International Journal of Advances in Medicine

Executive stress and burnout syndrome: focus on clinical lecturers in Nigerian

Enyidah Nonyenim Solomon — 2024-12-23

The clinical lecturers are academic staff of the faculties of clinical sciences in the universities. They are all executives at all levels. Their duties in the hospitals and the university keep all the stress pathways always activated in them, making them easy preys to executive stress. The major cause of stress in executives are work related in 65%, family related in about 44%, young age and reduce physical activities. The standard workload formula (SWF) and the course credit system (CCS) currently used in Nigeria and by the universities all over the world to assign, measure, monitor and remunerate staff are not applicable in this faculty, leaving the members in state of learned helplessness. Academic burnout occurs when the academic work and home life become overwhelmingly unbearable. They currently have the highest prevalence rates in most disorders hence the need for urgent attention and reconsideration of the faculty policies.

Rapid ventricular response atrial fibrillation in an uncontrolled hyperthyroidism patient

Putu Bagus Aditya Putra Semara — 2024-12-06

Hyperthyroidism, defined as elevated blood levels of thyroid hormone with reduced levels of thyroid-stimulating hormone (TSH). Atrial fibrillation (AF) is the most common cardiac complication in patients with hyperthyroidism. There is several pathophysiology of AF in hyperthyroidism such as an increase atrial pressure, ischemia, and ion disturbance of the myocardium. In hemodynamically unstable patients should be carried out electric cardioversion. The choice of rate or rhythm control is determined based on the case. Beta-blockers inhibit sympathetic activity in the AV node so that it can inhibit the ventricular rate. Antithyroid drugs are widely used in the management due to restoration of euthyroidism is fundamental in the management of hyperthyroidism related AF.

Acute rheumatic fever in young adult patients: a case report

Komang V. N. R. Kinasih — 2024-12-18

Acute rheumatic fever (ARF) is an inflammatory response to group A Streptococcus (GAS) infection. The incidence ranges from 8 to 51 per 100.000 children and young adults worldwide. A 19-year-old male patient admitted with complaint of abdominal pain and joint pain of knee in both legs and elbow in both hands. Multiple erythematous macules, round in shape, elevated of white blood cells and anti-streptolysin O titer (ASOT) are present in this case. The diagnosis of ARF is made using the Jones criteria. Intramuscular benzathine penicillin G as a single dose is recommended for management of ARF and as secondary prophylaxis to prevent recurrences. Comprehensive treatment was needed for patient with rheumatic fever to prevent reoccurrence and also complication which may arise.

Human immunodeficiency virus infected patient with cerebral infarction without non-infectious comorbidities

Ogek Dwi Shavitri — 2024-11-30

Human immunodeficiency virus (HIV) has been proven to increase the risk of stroke. The annual incidence rate of ischemic stroke in HIV was 216 per 100,000. Multiple factors, linked to HIV infection, could increase the susceptibility of developing cerebrovascular diseases (CVD), such as opportunistic infections, coagulation abnormalities, dyslipidemia, and toxicity of antiretroviral therapy (ART). HIV is thought to contribute to the incidence of stroke through both HIV-associated and traditional stroke risk factors. ARTs, namely protease inhibitors and nucleoside reverse transcriptase inhibitors, can increase the incidence of stroke.

Graves disease induced rapid ventricular response atrial fibrillation in association with hemorrhagic transformation in patient with ischemic stroke

Sagung I. Saraswati — 2024-12-18

Graves’ disease is the most common etiology of hyperthyroidism caused by the presence of autoantibodies that stimulate the thyroid-stimulating hormone receptor (TSH-R). If graves' disease is not effectively treated, it can result in several complications, including atrial fibrillation, which affects 5-15% of patients with the condition. In this case, we report a 48-years-old male with hemorrhagic transformation in patient with ischemic stroke associated with Graves' disease, which occurred as a result of complications from atrial fibrillation. The patient has a history of ischemic stroke about one month ago and presented to the emergency department with a relapse of symptoms that had previously improved. Based on the history, physical examination, and supporting tests, a triad of graves' disease was identified, which supported the patient's diagnosis, including thyrotoxicosis, diffuse goiter, and ophthalmopathy. This case report discusses the mechanisms and factors that contribute to hemorrhagic transformation with a history of previous ischemic stroke in a patient with graves' disease, as well as comprehensive treatment approaches.

Combination of zinc and probiotic for acute diarrhoea in adult

Putu Risma Yuvita Riadi — 2024-12-23

In Indonesia, diarrhea affected 9% of the population and was the fourth most common cause of death across all age groups (13.2%). Case 1: A 33-year-old female presented to the emergency room with a history of diarrhea without bloody or oily stools, nausea and vomiting. The patient was assessed with noninfective gastroenteritis, suspected to be caused by viruses. She was given rehydration therapy, symptomatic therapy, with combination of zinc and probiotic. Case 2: A 25-year-old female presented to the emergency room with a history of diarrhea without bloody or oily stools and mild epigastric pain. The patient was assessed with noninfective gastroenteritis, suspected to be caused by viruses. She was given rehydration therapy, symptomatic therapy, with combination of zinc and probiotic. The primary foundation treatment for acute diarrhea includes prescribing zinc and probiotic supplements to aid in recovery. Probiotics may have an impact on a variety of innate and acquired immunity-related cells, while zinc is an essential element of all highly proliferating cells in the human body. It plays a critical role in modulating resistance to infectious agents and reduces the duration, severity, and risk of diarrheal disease. Our case highlights that, combination of zinc and probiotic give a significant effect not only in children, but also in adult. Zinc and probiotic can help fasten the recovery phase of diarrhea and decrease the mean duration of acute diarrhea.

Diagnostic modalities imaging of sigmoid volvulus in adults

Ayu Aditya Willy Wrastuti — 2024-12-23

In adults, large bowel obstruction is predominantly attributed to colon or rectal cancer, diverticular disease, or colonic volvulus. Obstruction from the colonic volvulus results from twisting a redundant segment of the colon on its mesentery. Volvulus predominantly occurs in the sigmoid colon or cecum in over 95% of cases, with the remainder involving either the transverse colon or splenic flexure. The diagnosis of volvulus is established through clinical evaluation and imaging modalities. Abdominal plain x-rays are usually diagnostic with a coffee bean appearance showing a massive distended sigmoid colon, providing diagnostic clarity in 50% to 75% of cases. Nevertheless, the diagnostic efficacy of abdominal computerized tomography (CT) and magnetic resonance imaging (MRI) is typically claimed to exceed 90%. In CT and MRI, the characteristic finding of sigmoid volvulus is the mesenteric whirl sign, resulting from a rotating sigmoid mesentery, together with a dilated sigmoid colon and air-fluid levels in the small intestine. The diagnostic accuracy of CT and MRI was 97.3% and 95.6% respectively.

Febrile jaundice patient with hypophysis tumor and clinical symptoms of Weil’s disease: what do we think?

Putu B. A. P. Semara — 2024-12-12

Febrile jaundice is a condition that can be caused by infection and non-infection, one of the causes of infection is leptospirosis. Leptospirosis is caused by bacteria of the genus Leptospira. Leptospirosis is a fairly complex condition and can involve various organs. Severe leptospirosis is called Weil's disease. Weil’s disease is a febrile jaundice condition involving various organs, especially the liver and kidneys. The recommended serological tests for Leptospirosis are microscopic agglutination test (MAT) and IgM enzyme linked immunosorbent assay (ELISA). Negative serological results can occur in some cases with typical clinical conditions, requiring re-examination. Pituitary tumors are benign tumors with slow growth. It is very rare to cause liver or other organ metastases.

Thyroid storm in patient with uncontrolled hyperthyroid: a case-report

Komang Vika Nariswari Ratna Kinasih — 2024-12-20

Hyperthyroidism is a clinical condition which arise due to an increase of synthesis and secretion of thyroid hormone (TH) by the thyroid gland, and may lead to hyperthyroid crisis or thyroid storm which is a life-threatening emergency condition. Sudden discontinuation of anti-thyroid drugs influences the occurrences of thyroid storm. A 29-years-old female patient come to the emergency department with complaint of shortness of breath, cough, body weight loss, and palpitation. During hospitalization period, patient experienced symptoms of palpitation and seizure. The Burch-Wartofsky criteria score was ≥45 which consistent with thyroid storm. A multidisciplinary team approach is important in treating patient with thyroid storm.

A rare case of hyponatremia

Bhargavan Pallivalappil — 2024-12-23

Autoimmune hypophysitis (AH) is a rare inflammatory condition characterized by the immune-mediated destruction of the pituitary gland, leading to pituitary dysfunction. While AH predominantly affects females in their childbearing years, its occurrence in older males, especially at the age of 59, is exceptionally rare. Here, we discuss AH in a middle-aged male who presented with atypical symptoms. A 59-year-old male with no known co-morbidities presented with a 2-week history of headache with retro-orbital pain, accompanied by decreased appetite, fatigue, nausea, vomiting, blurred vision and low-grade fever (for 3 days). The patient also gave a history of hepatitis B infection twenty years ago. On examination, he had icterus, while vital signs and systemic examination were within normal limits. Laboratory investigations revealed elevated C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), unconjugated hyperbilirubinemia, and hyponatremia. Further evaluation of hyponatremia revealed low serum osmolality, increased urine spot sodium, and urine osmolality, suggestive of euvolemic hyponatremia. Hormonal assays indicated low levels of T4, thyroid stimulating hormone (TSH), cortisol, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone, suggestive of pituitary dysfunction. Magnetic resonance imaging (MRI) of the brain and pituitary gland revealed a bulky pituitary gland with thickening of stalk, suggesting hypophysitis.

Seizures in the shower: a case report on hot water epilepsy

Glory Dsouza — 2024-12-23

An uncommon kind of reflex epilepsy called hot water epilepsy is brought on by bathing in or being near hot water. In this case study, a 43-year-old man with a history of head trauma experiences seizures brought on by exposure to hot water. Concurrent symptoms include giddiness. The best course of treatment for HWE typically involves avoiding lukewarm water in the first place and utilizing either standard AEDs or benzodiazepines for intermittent oral prophylaxis.

Food and drug administration gives breakthrough: sanctioning of Rezdiffra for non-alcoholic steatohepatitis

Shrishti Agarwal — 2024-12-23

On March 14,2024, FDA i.e., the US food and drug administration, approved Rezdiffra (resmetirom) for treating noncirrhotic non-alcoholic steatohepatitis (NASH) in adults who may have moderate to advanced degrees of liver fibrosis. This is a game-changing moment for patients who until now had only diet and exercise as their options.

Validity of lung ultrasound with bedside lung ultrasonography in emergency protocol in diagnosing pneumonia

Putu Gita Indraswari — 2024-11-11

Background: Pneumonia is an acute inflammation of the lung parenchyma caused by microorganisms. In 2020, pneumonia was included in the top 10 diseases requiring hospitalization in Indonesia with a mortality rate of 23% for patients treated in the intensive care unit. The diagnosis of pneumonia is based on anamnesis, physical examination, and supporting examinations. However, in practice, diagnostic procedures in patients with immobilization or patients with unstable hemodynamics are difficult to perform. Lung ultrasound (LUS) with bedside lung ultrasonography in emergency (BLUE) protocol is a simple and portable supporting examination that is known to be able to diagnose pneumonia more easily, accurately, and quickly. Therefore, a study related to the validity of LUS in diagnosing pneumonia needs to be conducted.

Methods: This study is a diagnostic test. The study was conducted over a period of 6 months (August 2023 to February 2024) at Prof. Dr. I.G.N.G. Ngoerah hospital. In this study, the validity was assessed consisting of sensitivity, specificity, and accuracy of LUS in diagnosing pneumonia. Data were analyzed using STATA MP 17.

Results: The total subjects in this study were 70 people. The sensitivity of LUS in diagnosing pneumonia was 86.8% (CI95%=74.7-94.5%) and the specificity was 70.6% (CI95%=44-89.7%), with an accuracy of 82.8%. The positive test predictive value was 90.2% (CI95%=78.6-96.7%) and the negative test predictive value was 63.2% (CI95%=38.4-83.7%). Thus, in subjects with LUS suggestive of pneumonia, pneumonia management can be done immediately. However, in subjects with LUS results not showing pneumonia, further supporting examinations are needed to confirm the diagnosis of pneumonia. Sensitivity, specificity, and accuracy varies based on age, body mass index, immunocompromised status, and degree of pneumonia

Conclusions: LUS with BLUE protocol is a valid supporting examination in diagnosing pneumonia (rule in disease).

Analysis of positive predictors in diagnosing lung cancer on transthoracic and transbronchial procedure

Desy Irene Tandibua — 2024-11-16

Background: Lung cancer remains the most cause of death due to cancer. Due to high mortality rate of lung cancer, early diagnosis of lung cancer plays a very important role in therapeutic management. Clinical symptoms and tumor characteristics such as size and location are found to vary in lung cancer patients. Various modalities can be used to obtain materials or samples include transthoracic and transbronchial methods. Research was conducted to analyze positive predictors of cancer between transthoracic and transbronchial procedures in lung cancer patients.

Methods: This research is an analytical observational study with a cross-sectional design in using secondary data through medical records from January 2022 to December 2023. Univariate analysis presents data in the form of frequency, mean and standard deviation. Bivariate analysis was carried out using chi-square and multivariate analysis using multiple logistic regression. The measure used as a predictor is the adjusted odds ratio. Inference or conclusion is based on the 95% confident interval and p value at the alpha value limit of 0.05. The entire data process above uses SPSS 26.0 statistical software

Results: The total research subjects who met the research requirements were 111 patients. The characteristics of the research subjects were symptoms of cough (n=97; 87.4%), hemoptyisis (n=51; 45.9%), breathlessness (n=104; 93.7%) and chest pain (n=87; 78.4%), mostly peripheral tumor (n=70; 63.1%) and size >3 cm (n=103; 92.8%). Logistic regression analysis showed cough symptoms and peripheral tumor location each had an adjOR value of 5.247 (95% CI 1.432-19.552; p=0.013) and adjOR 0.088 (95% CI 0.034-0.229; p=0.000) for lung cancer positivity on transbronchial procedure. On transthoracic procedure, cough symptoms and peripheral tumor location respectively had an adjOR value of 0.190 (95% CI 0.051-0.703; p=0.013) and adjOR 11.407 (95% CI 4.374-29.747; p=0.000) for lung cancer positivity.

Conclusions: Cough is a positive predictor of lung cancer in transbronchial procedures. Meanwhile, peripheral tumor location is a positive predictor of lung cancer in transthoracic procedures.

Profile of triple elimination in maternal at Wangaya regional hospital in 2023

Ogek Dwi Shavitri — 2024-12-06

Background: Triple elimination is a program implemented by the Ministry of Health of the Republic of Indonesia, this program was adopted from the World Health Program or WHO to combat the transmission of HIV (Human immunodeficiency virus), syphilis and hepatitis B in pregnant women to their babies The aim of this study of this research is to determine the profile of pregnant women who undergo triple elimination testing.

Methods: This study was a descriptive observational study with a retrospective study design. The data was collected from the medical records of pregnant women at Wangaya Regional Hospital from January 2023 to December 2023.

Results: In this study involving 101 subjects, in this study, there were 65 people who underwent triple elimination examination and 36 people did not undergo triple elimination. These included HIV with 13 cases (12.8%) and hepatitis b with 4 cases (3.9%) and syphilis with 2 cases (1.98%).

Conclusions: The triple elimination screening is a mandatory examination for pregnant women conducted during the first trimester of pregnancy. Pregnant women who do not undergo the triple elimination screening may lack knowledge, sufficient information and proper education and communication from healthcare providers about the triple elimination program. Improving these factors will enhance pregnant women's motivation to utilize and access healthcare services.

Relationship between the degree of dengue hemorrhagic fever and comorbid in patients at Wangaya general teaching hospital

Anak Agung Ngurah Paramacarya Bodhinatha — 2024-12-23

Background: Dengue fever has become a major international public health problem in recent decades. Clinical manifestations of DENV infection can range from asymptomatic (no symptoms) or mild flu-like syndrome, also known as Dengue Fever (DF), to more severe and life-threatening forms, Dengue Hemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS). Comorbidities can make the primary disease more severe and worsen the prognosis. The aim of this research is to find out the relationship between the degree of dengue fever and comorbid in inpatients.

Methods: This study used an analytical approach and was conducted at Wangaya Regional General Hospital from January to May 2024. Medical records were the main data source for this study. A total of 425 patient samples were collected based on inclusion and exclusion criteria. The sampling technique used in this study was total sampling that met the inclusion and exclusion criteria. The data was processed using SPSS with the Fisher's Exact Test statistical test.

Results: In the group of dengue fever patients with comorbid hypertension, diabetes mellitus, CVD, and CLD, there is a higher risk of developing DHF than patients with comorbid COPD, CKD, Stroke, HIV.

Conclusion: Dengue fever with hypertension, diabetes mellitus, CVD, and CLD have a higher risk of developing DHF when compared with patients with dengue fever with other comorbidities. This finding helps us in triaging patients with comorbidities who develop dengue fever for specialized care and closer clinical monitoring.

An observational study on global longitudinal strain in acute coronary syndrome and its correlation with coronary angiogram

A. Raghupathi — 2024-12-10

Background: Coronary angiography (CA) is crucial for diagnosing acute coronary syndrome (ACS) and assessing coronary artery disease (CAD), enabling healthcare providers to determine treatment options and assess the risk of cardiovascular events. Global longitudinal strain (GLS) is a sensitive marker of cardiac function. This study aimed to determine the correlation between GLS in ACS and CA findings.

Methods: This prospective observational study was conducted at the cardiology department of the Salem government medical college. The study involved transthoracic echocardiography (TTE) to assess LV volumes, ejection fraction (EF), and LVGLS and strain analysis using 2D echocardiography to measure regional longitudinal peak systolic strain in different LV segments. CA was performed to visualise the coronary vessels and detect significant CAD.

Results: The study population consisted predominantly of male patients (n=93, 62%), with notable smoking (n=48, 32%) and alcohol consumption (n=36, 24%). A significant majority of the patients (n=111, 74%) exhibited ECG abnormalities. Obstruction was present in 82% of the patients (n=123), with those showing impaired myocardial function compared to those without obstruction. GLS values below 13.95 were more common in patients with obstruction (n=8 out of 11), indicating reduced myocardial deformation. The GLS demonstrated excellent diagnostic performance for detecting significant coronary artery obstruction, with a high sensitivity of 88.89%, specificity of 90.63%, and overall accuracy of 90.24%.

Conclusions: Our study revealed a strong correlation between reduced GLS and CAD, highlighting its importance in CAD assessment and risk stratification in ACS. GLS demonstrated excellent diagnostic performance for detecting significant CAD, showing high sensitivity and specificity.

Study of factors affecting sarcopenia in PLHIV

Ravi K. — 2024-12-23

Background: This study aims to determine the frequency of sarcopenia in PLHIV and determine the factors affecting sarcopenia in PLHIV.

Methods: The patients fulfilling the inclusion criteria were enrolled for the study after obtaining informed consent. Case record form was used to record relevant history. SARC-F (sluggishness, assistance in walking, rising from a chair, climbing stairs, falls) score is recorded by questionnaire. Hand grip strength and skeletal muscle mass index (SMI) were recorded. The correlation between grip strength and SMI with the duration of treatment in different regimens of HAART in PLHIV were studied. Possible factors affecting sarcopenia were determined based on history taken. All the parameters were compared between patients with and without sarcopenia. P value <0.05 was considered statistically significant. R version 4.1.2 statistical software was used for the statistical analysis.

Results: Sarcopenia was more commonly found in middle aged participants, who were less adherent to therapy, had a past history of tuberculosis, consumed alcohol, followed a vegetarian diet and did not exercise regularly.

Conclusion: Sarcopenia is more common in middle-aged individuals with long-term AIDS, especially those on prolonged ART. It’s linked to non-adherence to ART, alcohol consumption, history of tuberculosis, and reduced physical activity. Strict adherence to ART, avoiding alcohol, increasing protein intake, and exercising regularly helps to combat this.

Prevalence of T3 thyrotoxicosis and it’s management in new onset thyrotoxicosis patients: a prospective observational study

Shailendra Kumar Singh — 2024-12-23

Background: T3 toxicosis is a subtype of thyrotoxicosis where total triiodothyronine (TT3) level is high but total thyroxine (TT4) level is normal in presence of suppressed thyroid stimulating hormone (TSH). Accurate and rapid diagnosis is crucial in management of T3 toxicosis.

Methods: In this prospective observational study from India, newly diagnosed thyrotoxicosis patients were enrolled. T3 toxicosis patients were diagnosed based on diagnostic criteria. T3 toxicosis patients were randomized into two arms, based on dose of carbimazole (CBZ) used for treatment. All patients are following up for 12-14 weeks.

Results: Prevalence of T3 toxicosis was 8.5% in this study. 75% were diagnosed as Grave’s disease (GD) and 25% were diagnosed as toxic nodular goiter (TNG). Low dose (5 mg/day) of CBZ is safer and more effective than higher dose (20 mg/day).

Conclusion: Present study suggests that a significant number of patients with thyrotoxicosis are suffering from T3 toxicosis. So, for correct diagnosis of thyrotoxicosis one should investigate for TT3, TT4 and TSH, otherwise we can misdiagnose the T3 toxicosis as subclinical thyrotoxicosis (SCT). Majority of T3 toxicosis patients are diagnosed as GD. Low dose of CBZ is very much effective and safe in these patients. We recommend low dose of CBZ in all patients with T3 toxicosis.

A study on the prognostic value of red cell distribution width to total serum calcium ratio in acute pancreatitis and comparison with Ranson’s and BISAP score - a prospective observational study from a tertiary care center in Chennai

J. M. Judy Ancy — 2024-12-23

Background: Acute pancreatitis (AP) is a severe inflammatory condition with variable outcomes, and current scoring systems have limitations in predicting its severity. Our study aimed to determine the prognostic value of the red cell distribution width (RDW) -to-total serum calcium ratio in patients with AP.

Methods: This single-center prospective observational study included 100 patients at Madras Medical College, Rajiv Gandhi Government General Hospital between September 2023 and 2024. 16 patients with severe AP were compared to 84 mild AP cases by assessing demographics, aetiology, comorbidities, laboratory results, arterial blood gas, and RDW at 0 and 24 hours. The RDW-to-total serum calcium ratio was evaluated against the established prognostic scores within 24 h of admission.

Results: A total of 100 patients with acute pancreatitis were included in the study, of which 84 (84%) had mild AP, and 16 (16%) had severe AP. The RDW/TSC ratio demonstrated excellent predictive value for mortality, with an area under the receiver operating characteristic curve (AUROC) of 0.909, sensitivity of 95.40%, and specificity of 85.70%. This outperformed RDW at 0 hours (AUROC=0.789), bedside index of severity in acute pancreatitis (BISAP) (AUROC=0.764), and Ranson’s score (AUROC=0.711). RDW at 24 hours showed no significant predictive value (AUROC=0.529).

Conclusions: RDW and RDW 0h-to-TSC ratio are cost-effective, non-invasive markers that predict acute pancreatitis (AP) severity and mortality more effectively than Ranson and BISAP scores. An RDW 0 hours >14.15 and RDW 0 hours-to-TSC ratio >1.45 were strong predictors of AP severity.

Association of SGLT2 inhibitors and urogenital infections in patients attending a tertiary care hospital: a prospective observational study

Aleena Benoy — 2024-12-23

Background: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are known for efficacy in managing blood sugar levels in type 2 diabetes and also improving cardiovascular and renal outcomes. However, increased risk of urogenital infections (UGIs) remains a significant concern in their safety profile. This study aimed to investigate the association between SGLT2i therapy and UGIs in a real-world clinical set up of a tertiary care centre in India. The key hypothesis was SGLT2i use is associated with incidence of UGIs while the secondary hypothesis included the relationship of the incidence of risk with the dose.

Methods: This was a six-month prospective observational study, that enrolled 309 adults ≥18 years of age, who were newly prescribed SGLT2 inhibitors, particularly Dapagliflozin 5 mg and 10 mg from October 2023. The incidence of UGIs was assessed through patient interviews and medical records during the follow up from 2 weeks of initiation. UGIs were defined as clinical manifestations that resolved on SGLT2i discontinuation or appropriate treatment.

Results: Of 309 initiators, 300 patients were followed up. 9 patients didn’t follow up in OPD. From these, 58 (19.3%) patients developed UGIs, comprising of 47 (15.6%) bacterial infections and 11 (3.6%) UGIs of fungal origin. The association was performed on basis of logistic regression analysis which revealed a statistically significant association of UGIs with the prescription of SGLT2i. Higher doses of SGLT2 inhibitors was observed to be associated with significantly increasing the risk of UGIs (p<0.05). No significant risk factors such as body mass index (BMI), age, sex, HbA1c or educational status were identified to have significant associations with UGI occurrence.

Conclusions: This study highlights a clinically relevant association between SGLT2i use and urogenital infections.

Diagnostic and predictive utility of serum homocysteine in diabetic nephropathy among type 2 diabetics

Vineet Kumar — 2024-12-23

Background: Diabetic nephropathy (DN) is a leading cause of end-stage renal disease (ESRD) in patients with type 2 diabetes mellitus (T2DM). Early detection of DN is crucial for effective intervention, yet current biomarkers have limited sensitivity and specificity. Serum homocysteine, has been associated with vascular complications in diabetes and is hypothesized to be linked with DN. This study investigates the potential of elevated serum homocysteine levels as a marker for DN in T2DM patients.

Methods: A cross-sectional study was conducted involving 156 T2DM patients recruited from G. S. V. M. medical college, Kanpur. The inclusion criteria focused on adult patients with a confirmed diagnosis of T2DM. Exclusion criteria included conditions that could independently affect homocysteine levels or renal function. Statistical analyses were employed to assess the relationship between homocysteine levels and DN.

Results: The study found significantly higher homocysteine levels in patients with DN compared to those without DN. A positive correlation was observed between serum homocysteine levels and the severity of renal impairment, as indicated by a decline in glomerular filtration rate (GFR) and increased albuminuria. Logistic regression analysis confirmed that elevated serum homocysteine levels were an independent predictor of DN.

Conclusions: Elevated serum homocysteine levels are significantly associated with DN in T2DM patients and may serve as a useful biomarker for early detection and management of this complication. Given the limitations of current biomarkers, incorporating homocysteine measurements could improve the clinical management of patients at risk for DN.

Study of serum uric acid level in chronic liver disease and its association with Child-Turcotte-Pugh and model for end-stage liver disease score

Atul Gupta — 2024-12-23

Background: Chronic liver disease (CLD) involves progressive hepatic injury, inflammation, and fibrosis, potentially leading to cirrhosis, liver failure, and increased mortality. Despite advancements, CLD remains a significant clinical challenge due to its varied nature and course. Serum uric acid (SUA), a by-product of purine metabolism, is emerging as a potential marker for CLD progression and prognosis. This study investigates the correlation between SUA levels and CLD severity, assessed by Child-Turcotte-Pugh (CTP) and model for end-stage liver disease (MELD) scores.

Methods: This cross-sectional study at GSVM medical college, Kanpur, included 54 CLD patients over 18 years. Exclusions were pregnancy, known gout, diabetes mellitus, recent surgery/trauma, chronic kidney disease, hypothyroidism, specific medications, and malignancies on chemotherapy. Data were collected via interviews, medical records, and lab tests (SUA, liver function). Liver disease severity was assessed using CTP and MELD scores. Statistical analyses examined relationships between SUA levels, CTP and MELD scores.

Results: SUA exhibit a positive correlation with the CTP score (r=0.51, p<0.05). Mean SUA levels were 4.20±0.45 mg/dL for CTP A, 6.46±2.18 mg/dl for CTP B, and 8.83±2.55 mg/dl for CTP C. An ANOVA test showed a significant association (F value: 11.78, p<0.05). A significant positive correlation was found between MELD scores and SUA levels (r=0.438, p<0.05).

Conclusions: The significant associations between SUA levels and CTP and MELD scores indicate that SUA could be a valuable biomarker in managing CLD. Incorporating SUA measurements may enhance prognostic accuracy and support personalized treatments. Further research is needed to validate these findings across diverse populations and clinical settings, potentially identifying new therapeutic targets.

Comparative analysis of ligation of intersphincteric fistula tract and fistulectomy for complex fistula-in-ano: a prospective observational study

Balaji Elancheliyan — 2024-12-23

Background: Fistula-in-ano is a debilitating condition that poses significant treatment challenges, particularly in complex cases. Ligation of intersphincteric fistula tract (LIFT) and fistulectomy are two common procedures used for management, with differing outcomes in recurrence, pain, and morbidity. This study aimed to compare these two methods in a resource-limited setting.

Methods: This prospective observational study was conducted at Shri Sathya Sai Medical College and Research Institute from July 2023 to July 2024 – six months of study and six months of follow up period. Sixty patients diagnosed with complex fistula-in-ano were randomly assigned to either the LIFT or fistulectomy group. Postoperative outcomes, including recurrence rates, pain (using the visual analogue scale), bleeding, and incontinence (Browning and Park’s scale), were recorded and analyzed using statistical package for the social sciences (SPSS) version 22.0 software.

Results: The recurrence rate was significantly lower in the LIFT group (10%) compared to the fistulectomy group (37%, p=0.0069). LIFT patients experienced less postoperative pain (mean VAS score: 3.5±1.2) compared to fistulectomy (mean VAS score: 5.2±1.5, p=0.0082). Bleeding rates and incontinence showed no significant differences between the groups.

Conclusions: LIFT is a superior technique for managing complex fistula-in-ano due to lower recurrence rates and reduced postoperative pain. This sphincter-preserving method is particularly advantageous in resource-limited settings.

Evaluation of heparin binding protein as a prognostic biomarker for diagnosis of sepsis at tertiary care hospital, North India

Ashish K. Gupta — 2024-12-23

Background: Sepsis is a critical condition characterized by systemic inflammation in response to infection, often leading to organ dysfunction and mortality. Heparin-binding protein (HBP) has emerged as a potential biomarker for early sepsis detection due to its rapid release and association with inflammatory processes. This study aimed to evaluate HBP as a prognostic biomarker for diagnosing sepsis, assessing its correlation with demographic characteristics, infection status, organ dysfunction, and biochemical parameters.

Methods: A prospective analytical study was conducted at G.S.V.M. Medical College, Kanpur, from December 2022 to May 2024, involving 113 patients over 18 years old suspected of sepsis. Clinical data, including demographics, infection status, organ dysfunction, and HBP levels, were collected and analyzed using statistical methods.

Results: The study cohort exhibited a mean age of 53.2±19.3 years, with balanced gender representation (49.6% male, 50.4% female) and varied infection statuses (47.8% confirmed infections, 17.7% probable, and 9.7% viral). Organ dysfunction prevalence increased from 30.1% on admission to 43.4% within 72 hours. HBP levels decreased significantly from baseline (11.28 ng/ml) to 72 hours (5.68 ng/ml), showing potential for monitoring disease progression. Significant differences in baseline HBP levels among patient groups were observed (p≤0.001).

Conclusions: The study concludes that HBP is a promising biomarker for distinguishing infection statuses, aiding in sepsis diagnosis, with significant differences observed in HBP levels across diagnostic categories, enhancing early detection and targeted treatment.

A comparative study of albumin bilirubin score, with meld for predicting the in-hospital mortality in cirrhotic patients complicated with upper gastrointestinal bleeding in a tertiary care hospital

Parmendra Kumar Prajapati — 2024-12-23

Background: Chronic liver disease (CLD) encompasses a spectrum of injury from simple steatosis to frank cirrhosis which is evaluated by many scoring systems. Aim of the study was to evaluate the discriminative abilities of model for end-stage liver disease (MELD) score and albumin-bilirubin (ALBI) score in predicting the in-hospital mortality in cirrhotic patients complicated with upper gastrointestinal bleeding.

Methods: Data of patients with liver cirrhosis secondary to ethanol, hepatitis B and hepatitis C and cryptogenic liver cirrhosis, with upper gastrointestinal bleed was prospectively reviewed from admission to date of discharge. MELD and ALBI score, calculated for the patient from ROC curves were analysed.

Results: Our study was conducted on 149 patients. Age distribution was between 18-80 years with mean age of patients being 44.7±12.37 years, male to female sex ratio 127:22, with mortality calculated at 23.5%. The MELD score demonstrated a high predictive accuracy with an area under ROC curve of 0.953, with a 95% confidence interval ranging from 0.903 to 1.000. In contrast, ALBI score showed a lower predictive accuracy with an area under the ROC curve (AUROC) of 0.672 and 95% confidence interval ranging from 0.577 to 0.766.

Conclusions: The prognostic performance of two scores was comparable but MELD score was found to have a better prognostic significance than ALBI score.

Expert consensus on the multifaceted utility of alginates in addressing diverse manifestations of acid reflux

K. R. Palaniswamy — 2024-11-16

Gastroesophageal reflux disease (GERD) is one of the most frequent reasons for seeking outpatient gastroenterology consultations. Current professional guidelines advocate the use of proton pump inhibitors (PPIs) as the primary medical approach to manage GERD. However, PPIs may not be as effective, especially for certain patients like those with non-erosive reflux disease (NERD). An alternative strategy for addressing symptomatic GERD involves obstructing the flow of acidic refluxate. Alginate-based pharmaceutical formulations have proven effective in alleviating symptoms of acid reflux for many years and provide rapid relief of symptoms with a long duration of action. Alginic acid derivatives, or alginates, combat acid reflux through a unique mechanism: they create a physical barrier that displaces the post-prandial acid pocket. Alginates have recently garnered renewed interest for promoting symptomatic relief especially when employed alongside antacids or PPIs. Here, the role of alginates is reviewed in the treatment of various profiles of acid reflux, including post-prandial acid reflux, nocturnal GERD, refractory GERD, and GERD during pregnancy, along with the opinion of expert gastroenterologists on the same. The experts believed that not all alginate formulations are equivalent and raft strength is the most important physicochemical property to be considered while selecting the alginate-based product. The physicochemical properties of the rafts eventually impact their effectiveness in relieving symptoms in clinical settings.

Visceral hypersensitivity and diagnostic markers in functional gastrointestinal disorders: expert opinion

Puneet Mehrotra — 2024-12-23

Functional gastrointestinal disorders (FGIDs), including irritable bowel syndrome (IBS), present diagnostic challenges due to the absence of specific biomarkers and reliance on symptom-based criteria like the Rome IV classification. IBS, characterized by abdominal discomfort, irregular bowel habits and bloating, affects up to 21% of populations globally, with varying prevalence across regions. Visceral hypersensitivity (VH) is a hallmark of IBS, particularly in diarrhea-predominant IBS (IBS-D), contributing to enhanced pain perception and gut dysmotility. VH involves complex mechanisms integrating peripheral and central nervous system pathways, affecting pain processing and emotional responses. Diagnostic approaches for IBS are hindered by overlapping symptoms with other gastrointestinal disorders and the dynamic nature of gut microbiota. Biomarkers, such as serum and fecal panels, gene expression profiles and psychological assessments, aim to enhance diagnostic accuracy and differentiate IBS subtypes. These biomarkers, including fecal calprotectin, short-chain fatty acids (SCFA), volatile organic compounds (VOCs) in breath tests and specific antibodies against microbial toxins, offer insights into the pathophysiology of IBS and aid in subtype prediction. Considering the scarcity of information on intricacies of VH in IBS and need gap in understanding the precise diagnostic markers for IBS, three physical focus group meetings were conducted with 25 expert gastroenterologists across India. Existing evidence and clinical experience with respect to the diagnosis of IBS, concept of visceral hypersensitivity and its importance in managing IBS, current treatment modalities and the role of various diagnostic biomarkers were discussed in detail by the experts and expert opinions were consolidated and finalized after approval by all participants.

Seamless innovations: exploring the latest advancements in sutures

Sunil Kumar Venkatappa — 2024-12-23

In the realm of surgical medicine, sutures play a pivotal role in the closure of wounds and incisions, serving as a cornerstone technique for promoting efficient healing and minimizing infection risk. The art of suturing demands a surgeon's deft touch and precision, ensuring the seamless union of tissue edges while striving to mitigate the formation of conspicuous scars. Over the years, the landscape of sutures has evolved significantly, witnessing the advent of novel methodologies aimed at enhancing both the efficacy and efficiency of wound closure. This review article delves into these pioneering advancements in sutures that have emerged, ushering in a new era of medical innovation. Among these advancements, modified antimicrobial sutures have emerged as a promising development, arming threads with properties to combat infections at the site of wound closure. Drug-eluting sutures represent another remarkable breakthrough, where medications can be released gradually, offering therapeutic benefits during the healing process. Stem cell-seeded sutures have taken regenerative medicine to a new level, promoting tissue regeneration, and accelerating recovery. In the age of cutting-edge technology, "smart sutures" have become a reality, equipped with sensors and integrated electronics to monitor wound healing in real-time, providing crucial data to healthcare professionals. Surgical zippers offer a unique approach to wound closure, simplifying the process and reducing operating time. Collectively, these novel advancements in sutures demonstrates a remarkable capacity to reduce the incidence of infections, expedite the healing process, and enhance patient outcomes. Moreover, they hold the promise of revolutionizing the field of surgery by rendering procedures less invasive and more effective. However, it is important to note that each suture has its own set of advantages and disadvantages, and the selection of the most suitable suture will be contingent on factors such as the nature and location of the wound, as well as the surgeon's preferences and expertise. As we stand on the precipice of medical innovation, these new sutures underscore the ongoing quest to refine surgical practices and improve patient care, illuminating a path towards a brighter and more advanced future in the field of surgery.