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International Journal of Advances in Medicine
Number of Followers: 1  

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ISSN (Print) 2349-3925 - ISSN (Online) 2349-3933
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  • Intraoperative haemofiltration during on-pump cardiac surgery at Queen
           Alia Heart Institute

    • Authors: Ahmad A. Awamlah, Abdallah A. Hadidi, Wael A. Shobaki, Bashar A. Qudah, Mutaz A. Badaren, Ashraf F. Mohd
      Pages: 53 - 56
      Abstract: Background: Objective of the study was to determine the frequency, indications and benefits of utilizing haemofiltration during cardiopulmonary bypass in adult cardiac surgical patients. Methods: This is a prospective observational analysis of data of adult cardiac surgical patients presented for on-pump cardiac surgery in the period between September 2023 and December 2023 at Queen Alia Heart Institute. Data was collected using Google Forms online and was subsequently recorded on Excel sheaths. Patients were divided into two groups: the haemofiltration group and the non-haemofiltration group. Both groups were compared according to perioperative laboratory and clinical variables. Statistical analysis of results using Microsoft excel followed data collection. Ethical committee approval was obtained. Results: Data from 130 adult cardiac surgical patients (105 males and 25 females) enrolled in this analysis showed that haemofiltration was used in 25 patients (19.2%). The most frequent indication for intraoperative haemofiltration was haemodilution in 14 patients (56%). Blood transfusion was needed in 17 (68%) of patients who had haemofiltration and in 35 (33.4%) of patients who did not need haemofiltration. Patients from the haemofiltration group were extubated 5 hours earlier than patients from the non-haemofiltration group, as the duration of mechanical ventilation in the ICU was 17.9 hours in the haemofiltration group versus 24.9 hours in the non-haemofiltration group. The average overall hospital stay was 3 days less in the haemofiltration group. Conclusions: Haemofiltration during cardiopulmonary bypass main indications were severe haemodilution, hyperkalaemia and preoperative renal impairment. The use of haemofiltration during CPB was associated with earlier tracheal extubation and shorter hospital stay.
      PubDate: 2024-01-06
      DOI: 10.18203/2349-3933.ijam20240008
      Issue No: Vol. 11, No. 2 (2024)
       
  • Ameliorative effects and histological assessment of active fractions of
           ethanolic fruits extract of Raphia hookeri on AlCl3 induced toxicity in
           rats

    • Authors: Ojochenemi Eje Yakubu, John Akighir, Chinedu Imo, Lukas De Jesus Akaangee, Isaac Eleojo Shaibu, Reuben Owuna
      Pages: 57 - 65
      Abstract: Background: Aluminium chloride is a widely distributed element with a well-established toxicity. The study aimed at evaluating ameliorative effects of active fractions and ethanolic fruits extracts of Raphia hookeri on AlCl3-induced toxicity in male rats. The objectives included; determination of liver and kidney function biomarkers, lipid profile, histopathological assessment of the organs. Methods: A total of 110 healthy male rats weighing 180-200 g were grouped into 11 groups of 10 rats each. Group 1: Normal feed and water (normal control). Group 2: AlCl3 only. Group 3: 200 mg/kg b. w of vitamin C. Group 4 and 5: N-hexane fraction at 10 and 20 mg/kg b. w. Group 6 and 7: ethyl acetate fraction at 10 and 20 mg/kg b. w. Group 8 and 9: Aqueous fractions at 10 and 20 mg/kg b. w. Group10 and 11: Ethanol extract at doses of 200 mg/kg b. w and 400 mg/kg b. w. The treatment lasted for 21 days. Results: Results revealed a significant (p˂0.05) decreased in the activities of ALT, AST, ALP, TB, DB and TP. It further revealed a significant (p˂0.05) decrease in urea, creatinine, sodium, potassium and chloride. Also, a significant (p˂0.05) decrease in CHOL, TG, HDL-C, LDL-C was observed. Histopathological assessment of the liver and kidney tissues corroborated the observed changes in enzymes activities. Conclusions: The findings demonstrated ameliorative potentials of active fractions and ethanolic fruit extract of Raphia hookeri against hepatic and renal damage induced by AlCl3 in a dose and time dependent manner.
      PubDate: 2024-02-22
      DOI: 10.18203/2349-3933.ijam20240357
      Issue No: Vol. 11, No. 2 (2024)
       
  • The use of cell salvage in adult cardiac surgery at Queen Alia Heart
           Institute

    • Authors: Dya D. Alsmadi, Abdallah Alhadidi, Ahmad Alawamleh, Suhaib Alghawanmeh, Wael Alshobaki, Ashraf F. Mohd
      Pages: 66 - 70
      Abstract: Background: Objective of the study was to determine the incidence of use cell salvage, indications, efficacy in blood conservation and benefits on recovery after adult cardiac surgery. Methods: This is an observational analysis of adult cardiac surgical patients presenting for cardiac surgery at Queen Alia Heart Institute in the period between September 2023 and December 2023. Patients’ demographics, type of surgery (cardiac pathology), comorbidities, preoperative and postoperative laboratory results, blood transfusion requirements, extubation and intensive care unit (ICU) length of stay were recorded and statistically analysed to determine the effectiveness of cell salvage. Patients were divided into two groups: The cell saver group and the no cell saver group for comparison. Results: Data from 141 adult cardiac surgeries is included in this analysis. Indications for cell saver use were recent anticoagulation (41.4%), more complex surgery (20.7%), high risk of bleeding (13.8%), preoperative anaemia (6.9%), intraoperative major bleeding (6.9%), coagulopathy (6.9%) and rare patient blood type (3.45%). Patients from the cell saver group required blood transfusion 2.1% more than the no cell saver group. There was no significant difference in the length of hospitalization between those who had and those who had not cell saver used during surgery (11.9 and 12 days, respectively). Conclusions: Cell saver was used in one fifth of adult cardiac surgeries. Most common indications for cell saver use during cardiac surgery were recent anticoagulation and more complicated cardiac surgery. The use of cell saver had no impact on postoperative haematocrit or overall time of hospitalization.
      PubDate: 2024-01-11
      DOI: 10.18203/2349-3933.ijam20240015
      Issue No: Vol. 11, No. 2 (2024)
       
  • Clinical validation of artificial intelligence-based cataract screening
           solution with smartphone images (Logy AI cataract screening module)

    • Authors: Mano Aarthi V. M., Nivedita Tiwari, Vinay Khobragade, Mitali Pareek, Anand Panchbhai, Priyanjit Ghosh, Jayachandhran Saravanan
      Pages: 71 - 77
      Abstract: Background: Purpose of the study was to clinically assess the accuracy of Logy AI cataract screening solution, an artificial intelligence-based module, which works through WhatsApp and also as a separate smart phone application, that can detect cataracts using images taken by a smartphone camera, by comparing with slit lamp based diagnoses made by ophthalmologists. Methods: A prospective clinical study was conducted in an eye clinic of a tertiary care hospital in the southern part of India with 437 patients. Smartphone images taken were sent to the Logy AI cataract screening solution which predicted if the patient had cataract or not. It graded cataracts as immature and mature. Patients were examined by ophthalmologists with slit-lamp and diagnosis was documented. Both were compared. Results: 794 eye images were included in the study. The overall accuracy of the AI screening solution for cataract detection was computed to be 90.08%. Further, the accuracy was 88.02% for immature cataract, 97.16% for mature cataract, and 90.08% normal category. The sensitivity was 90.38%, the specificity was 89.87%, and the F1 score was 87.98%. The positive predictive value was 85.71% and the negative predictive value was 93.29%. Logy AI cataract prediction module’s AUC (0.8946) falls under the good category. Conclusions: Logy AI cataract screening module could work as an effective cataract screening tool at the community level in remote areas where there is no expensive equipment and ophthalmic health care workers considering the accuracy and efficiency to work in low resource settings. It can also be a good home screening tool suitable for the post-COVID era.
      PubDate: 2024-01-06
      DOI: 10.18203/2349-3933.ijam20240007
      Issue No: Vol. 11, No. 2 (2024)
       
  • A study of safety and efficacy of vitamin D3 supplementation in pregnancy

    • Authors: Huma Afzal Mirza, Nigare Arzoo, Pooja Prajapati
      Pages: 78 - 83
      Abstract: Background: Vitamin D is a lipid-soluble prohormone that is vital for the maintenance of bone and muscle health. Vitamin D deficiency is an unrecognized epidemic, common in all age groups and is associated with preeclampsia, gestational diabetes, preterm birth, early labour and pregnancy loss. Methods: Our study was conducted in Batra hospital and medical research centre, New Delhi from October 2018 to May2019. 126 women were taken, of those seen before 20 weeks of pregnancy who received vitamin D3 supplementation comprised of study group and control group were those who came directly for delivery and without vitamin D3 level done. The outcomes measured were vitamin D3 level at 20 weeks, at delivery, in cord blood and clinical outcomes like pre-eclampsia, gestational diabetes, preterm delivery. Results: Gestational hypertension was seen in 4 (6.3%) of subjects while in control group it was seen in 11 (17.5%), Gestational diabetes was seen in 3 (4.8%) women while it was observed in 10 (15.9%) women of control group. Premature rupture of membranes was seen in 2 (3.2%) women in study group and 8 (12.7%) women of control group. Vitamin D level at the time of delivery in study group was significantly higher than control group (56.84±15.78 versus 18.12±8.97ng/ml). Conclusions: Preterm labor, low birth weight and preeclampsia were uncommon in the subjects and the administered vitamin D3 dose had no adverse effects but more research with larger sample size is strongly urged to assess the safety and effect of vitamin D3 supplementation.
      PubDate: 2024-02-22
      DOI: 10.18203/2349-3933.ijam20240358
      Issue No: Vol. 11, No. 2 (2024)
       
  • Comorbidities in adult cardiac surgical patients

    • Authors: Abdallah Alhadidi, Dya Adeen Al Smadi, Wael Alshobaki, Ahmad Alawamleh, Suhaib Al Ghawanmeh, Ashraf F. Mohd
      Pages: 84 - 88
      Abstract: Background: The objective of this study was to describe the prevalence of comorbidities in adult cardiac surgical patients and their impact on post-operative outcomes. Methods: This was an observational analysis of patients presenting for cardiac surgery at Queen Alia Heart Institute in the period between September 2023 and January 2024. Patients’ demographics, comorbidities, type of surgery (cardiac pathology), intensive care unit and hospital length of stay were analysed. Patients were divided into four groups according to their number of extra cardiac comorbidities: Group 0 with no comorbidities, group 1 with 1 comorbidity, group 2 with 2 comorbidities and group 3 with more than 2 comorbidities. These groups were compared in relation to extubation time, intensive care unit length of stay, hospital stay and mortality. Results: Data from 152 adult cardiac surgical patients who underwent 159 procedures was analysed. Male patients were 123 (80.9%). Average age of patients was 57 years and 32 patients (21%) were over 65 years. Most common procedure was CABG 130. Most common comorbidities were: hypertension as 113 (74.3%), diabetes 81 (53.26%), obesity 57 (37.5%), smoking history or respiratory disease 106 (69.73%), peripheral vascular disease 5 (3.29%), renal failure 4 (2.63%). The average Euroscore was 5.25%. Majority of patients 59.9% had more than two extra cardiac comorbidities. Time of tracheal extubation increased from 8.2 hours in group 0 to 18.4 hours in group 3. Mortality increased from 0% in group 0 to 12.1% in group 3. Conclusions: Most of the cardiac surgical patients present with more than two extra cardiac morbidities. As the number of preoperative comorbidities increases; the longer is the duration of postoperative mechanical ventilation and the mortality.
      PubDate: 2024-01-23
      DOI: 10.18203/2349-3933.ijam20240032
      Issue No: Vol. 11, No. 2 (2024)
       
  • Biochemical profile of diabetic ketoacidosis in type 2 diabetes patients:
           an observational study

    • Authors: Hardik More, Dilip Patil, Chahat Singh
      Pages: 89 - 93
      Abstract: Background: The present study was conducted to assess the clinical profile of type 2 diabetes patients presenting with diabetic ketoacidosis and review their biochemical parameters at the time of presentation. Methods: The present study was an analytical, cross-sectional study conducted over the period of two years. All the type 2 diabetes patients with diabetic ketoacidosis admitted during the study period constituted the study population, after being subjected to prefixed selection criteria. All the participants were subjected to detailed clinical examination and biochemical analysis during hospitalization and parameters were monitored. Results: Out of the total 60 type 2 DM patients with DKA studied, 53.3% patients belonged to 51 to 60 years age group and 55% were males. One patient died and 59 survived (mortality rate-1.6%). Comparatively higher mean RBS, higher mean serum osmolality and lower pH were observed in the death case in comparison with those who survived. The patient who died had no statistically significant difference in serum sodium, potassium, calcium and magnesium but had lower serum HCO3- than alive patients on admission. Conclusions: DKA is a serious metabolic complication even in cases of type 2 diabetes and higher RBS, higher Sr Osmolality and lower pH at the time of presentation correlate directly with poorer outcomes.
      PubDate: 2024-02-22
      DOI: 10.18203/2349-3933.ijam20240359
      Issue No: Vol. 11, No. 2 (2024)
       
  • Expert opinion on the prescription practice of silodosin for treating
           benign prostatic hyperplasia patients in Indian clinical settings

    • Authors: Manjula S., Krishna Kumar M.
      Pages: 94 - 98
      Abstract: Background: The effectiveness and safety of silodosin compared to other drugs have been the subject of numerous studies to date, although the findings are debatable. So, this study aims to gather expert opinion on the prescription practice of silodosin for men with lower urinary tract symptoms leading to benign prostatic hyperplasia. Methods: This cross-sectional, multiple-response questionnaire-based survey, included experts from various states across India with expertise in treating BPH. The study questionnaire, comprising 25 survey items on the management of BPH utilizing silodosin (8 mg) and other drug combinations to gather data via email or an online survey platform. Results: Out of the 55 experts, 76% identified non-specific urinary tract infections as the most prevalent concomitant ailment in BPH patients. The majority of the experts (89.09%) recommended silodosin medication for these patients, and about 58% reported that patients might need to continue silodosin medication for three months. Another major benefit reported was its high selectivity for alpha 1A receptors (34.55%). However, 47% of experts reported retrograde ejaculation as a side effect, and 27% reported orthostatic hypotension. According to nearly 80% of responders, patients with BPH can use silodosin in combination with mirabegron (25/50 mg). A combination of silodosin and dutasteride was favoured by 67% of responders for BPH patients with acute urine retention. Conclusions: The expert consensus has highlighted silodosin as an effective treatment option for LUTS in men with BPH in Indian settings. Silodosin and dutasteride combination were recommended by specialists for BPH patients with acute urine retention.
      PubDate: 2024-02-22
      DOI: 10.18203/2349-3933.ijam20240360
      Issue No: Vol. 11, No. 2 (2024)
       
  • The use of intra-aortic balloon pump in cardiac surgery

    • Authors: Bashar Alqudah, Wael Alshobaki, Suhaib Alghawanmeh, Hamza Abuamira, Hamzeh A. Alhrahsheh, Sakher A. Alsharo, Ashraf F. Mohd
      Pages: 99 - 103
      Abstract: Background: Objective of the study was to determine the incidence of use, indications, complications of intra-aortic balloon pump (IABP) and its impact on outcome. Methods: Retrospective study of adult cardiac surgical patients presenting for cardiac surgery at Queen Alia Heart Institute in the period of time between September 2023 and February 2024. Patients’ demographic, clinical, perioperative data were recorded and analysed. Time of initiation of intra-aortic balloon, indications and monitoring for complications were observed by the authors. Patients were divided into two groups according to the use of IABP; the IABP group and the non-IABP group. Both groups were compared regarding outcome. Ethical committee approval obtained. Results: Data from 202 adult cardiac surgeries was analysed. Average age of patients was 57.2 years. Patients were 34 females (16.8%) and 168 males (83.2%). Most surgeries were elective (93.6%), while urgent surgeries comprised 3.5% and emergency surgeries were 3%. Coronary artery bypass grafting (CABG) was the most common procedure (78.2%). The IABP was most commonly used after combined procedures (50%) and to a lesser extent after isolated CABG (15.3%). IABP was inserted least frequently pre-operatively (10.7%), followed by postoperative insertion (35.7%), while intraoperative insertion to aid weaning from CPB was most common (53.6%). Patients from the IABP group were older, had longer CPB time (136.7 minutes) and AXC times (70.5 minutes), they also spent around 2 days more in the ICU and around 4 days more in hospital. Conclusions: IABP was most commonly utilised for combined procedures, after prolonged CPB and aortic cross clamping. The use of IABP was associated with delayed tracheal extubation, longer ICU stay, longer hospitalisation, and higher rates of blood transfusion, higher incidence of re-opening and higher mortality.
      PubDate: 2024-02-17
      DOI: 10.18203/2349-3933.ijam20240329
      Issue No: Vol. 11, No. 2 (2024)
       
  • Spontaneous tension pneumothorax: a devastating consequence of pulmonary
           tuberculosis

    • Authors: Yolanda Kadir, Elok Ariyani Safitri
      Pages: 104 - 108
      Abstract: Tuberculosis (TB) was the world’s second leading cause of death from a single infectious agent, with mortality reaching 50% in untreated cases. It has been acknowledged as a potential cause of secondary spontaneous pneumothorax. A 57-year-old male presented to emergency department due to shortness of breath since 12 hours before admission. He had a history of chronic cough along with significant weight loss. He was cachexic and fully alert, with normal blood pressure, tachypnea, and slight tachycardia. Decreased breath sounds on the right hemithorax was noted. Chest x-ray revealed right tension pneumothorax and active pulmonary TB. Emergency needle decompression was performed with 14-gauge intravenous catheter. Unfortunately, he died eight hours later following a cardiac arrest. Occurrence of spontaneous tension pneumothorax in TB involves several mechanisms such as pleural porosity, chronic inflammation, and alveolar rupture. Compensatory mechanisms including gradual tachycardia, respiratory rate elevation, along with increasingly negative contralateral intrathoracic pressures could preserve venous return, serving as protective factors against hypotension until the late stages. Late presentation of 12 hours after the first onset might contribute to enormous air leak that could not be effectively managed by needle decompression. Undiagnosed and untreated TB could lead to morbid consequence such as tension pneumothorax, highlighting the importance of TB detection within the community. Clinicians should be aware of variations in the clinical presentation of tension pneumothorax as compensatory mechanisms may hinder the diagnosis at initial presentation. Strategic approaches are imperative to reinforce our commitment to eliminate TB by 2030.
      PubDate: 2024-02-08
      DOI: 10.18203/2349-3933.ijam20240315
      Issue No: Vol. 11, No. 2 (2024)
       
  • A case of tuberculous peritonitis accompanied by tuberculous pleuritis

    • Authors: Larasati A. Wahyu, Pramarta Y. Dwiputra
      Pages: 116 - 119
      Abstract: Tuberculous peritonitis is a form of extrapulmonary tuberculosis, a peritoneal or visceral inflammation caused by Mycobacterium tuberculosis. The disease is rarely independent, but is usually a continuation of the tuberculosis process elsewhere, especially pulmonary tuberculosis. We report a case of TB peritonitis accompanied by TB pleurisy, a 29-year-old female patient with complaints of an enlarged abdomen, heartburn, fever, diarrhea, and decreased appetite. Treatment history was Acitral, Zinc, and Metronidazole. On physical examination, it was found that the general condition was weak and the axilla temperature was 39.5ºC. Thorax examination; decreased vesicular sound on the left chest. Abdominal examination; found distension, epigastric tenderness, undulation, shifting dullness, checkerboard phenomenon, and increased bowel noise. Laboratory examination of complete blood; within normal limits. Complete stool; yellow color, mucus (+), leukocytes 4-6/LPB, bacteria (+). The thorax photo showed left pleural effusion, BOF 3 position: ascites. Abdominal ultrasound results: thickening of the peritoneum, ascites, suspected TB peritonitis. Results of ascites and pleural fluid analysis: rivalta (+) and Adenosine Deaminase (ADA) increased. So that from anamnesis, physical examination, supporting examination can be established diagnosis of TB Peritonitis and TB Pleuritis, followed by OAT therapy; FDC for 12 months. From this case it can be concluded that clinical and supporting examinations (radiology) are needed to make a correct diagnosis and body fluid analysis examinations can help confirm the diagnosis.
      PubDate: 2024-02-22
      DOI: 10.18203/2349-3933.ijam20240361
      Issue No: Vol. 11, No. 2 (2024)
       
  • Orbital pseudolymphoma: a benign condition mimicking malignancy

    • Authors: Nirupama Kasturi, Salwa Kaidakath, Mary Stephen, Jayasri P.
      Pages: 120 - 122
      Abstract: Orbital lymphomas are not a rare condition that causes systemic and ocular morbidity, in which vision loss often occurs due to compressive optic neuropathy, and whose treatment is complex, involving chemotherapy and radiotherapy. We report a 54-year-old male with protrusion of the right eye associated with mild diminution of vision for one year, limitation of extraocular movements, and a relative afferent pupillary defect with optic disc edema. Imaging revealed a well-defined soft tissue lesion filling the retro-orbital intraconal space, suggestive of orbital lymphoma. Incisional biopsy and fine needle aspiration cytology revealed the lesion to be a reactive lymphoid hyperplasia. Following the administration of oral steroids, the patient showed significant improvement. To our knowledge, a benign lesion with an aggressive presentation is rare, and histopathology plays an important role in diagnosis and management.
      PubDate: 2024-02-22
      DOI: 10.18203/2349-3933.ijam20240362
      Issue No: Vol. 11, No. 2 (2024)
       
  • Role of flowcytometry in atypical lymphocytosis

    • Authors: Rashan Kullar, Preeti Tripathi, Kundan Mishra, S. Venkatesan, Jasvinder Kaur Bhatia
      Pages: 123 - 125
      Abstract: Infectious mononucleosis (IM) is a benign condition defined by lymphomononuclear cell proliferation. Symptoms range from a vague constitutional syndrome to fever, rash, jaundice, hepatosplenomegaly, lymphadenopathy, and in rare cases, autoimmune hemolytic anemia. The viruses responsible for this syndrome are EBV (the most prevalent), CMV, HIV, Hepatitis virus, Adenovirus, and others. Because the virus mostly impacts lymphomononuclear cells and the reticuloendothelial system, it may trigger intense lymphoproliferation, leading to uncommon manifestations in peripheral smear. These can be misdiagnoses as leukemia/lymphoma. The clinical profile of a brief history, mild organomegaly, and peripheral smear morphology commonly overlaps. This pitfall in the diagnosis can lead to ineffective treatment. Immunophenotyping by flowcytometry or immunohistochemistry, a mono-spot test, and specific viral ag/ab assays are required for a correct diagnosis. Flowcytometry profiles are not always adequate to rule out neoplastic proliferations. We provide a case study of a young teenage boy who arrived with an abrupt history of low-grade fever, hepatosplenomegaly, cervical lymphadenopathy, elevated leukocyte count, and atypical lymphoid cells on peripheral smear. What was previously thought to be a hematological malignancy was discovered to be a self-limiting acute IM (CMV caused), and the patient was discharged after a brief course of treatment.
      PubDate: 2024-02-22
      DOI: 10.18203/2349-3933.ijam20240363
      Issue No: Vol. 11, No. 2 (2024)
       
  • Novel reports of distal hereditary neuropathy due to mutations of SIGMAR 1
           from India

    • Authors: Arjun G. Shah, Gaurav Chaudhary, Anuradha P. Mahto, Aamna Maniyar, Akash Chheda, Kamlesh A. Jagiasi
      Pages: 126 - 129
      Abstract: Distal hereditary neuropathies (dHMN) are hereditary neuromuscular disorders characterized by predominant distal motor neuropathy, leading to muscle atrophy, with a striking preservation of the sensory nervous system. While there is occasional overlap with Charcot-Marie-tooth disease (CMT) and familial amyotrophic lateral sclerosis (fALS), these conditions typically represent distinct entities with better prognosis. Numerous gene defects are associated with dHMN, and on-going research continues to unveil novel mutations. Among these, the mutation in the sigma non-opioid intracellular receptor 1 gene (SIGMAR1) has been identified across diverse populations. SIGMAR1 encodes a non-opioid endoplasmic reticulum protein present in both the central and peripheral nervous systems, playing a crucial role in neuronal survival and maintenance. Notably, SIGMAR1 gene mutations are linked to two distinct motor neuron disease phenotypes: fALS and dHMN. This signifies the broad impact of SIGMAR1 mutations on the neurogenetic landscape, contributing to the understanding of the complex interplay between genetic factors and motor neuron disorders. The continuous discovery of new mutations emphasizes the dynamic nature of research in this field, shedding light on the intricate mechanisms underlying these debilitating conditions.
      PubDate: 2024-02-22
      DOI: 10.18203/2349-3933.ijam20240364
      Issue No: Vol. 11, No. 2 (2024)
       
  • An observed repeat case of drug reaction with eosinophilia and systemic
           symptoms syndrome with modified anti-tuberculosis therapy: a case report

    • Authors: Indu Priyadarshini, Akhilesh Thole, Kapil Hazarika, Manik S. Ghadlinge
      Pages: 130 - 134
      Abstract: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome, while uncommon, presents a potentially hazardous condition. It is a drug-induced multi‑system immunological hypersensitivity reaction, characterized by the triad of fever, rash, and internal organ involvement. This is a case report of a 60-year-old Indian female who developed a repeat episode of DRESS syndrome following modified anti-tuberculosis therapy (ATT). She had a past history of DRESS syndrome caused by first-line antitubercular drugs. This case report aims to highlight the challenges in managing DRESS syndrome in the context of tuberculosis (TB) treatment, as well as to emphasize the importance of prompt withdrawal of the culprit drugs and immediate initiation of appropriate supportive care. This case report also highlights the high risk of recurrence of DRESS syndrome following the re-administration of the offending medication, especially antitubercular drugs.
      PubDate: 2024-02-22
      DOI: 10.18203/2349-3933.ijam20240365
      Issue No: Vol. 11, No. 2 (2024)
       
  • Pyrexia of unknown origin in a healthy adult: a case report

    • Authors: Karun S. Sam, Kunal Chawla, Rishikesh Dessai, Shipra Gulati
      Pages: 135 - 137
      Abstract: A 23-year-old male, with no known co-morbid illnesses, presented with a history of chronic fever and left hip pain of 6-months duration. The persistence of the fever with the progressive worsening of pain despite outpatient management prompted him to seek further evaluation. He was evaluated outside on multiple occasions and was diagnosed with a left sacroiliitis with left gluteal and paraspinal fluid collection 2 months prior, for which he was initiated on empirical anti tubercular treatment (ATT). In view of worsening of symptoms, he presented to our centre where he underwent a curettage and bone grafting of the left SI joint following repeat imaging. Tissue culture grew Cryptococcus neoformans and he was started on liposomal Amphoterecin B with Flucytosine. Patient clinically improved and was discharged on the same regimen. This case report aims shed light on the evidence of primary skeletal cryptococcal infection in an immunocompetent individual.
      PubDate: 2024-02-22
      DOI: 10.18203/2349-3933.ijam20240366
      Issue No: Vol. 11, No. 2 (2024)
       
  • Use of acenocoumarol in cardioembolic stroke: an evidence-based review

    • Authors: S. Meenakshisundaram, Subhash Kaul, Sucheta Mudgerikar, U. P. Sharma
      Pages: 138 - 146
      Abstract: Stroke is the leading cause of long-term disability and the second most common cause of death worldwide. Nearly two-thirds of all strokes represent cerebral ischemia, of which about 15%-30% are of cardioembolic origin. Atrial fibrillation accounts for about 60% of all cardioembolic strokes. Current clinical evidence suggests that oral anticoagulant therapy can prevent around 70% of strokes in patients with atrial fibrillation. Oral anticoagulation therapy is preferred over antiplatelet therapy in patients with cardioembolic stroke. Vitamin K antagonists (VKAs) and nonvitamin K antagonist oral anticoagulants (NOACs) are routinely prescribed oral anticoagulants in patients at risk of stroke; however, there are specific indications where VKA use surpasses NOAC use or there are conditions where NOACs are contraindicated. A group of experts revisited the role of oral anticoagulants in the management of cardioembolic stroke in India with emphasis on VKA, specifically acenocoumarol. This article discusses various aspects of anticoagulation therapy, including the timing of initiation and patient monitoring, in patients with cardioembolic stroke with reference to current clinical evidence and expert opinion based on Indian clinical experience.
      PubDate: 2024-02-22
      DOI: 10.18203/2349-3933.ijam20240367
      Issue No: Vol. 11, No. 2 (2024)
       
  • Technological advancements, digital transformation, and future trends in
           blood transfusion services

    • Authors: Abin Varghese, Kavitha Thilak, Saritha Mary Thomas
      Pages: 147 - 152
      Abstract: Misidentification, mistransfusion, and pre-analytical errors are all regarded as major challenges and risks in safe blood transfusion procedures. To provide a high level of accuracy, traceability, automation, and reliability in blood transfusion services, traditional methods should be upgraded with modern technologies such as block chain technology, machine learning, artificial intelligence (AI), artificial neural networks, algorithm-based learning, and the implementation of radio frequency identification (RFID) and the internet of things (IoT). This technology helps reduce errors, retrieve data, forecast blood demand, reduce blood waste, manage blood storage, and manage workload, ensuring transfusion safety. The technology is still in the initial stages of development and by addressing issues such as data loss, patient data privacy, and cost-effectiveness, the technology will become a revolution in transfusion services.
      PubDate: 2024-02-22
      DOI: 10.18203/2349-3933.ijam20240368
      Issue No: Vol. 11, No. 2 (2024)
       
  • Digital homeopathy, the method of comprehensive digital medicine leads to
           health promotion by curing diseases of various organs, as well as of
           immune, endocrine and nervous systems, of human body

    • Authors: Abhijit Biswas, Krishnan Ramasubramanian
      Pages: 153 - 159
      Abstract: Health promotion methodology of digital-homeopathy is very useful to achieve and maintain near zero disease-levels in the various organs and the immune, endocrine and nervous systems of any human being, for all health-conscious persons, who want to continue sincerely with the preventive medicines of digital-homeopathy and evolved-homeopathy, and occasional gas-discharge-visualization (GDV) check-up, as may be necessary. The methodology of evolved-homeopathy utilizes medicines of digital-homeopathy and evolved-homeopathy for prevention and cure, according to the first fundamental-principle of cure (“prevention is better than cure”). True “nipping in the bud” of any disease from a patient’s body is possible only when the treatment starts based not on a patient’s perception of symptom(s) but on a whole-body diagnostic chart generated by a sophisticated device like the GDV scanner. Based on the experience of the persons who are utilizing the side-effect free preventive and curative medicines of digital-homeopathy and evolved-homeopathy for preventing and curing problems of various organs and systems, to achieve near zero disease-level, it is clear that the methodology of digital-homeopathy and evolved-homeopathy for health promotion, is very effective. It seems evident that for the sincere followers of the three fundamental-principles of cure as detailed below, health promotion methodology of digital-homeopathy and evolved-homeopathy, is very beneficial. When the condition of near zero disease-levels in the various organs and systems of a person’s body, is achieved, about 20-years age-reduction is felt along with improvement of physical and mental stamina and increment in longevity.
      PubDate: 2024-02-22
      DOI: 10.18203/2349-3933.ijam20240369
      Issue No: Vol. 11, No. 2 (2024)
       
  • Local management of unresectable lung atypical carcinoid tumor: a case
           report and review of literature

    • Authors: Joana Martins Pisco, Pedro Miguel Silva, André Pinheiro Figueiredo, Manuel Carmo Silva, Maria Filomena Pina
      Pages: 109 - 115
      Abstract: Neuroendocrine tumors comprise a rare but increasing heterogeneous group of malignancies arising from neuroendocrine cells, most commonly from the lung and gastrointestinal tract. Due to the vast histopathological differentiation of each subtype and the scarce clinical data published, choosing the most effective therapy can be challenging. Radiotherapy can play a significant role in the treatment of locally advanced metastatic tumors, however there is a lack of randomized clinical trials in this setting. This article reviews the current knowledge on the classification and treatment of unresectable lung atypical carcinoids. We present a clinical case of a ULAC treated with systemic therapy and RT in different settings of the disease. The subject is a 48 years old male, diagnosed with a well differentiated pulmonary NET, classified as cT4N3M1b (supraclavicular and mediastinal adenopathies and an adrenal metastatic lesion) with disease progression after systemic treatment, and with superior vena cava compression. The primary tumor and involved nodal areas were treated to 54Gy/30 fractions using VMAT. SBRT was given to the metastatic left adrenal gland. Five months after RT, CT showed a volumetric reduction of <25% of the thoracic disease and adrenal gland’s lesion stability. The disease remained stable for the next year and a half, when local and distant progression occurred, starting systemic treatment. A year and a half later, the patient presented with brain metastasis and underwent radiosurgery. At last follow-up, 5 years after diagnosis, the patient maintains treatment with capecitabine and temozolomide and is clinically stable. Definitive RT should be considered in the management of ULAC to improve local control.
      PubDate: 2023-12-30
      DOI: 10.18203/2349-3933.ijam20234162
      Issue No: Vol. 11, No. 2 (2023)
       
 
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Email: journaltocs@hw.ac.uk
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