International Journal of Advances in Medicine

DeepSeek and diarrhoea: addressing missed questions to improve AI-assisted patient care

Abhishek Mehan — 2025-09-25

The use of artificial intelligence (AI) models has significantly impacted healthcare delivery, with people using Gen AI chatbots for healthcare questions.Currently, narrow AI with limited memory models dominate the use of AI in healthcare. Chinese generative AI models, such as DeepSeek, have demonstrated efficacy superior to ChatGPT-4 models in ophthalmology and great potential in transforming cardiovascular diseases.

Complete remission of severe nephrotic syndrome: a case report of outpatient therapy

Kadek Nova Adi Putra — 2025-10-24

Nephrotic syndrome is characterized by massive proteinuria, hypoalbuminemia, generalized edema, and hyperlipidemia, often resulting from primary glomerular diseases or secondary systemic conditions. Severe hypoalbuminemia and dyslipidemia can lead to life-threatening complications, necessitating timely and effective treatment. Here, this report presents a case of a 21-year-old male presenting with generalized edema, severe hypoalbuminemia (0.6 g/dl), and marked hyperlipidemia (LDL 501 mg/dl, triglycerides 401 mg/dl), consistent with nephrotic syndrome. Despite the recommendation for hospitalization, the patient opted for outpatient care. Management included high-dose oral corticosteroids, angiotensin-converting enzyme (ACE) inhibitors, dual lipid-lowering therapy (statin and fibrate), diuretics, nutritional support, and close biochemical monitoring. Over 24 weeks, the patient demonstrated complete clinical and laboratory remission. Proteinuria resolved by week 8, serum albumin normalized by week 16, and lipid profile returned to baseline by week 24. No significant complications were observed during follow-up. This case highlights the potential for successful outpatient management of severe nephrotic syndrome in a compliant and closely monitored patient. It underscores the importance of individualized care, adherence, and interdisciplinary collaboration in achieving favorable outcomes outside a hospital setting.

Diagnostic dilemma in CNS vasculitis: a case of primary angiitis of central nervous system mimicking anti-neutrophilic cytoplasmic antibody-associated vasculitis

Deepak Gupta — 2025-10-24

Authors present a diagnostically challenging case of Central Nervous System (CNS) vasculitis presenting with aphasia, confusion, and right-sided weakness due to cerebral vascular accident, initially suspected to be Anti-Neutrophilic Cytoplasmic Antibody (ANCA)-associated vasculitis due to elevated PR3 ANCA titers. The work up for lupus and anti-phospholipid antibodies was negative. Magnetic Resonance Imaging of brain demonstrated abnormal T2 FLAIR and diffusion-weighted imaging with patchy, enhancing lesions, progression of middle cerebral artery involvement, and subacute infarcts in the left parietal and occipital lobes. He responded to Intravenous methylprednisolone followed by oral prednisone and Rituximab infusions every 6 months. Inspite of this, his disease progressed as he developed recurrent headaches, transient ischemic attacks, seizures, paranoia, altered mental status, and agitation. His repeat ANCA test came back negative. Due to the absence of systemic features and subsequent negative ANCA result, his diagnosis was revised to Primary Angiitis of the CNS (PACNS). Treatment with daily oral cyclophosphamide in a dose of 2 mg per kg body weight resulted in disease stabilization and clinical improvement.

A silent spore: when fungi take over the lung

Harini Raman — 2025-10-24

Pulmonary mucormycosis is a rare but aggressive opportunistic fungal infection, predominantly affecting immunocompromised individuals such as those with poorly controlled diabetes mellitus. This case report describes a 65-year-old diabetic woman who presented with fever, cough, haemoptysis, and rapidly progressing dyspnoea. Initial misdiagnosis as bacterial pneumonia delayed appropriate treatment. High-resolution computed tomography (CT) revealed the reverse halo sign and cavitary lesions, raising suspicion for an invasive fungal infection. Microbiological testing showed broad, aseptate hyphae with right-angle branching on potassium hydroxide (KOH) mount, consistent with mucormycosis, despite negative fungal cultures. She was treated with liposomal amphotericin B and later switched to oral posaconazole due to financial limitations. This case underscores the importance of early imaging and microbiological assessment in high-risk patients, especially those with uncontrolled diabetes. It also highlights diagnostic limitations in resource-constrained settings and the critical need for timely antifungal therapy to improve outcomes in pulmonary mucormycosis. Multimodal diagnosis and clinical vigilance remain essential for survival.

Lupus podocytopathy presenting as lupus cerebritis: a rare diagnostic challenge in a young female

Geeta Sheth — 2025-10-24

Lupus cerebritis is a serious complication usually seen in patients with lupus nephritis. However, lupus podocytopathy presenting as lupus cerebritis is extremely rare and, to the authors’ knowledge, has not been reported. We present the case of a 19-year-old female with no known comorbidities who presented with seizures, headache, and altered sensorium. Cerebrospinal fluid analysis showed lymphocytic pleocytosis, and brain imaging revealed diffuse encephalitis. She was initially treated as viral encephalitis, but subsequent serology confirmed systemic lupus erythematosus with high-titer ANA and positive nucleosome and histone antibodies. The diagnosis of lupus cerebritis was made, and she improved with high-dose corticosteroids and immunosuppressive therapy. Within days, she developed nephrotic-range proteinuria and hypoalbuminemia (1.8 g/dl). Kidney biopsy demonstrated diffuse podocyte foot process effacement without immune complex deposition, consistent with lupus podocytopathy. She was treated with corticosteroids, hydroxychloroquine, and mycophenolate mofetil, resulting in remission. This case highlights that lupus podocytopathy can rarely present with neurological symptoms, and timely diagnosis and treatment can lead to excellent outcomes.

Zika virus in northern Kerala: a case report

Bhargavan Pallivalappil — 2025-10-24

Being a tropical country, emerging Zika virus infection is a major concern in India. In India, the first case of confirmed Zika virus disease was reported from Gujarat. In Kerala, the first Zika Virus outbreak was reported in June 2021 in the southern district of Thiruvananthapuram. Till now there have been no documented reports in the literature about the Zika virus disease in the northern part of Kerala. Hence, we are reporting a 44-year-old lady with fever, maculopapular rash, arthralgia, retro auricular lymphadenitis, gingivitis and bleeding manifestations who on evaluation had anemia, thrombocytopenia and was later diagnosed to have Zika virus infection along with Vitamin B12 deficiency in Tellichery in the northern part of Kerala. This case serves as a reminder of the ongoing threat of emerging infectious diseases in tropical regions and the need for early detection.

A case report on gastrointestinal mucormycosis

B. Vijay Kumar — 2025-10-24

Mucormycosis is a rare but often fatal opportunistic fungal infection and gastrointestinal (GI) mucormycosis is an uncommon subtype associated with high mortality, particularly in immunocompromised individuals such as those with diabetes, malignancy or organ failure. A 57-year-old man reported with symptoms of fever, jaundice, altered mentation and generalised weakness. He was intubated and managed in ICU for sepsis, MODS and encephalopathy. Investigations revealed hyperglycaemia, renal dysfunction and leucocytosis and were managed with several intravenous antibiotics and other supportive care, sustained low-efficiency dialysis (SLED) was performed due to hyperkalemia and metabolic acidosis, along with acute kidney injury (AKI). After an endoscopy showed an ulcerated tumor in the stomach fundus, a sleeve gastrectomy and laparotomy were carried out. Histopathology confirmed gastric mucormycosis with angioinvasion. Initial treatment with liposomal Amphotericin B (300 mg, IV, once daily) was given and stopped due to acute kidney injury and replaced by Isavuconazole (200 mg, oral, once daily). Multidisciplinary care led to clinical improvement and the patient was discharged in stable condition. Prompt endoscopic evaluation, surgical intervention, and timely antifungal therapy, especially Isavuconazole when Amphotericin B is contraindicated, can significantly enhance survival and multidisciplinary approach is vital in managing such complex infections.

Anatomical variants of the vertebral artery: insights from cadaveric and radiological studies-a review

Shrikrishna H. Basagoudanavar — 2025-10-24

Vertebral artery (VA) anatomical variations pose significant clinical challenges in neurosurgical, diagnostic, and endovascular interventions. This review aims to consolidate cadaveric and radiological evidence to map the morphologic spectrum and prevalence of such variants. A comprehensive search strategy was applied to PubMed using Boolean terms, retrieving 446 articles. Following strict inclusion criteria, 31 studies were selected. The most common variant identified was the origin of the left VA from the aortic arch, observed in 13 studies with a frequency range of 0.79%–9.3%. Entry level variations at cervical vertebrae C3–C7, hypoplasia (16.1%–59.3%), duplication (~0.16%), fenestration (~0.4%), and other anomalies such as triplication and abnormal origins from the brachiocephalic or common carotid artery were also reported. Course-related anomalies including tortuosity and anomalous trajectories further highlight the importance of preoperative imaging. Radiological studies offered population-level data, while cadaveric studies revealed detailed morphological nuances. Geographic variation in findings underscores the role of ethnicity and embryological development. The findings emphasize the need for standardized nomenclature, enhanced imaging protocols, and greater awareness among clinicians to mitigate intraoperative risks and improve patient outcomes.

Artificial intelligence in medical imaging: bridging innovation, ethics, and clinical impact

Varahalarao Vadlapudi — 2025-10-24

Medical imaging is essential for diagnosis, treatment planning, and disease monitoring. The integration of artificial intelligence (AI), particularly machine learning (ML) and deep learning (DL), is revolutionizing this field by automating image analysis and improving diagnostic performance. This review synthesizes recent advancements in AI applications for medical imaging, with a focus on radiology, oncology, and digital pathology. Core methodologies, including image classification, segmentation, reconstruction, and multimodal integration, are examined alongside emerging approaches such as federated learning and explainable AI. AI models demonstrate strong potential in enhancing diagnostic accuracy, reducing variability, and improving workflow efficiency. However, key barriers remain, including data quality limitations, algorithmic bias, lack of interpretability, and regulatory challenges. Novel strategies, including cross-modality fusion and privacy-preserving frameworks, are being explored to address these issues and improve generalizability. AI-driven medical imaging tools are poised to advance personalized care and clinical decision-making. Achieving widespread adoption will require fairness, transparency, clinician engagement, and rigorous real-world validation to ensure safe and effective integration into healthcare practice.

Indapamide: the diuretic of choice for managing blood pressure in Indian populations

Janakiraman Ezhilan — 2025-10-24

Hypertension is a leading global risk factor for morbidity and mortality, with considerable burden in India, where salt sensitivity and poor blood pressure (BP) control raises the challenges for its management. Diuretics, particularly thiazide agents have key role in hypertension therapy. However, their use is associated with clinically significant metabolic and electrolyte abnormalities. Among the available thiazide diuretics, Indapamide stands out because of to its favourable pharmacological profile, superior efficacy and safety. In contrast to thiazides, Indapamide structures have a lipophilic methylindoline moiety, enhancing vascular penetration. Moreover, its moderate carbonic anhydrase inhibition contributes to potent natriuretic and vasodilatory effects. Its pharmacokinetic properties provide 24-hour control of BP with minimal metabolic and electrolyte imbalance and is effective clinically in moderate renal impairment up to GFR <30-40 ml/min. Clinical evidence and real-world data supports Indapamide’s efficacy as monotherapy and in combinations HTN management, achieving recognition in recent guidelines- ESC 2024, ADA 2025 and Indian guidelines. This review emphasizes Indapamide’s role as an optimal antihypertensive, especially in Indian hypertensive, where BP control is challenge

Risk factors and attitudes towards osteoporosis among the Palestinian females in occupied Palestinian territories

Nihal Natour — 2025-10-24

Background: Osteoporosis is a leading cause of fracture associated mortality and morbidity and its prevention is important for Palestinian society.

Methods: A structured questionnaire was distributed to females in Palestinian territories about risk factors for osteoporosis and attitudes towards the diseases. Data was analyzed using SPSS.

Results: 92 women participated in this study, among studied women only 7 were postmenopausal, Age was 30.8±12.3 y, BMI is 25.1±6.6 Kg/m², attitude score was 5.75±1.6. 58% had bachelor’s degree, 44% were teachers, 23.5% were health workers. 65.9% lived in separate houses. Having job was associated with lower attitude towards importance (0.04) of osteoporosis but improved dairy products consumption. The rate of consuming dairy product on regular basis was higher than 50%, but there was high rate of vitamin D deficiency (37%) and low level of physical activity performance (18%).

Conclusions: There is high prevalence for osteoporosis risk factors, but high rate of using dairy products and modest attitude towards importance of osteoporosis.

A study on psychiatric illness in self-poisoning patients in a tertiary care hospital

Amarnath Duraikannan — 2025-09-12

Background: Self-poisoning, also known as self-ingestion or self-intoxication, refers to the deliberate ingestion of toxic substances with the intent of harming oneself. This study aimed to understand the close associations between self-poisoning patients and psychiatric illness, and to examine whether behaviour-based treatment was more effective than treatment as usual for people who harmed themselves.

Methods: This retrospective study was conducted on 574 patients who were admitted with a history of self-poisoning in Thanjavur Medical College Hospital during the period of 1 year from 2015 to 2016. Patient history included age, sex, type of psychiatric illness, and type of poisoning consumed. A psychiatric diagnosis based on the ICD 10 was made by a psychiatrist once the clinical picture was clear.

Results: Of 543 patients, 279 were female and 264 were male. A total of 184 (33.9%) patients consumed rat killer paste, 153 (28.2%) consumed OPC, 62 (11.4%) consumed ant killer powder, 38 (7%) consumed oleander, and 37 (6.8%) consumed tablets. Most patients had AD, ADS, AUD, IR, BPD, and acute psychosis for most poisons, such as ant killer powder poisoning, OPC, tablet poisoning, herbicide, kerosene, non-OPC, and rat killer paste poisoning.

Conclusions: Implementing rigorous measures such as enforcing anti-dowry laws, promoting marriage counselling and women's empowerment, identifying and referring individuals with psychosocial issues for psychiatric support, and providing assistance to those with adjustment disorder could effectively reduce the incidence of poisoning and its associated mortality and morbidity rates.

The status of liver enzymes in patients of newly diagnosed human immuno-deficiency virus and their correlation with CD4 counts in a tertiary centre of North Eastern region of India

Poonam Gupta — 2025-10-24

Background: Liver dysfunction is a common complication in human immunodeficiency virus (HIV)-infected individuals due to factors like co-infections, antiretroviral therapy (ART) toxicity, and immune dysregulation. Evaluating liver enzyme abnormalities can help predict disease progression and guide therapy.

Methods: A cross-sectional study was conducted on 100 newly diagnosed HIV-positive individuals. Liver function was assessed using serum glutamate-oxaloacetate transaminase (SGOT) and serum glutamate-pyruvate transaminase (SGPT) levels, and immune status was measured by CD4 counts. The correlation between liver enzymes and CD4 levels was analyzed statistically.

Results: The study population had a male predominance (70%) with a mean age of 37.29±13.01 years. A weak positive correlation was found between CD4 count and both SGOT and SGPT levels. Liver enzyme derangements were more prominent in patients with lower CD4 counts, indicating advancing immunosuppression.

Conclusion: This study highlights the universally raised liver enzymes in all the patients of newly diagnosed HIV indicating hepatic injury by the virus itself. Medical literature regarding the probable mechanism is all together lacking. There was minimal positive correlation found between CD4 count and liver enzymes.

Efficacy of sustained natural apophyseal glides in neck pain: a comparative study

Navjot Kaur — 2025-10-24

Background: Neck pain stems from mechanical and postural factors. When an incorrect alignment or narrowing of intervertebral space occurs due to incorrect posture or collateral medical problems the individual may experience neck pain but also more dangerous symptoms, such as compression of spinal nerves, muscle weakness or functional impairment in the limbs.

Methods: Subjects were screened as per inclusion and exclusion criteria in neck pain. A written consent was assigned by the subjects and were rehabilitated for 5 days in a week for a period of 4 weeks. A total of 60 subjects of both genders aged 30-50 years were divided into three groups at random by simple random sampling method. Group A (n=20): treated with hot pack, Maitland and ultrasound. Group B (n=20) treated with hot pack, SNAGS and ultrasound therapy. Group C (n=20): treated with hot pack. Outcome analyzed by using Visual Analogue Scale (VAS) and neck disability index (NDI). Treatment provided for 5 days per week for 4 weeks. Assessment was done before the treatment and after the treatment of four weeks. Results were analyzed by using SPSS software 26.

Results: Results showed a statistically significant improvement in VAS and NDI in experimental groups. Group B statistically more improvement than Group A.

Conclusions: The study concluded that treatment protocol received by Group B, mulligan mobilization was more effective compared to Group who received Maitlands mobilization.

Determining the role of SGLT2 inhibitors (dapagliflozin) on progression of proteinuria among non-diabetic adult patients with chronic kidney disease: a randomized controlled trial

Shivam Srivastava — 2025-10-24

Background: In patients with type 2 diabetes, SGLT2 inhibition lowers albuminuria and the risk of renal disease progression. Improvement in glycemic control is unlikely to be the only factor mediating these advantages. The goal of this study was to determine any possible benefit of the SGLT2 inhibitor among subjects with non-diabetic kidney disease. To determine the effect of SGLT2 inhibitor (Dapagliflozin) on proteinuria among subjects with non-diabetic kidney disease.

Methods: A randomized control trial was conducted at K.P.S PG institute of medicine in association with Department of Nephrology, GSVSPGI, GSVM medical college, Kanpur. Eligible subjects were adult patients with non-diabetic CKD with eGFR between 25-90 ml/min/1.73m² and having proteinuria with urinary albumin creatinine ratio (ACR)>30 mg/g for more than 3 months. Subjects were randomized to receive either dapagliflozin (10 mg) or placebo.

Results: A total of 228 subjects were screened between June 2022 to May 2023. Sixty-seven subjects met the inclusion criteria and only 46 subjects consented to participate in the study. The subjects were randomized in 1:1 ratio to receive either intervention or placebo for duration of 6 months. At the end of 6 months study period the intervention group demonstrated a median (IQR) reduction of-9.99(-63.17 -(-4.78)) mg/g (p value<0.01) in ACR along with a median (IQR) increase in eGFR of 19.23 (3.85-23.81) ml/min/1.73m² from baseline. The placebo group continued to show a constant decline in eGFR with a median reduction of -32.43 (-59.8- (-23.04)) ml/min/1.73m² from baseline with no significant change in ACR.

Conclusions: Use of SGLT2i among subjects with non-diabetic kidney disease resulted in reduction of proteinuria and an improvement in the real function. Therefore, SGLT2i may also be used among patients with non-diabetic kidney disease to check its progression.

Assessing the risk of heart failure in patients with diabetic retinopathy with type 2 diabetes mellitus

Praful Sharma — 2025-10-24

Background: Type 2 diabetes mellitus (T2DM) is associated with both microvascular and macrovascular complications, notably diabetic retinopathy (DR) and heart failure (HF), respectively. While DR is a well-established marker of retinal microangiopathy, emerging evidence suggests it may also reflect systemic vascular pathology. However, data on this association in the Indian population remains limited.

Methods: A hospital-based cross-sectional observational study was conducted at GSVMMC, Kanpur, between August 2023 and February 2025. Ninety-two adults with T2DM were enrolled and assessed for DR using fundoscopic examination and graded from 0 to 3. Heart failure was diagnosed and classified via echocardiography into HFpEF, HFmrEF, and HFrEF. Biochemical markers, including HbA1c and NT-proBNP, were evaluated. Statistical analysis included Chi-square tests and ANOVA using statistical package for the social sciences (SPSS) v20.

Results: Among the 92 patients, 73 (79.34%) had some form of heart failure, and 74 (80.43%) had DR. A significant association was found between DR and HF (p=0.001). The prevalence of HFrEF increased with DR severity from 10% in grade 0 to 35% in grade 3 DR (p=0.045). Additionally, poor glycemic control and higher body mass index (BMI) were common in patients with more severe DR and HF.

Conclusion: DR is significantly associated with both the presence and severity of HF in T2DM patients. Retinal examination may serve as a practical, non-invasive tool for early cardiovascular risk stratification. These findings support integrated screening strategies in diabetic care.

Pantoprazole in the management of dyspepsia in diabetic gastroparesis: evaluating efficacy and safety

Bibhuti Saha — 2025-10-24

Background: Pantoprazole is used in treatment of erosive esophagitis associated with gastroesophageal reflux disease (GERD). This questionnaire-based study aims to provide insights into pantoprazole’s real-world effectiveness and safety in managing dyspepsia due to diabetic gastroparesis (DGP).

Methods: This questionnaire-based study was conducted among Indian healthcare professionals (HCP) from September 2024 to March 2025. A questionnaire comprising 13 questions explored preferences of HCPs for use of pantoprazole in last 10 patients with dyspepsia due to diabetic gastroparesis.

Results: A total of 86 HCP were included in this study. The highest percentage of HCPs (30.23%) reported duration of diabetes in patients greater than 10 years with age group of patients 40-60 years. A majority of 89.53% HCPs reported GERD, with abdominal discomfort reported by 38.37% of HCPs. Symptoms like post-prandial fullness and early satiety was observed at frequency of 6/10 patients by 38.37% HCPs, while poor glycemic control at a frequency of 5/10 patients by 38.37% of HCPs. Majority of 59.30% HCPs prescribed pantoprazole treatment for 4 weeks and 95.35% of HCPs added a prokinetic to pantoprazole. The largest proportion of HCPs (43.02%) reported symptom relief in 8/10 patients with 48.84% of HCPs observed glycemic control improvement in <8 patients. Loose stools were the most commonly reported adverse effect by 70.93% of HCPs. Approximately 90% of HCPs rated pantoprazole's efficacy, safety and adherence to treatment as excellent and good.

Conclusion: This study revealed strong clinical, therapeutic, and patient-centric outcomes across India for use of pantoprazole in patients with dyspepsia due to DGP.

A study on the occurrence of metabolic syndrome among young subjects presenting with acute myocardial infarction

Shashank Gupta — 2025-10-24

Background: Coronary artery disease (CAD) is a leading global cause of mortality, with rising prevalence in both urban and rural populations. Atherosclerosis drives coronary heart disease (CHD), and its increasing occurrence in younger individuals underscores the need for early risk factor detection. This study evaluates the prevalence of metabolic syndrome in Indian patients aged ≤45 years presenting with acute myocardial infarction (AMI). The objective was to study the occurrence of metabolic syndrome in subjects 45 years or less having acute myocardial infarction in Indian patients.

Methods: A cross-sectional study on 182 acute myocardial infarction patients ≤45 years excluded those with comorbidities. Statistical analysis assessed metabolic syndrome prevalence and component correlations, highlighting key risk factors contributing to young myocardial infarction in the Indian population.

Results: The study found a mean patient age of 35.55±6.25 years, with males comprising 71.97%. Metabolic syndrome prevalence was 54.39%, significantly associated with smoking and alcoholism. Abnormal waist circumference, fasting sugar, triglycerides, low high density lipoprotein (HDL), and elevated blood pressure were observed in 73.7%, 76%, 85%, 86%, and 45% of cases, respectively.

Conclusion: There is high prevalence of metabolic syndrome among young patients with acute myocardial infarction and there is need for early identification and management of risk factors for prevention of MI in young population.

Clinical presentation patterns and neurological status among stroke subtypes

M. Mizanur Rahman — 2025-10-24

Background: Differentiating stroke subtypes through distinct clinical presentation and neurological severity is essential for prompt management, especially in resource-constrained settings. This study aimed to compare clinical presentation patterns and neurological status among ischemic and hemorrhagic stroke patients in Bangladesh.

Methods: A cross-sectional observational study was conducted among 100 adult stroke patients admitted to a tertiary hospital. Clinical features and neurological severity (Glasgow coma scale, GCS) were assessed and compared by stroke subtype. Predictors of impaired consciousness were identified using Cox regression analysis.

Results: Among participants, ischemic stroke (74%) predominated over hemorrhagic stroke (26%). Hemorrhagic stroke was significantly associated with impaired consciousness (80.76% versus 59.45%; p=0.023), headache (80.76% versus 45.94%; p=0.004), vomiting (73.07% versus 41.89%; p=0.019), neck rigidity (80.76% versus 6.75%; p<0.001), hiccups (46.15% versus 22.97%; p=0.041), and convulsions (30.76% versus 12.16%; p=0.041). Unconsciousness (GCS≤8) was notably higher in hemorrhagic stroke (38.5% versus 20.3%; p=0.041). Cox regression identified hemorrhagic stroke (HR 2.85, p=0.006), neck rigidity (HR 3.41, p=0.003), convulsions (HR 2.12, p=0.047), age >55 years (HR 1.26, p=0.01), and BMI >30 (HR 1.08, p=0.03) as independent predictors of impaired consciousness.

Conclusion: Significant subtype-specific clinical presentations and neurological impairment were observed, with hemorrhagic stroke associated with greater severity. Enhanced clinical awareness and targeted management strategies are essential in improving acute stroke care outcomes in Bangladesh.

Clinical profile of acute on chronic liver failure patients in a tertiary care hospital: a cross-sectional study

C. S. Arun — 2025-10-04

Background: Acute-on-chronic liver failure (ACLF) is characterized by the sudden worsening of chronic liver disease (CLD) and high short-term mortality. This study evaluated the clinical profiles, outcomes, and predictors of early mortality.

Methods: A cross-sectional study was conducted in 51 patients with ACLF at Tirunelveli Medical College Hospital from April 2023 to April 2024. Clinical features, aetiologies, triggering factors, and prognostic scores such as model for end-stage liver disease (MELD), MELD-Na, chronic liver failure - organ failure (CLIF-OF), chronic liver failure - consortium acute-on-chronic liver failure (CLIF-C ACLF), APASL ACLF Research Consortium (AARC) were recorded. Outcomes, including intensive care unit (ICU) admission, readmission, early mortality, and transplant-free survival (TFS), were analyzed.

Results: Ethanol-related CLD was most common in males 43 (84.3%), and CAM-related factors were the leading trigger 26 (51%). The clinical features included jaundice (100%), ascites (98%), and encephalopathy (56.9%). Early mortality occurred in 13 (25.5%), overall mortality in 15 (29.4%), ICU admission in 40 (78.4%), and readmission in 22 (43.1%). TFS was 72.5% at 28 days, 66.6% at 3 months, 58.8% at 6 months, and 52.9% at 1 year. Non-survivors had significantly higher MELD-Na (31.5±3.6 versus 27.9±3.6; p=0.0028), AARC (11.2±1.9 versus 8.1±1.3; p<0.0001), CLIF-OF (11.2±1.0 versus 8.9±1.1; p<0.0001), and CLIF-C ACLF scores (52.4±5.5 versus 42.4±5.1; p<0.0001). Among 5 cases receiving PLEX, early mortality was 20% versus 26.1% without plasma exchange (PLEX) (p=1.000), and 28-day TFS was 100% versus 69.6% (p=0.300). Higher MELD-Na and AARC scores were associated with increased risk of death (p=0.011 and p=0.033, respectively).

Conclusion: Ethanol-related CLD was the predominant cause of ACLF, with complementary and alternative medicine (CAM)-related triggers. Higher MELD, MELD-Na, CLIF-OF, CLIF-C ACLF, and AARC scores predicted early death.

Prevalence of vitamin B12 deficiency in thyroid dysfunction and its correlation with anti-thyroid peroxidase antibodies

Mrityunjay Sahoo — 2025-10-24

Background: Thyroid dysfunction, particularly autoimmune thyroid disease (AITD), is linked to micronutrient deficiencies. This study assessed the prevalence of vitamin B12 deficiency in thyroid dysfunction, its levels in subclinical hypothyroidism, and its correlation with anti-thyroid peroxidase (anti-TPO) antibodies.

Methods: A cross-sectional study of 124 thyroid dysfunction patients and 90 euthyroid controls was conducted. Serum TSH, free T3, free T4, anti-TPO, and vitamin B12 were measured. Statistical analyses included Chi-square tests, t-tests, ANOVA, and Pearson correlation.

Results: Vitamin B12 deficiency was significantly higher in cases (29.84%) versus controls (16.67%, p=0.034). Among thyroid subtypes, overt hypothyroidism had the lowest mean B12 (151.63±45.78 pg/ml). Anti-TPO positivity was higher in cases (56.45% versus 0%, p<0.0001) and negatively correlated with B12 (r=-0.159, p=0.020). Subclinical hypothyroidism (49.20% of cases) showed intermediate B12 levels (201.86±54.45 pg/ml). Anaemia (Hb: 10.99±2.27 g/dl versus 12.70±2.88 g/dl, p<0.0001) and lower albumin (4.08±0.69 g/dl versus 4.33±0.61 g/dl, p=0.0056) were prevalent in cases.

Conclusion: Vitamin B12 deficiency is common in cases with thyroid dysfunction, especially in autoimmune hypothyroidism. Routine vitamin B12 screening is recommended in these patients.