigmoid sinus thrombosis. Blood investigations revealed polycythemia, elevated RBC counts and hematocrit levels. Peripheral smear showed increased RBC, WBC and platelets. Serum erythropoietin was low. Bone marrow aspiration study revealed hypercellular marrow. Patient tested positive for JAK2 V617F mutation. Patient was treated with anticoagulants, therapeutic phlebotomy and other supportive measures. Here we present a rare case of PV presenting with CVT.

Acute limb ischemia in patient with COVID-19 infection

Agus Dody Pranata Suadi Putra — 2023-02-22

The severe acute respiratory syndrome coronavirus 2, the virus that causes coronavirus disease 2019 caused a worldwide pandemic and became a massive problem in our healthcare system. This infection has broad clinical presentation from asymptomatic to severe symptoms, and unfortunately death. Hypercoagulability associated with this infection can cause a significant morbidity, that increased risk of microthrombosis, vascular hyperpermeability, disseminated intravascular coagulation, and multiorgan failure. Acute limb ischemia (ALI) is the one of coronavirus disease 2019 associated coagulopathy that threaten the limb viability in a very short interval. We report a case of a 98-year-old woman with coronavirus disease 2019 infection, then suddenly has ALI in the right foot.

Clinical spectrum of dengue fever in patients admitted to a tertiary care hospital in Bangladesh

A. F. M. Helal Uddin — 2023-02-09

Background: Dengue fever is a viral infection transmitted by mosquitoes and is a significant public health problem in many tropical and subtropical countries, including Bangladesh. The clinical spectrum of dengue fever can vary widely, ranging from asymptomatic infection to severe and potentially life-threatening illness. In this study, we aimed to describe the clinical spectrum of dengue fever in patients admitted to a tertiary care hospital in Bangladesh. The aim of the study was to observe the clinical spectrum of dengue fever patients.

Methods: This prospective observational study was conducted at the department of medicine, Sir Salimullah Medical College and Mitford Hospital, Dhaka, Bangladesh. The study duration was 7 months, from June 2022 to December 2022. During this period, a total of 65 cases of dengue fever cases admitted to the hospital for treatment were included in the study, who had a hospital stay of at least 3 days.

Results: The mean age of the participants was 30.78 years, and the male: female ratio was 1:1.95. 86.15% of the participants had no comorbidities, while diabetes and hypertension were observed in 6.15% of patients each. Patients' mean temperature had been high at the first check-up and dropped slowly to normal levels throughout the following check-ups, but the mean platelet count had significantly dropped from the first check-up throughout the following check-ups, improving only at the 6^th check-up. ≤20,000 platelet count was observed in 6.15% at the first check-up, 9.23% at the 2^nd check-up, 15.38% at the 3^rd, 5.41% at the 4^th, 15% at the 5^th, and 0% at the 6^th check-up. The most common warning signs were a positive tourniquet test (21.54%), vomiting (16.92%), and abdominal pain (15.38%). Hospital stay duration was <1 week for 95.38% of participants, and during discharge, only 3 patients had minor complications, with 3.08% mortality.

Conclusions: The study observed a higher prevalence of dengue among younger age groups, and females had a higher prevalence in the study. The regular-interval check-ups revealed that dengue severity progressed slowly, and did not become worse immediately after the infection, rather continued to progress adversely slowly throughout the check-ups. Hospital stay was <1 week for the majority of the participants, and minor mortality was observed in the study.

Prevalence and pattern of breastfeeding among mothers in Al-Qassim region

Yazeed A. Al-Ghasham — 2023-02-22

Background: The objective of this study was to explore the prevalence of breastfeeding (BF) among the mothers living in the Al-Qassim region of Saudi Arabia. This study also aimed to evaluate the factors causing delayed initiation of BF.

Method: This cross-sectional study was conducted between November and December 2022 in which mothers who were living in the Al-Qassim region were eligible to participate. A self-administered questionnaire was used for collecting the data which was sent electronically.

Results: Out of 265 mothers participated in the study, 38.9% were 30-40 years old and over 70% were having at least bachelor’s degree. Findings revealed that 82.5% timely initiated the BF while 25.3% had exclusive BF in the initial first six months. Mothers who had cesarean delivery and those who did not complete gestational age were in significantly less in proportion of receive education about BF after delivery (p=0.034 and p=0.015 respectively). In addition, mothers having cesarean delivery had 4.13 times higher odds of delayed initiation of BF (p=0.000) and mothers who had preterm delivery had 7.76 times more likely to delay initiation of BF (p=0.027).

Conclusions: Prevalence of exclusive BF for initial six months were found to be among quarter of the mothers participated in the study. It was required to increase mothers’ knowledge and to educate them before and after delivery which facilitate to increase the prevalence of BF. Delivery method and gestational age were the factors causing delayed initiation of BF hence healthcare providers are required to counter the situation to increase the prevalence.

Colonoscopic and histopathological assessment of colorectal polyps among north Indian population

Shafat S. Lone — 2023-02-01

Background: Colonic polyps are the abnormal growths from the colonic mucosa, usually benign but there is a definite though a small risk for cancerous transformation. Scarce data about this condition is available from Northern India. In this study we aimed to determine the prevalence of colonic polyps in patients undergoing colonoscopy for various health indications. In addition, we studied the various characteristics of these polyps including the histological classification

Methods: In this observational cross-sectional study we included adult patients (≥18 years) who underwent colonoscopy from July 2016 to June 2018 at a tertiary care hospital setting in New Delhi, India. The socio-demographic variables were ascertained for all patients. Data about indication of colonoscopy, the findings on colonoscopy, finding regarding the colonic polyps (type, number, size, location and histological type) was collected.

Results: We found a total of 246 patients to have colonic polyps and total number of polyps found was 369.The median age of the patients was 56 years (IQR 44-68). Majority of the patients with polyps (74.8%) were males. Polyps were most commonly seen in left colon (35.36%). Histologically, most common type was adenomatous polyps 58.9% (Tubular adenoma in 44% and tubule-villous adenoma in 8%). Hyperplastic polyps were noted in 22% followed by inflammatory polyps in 14% polyps. Adenocarcinoma was reported in 2 polyps (0.8%).

Conclusions: Prevalence of colorectal polyps in our study is lower compared to most of the western countries. On histology majority of polyps were adenomatous.

Fast-acting insulin aspart in pediatric type 1 diabetes mellitus patients in a tertiary care center: Indian experience

Inderpal Singh Kochar — 2023-02-03

Background: The objective of this retrospective study was to evaluate the effectiveness and safety of fast-acting insulin aspart with additional drug excipients (L-arginine and niacinamide) in the Indian pediatric population.

Methods: Data of pediatric type 1 diabetes mellitus (T1DM) outpatients in the age group of 1 to 18 years on treatment with injection degludec as long-acting Insulin OD and faster aspart as rapid-acting mealtime insulin 5-minutes before the meal for 20-weeks, was collected from the medical records of subjects. The primary endpoint was the mean change in glycated hemoglobin (HbA1c) and the secondary endpoints were mean changes in fasting plasma glucose (FPG) and 1 and 2-hour postprandial glucose (PPG), from baseline to 20-weeks post-treatment. The safety of treatment was also evaluated.

Results: Data of 30 pediatric patients (Male: Female-14:16) with a mean age of 7.98 years was considered for this retrospective data analysis. Compared to baseline, there was a significant decline (p<0.001) in mean HbA1c levels by -0.72, in FPG by -32.87 mg/dl, in 1-hour PPG levels by -8.57 mg/dl, and 2-hour PPG levels by -11.3 mg/dl, after 20-weeks of treatment. Three and two patients reported symptomatic undocumented hypoglycemia and symptomatic documented hypoglycemia respectively, and one patient each reported local site reaction, and lipodystrophy. No episodes of nocturnal hypoglycemia were reported.

Conclusions: In Indian pediatric T1DM patients 20-weeks mealtime faster aspart along with insulin degludec provided effective glycemic control, and treatment resulted in lower HbA1c, FPG, and 1 and 2-hour PPG levels.

Conclusions: In Indian pediatric T1DM patients 20-weeks mealtime faster aspart along with insulin degludec provided effective glycemic control, and treatment resulted in lower HbA1c, FPG, and 1 and 2-hour PPG levels.

Study of albuminuria in heart failure patients- an original research article

Kaushik Senthilnathan — 2023-02-22

Background: Heart failure is associated with albuminuria, frequently microalbuminuria and it has shown to correlate with the severity of heart failure.

Methods: Prospective observational study. Hundred patients were studied, with albuminuria being measured before and after correction of heart failure.

Results: One third of patients with heart failure had microalbuminuria. No correlation of albuminuria with severity of heart failure was found. The decrease in albuminuria following treatment of heart failure was statistically significant.

Conclusions: This study shows association of albuminuria to be statistically associated with heart failure and its reversibility with treatment of heart failure.

Prevalence of pulmonary function abnormalities in type 2 diabetes mellitus and its association with HbA1c in nonsmokers

Suman Sarkar — 2023-02-22

Background: Diabetes mellitus is a chronic metabolic disorder with vast social and economic consequences an ageing population and obesity due to sedentary lifestyle are one of the foremost reasons for the development of type 2 diabetes mellitus. Aim of the current study was to ascertain the burden of respiratory function abnormalities in type 2 diabetic subjects and its correlation with symptom and hba1c in non-smokers.

Methods: This cross-sectional study was conducted in KPC medical college, Jadavpur. Patients of type 2 diabetes mellitus between the age of 30-80 years fulfilling the modified Borg dyspnoea scale were included after excluding heart failure, COPD, musculoskeletal disorders. The selected subjects were then subjected to a PFT with reversibility and DLCO assessment Pattern of PFT abnormality recorded. Total of 65 subjects were chosen for the study.

Results: In our study most of the patients had Restrictive abnormality Female 24 (42.9%) and male 32 (57.1%). Rest 3 (50.0%) Female patients and 3 (50.0%) male patients had Mixed abnormality. 2 (66.7%) female patients and 1 (33.3%) male patient had normal abnormality which was not statistically significant (p=0.6939).

Conclusions: Pulmonary function is reduced in type 2 diabetes. Diabetes duration seems a more important influence than glycaemic control, but the definitive direction as well as the exact pathophysiological mechanism to explain this association requires further investigation.

Evaluation of platelet indices in dengue fever in a tertiary care hospital in Bangladesh

Debatosh Paul — 2023-02-22

Background: Dengue fever is the most rapidly spreading mosquito-borne viral diseases in the world. Some evidence suggests that platelet indices may have diagnostic and prognostic value in Dengue fever. The aim of the study is to evaluate platelet indices and to find their correlation between platelet count in Dengue fever.

Methods: This retrospective cross-sectional study was conducted through the use of stored data in Bangabandhu Sheikh Mujib Medical University (BSMMU) dengue cell from July 2019 to September 2019 at department of laboratory medicine and department of internal medicine, BSMMU, Dhaka. Among them, clinical records of 260 cases are preserved in a structured clinical record form (CRF). After ethical clearance from institutional review board (IRB), form clinical records of 260 cases which were preserved in a structured CRF patients who fulfilled the inclusion and exclusion criteria was selected as study population.

Results: Platelet indices (MPV and PDW) were statistically significant difference among different platelet counts (p<0.05). There was significant negative correlation between platelet count and PDW (r=-0.228, p≤0.001). There was also negative correlation between platelet count and MPV (r=-0.106) which was not statistically significant (p=0.088).

Conclusions: Platelet indices are useful parameters in dengue infection. Other than platelet count, PDW and MPV are useful to monitor dengue fever.