International Journal of Advances in Medicine

Management of intractable ascites in cirrhosis: a review article

I. Dewa Ayu Made Dian Lestari, Ketut Suryana — Tue, 23 Dec 2025 00:00:00 +0530

Intractable ascites (IA) also referred to as refractory ascites, is a severe complication of cirrhosis marked by resistance to standard diuretic therapy. Its occurrence reflects advanced portal hypertension and is associated with poor prognosis. This literature review summarizes current evidence and management strategies for IA in cirrhotic patients. Sodium restriction remains a core component of management, even in diuretic-resistant cases. Large-volume paracentesis (LVP) with albumin infusion is considered first-line therapy, though it carries the risk of post-paracentesis circulatory dysfunction. Long-term albumin administration shows potential benefits but requires further confirmation. In selected patients, transjugular intrahepatic portosystemic shunt (TIPS) offers sustained ascites control. For non-TIPS candidates, the alfapump system provides continuous ascites drainage, improving appetite, mobility, and quality of life, though long-term antibiotic prophylaxis is required to prevent device-related infection. Liver transplantation remains the only curative option, and combined liver–kidney transplantation should be considered in patients with concurrent chronic kidney disease. Management of IA in cirrhosis requires a multidisciplinary approach. While LVP and TIPS remain the therapeutic mainstays, emerging strategies such as long-term albumin therapy and alfapump devices are promising. Given its poor prognosis, timely evaluation for liver transplantation is crucial.

Gut dysbiosis and multiple sclerosis

V. Padma, Gouri Gaur, Shobana S. — Wed, 26 Nov 2025 00:00:00 +0530

Multiple sclerosis (MS) is a chronic, immune-mediated disorder of the central nervous system marked by multifocal demyelination, neuroinflammation, and progressive neurodegeneration. Globally, it affects about 2.9 million people, creating significant personal, social, and economic burdens. In India, approximately 100,000 to 150,000 individuals live with MS, with prevalence estimates ranging from 8-11 per 100,000 population, and an estimated 6,500 new diagnoses annually. MS imposes a heavy healthcare burden: early diagnosis is often delayed due to low awareness, limited access to neurologists, and inconsistent diagnostic protocols leading to prolonged hospital stay, longer duration of clinically undiagnosed disease and worse overall outcomes. In India, clinical management of MS faces a multitude of challenges in the form of inadequacies in diagnostic ability arising due to lack of advanced training, medical supplies, diagnostic tools and lack of trained neurologists per capita. Additionally, drugs used to manage MS are often expensive and require longer durations of therapy and frequent adjustments on follow up, leading to financial exhaustion for the patient, and subsequently adding to their inaccessibility. In recent years, there has been evidence suggesting a correlation of altered composition of gut commensals with CNS autoimmune diseases like MS. This association opens new avenues for understanding, diagnosing and managing such diseases beyond conventional neurotropic therapy. Any deviation from normal in the gut flora can trigger oxidative damage, that promotes mitochondrial dysfunction, and sets in motion cascades of inflammation via the gut brain axis that eventually led to demyelination and degeneration. Also, various humoral, endocrine and immune connections exist between the gut and brain, that influence release of neurotransmitters, peptides and cytokines that further serve to modify CNS function. This review aims to consolidate evidence that corroborates the link between gut dysbiosis and MS.

Systemic lupus erythematosus in a 20-year-old woman: a case report

Ayu S. Manikasari, I. Gusti Ayu Wiradari Tedja, Made A. V. Prianggandanni — Tue, 23 Dec 2025 00:00:00 +0530

Systemic lupus erythematosus (SLE) is a complex autoimmune disease affecting multiple organ systems. It predominantly occurs in women of reproductive age, with a global prevalence ranging from approximately 20 to 150 cases per 100,000 individuals. The diagnosis of SLE can be supported by antinuclear antibody (ANA) testing, which includes an initial screening with immunofluorescence ANA (ANA-IF), followed by an ANA profile to identify specific autoantibodies. A 20-year-old female presented with complaints of easy fatigue, fever, joint pain, and hair loss. Laboratory investigations revealed anemia. Immunological testing demonstrated a positive ANA-IF result with a titer of 1:1000 and a delicate speckled pattern, meeting the EULAR/ACR criteria that consider a positive ANA-IF titer ≥1:80. Based on these clinical and laboratory findings, the patient was diagnosed with SLE and commenced on corticosteroid therapy. Subsequent follow-up showed clinical improvement. This case highlights the importance of careful interpretation of ANA-IF titers and patterns for the early detection of SLE. Additionally, specific autoantibody profiling remains essential to support a more precise diagnosis.

Subarachnoid anaesthesia for emergency caesarean section in a parturient with thyroid storm: a case report

Azubuike O. Nwaneri, Alfred T. Aggo — Tue, 23 Dec 2025 00:00:00 +0530

A 35-year-old multiparous woman, at 36 weeks of singleton gestation with a history of poorly controlled hyperthyroidism, presented in obstructed labour and thyroid storm (Burch-Wartofsky score: 50); she was anxious, agitated, pyrexic, tachycardic, hypertensive, with pedal oedema, atrial fibrillation and bearing live foetus. Following intravenous hydrocortisone and oral digoxin, while on Oxygen supplementation, she had an emergency Caesarean section under subarachnoid block, plus titrations of intravenous labetalol and propofol. Intraoperatively, her haemodynamic parameters remained stable and a live foetus was extracted with APGAR scores of 5 and 7 at 1 and 5 minutes of birth, respectively. Postoperatively, she received multidisciplinary management in the intensive care unit (ICU) culminating in her recovery and discharge. This report highlights the anaesthetic challenges and the critical significance of judicious subarachnoid anaesthetic technique, in the management of a patient with the combination of thyroid storm and obstructed labour in poor-resourced setting.

Ineffective red blood cell transfusion in a case of macrocytic normochromic anemia: what is the cause?

Dewa A. T. Jayaningrat, Ketut Suryana — Tue, 23 Dec 2025 00:00:00 +0530

Blood transfusion is an essential medical procedure used to replace blood loss due to bleeding or to increase red blood cell count in patients with certain conditions such as anemia. The effectiveness of a transfusion is generally assessed by an increase in hemoglobin levels 1 g/dl each packed of red blood cell and clinical improvement following transfusion. Transfusions are typically administered when hemoglobin levels fall below 7 g/dl in stable patients, or below 8 g/dl in those with cardiovascular disease. Ineffectivenes of tranfusion may be caused by many factors, the common cause that the anemia may be associated with hemolysis. However, not all such cases are attributable to hemolytic anemia hemolytic. That can be caused by active bleeding, poor blood component quality, massive transfusion, underlying clinical conditions such as hypersplenism and chronic kidney disease can also cause transfusion failure. We explore the possible causes that may affect the effectiveness of blood transfusion.

Pancreatic adenocarcinoma presenting as biliary sepsis in a young female: a case report highlighting diagnostic challenges and management strategies

Krishn Kant Bhardwaj, Pradeep Kumar Moolchandani, Saurabh Saigal — Tue, 23 Dec 2025 00:00:00 +0530

Pancreatic malignancy is typically associated with advanced age, with the highest incidence occurring globally in the 6^th to 7^th decade of life and a higher prevalence in men than women. We present a case of pancreatic adenocarcinoma in a 19-year-old female who presented with obstructive jaundice complicated by biliary sepsis, septic shock, and severe acute respiratory distress syndrome (ARDS). Management involved initiating broad-spectrum antibiotics and performing percutaneous transhepatic biliary drainage (PTBD) for source control. With gradual improvement, she was weaned off vasopressor and ventilator support and subsequently extubated. Magnetic resonance cholangiopancreatography (MRCP) revealed an ulcer proliferative growth, prompting endoscopic retrograde cholangiopancreatography (ERCP) with biopsy, which confirmed moderately differentiated adenocarcinoma of the pancreas. Pancreatic cancer, particularly ductal carcinomas, are rare in younger individuals, often leading to underappreciation of their clinical features and treatment among physicians. This case emphasizes the importance of considering malignancy in young patients presenting with pancreatic biliary sepsis. High suspicion warrants MRCP, and if malignancy is suspected, ERCP with histopathology should be performed for early diagnosis and intervention to impede disease progression.

Gentamicin graded challenge as an alternative therapy for cellulitis pedis in a patient with history of multiple drug allergies

I. G. Wahyu M. Pinatih, Ketut Suryana, Dewi C. Wulandari — Tue, 23 Dec 2025 00:00:00 +0530

Cellulitis pedis is a complication of diabetic neuropathy affecting the foot and most commonly caused by Staphylococcus aureus and Streptococcus pyogenes. A 55-year-old female patient presented with swelling and redness of the left foot that had persisted for one week. She had a history of type 2 diabetes mellitus and multiple drug allergies, including levofloxacin and cefadroxil. These comorbidities posed challenges in selecting an appropriate and safe antibiotic choice. Intravenous gentamicin was chosen as an alternative therapy in this case. A dose of 80 mg was administered using a graded challenge method to minimize the risk of severe hypersensitivity reaction.

From teratoma to sarcoma: unveiling a rare somatic transformation in a mediastinal germ cell tumor

Tue, 23 Dec 2025 00:00:00 +0530

Germ cell tumors (GCTs) are neoplasms primarily arising from gonadal tissues, occasionally occurring in extra gonadal sites. Though generally responsive to chemotherapy, a rare complication is the development of somatic malignancy within the tumor, such as sarcomas or carcinomas, leading to poorer prognosis and complex management. They are driven by genetic/epigenetic changes and dedifferentiation of pluripotent cells. Here we present a rare case of 31-year-old male with malignant peripheral nerve sheath tumor (MPNST) subtype of somatic-type malignancy within a mediastinal GCT.

Prevalence of microalbuminuria in patients with essential hypertension and its correlation with retinopathy and carotid artery intimal-medial wall thickness

Aditya K. Singh, Shri K. Gautam, Richa Giri — Tue, 23 Dec 2025 00:00:00 +0530

Background: Hypertension affects wide range of organs, eventually resulting in events like heart failure, chronic kidney disease, stroke and blindness. However, there are only subtle changes present initially, like microalbuminuria (MA), elevated CCIMT and retinopathy, in patients with uncontrolled hypertension. Patients with microalbuminuria are postulated to have significantly high risk of TOD and this study aims to explore this association. The primary objective of this study was to explore prevalence of MA in patients of essential hypertension and ascertain its correlation with elevated CCIMT and retinopathy.

Methods: A cross-sectional study was done on 250 patients of essential hypertension, designated as per JNC8 guidelines. Patients of diabetes (Type I/II), thyroid disorders, CKD, UTI, obesity (BMI>30 kg/m²), cataract and those with history of stroke, were excluded from this study. A statistical analysis was performed and relationship between microalbuminuria and TOD evaluated.

Results: Significant prevalence of TOD was seen, namely, microalbuminuria in 44.8%, retinopathy in 56.8% and elevated CCIMT in 35.6% patients. Significant association could also be appreciated in hypertensive patients with microalbuminuria when compared to those without, with respect to the presence of other TOD, specifically, retinopathy (OR 6.21, 95% CI, p-value<0.001) and elevated CCIMT (OR 26.5 95% CI, p value<0.001).

Conclusions: Given the high prevalence and significant association, it was concluded that microalbuminuria could function as a great tool to identify possibility of other on-going target organ damage and initiate timely treatment, to prevent the occurrence of catastrophic events in the future.

LiberatePro™ for cervical cancer literacy in Kenya: a real-world insight

Tue, 23 Dec 2025 00:00:00 +0530

Background: Cervical cancer remains a leading cause of cancer-related mortality among women in Kenya. Although largely preventable through early detection, national screening coverage remains low largely due to inadequate awareness, stigma and limited access to tailored health education. The aim of the program was to evaluate the effectiveness of LiberatePro™, a culturally adaptable digital education platform, in improving knowledge, confidence and behavioral intent regarding cervical cancer among Kenyan patients.

Methods: The intervention was implemented across 10 hospitals involving over 200 trained healthcare workers. Participants received condition-specific educational material via secure weblinks sent to them through SMS and email, eliminating the need for any app downloads. A post-intervention survey assessed understanding, ease of content access, value perception, likelihood of behavioral adherence and overall satisfaction.

Results: Following the intervention, 94% of participants reported improved understanding of their condition, with 63.6% noting significant improvement. Approximately 67.2% rated the educational materials as very valuable and 84% indicated they were likely to follow health recommendations. Confidence in managing one’s condition rose to 95% and overall satisfaction reached 93%. Most users found the platform easy to access (68.5%) and the content simple to understand (85.7%).

Conclusions: LiberatePro™ demonstrated strong feasibility, acceptability and user engagement. By delivering culturally relevant information without technological friction, the intervention addressed key educational gaps in cervical cancer awareness. These findings support the role of digital health tools in enhancing screening uptake and preventive behavior, although long-term studies are required to measure sustained impact on health outcomes.

Effect of charcoal supplementation on the accuracy of direct antimicrobial susceptibility testing from blood cultures for key Gram-negative bacilli: an in vitro evaluation

Tue, 23 Dec 2025 00:00:00 +0530

Background: Gram negative bacilli such as Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa are major causes of bloodstream infection and are associated with high mortality rates in critical care settings. Rapid antimicrobial susceptibility testing (AST) directly from positive blood cultures can reduce diagnostic turnaround time and improve patient management. To evaluate the in vitro performance of direct antimicrobial susceptibility testing from blood culture systems, with and without charcoal supplementation, for Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa.

Methods: In this study, using clinical isolates from various blood culture systems, Brain Heart Infusion broth (BHI), BHI with charcoal (BHI-C), Tryptic Soy Broth (TSB) and TSB with charcoal (TSB-C). DST was performed directly on the positive broth samples using disk diffusion, and the results from each medium type were compared.

Result: Charcoal supplementation significantly increased mean zone diameters for most antibiotics across all organism. TSB-C demonstrated consistently higher susceptibility reading compared to other media.

Conclusion: Direct AST using TSB supplemented with charcoal enhances susceptibility accuracy and could be adopted in laboratories lacking automated AST systems for rapid bloodstream infection management.

Association of lipid accumulation product index and conicity index in predicting systolic and diastolic blood pressures in hypertensive patients: a hospital based study

Deepti Deepshikha, Shivraj Meena — Tue, 23 Dec 2025 00:00:00 +0530

Background: An epidemiological association between adiposity and hypertension has been well established. However, not all obese individuals develop hypertension, possibly due to variations in fat distribution. The present study aimed to evaluate the relationship of the lipid accumulation product (LAP) index with systolic and diastolic blood pressures in newly diagnosed hypertensive patients. Visceral fat accumulation is known to influence mean blood pressure levels, and indices like LAP and conicity index (CI) may serve as better indicators of central adiposity compared to body mass index (BMI) and waist circumference (WC).

Methods: This observational cross-sectional study included 40 Indian patients attending the medicine OPD of a tertiary care centre in North India between July 19 and September 19, 2019. Blood pressure, WC, and serum triglyceride levels were measured, and LAP and Conicity indices were calculated. Correlations between these parameters were analysed statistically.

Results: Among the participants, 62.5% were females and 37.5% males, with a mean age of 50.02±8.48 years (median: 49.5 years). A strong positive correlation was found between serum triglyceride levels and LAP index (r=0.867, p<0.001) and a moderate positive correlation with CI (r=0.326, p=0.040). Pulse pressure also showed a moderate positive correlation with LAP index (r=0.341, p=0.031).

Conclusions: LAP and Conicity indices are promising, simple, and effective measures of visceral adiposity and may help in predicting hypertension risk and guiding clinical assessment.