International Journal of Advances in Medicine

Insulin resistance dealt with homoeopathy

Tue, 27 Aug 2024 00:00:00 +0530

One of the intricacies of diabetes is to understand the phenomenon of insulin resistance (IR). The phenomenon of IR applies to all types of diabetes. IR is a condition where the body’s cells stop responding to the glucose control hormone. In the current article, the lead author focuses on the IR related intricacies of diabetes and the role of homoeopathy in all the 4 types of diabetes. The first three types ate type 1, type 2 and type 3 the 4^th type is maturity onset of diabetes in the young (MODY). The IR phenomenon cuts across among all sections of population including the working group and that’s why the discussion of IR is related to the growing economy as it puts burden on the economy. The article discusses the epidemiology, patho-physiology, prevention, control and treatment of IR especially at the global and national level. Thereafter, it discusses the integration of homoeopathy in to the IR domain. The properties of homoeopathy regarding the essential medicine (EM) in the national list of EM (NLEM) and the national list of essential AYUSH medicines (NLEAM) are also dealt upon. A suggested treatment protocol based on homoeopathic therapeutics is given at the end of the article after focusing on the burden of IR at national level through data from large scale surveys. In that section, the benefits that are to be accrued as a result of homoeopathic integration is also touched upon.

The impact of exercise on mental health: a narrative review

Archana Priyadarsini — Tue, 27 Aug 2024 00:00:00 +0530

It has become increasingly clear that exercise not only improves physical health but also significantly affects mental well-being, presenting a non-pharmaceutical approach to manage various psychological conditions. This narrative review summarizes studies from the literature to understand the effects of exercise on mental health, particularly in depression, anxiety, and global psychological well-being. Results indicate that regular physical activity, including aerobic and resistance exercises, reduces depression and anxiety symptoms, improves mood, and enhances cognitive abilities. Theoretical models, such as the endorphin hypothesis and neurogenesis hypothesis, explain these benefits through mechanisms including endorphin release, reduced stress hormones, improved sleep, and neurogenesis. Evidence suggests that structured exercise programs can match the effectiveness of psychotherapy or medication with fewer adverse effects. The benefits of regular exercise have garnered attention from professionals, physicians, and policymakers, highlighting the necessity of incorporating exercise plans into mental health clinical practice. Additionally, this review advocates for more specific and personalized exercise interventions tailored to individual characteristics and preferences. It also aims to inform health and research agendas by specifying the optimal exercise type and intensity for eliciting desired benefits, and evaluating the potential for exercise interventions to sustain long-term psychological well-being.

Impact of gender on outcome of adult cardiac surgery

Tue, 16 Jul 2024 00:00:00 +0530

Background: Objective of the study was to identify differences in preoperative, intraoperative, and postoperative parameters between female and male cardiac surgical patients.

Methods: This is a prospective observational analysis of adult cardiac surgical patients presenting for cardiac surgery at Queen Alia Heart Institute in the period between September 2023 and January 2024. Patients’ demographics, type of surgery (cardiac pathology), comorbidities, and perioperative, parameters were recorded and analysed. Males and females were compared according to their age at time of surgery, operative time, intensive care unit (ICU) stay, hospitalisation time and mortality. Male and female patients undergoing coronary surgery were compared.

Results: Data from 166 adult cardiac surgical patients was analysed. They constituted 135 males and 31 females. Male to female ratio was 4.4:1. When considering all types of cardiac surgery, female patients had longer duration of hospitalisation (13.1 days) than males (11.5 days). Moreover, mortality was higher in the female subpopulation (12.9%) than the male subpopulation (8.1%). Only 14% of coronary artery bypass grafting (CABG) patients were females and they had higher in-hospital mortality (20%) versus 7.4% in males.

Conclusions: Female patients present for CABG less commonly than males and at more advanced age. Mortality rates are higher in females and hospitalisation time is longer.

Assessment of measurable residual disease after induction chemotherapy in acute lymphoblastic leukemia patients in a tertiary care hospital

Tue, 27 Aug 2024 00:00:00 +0530

Background: Measurable residual disease (MRD) is a crucial prognostic factor in acute lymphoblastic leukemia (ALL), influencing treatment outcomes and long-term survival. This study investigates the prevalence of MRD post-induction chemotherapy and its association with clinical, demographic, and biochemical markers in ALL patients at a tertiary care hospital.

Methods: This observational cross-sectional study was conducted at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, from August 2021 to July 2022. A total of 22 newly diagnosed ALL patients underwent induction chemotherapy and MRD evaluation using flow cytometry. Clinical signs, demographic data, and laboratory findings, including serum creatinine, uric acid, and BCR-ABL1 status, were recorded. Statistical analyses assessed the relationships between MRD status and various predictors.

Results: Of the 22 patients, 7 (31.82%) remained MRD positive after induction chemotherapy. Anaemia was prevalent, affecting 20 participants (90.91%). MRD positive patients had higher serum creatinine (mean 1.23±0.31 mg/dl) and uric acid levels (mean 7.09±1.62 mg/dl) compared to MRD negative patients. None of the MRD positive patients tested positive for BCR-ABL1. Six of the 7 MRD positive patients were male (85.71%). Bone marrow analysis showed 5 MRD positive patients (71.43%) achieved complete remission. Risk stratification did not significantly correlate with MRD status.

Conclusions: MRD is a critical prognostic tool in ALL management, correlating with higher biochemical markers of tumor burden and a distinct clinical profile. These findings support integrating MRD assessment with detailed clinical and laboratory evaluations to refine treatment strategies and improve patient outcomes in ALL.

Clinical characteristics of COVID-19 patients at Bali Mandara hospital

Putu Satyakumara Upadhana, Putu Gede Surya Wibawa — Tue, 27 Aug 2024 00:00:00 +0530

Background: Coronavirus disease 2019 (COVID-19) is an infectious disease that has spread in various parts of the world, including Bali, Indonesia. This study aims to identify the clinical characteristics of COVID-19 patients at Bali Mandara hospital.

Methods: This research is a descriptive observational study with a cross-sectional approach. This research uses secondary data from medical records at Bali Mandara hospital. The sample in this study was all COVID-19 patients treated at Bali Mandara hospital in the period January 2022-August 2023.

Results: There were 59 patients in this study. Most were female (n=37;62.70%) and aged >61 years (n=29; 49.20%) with a median age of 60 years. The median white blood cells and neutrophils to lymphocytes ratio (NLR) in patients were 7.20×10³/uL and 4.40, respectively. The type of comorbidity most frequently found in patients was hypertension (n=23; 39.00%), followed by kidney disease (n=17; 28.80%) and type 2 diabetes mellitus (n=11;18.60%). Most patients had a hospital stay of >6 days (n=40; 67.80%) with a median of 6 days. The prevalence of death in patients was 15.30%. A total of 15 patients suffered from severe COVID-19.

Conclusions: Most of the patients were female and aged >61 years. The most common comorbidity found in patients is hypertension. Most patients had a hospital stay of >6 days.

Awareness and knowledge of glaucoma among the patients attending a tertiary eye hospital with and without glaucoma diagnosis

Habiba, Khairul Islam, M. Sajidul Huq — Tue, 27 Aug 2024 00:00:00 +0530

Background: Glaucoma, a leading cause of irreversible blindness, remains under-recognized in many regions, including Bangladesh. This study aimed to assess the awareness and knowledge of glaucoma among the patients attending a tertiary eye hospital with and without glaucoma diagnosis.

Methods: This cross-sectional study was conducted on 300 individuals attending deep eye care foundation, Rangpur, from April 2023 to September 2023. Informed consent was obtained from eligible participants over 18 years. The questionnaire, available in both English and Bengali, collected demographic data and included questions on glaucoma awareness and knowledge. Data were analysed using SPSS 25, and the chi-square test was applied to determine statistical significance.

Results: Among the participants, 34.7% had heard of glaucoma, with doctors/hospitals being the primary source of information. Awareness varied significantly based on age, residency, education, occupation, and income levels. Among those aware of glaucoma, 59.6% had poor knowledge, 33.7% had average knowledge, and only 6.7% had good knowledge. No significant association was found between glaucoma patients and non-glaucoma patients regarding knowledge level.

Conclusions: This study revealed a substantial gap in glaucoma awareness and knowledge in Bangladesh. While a notable portion of the population had heard of glaucoma, their understanding of the condition was limited, emphasizing the need for targeted awareness campaigns and improved access to eye care services. Addressing these gaps is crucial for early diagnosis, treatment, and preventing irreversible blindness while reducing the economic burden associated with glaucoma-related healthcare costs.

Correlations between level of vitamin D serum and disease severity COVID-19

I. Gede Ketut Sajinadiyasa, Ketut Suega, Nova Andari K. — Tue, 27 Aug 2024 00:00:00 +0530

Background: Corona virus disease (COVID-19) Was a respiratory disease. Severity of the disease was related to inflammation process. SCAP scoring system can be used to asses COVID-19 severity. Asses the severity of the disease is an important thing to determine the management. Vitamin D is shown to have anti-inflammatory effect. Vitamin D can downregulate cytokines storm and also induce innate immune activity. Here we want to know about the correlation between level of vitamin D and disease severity of COVID-19.

Methods: Cross sectional study was observed 68 patient COVID-19 in Prof. Dr. I. G. N. G Ngoerah Denpasar hospital. They were asses with SCAP scoring system dan measured their vitamin D level at the same time. The correlation between two variable was analyze by Spearman correlation.

Results: Among those 68 Sample, the median age of the sample is 64 years old, and 52.9 % of them are male. There is correlation between level of vitamin D and severity of COVID-19, the coefficient correlation was -0.47 with p<0.001.

Conclusions: There is correlation between level of vitamin D and severity of COVID-19.

The relationship between lobar distribution and primary lung cancer histological types

Tue, 27 Aug 2024 00:00:00 +0530

Background: Lung cancer is the primary cause of cancer-related deaths globally. Accurate tumor location and subtype characterization are critical for optimizing treatment and predicting outcomes. This study aims to identify the relationship between lobar distribution and primary lung cancer histological types and describe the most recent patterns at the country-level origin.

Methods: This cross-sectional study was conducted at a major tertiary care hospital in Bangladesh, including 165 patients recruited using purposive non-probability sampling. Data were collected using a semi-structured case record form and analyzed using SPSS version 28.0.

Results: Tumors were most commonly found in the central area (58.2%). Squamous cell carcinoma was the most prevalent type (46.1%), followed by adenocarcinoma (38.8%), small cell carcinoma (13.9%), and large cell carcinoma (1.2%). The incidence of squamous cell carcinoma was significantly higher in the upper lobe of the right lung (55.9%) compared to other forms, particularly in the central region of the right lung (P < 0.001). Squamous cell carcinoma was more common in the lower part of the left lung (42.9%), while adenocarcinoma was exclusively observed in the lingular portion of the left lung (100%). The major bronchus of the left lung primarily exhibited squamous cell carcinoma (60%), but this finding was not statistically significant (p=0.899).

Conclusion: The study highlights the significant association between lobar distribution and histological types of primary lung cancer, emphasizing the need for precise tumor characterization for better treatment strategies and prognostic evaluation.

Outcome of severe to critical COVID-19 patients with tocilizumab therapy

Tue, 27 Aug 2024 00:00:00 +0530

Background: The inflammatory response plays a critical role in COVID 19 and inflammatory cytokine storm increases the severity of COVID-19. Tocilizumab, an IL-6 receptor monoclonal antibody, has been used for the treatment of patients with COVID-19. This study compared the outcome of tocilizumab therapy with other standard therapy in the management of severe to critical COVID-19 patients.

Methods: This observational prospective comparative study was conducted at the COVID-19 unit of Bangabandhu Sheikh Mujib medical university (BSMMU), for one year period following approval of this protocol. A total of 60 severe to critical COVID-19 patients were enrolled in this study and categorized into two groups: Tocilizumab along with standard therapy (n=30) and another group receiving standard therapy only (n=30). After taking written informed consent, a detailed history and thorough clinical examination were carried out along with relevant investigations. After the collection of all the required data, analysis was done by SPSS 24.0.

Results: The study's predominantly male patients (mean age 53.7±11 years) had high rates of hypertension (63.3%) and diabetes (48.3%), with most experiencing severe COVID-19 (76.6%). Initial similarities in both groups included socio-demographics and disease severity (p>0.05). After 2 weeks, the tocilizumab group had lower WBC counts (5.15±2.39 vs 7.56±1.47×10⁹/l), lower CRP levels (2.7±0.93 vs 7.5±2.38 mg/l, p<0.05), shorter hospital stays (18.25±4.58 vs 25.4±2.70 days, p=0.005), reduced oxygen requirements (7.25±4.23 vs 12±7.29%, p=0.005), and lower mortality (40% vs 66.66%, p=0.027).

Conclusions: Tocilizumab therapy has better outcomes in severe to critical COVID-19 patients. However, a further larger study is recommended.

Assessing the impact of the human resources department's nurturing connect program on compassion and empathy in physicians and surgeons and its influence on patient advocacy

Dhiraj Solanki — Tue, 27 Aug 2024 00:00:00 +0530

Background: Empathy and compassion, key to medical practice, enhance patient adherence to treatments. These traits can be developed, not just inherent. This study implemented the "human resources nurturing connect (HRNC)" program to boost empathy and compassion in healthcare providers, evaluating its impact on patient advocacy over time.

Methods: This study was a two-arm, prospective, randomized, single-center conducted from March 2023 to June 2024 at Bhaktivedanta hospital and research institute, Thane, India. Thirty doctors (age 25 to 60) were randomly assigned to intervention and control groups (15 each). The intervention group underwent the HRNC Program to enhance empathy and compassion, measured by the Bhaktivedanta’s index of compassion and empathy in physicians and surgeons (BICEPS) scale, and its effect on patient advocacy assessed by the PAS scale, conducted at baseline, 3, 6, 9, and 12 months.

Results: Both BICEPS and PAS scores increased more significantly in the intervention group compared to the control group (p<0.0001). The intervention group’s BICEPS scores rose from 65.47±4.99 at baseline to 83.79±7.19 at 12 months, while the control group showed minimal changes, with scores increasing from 65.48±4.41 to 67.69±5.26. The PAS score in the intervention group also increased significantly (p=0.001) from mean score of 64.48±7.39 to 90.12±10.13, with a percentage change from 21.39% to 39.76%. In contrast, the control group showed a slight increase from 63.53±3.26 to 65.89±3.34, with a percentage change from 0.87% to 3.72%.

Conclusions: Study evidenced effectiveness of targeted developmental interventions in fostering empathy and compassion among healthcare providers resulting in better patient outcomes, overall healthcare quality which also translate in patient advocacy.

Study of serum gamma glutamyl transferase in acute stroke - a single centre experience

Tue, 27 Aug 2024 00:00:00 +0530

Background: Gamma-glutamyl transferase (GGT) is an enzyme involved in oxidative stress and inflammation, which are key mechanisms in the pathogenesis of stroke. Recent evidence suggests serum GGT levels may be associated with the risk and prognosis of acute ischemic stroke. This study aimed to investigate serum GGT levels in patients with acute stroke at a single center in India.

Methods: This case-control study included 100 patients (50 with acute stroke and 50 age and sex-matched controls). Patients aged 40 to 80 years and diagnosed with acute stroke (encompassing first-time occurrences of intracerebral hemorrhage, ischemic stroke, and subarachnoid hemorrhage) were included in the study. Serum GGT levels were compared between stroke patients and controls. The association of GGT with various risk factors was also analyzed among cases.

Results: The mean age of cases is 60.2±10.07 years. Hemorrhagic stroke was most common and found in 52% of cases. Mean serum GGT levels were significantly higher in stroke patients (55.2540±40.8909 U/l). Higher serum GGT levels were associated with male gender, presence of diabetes, hypertension, dyslipidemia and smoking and were found to be statistically significant (p<0.005). Age and stroke type were found to be not significantly associated with GGT levels.

Conclusions: In conclusion, our study findings indicate that elevated serum GGT levels are associated with an increased risk of stroke, particularly in male patients and those with hypertension, dyslipidemia, and diabetes. Further prospective studies are needed to establish the predictive value of GGT for stroke.

Prevalence of hemoglobinopathies detected by high performance liquid chromatography in tertiary care centre, Kota, Rajasthan

Vandana Pathak, Ila Sharma, Akshat Agrawal, Poonam Mund — Tue, 27 Aug 2024 00:00:00 +0530

Background: Hemoglobinopathies are the most common heterogeneous group of monogenetic disorder in the world. Their prevalence varies with geographical regions. India is developing country and many studies have shown a significant burden of hemoglobinopathies in India. Our aim is to estimate prevalence of various hemoglobinopathies in our region.

Methods: The present study was conducted at the department of pathology, Government Medical College, Kota on patients referred for antenatal or voluntary premarital checkup, patients with clinical history and complete blood count (CBC) suggestive of hemolytic anemia, and family members of known cases of hemoglobinopathies. Transfusion-dependent patients were also included. However, patients with history of blood transfusion within the last 1 month were excluded. EDTA samples were used for CBC using 6-part differential cell counter and high-performance liquid chromatography (HPLC) using BIORAD D10 analyzer. The results were tabulated and analyzed.

Results: Of the 226 cases studied, 139 (61.5%) were females and 87 (38.5%) were males. Most common age group was 21 to 30 years. The number of thalassemia traits were 26 (11.5%), sickle cell traits were 7 (3.1%), sickle cell homozygous was 1 (0.4%), compound heterozygous for sickle cell and thalassemia were 2 (0.9%), while the remaining 190 patients (84.07%) were found to have normal HPLC, with presence or absence of nutritional deficiency.

Conclusions: In our study, we found a high prevalence of hemoglobinopathies among patients. The most common disorder detected was beta thalassemia trait. Most of the hemoglobinopathies found in our study could be accurately quantified by HPLC which is a rapid, sensitive, and reproducible method for the detection of different hemoglobinopathies.

A study of knowledge, attitude and behavior of patients towards their illness and their relation to sociodemographic factors

Arti Muley, Sona Mitra, Juhi Ramnani, Priyal Patel, Kuldeep Viramgama — Tue, 27 Aug 2024 00:00:00 +0530

Background: This study was conducted to assess basic knowledge, attitudes, and practices of patients to their illness and find its correlation with various socio-demographic factors.

Method: This was a cross-sectional questionnaire-based analytical study. All patients over 18 years of age who attended the OPD or were admitted to the medical ward and who agreed to participate in the study were included. A questionnaire regarding the demographic characteristics of the study participants as well as the patient’s knowledge, attitudes, and practices regarding their disease was administered regularly by experienced physicians dealing with OPD and IPD both type of patients.

Results: Out of total 100, only 38% patients came for regular follow up and only 57% brought old records. 36% were not taking medications regularly for various reasons (trying alternative medicine (22.2%), advice from others (11.1%), found medicines ineffective and stopped without reconsulting (8.3%), fear of adverse effects (8.3%), couldn’t afford (8.3%), worsening of symptoms (5.6%) etc. 19.4% had no reasons. 67% patients got medicines prescribed from a qualified clinician while other sources were pharmacist (9%), relatives/friends (5%) and self-medication (6%). Significantly more females, educated and employed were aware about their medical condition and medications. Significantly more educated and employed brought old records and came for regular follow up (p-0.0187), Significantly more educated seeked qualified doctor’s advice as compared to uneducated. (p=0.0002).

Conclusion: There is a need to educate patients about the importance of medication awareness, adherence, regular follow up, disadvantages of unscientific and unreliable information to improve compliance to treatment.

Delayed neurological complication of organophosphate intoxication

Shubham Aryan, Kirti, Sumit Kumar, Chavi Sharma, Naveen Rao, Himanshu Lata — Tue, 27 Aug 2024 00:00:00 +0530

Organophosphate are one of the most commonly used pesticide in India and across the global, because of easy accessibility it is often misused as homicidal and suicidal cases that carry high rate of mortality and morbidity. It often affects the body by acting on synaptic cleft and interfere acetylcholine present inside the clefts. Early manifestation includes the increased secretion across the body with decrease heart rate. Here we had a case series of patients presented with delayed neurological complication of organophosphorus compounds (OPC).

Congenital absence of the appendix in a 21-year-old male with clinical presentation of acute appendicitis: a diagnostic challenge at Prince Ali Military Hospital

Tue, 09 Jul 2024 00:00:00 +0530

Acute appendicitis is commonly associated with right lower quadrant abdominal pain and is a leading cause of emergent abdominal surgeries, carrying a significant morbidity risk. The rarity of anatomical deviations, such as appendix agenesis, complicates diagnosis and can exacerbate clinical outcomes due to diagnostic delays or mismanagement. We report the case of a 21-year-old male, who was surgically explored at prince Ali military hospital for suspected acute appendicitis based on clinical symptoms and an Alvarado score of 7. Despite strong clinical indications, imaging studies, including ultrasound and computed tomography, failed to visualize the appendix. Intraoperatively, appendix agenesis was confirmed, a finding seldom reported in medical literature. This case underscores the challenges of diagnosing congenital appendix absence and highlights the need for heightened awareness among clinicians to prevent unnecessary surgical interventions. Such awareness could potentially improve patient outcomes by sparing them from unnecessary surgical risks and complications.

Suicidal corrosive ingestion in diabetes mellitus patient: what should we do?

Pauliana, Ketut Suryana — Fri, 02 Aug 2024 00:00:00 +0530

The corrosive agent is often used for suicide plans, and it can cause severe damage, including various gastrointestinal pathologies such as strictures, perforation, and bleeding. In more severe cases, it can lead to multiorgan system failure, disseminated intravascular coagulation, and sepsis. These was a reported case of corrosive ingestion with diabetes mellitus as a comorbidity. Prompt, appropriate, and immediate initial management by healthcare professionals is crucial to reduce complications from corrosive agents.

Gastric adenocarcinoma due to H. Pylori infection on patient with chronic kidney disease on hemodialysis

Riyan Adiputra, I. Made Suma Wirawan — Tue, 27 Aug 2024 00:00:00 +0530

A 53-year-old Male was admitted to our emergency department presenting with severe anemia (Hb 6.9 gr/dl) with a history of chronic kidney disease on routine hemodialysis twice a week and insulin-dependent type 2 diabetes. He was diagnosed with gastric adenocarcinoma after biopsy sample acquired from endoscopy confirmed by pathologist. The patient also has a positive HPSA test result. He was given rapid insulin 3 times daily and long-acting insulin once daily, continued routine hemodialysis and planned to do partial gastrectomy after recommended serum-creatinine level and minimum hemoglobin level are reached. We will take into consideration the routine use of anti-platelets and anti-coagulants during hemodialysis and how it will affect our decision to do surgery. Currently the patient still discusses the option of surgery even though it has been suggested by the digestive surgeon. In conclusion, we are discussing the difficulties of managing patient with gastric adenocarcinoma caused by H. pylori infection with chronic kidney disease and diabetes as the aggravating factors, including the use of routine medication and managing the blood sugar.

Biphasic anaphylaxis reaction in adult female: how to approach?

Putu A. D. Nirmala, Ketut Suryana — Tue, 27 Aug 2024 00:00:00 +0530

Anaphylaxis is a severe allergic reaction, usually occurring one to two hours after exposure to an allergen, that can lead to death. Estimated lifetime prevalence of anaphylaxis is 1.6-5.1%, with global incidence between 50 to 112 episodes per 100.000 persons per year. Biphasic anaphylaxis is a form of recurrent anaphylaxis occurring between 1 to 72 hours after resolution of initial anaphylactic episode. Our case presents an 18-year-old female patient admitted to the emergency department (ED) with chief complaint of shortness of breath and swollen eyes after contact with caterpillar while gardening. General physical examination presented tachycardia, tachypnea, angioedema, urticaria. Localized lung examination presented bilateral wheezing. Patient fulfilled NIAID/FAAN criteria. Patient was administered 0.3 mg epinephrine intramuscular, diphenhydramine injection 10 mg, dexamethasone injection 5 mg, and observed in ED for 1 hour. Patient was then transferred to intensive care unit (ICU) and was in resolution. However, patient presented again with initial symptoms of dyspnea, swollen eyes, and itchiness while under observation. The objective of this paper is to present a rare case of biphasic anaphylaxis and further highlight the importance of awareness to occurrence of biphasic anaphylaxis.

People living with HIV presenting with hemiparesis: what are the possible causes?

Yovita Gotama, Ketut Suryana — Tue, 27 Aug 2024 00:00:00 +0530

People living with HIV (PLWH) are commonly associated with opportunistic infections, particularly with low CD4 count, less than 200 cells/μL. Neurological manifestation can be occurred 70% in PLWH and the most symptoms is hemiparesis, seizure, headache, behavioural changes, decrease of consciousness, and cognitive impairment but depends on the localization of the brain lesions. We present a case of 53-year-old man with initial presentation of right hemiparesis and was on highly active antiretroviral therapy (HAART). With laboratory and CT-scan result, the patient diagnosed with stroke ischemic and occurred at the same time with toxoplasma encephalitis (TE) as an opportunistic infection. In PLWH, many possible causes involve central nervous system-caused hemiparesis. The initial differential diagnosis should be considered to prevent delayed treatment and potential of severe complications.

Generalized edema on a hypothyroid patient with incorrect use of levothyroxine

Irianto, Dewi Catur Wulandari — Tue, 27 Aug 2024 00:00:00 +0530

Hypothyroidism is manifested when thyroid hormone isn’t enough for body's requirement and is usually diagnosed by high levels of TSH and low levels of fT4. Generalized edema is commonly associated with cardiovascular, hepatic, or renal diseases and is quite uncommon to see in hypothyroidism; the edema is usually generalized when the disease is severe. Generalized edema in hypothyroidism is traditionally accompanied with more serious hypothyroid symptoms, which is not the case here. It is discussed why the other common causes of generalized edema such as heart failure, advanced kidney disease, nephrotic syndrome, and cirrhosis do not fit here. And we emphasize the importance of thyroid hormone and drug use evaluation. In our case, a 60-year-old man comes with chief complaint of generalized swelling of his body and weakness that slowly worsening. He presents with extremely high blood pressure and generalized edema but with otherwise normal findings. From the labs there is high TSH and low ft4. He was then admitted and given supportive treatment. His levothyroxine was adjusted and he was reeducated for his wrong levothyroxine use, which he took after meal. He was then slowly improving and was discharged.

Acute kidney injury in patient with acute gastroenteritis and history of consuming energy drink

Pauliana, I. Wayan Sunaka — Tue, 27 Aug 2024 00:00:00 +0530

An abrupt decline in kidney function is a characteristic of acute kidney injury (AKI), a disorder that affects the structure and function of the kidneys. Hypovolemia from gastroenteritis is known as one of the causes from prerenal AKI. Energy drinks, which are consumed a lot by workers and young people are also known can decrease kidney function and liver function even without having any pre-existing diseases. There were two reported cases of consumption energy drink that worsening kidney and liver function in gastroenteritis patient with mild-moderate dehydration state.

Pulmonary tuberculosis and secondary spontaneous tension pneumothorax in HIV patient: case report

Bernard Jonathan Christian Yong, Ni Made Dwita Yaniswari — Tue, 27 Aug 2024 00:00:00 +0530

Tuberculosis remains as one of the top 10 infectious diseases causing mortality worldwide. In year 2022, Tuberculosis has caused an estimated 1.30 million deaths with 1.13 million of death caused by tuberculosis alone, while 167000 cases in TB-HIV coinfection. Secondary Spontaneous Pneumothorax has been well known as a complication of Tuberculosis, although the incidence is quite rare, it could be life threatening especially if the pneumothorax progress to tension pneumothorax. Patient, male 19 years old came to the emergency room with a sudden shortness of breath for 3 hours prior to hospital admission. X-ray thorax examination showed collapse of the right lung with hyperlucent avascular findings on the right lung, which suggest secondary spontaneous tension pneumothorax. He was treated with chest tube insertion and WSD placement, 2 hours after WSD placement, he became pulseless. ACLS protocols were given and unfortunately, we were unable to achieve ROSC on him. Tuberculosis remains one of the deadliest infection diseases, but can still be treated with the DOTS regimen. Some condition can make tuberculosis difficult to treat, such as immunodeficiency patient like HIV/AIDS. Spontaneous Pneumothorax has been well known as a complication of tuberculosis, although the incidence rate of pneumothorax in tuberculosis are quite low, however it could be life-threatening if it develops into a tension pneumothorax, especially in the settings of advanced stage HIV patients. Spontaneous pneumothorax can be fatal especially when it develops to tension pneumothorax. Further research is needed to know what population who are at risk of developing pneumothorax.

A febrile thrombocytopenia is it always dengue

Putu Risma Yuvita Riadi, Ketut Suryana — Tue, 27 Aug 2024 00:00:00 +0530

Dengue is tropic infectious disease which concentrated in tropical and subtropical regions. Human immunodeficiency virus (HIV) is an infection that attacks the body’s immune system. A 29-year-old female admitted to hospital with history of febrile thrombocytopenia with HIV infection on highly active anti-retroviral therapy (HAART). First, the patient was assessed with dengue hemorrhagic fever, but anti-dengue immunoglobulin G (IgG) and IgM were negative. Febrile thrombocytopenia occurs not only in dengue, but also in other conditions. Person with HIV experience a wide range of hematological abnormalities, the most prevalent of which are cytopenias, which can be anemia, leukopenia, thrombocytopenia, or a combination of these. Fever and thrombocytopenia are closely related to dengue infection, but this condition can also be caused by various factors.

Paroxysmal nocturnal haemoglobinuria - a rare entity in pancytopenia: a case report

Amolpreet Kaur, Manish Chandey, Parminder Singh — Tue, 27 Aug 2024 00:00:00 +0530

Paroxysmal nocturnal hemoglobinuria (PNH) is a rare, acquired hematologic disorder characterized by hemolysis, bone marrow failure, and thrombosis. This case report details a 22-year-old male diagnosed with subclinical PNH, who presented with symptoms of fatigue and dyspnea on exertion. The classical symptoms of hemoglobinuria were not seen in our patient. Laboratory evaluation revealed pancytopenia, macrocytosis and low reticulocyte count. Serum B12 levels and iron studies were normal. Flow cytometry identified deficient expression of glycosylphosphatidylinositol (GPI)-anchored proteins on the patient’s erythrocytes, confirming the diagnosis of PNH. As our patient was in the subclinical stage, he responded to conservative therapy. Avoidance of stressors lead to significant clinical improvement. This case highlights the importance of considering PNH in young adults with unexplained pancytopenia, hemolysis, hematuria or venous thrombosis and provides insights into the management of this challenging condition. Financial constraints to the use of eculizumab in PNH, in developing countries like India, may present as a therapeutic challenge. However, response to bone marrow transplantation underscores its efficacy in controlling hemolysis and improving quality of life in PNH patients who develop aplastic anemia.

Primary tricuspid regurgitation: a rare case report

Tue, 27 Aug 2024 00:00:00 +0530

Tricuspid regurgitation is no longer a forgotten valve as TR can be clinical challenge for the treating physician especially patients with moderate to severe tricuspid regurgitation. The aetiology can be primary and secondary TR of which secondary TR is more common with female predominance. Another entity called isolated TR is now seen. Primary TR due to infective endocarditis is a rare condition. Clinical examination must look for signs of right heart failure. Investigations like Transthoracic and transesophageal echocardiogram has to meticulously done to grade the severity of TR and look for morphological changes. Medical management must be tailored made for patients based upon the severity and the clinicians must know when to refer to the valve team for appropriate intervention.

Challenges and insights: a case report on refractory dermatomyositis

Athul H., Akshara K. R., Angel Sona, Vishnu S. Chandran — Tue, 27 Aug 2024 00:00:00 +0530

Dermatomyositis is a rare inflammatory myopathy known for its unique skin symptoms and muscle inflammation leading to proximal muscle weakness. It can be classified as idiopathic, juvenile dermatomyositis, or amyopathic dermatomyositis in adults, and may be associated with solid organ tumors. The pathophysiology of the disease is most likely influenced by immune-related variables, but genetic and environmental factors may also play a significant role. The majority of patients who receive immunosuppressive medication treatment report success, but there are chances of relapse. We report a case of dermatomyositis relapse that is refractory to pulse therapy and methotrexate.

Efficacy study of hyperbaric oxygen therapy for the treatment of central retinal artery occlusion: a systematic review

Tue, 27 Aug 2024 00:00:00 +0530

Central Retinal Artery Occlusion (CRAO) is a rare ophthalmology emergency caused by central retinal artery embolism. Many CRAO management strategies exist. However, no treatment has consistently improved visual outcomes following CRAO. These medicines have many negative effects and unclear efficacy. HBOT has been considered for CRAO management. HBOT may minimize ischemia damage between CRAO and retinal artery recanalization, which normally occurs within 72 hours.⁹ There is continuous disagreement about whether this treatment procedure achieves the desired visual target. The method use is PRISMA principles were followed for a systematic review. This systematic review examines HBOT's efficacy in CRAO. The search terms were “Hyperbaric Oxygen Therapy” (“HBOT”) and “Central Retinal Artery Occlusion” (“CRAO”). The 5 investigations were primarily cohort retrospective. Four studies found no link between onset-to-HBOT time and visual outcome, two found no correlation between HBOT session and VA improvement, and three found no correlation between first therapy before HBOT and VA improvement. All said this therapy produced side effects. The conclusion is in this study is more investigations showed no significant link between onset-to-HBOT time, initial treatment before HBOT, and VA improvement. HBOT can produce barotrauma, ear pain, tympanic membrane rupture, and central nervous system oxygen poisoning seizures, so these must be considered.