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Indian Journal of Clinical Medicine
Journal Prestige (SJR): 2.636

Citation Impact (citeScore): 7
Number of Followers: 0

This is an Open Access Journal

Open Access journal
ISSN (Print) 1179-9161
Published by Sage Publications

[1174 journals]

Editorial
- Authors: P. S. Indu
  Pages: 5 - 5
  Abstract: Indian Journal of Clinical Medicine, Volume 10, Issue 1-2, Page 5-5, June-December 2020.
  
  Citation: Indian Journal of Clinical Medicine
  PubDate: 2022-02-22T07:40:28Z
  DOI: 10.1177/26339447211070333
  Issue No: Vol. 10, No. 1-2 (2022)
Healthy Humans, Healthy Planet
- Authors: PS Indu
  Abstract: Indian Journal of Clinical Medicine, Ahead of Print.
  
  Citation: Indian Journal of Clinical Medicine
  PubDate: 2022-06-29T07:51:24Z
  DOI: 10.1177/26339447221105954
A Rare Report of Heavy-Metal-Associated Hemodialysis-Dependent Chronic
Kidney Disease Secondary to Ayurvedic Medication
- Authors: Himansu Sekhar Mahapatra, Sutanay Bhattacharyya, Vineeta V. Batra
  Abstract: Indian Journal of Clinical Medicine, Ahead of Print.
  IntroductionHeavy metals are a component of many traditional medications. However, they continue to be used for trivial causes. Chronic heavy metal exposure is an important but under-recognized cause of renal damage. We report to our knowledge the first case of a heavy-metal-associated chronic kidney disease secondary to Ayurvedic medication.Case ReportA 24-year-old with history of chronic Ayurvedic medication for altered bowel habits presented with neuromuscular symptoms and bilateral lower limb swelling and was found to have hypocalcemia and renal dysfunction. He was initiated on dialysis and underwent an uncomplicated renal biopsy which was suggestive of chronic glomerulosclerosis. In view of significant exposure to Ayurvedic medication, he underwent heavy metal screening in blood, urine, and renal biopsy tissue along with the Ayurvedic medication he had. His blood tested positive for cadmium, copper, and mercury along with same positive results in Ayurvedic medication. He underwent chelation with dimercaprol 250 mg iv for 7 days with blood samples testing negative repeatedly for the same heavy metal that tested positive earlier. However, in view of significant chronicity, he became dialysis dependent and was initiated on twice weekly hemodialysis. His persistent gastrointestinal symptoms were attributed to nonspecific colitis following a computed tomography of the abdomen and colonoscopy with biopsy. He responded to rifaximin and probiotics.ConclusionHeavy metal exposure, secondary to chronic Ayurvedic medication intake, is an unrecognized cause of renal dysfunction. The use of such medications for trivial purposes is rampant, especially in developing countries like India. Delaying diagnosis can lead to permanent renal damage with patients eventually becoming dialysis dependent.
  Citation: Indian Journal of Clinical Medicine
  PubDate: 2022-06-27T04:32:07Z
  DOI: 10.1177/26339447221099991
Discrete Subaortic Stenosis in an Elderly Patient
- Authors: Jaideep Dey, Nadeem Akhtar, Vivek Shama, Arif Mustaqueem, Sameer Shrivastava
  Abstract: Indian Journal of Clinical Medicine, Ahead of Print.
  Discrete subaortic stenosis is an uncommon condition in the elderly population. Echocardiographic examination can be useful for diagnosis with high accuracy. We present a case report of an elderly female patient who presented with accelerated hypertension and was subsequently diagnosed with discrete subaortic stenosis on transthoracic echocardiography. A significant, non-dynamic, left ventricular outflow tract pressure gradient in the presence of aortic regurgitation should raise the possibility of this condition in patients of geriatric age group.
  Citation: Indian Journal of Clinical Medicine
  PubDate: 2022-06-24T07:00:49Z
  DOI: 10.1177/26339447221098465
A Successful Medical Management of Enterococcal Endocarditis Presenting as
Cellulitis
- Authors: Riya Kataria, N. Senthil, Suja Lakshmanan, Archa Anna Anil
  Abstract: Indian Journal of Clinical Medicine, Ahead of Print.
  Infective endocarditis is an infection commonly caused by bacterial pathogens and is known to affect intracardiac structures. We herein report a previously healthy man who presented with complications of infective endocarditis caused by Enterococcal faecalis and was further managed with appropriate antibiotics without the needed surgical interventions.
  Citation: Indian Journal of Clinical Medicine
  PubDate: 2022-06-23T06:35:00Z
  DOI: 10.1177/26339447221103023
COVID-19-Related Knowledge and Anxiety Among Health-Care Workers in a
Tertiary Care Centre in Kerala
- Authors: Lakshmi K. P., Preetha Prasanna, Subash Chandra, Arya G. Krishnan, Abhinandh Babu, Binil Babu, Merlin Moni, Dipu T. Sathyapalan
  Abstract: Indian Journal of Clinical Medicine, Ahead of Print.
  Introduction:The COVID-19 pandemic has posed an immense threat to both physical as well as mental health globally. The outbreak is immeasurably affecting all the communities worldwide. The pandemic fatigue has led to inadequate addressing of the impact of COVID-19 on mental health especially among the health-care workers (HCWs), mainly due to the fear of disease contraction, mortality of the condition, raised work stress, as well as the saturation of news on media and other social platforms. Prolonged confinement at home may also adversely impact mental health.Method:An online survey was conducted using a developed questionnaire to evaluate the knowledge and anxiety among 118 HCWs regarding the COVID-19 pandemic in a tertiary care hospital. Since the study was conducted during the period in which no standard questionnaires were available, an online questionnaire was developed based on a few articles published in indexed journals on the similar topic which was further approved by 5 experts in the field. The questionnaire along with an informed consent was sent to all the HCWs employed in the hospital to assess their knowledge and anxiety related to COVID-19.Result:A total of 92.47% of participants were strongly aware that the major mechanism in COVID spread is droplet infection. An equal percentage of participants had good knowledge that the infection can always be prevented by maintaining social distance, appropriate hand washing, hand sanitizing, and using a mask. However, around 40.67% of participants avoided large meetings even in hospitals due to fear of the pandemic.Conclusion:It is important to study the mental health impacts of HCWs during the pandemic. There is a need to intensify the awareness program and address the mental health issues of HCWs during this COVID-19 pandemic.
  Citation: Indian Journal of Clinical Medicine
  PubDate: 2022-06-22T10:04:36Z
  DOI: 10.1177/26339447221098464
Herpes Simplex Hepatitis Presenting as Fulminant Hepatic Failure in
Pregnancy
- Authors: Kalyani Parvathy, Aravind Reghukumar, Athul Gurudas, Kirankumar V. Sasidharan, Lakshmi J. Nair
  Abstract: Indian Journal of Clinical Medicine, Ahead of Print.
  Herpes simplex hepatitis can progress to fulminant hepatic failure in immunocompromised patients as well as in pregnancy due to alterations in T cell-mediated immunity in these populations. If not identified early, herpes simplex virus (HSV) hepatitis will progress to fulminant hepatic failure requiring liver transplantation. Early identification and treatment with acyclovir can be life-saving as HSV hepatitis in pregnancy has been found to be associated with high mortality rate. We report the case of a 23-year-old woman who developed HSV-induced fulminant hepatic failure in the third trimester of pregnancy.
  Citation: Indian Journal of Clinical Medicine
  PubDate: 2022-05-26T03:47:03Z
  DOI: 10.1177/26339447221096200
Hepatocellular Carcinoma With a Floating Right Atrial Thrombus and Rupture
of the Primary Lesion Causing Right-Sided Hemothorax
- Authors: Jomy Vadasseril Jose, Shreetal Rajan Nair, Shajudeen Kayakkal, Antony George Francis Thottian, Abdul M. M. Rasak
  Abstract: Indian Journal of Clinical Medicine, Ahead of Print.
  A 68-year-old gentleman presented to us with a low back ache and paraparesis. Magnetic resonance imaging of the spine revealed vertebral body lesion compressing the spinal cord. As part of the preoperative evaluation for spinal decompression surgery, an echocardiography was done which revealed a normal heart with a floating mass in right atrium extending from the inferior vena cava. On further workup, he was diagnosed to have hepatocellular carcinoma with vertebral metastasis. Subsequently, the primary lesion ruptured leading to massive right-sided hemothorax.
  Citation: Indian Journal of Clinical Medicine
  PubDate: 2022-05-23T05:45:41Z
  DOI: 10.1177/26339447221095344
Case of an Exotic Skin and Soft Tissue Infection Associated with Cyclone
Ockhi
- Authors: Sreekumar Sivadasan, Aravind Reghukumar, Athul Gurudas, Kiran Kumar V. Sasidharan, Sruti P. Nair
  Abstract: Indian Journal of Clinical Medicine, Ahead of Print.
  Vibrio vulnificus is a halophilic marine gram-negative bacillus that is known to cause fulminant primary septicemia and complicated skin and soft tissue infections in humans. Vibrio vulnificus is referred to as flesh-eating bacteria. In the absence of timely detection and treatment, it results in sepsis with mortality of 50% and septic shock with mortality as high as 100%. Primary septicemia occurs following ingestion of contaminated seafood, and wound infections are acquired following exposure of open wounds to contaminated seawater. Early clinical suspicion and initiation of the appropriate antibiotics is essential to ensure good clinical outcome in case of Vibrio vulnificus septicemia. Here we report the case of a fisherman injured in cyclone Ockhi admitted to our hospital with lower limb cellulitis, who was diagnosed as Vibrio vulnificus wound infection. This case emphasizes the importance of history and clinical examination in antibiotic stewardship.
  Citation: Indian Journal of Clinical Medicine
  PubDate: 2022-04-20T03:59:27Z
  DOI: 10.1177/26339447211070986
Quintessential Case of POEMS Syndrome Associated With Multicentric
Castleman Disease
- Authors: Krishnarathnam Kannan, Indhuja Muthiah Vaikundaraja, Kanchan Murhekar, Swathy Pitti Umasankar
  Abstract: Indian Journal of Clinical Medicine, Ahead of Print.
  Castleman disease (CD) is a rare lymphoproliferative disorder, closely related to Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal plasma cell disorder, and Skin changes (POEMS) syndrome. We report a typical patient of multicentric CD with POEMS syndrome with all the classical features.
  Citation: Indian Journal of Clinical Medicine
  PubDate: 2022-04-20T03:53:27Z
  DOI: 10.1177/26339447221086398
The Hulk Hand!—In a Hemodialysis Patient (Case Report)
- Authors: Manoj Prabhakaran, Himanshu Sekhar Mahapatra, Amandeep Singh, Sanket Patil, Abhisek Gautam
  Abstract: Indian Journal of Clinical Medicine, Ahead of Print.
  A 35-year-old gentleman who was on maintenance hemodialysis for last 20 months presented with progressive swelling of the left upper limb. Initially, he had right nontunneled internal jugular vein (IJV) catheter followed by left nontunneled IJV catheter through which he received dialysis for 2 months. Further, his left brachiocephalic fistula (BCF) was created 18 months back. Since then, he was on regular thrice weekly dialysis through BCF. He started developing swelling of the left upper limb 8 months after fistula creation, which was gradually increasing. Blood flow was found to be normal during dialysis, examination suggestive of entire left upper limb swelling with thick induration. Doppler showed dilated outflow veins with high flow without any narrowing/stenosis of veins. Computed tomography venography done showed left brachiocephalic vein stenosis. He was found to have mega-fistula secondary to central vein stenosis which was managed successfully being discussed in this case report. Undiagnosed occult central venous stenosis in the prearteriovenous fistula (AVF) construction can manifest in various ways; one of them is as mega-fistula. It is the generalized aneurysmal dilatation of the entire outflow vessels of an AVF. Management option for this condition is limited depending on the etiology, fistula flow has to be reduced either by banding of the vessel or by fistula closure. Assessment of central veins before AVF construction and regular access surveillance in dialysis patients may prevent complications like these.
  Citation: Indian Journal of Clinical Medicine
  PubDate: 2022-04-08T10:19:40Z
  DOI: 10.1177/26339447221084415
Cytokine Storm in COVID 19 Culminating in Candida Endocarditis
- Authors: Mala Vinod Kaneria, Abhijeet Budhe, Prasenjit Lade, Tejas Poyekar
  Abstract: Indian Journal of Clinical Medicine, Ahead of Print.
  Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), had made its demonic debut on the world stage in December 2019 and has been sweeping across the globe since then. This new kid on the block soon also joined the cluster of risk factors, leading to fungal infections. Cases of mucormycosis, colloquially called “black fungus,” (COVID-19 associated mucormycosis [CAM]), had escalated in India, and the focus then shifted to Candida, the so-called “white fungus.” The dysregulated immune system in COVID-19, along with the immunosuppressants used to treat it, may give rise to fatal secondary infections. We present a patient who had a stormy, prolonged course following COVID-19, with multiple bacterial and viral infections, subsequently culminating in fungal endocarditis with Candida tropicalis.
  Citation: Indian Journal of Clinical Medicine
  PubDate: 2022-04-08T10:15:32Z
  DOI: 10.1177/26339447221090071
Sepsis due to Sphingomonas Paucimobilis in a Polytrauma Patient
- Authors: Arya S. Devi, Ramani Bai J. T., Ashish Jitendranath, Ivy Viswamohanan, Ganga Raju Krishna
  Abstract: Indian Journal of Clinical Medicine, Ahead of Print.
  Sphingomonas paucimobilis is a yellow-pigmented, aerobic, glucose nonfermenting, Gram-negative bacillus, causing a rare human infection normally associated with immunocompromised host. A 47-year-old male, known diabetic and hypertensive on treatment, with a history of trauma, underwent surgical intervention and developed fever postoperatively. A positive growth was detected on BACT/ALERT 3D. Blood culture smear shows Gram-negative bacilli which was identified as S. paucimobilis.
  Citation: Indian Journal of Clinical Medicine
  PubDate: 2022-04-07T06:30:12Z
  DOI: 10.1177/26339447221077501
Dengue-Associated Hemophagocytic Lymphohistiocytosis With Severe
Multiorgan Complications—A Case Report
- Authors: Rahul Agrawal, Prabha Agrawal, Sudha Madhuri, Thakur Abhijit Singh
  Abstract: Indian Journal of Clinical Medicine, Ahead of Print.
  Hemophagocytic lymphohistiocytosis (HLH) is a rare life-threatening syndrome characterized by pathologic immune hyperactivation, extreme inflammation, and multiorgan involvement with variable cytopenias. We report a case of a 53-year-old male with no known comorbidities, who presented with unrelenting dengue fever, pancytopenia, high ferritin levels, and multiple organ dysfunction with progressive clinical deterioration despite treatment. Based on the clinicolaboratory findings, he was diagnosed as dengue-associated HLH on day 6 of admission. As per HLH treatment protocol, he was started on immunosuppressants and showed significant improvement. In dengue patients with severe disease, prolonged hospital stay, persistent cytopenia, and multiorgan dysfunction out of proportion to the plasma leakage phase should prompt a high index of suspicion for the possibility of infection-triggered HLH. Although prompt diagnosis and early initiation of therapy is the key to prevent irreversible end organ damage and mortality, the hindrance lies in its rarity in adults, variable clinical presentation, and nonspecific laboratory findings.
  Citation: Indian Journal of Clinical Medicine
  PubDate: 2022-04-04T04:05:12Z
  DOI: 10.1177/26339447221080314
Barriers and the Role of Assistive Technology to Access Education for
Children with Visually Impaired During COVID-19 Times
- Authors: Shweta Kapote, Pallerla Srikanth
  Abstract: Indian Journal of Clinical Medicine, Ahead of Print.
  
  Citation: Indian Journal of Clinical Medicine
  PubDate: 2022-03-30T10:48:19Z
  DOI: 10.1177/26339447221089124
Perceived Stress Levels and Associated Factors Among SARS-CoV-2-Affected
Young Adults Under Home Isolation—A Cross-Sectional Study From Kerala,
India
- Authors: Anjana Nalina Kumari Kesavan Nair, Jisharaj Vijayakumari Rajasekharan Nair, Siji Vincent Swarnabai, Reshma Rajan Sudha, Alice Metilda Mendez, Leela Itty Amma
  First page: 11
  Abstract: Indian Journal of Clinical Medicine, Ahead of Print.
  IntroductionThe impact of SARS-CoV-2 is not only on physical health but also on mental health. This pandemic raised concerns of fear, anxiety, and stress among patients affected with the disease. Quarantine and home isolation might have created psychological distress and helplessness in patients due to social and economic reasons. This study aimed in assessing the level of perceived stress and factors associated with it among SARS-CoV-2-affected young adults who were under home isolation.MethodologyA cross-sectional study was conducted among 147 SARS-CoV-2-affected young adults who were under home isolation during June 2021 to August 2021. A semi-structured proforma was created using KoBo Toolbox for humanitarian response for data collection. Perceived Stress Scale (PSS-10) was used for measurement of stress among COVID-19 patients. The questionnaire was shared in online platform. Data was analyzed using Statistical Package for Social Sciences version 23.0. Significance of association was tested using chi square test and independent sample t test. Logistic regression was done to predict the factors associated with perceived stress.ResultsOut of the 147 study participants, 56.5% were females and 43.5% were males. Symptoms were present in 94 (63.9%) of patients. The mean age of the study participants was 26 (10.5) years. The mean PSS score was 17.5 (6.4). Among the cases under home isolation, 24.5% had low stress levels, 68% had moderate stress levels, and 7.5% had severe stress levels. Feeling of loneliness during home isolation (odds ratio [OR]: 4.7, 95% confidence interval [CI] [1.9-11.63], P = .008), presence of elderly or under-5 children in the same house (OR: 15.45, 95% CI [2.03-117.5], P = .001), and presence of cough (P = .05) were found to be significantly associated with higher PSS scores. Age and sleep were negatively correlated with stress score.ConclusionOne-third of the study participants had moderate to severe levels of perceived stress. Age, sleep hours, presence of cough, presence of under-5 children or elderly in the same house, and feeling of loneliness during home isolation were found to be significantly associated with high perceived stress level scores.
  Citation: Indian Journal of Clinical Medicine
  PubDate: 2022-01-10T03:46:20Z
  DOI: 10.1177/26339447211058643
Case of Mycotic Pseudoaneurysm of the Common Carotid Artery due to
Salmonella typhi Bacteremia
- Authors: Sruti P. Nair, Aravind Reghukumar, Athul Gurudas, Kiran Kumar V. Sasidharan, Sreekumar Sivadasan
  First page: 39
  Abstract: Indian Journal of Clinical Medicine, Ahead of Print.
  Aneurysm of the extracranial carotid artery is a rare disease, mycotic pseudoaneurysms being even less common. They are a life-threatening complication of systemic infection and atherosclerosis. Immunocompromised people, including patients with HIV, uncontrolled diabetes melltus, those on immunosuppressants like high-dose steroids, and chemotherapy, are at a higher risk for development of mycotic pseudoaneurysms. Due to the high risk of potential complications like rupture and thromboembolic events, mycotic aneurysms always require surgical management. Early detection followed by restoration of blood flow is critical to minimize a fatal outcome. Here we report the case of a 52-year-old man with a past history of hypertension and dyslipidemia who presented with a pulsatile painful neck swelling. On evaluation, the patient was diagnosed to have Salmonella typhi bacteremia, HIV infection, and a mycotic aneurysm of the left common carotid artery.
  Citation: Indian Journal of Clinical Medicine
  PubDate: 2022-01-10T11:08:27Z
  DOI: 10.1177/26339447211061041
Hoagland Sign as an Aid for Antimicrobial Stewardship—A Case Report
- Authors: Lakshmi J. Nair, Aravind Reghukumar, Athul Gurudas, Kirankumar V. Sasidharan, Kalyani Parvathy
  First page: 43
  Abstract: Indian Journal of Clinical Medicine, Ahead of Print.
  Hoagland sign is an early and transient bilateral painless upper eyelid edema observed in patients with Epstein-Barr virus (EBV)-related infectious mononucleosis. This sign can predate the appearance of exudative pharyngitis and cervical lymphadenopathy. Usually, this sign disappears by first week of infection. Here, we describe the occurrence of late onset Hoagland sign in a 14-year old boy who presented to us on 10th day of fever. Hoagland sign appeared after 10 days from symptom onset in our patient. Despite persistence of fever, the presence of Hoagland sign which appeared prior to confirmation of EBV infection was a helpful indicator for stopping antibiotics. In view of tonsillar hypertrophy with potential airway compromise and biochemical parameters suggestive of possible secondary hemophagocytic lymphohistiocytosis, he was initiated on steroids with which defervescence and prompt resolution of symptoms occurred. EBV can present as acute undifferentiated febrile syndrome which might result in inappropriate use of antibiotics. This case highlights the importance of using clinical clues like Hoagland sign to optimize antimicrobial stewardship.
  Citation: Indian Journal of Clinical Medicine
  PubDate: 2022-01-10T11:09:27Z
  DOI: 10.1177/26339447211068967
Weil’s Disease Death Investigation and Outbreak Control Measures
Instituted in the Field Area of a Family Health Center in
Thiruvananthapuram, Kerala—A Case Report
- Authors: Pranav V. Vasisht
  First page: 47
  Abstract: Indian Journal of Clinical Medicine, Ahead of Print.
  Introduction: Weil syndrome, a rare infectious disorder, is a severe form of the bacterial infection caused by Leptospira bacteria known as leptospirosis. Weil syndrome is characterized by dysfunction of the kidneys and liver, abnormal enlargement of the liver (hepatomegaly), persistent yellowing of the skin, mucous membranes, whites of the eyes (jaundice), and/or alterations in consciousness. In most cases, Weil syndrome occurs among individuals who are exposed to affected animals.Case Presentation and Summary: The investigation of death was done by a team consisting of doctor, junior health inspector, and ASHA workers of the area. We did a qualitative approach of in-depth interview of the wife and daughter-in-law of the deceased for data collection. The patient’s name and other details are not revealed for anonymity. No particular statistical analyses are used for this case reporting. The CARE guidelines were followed for writing this report.Conclusion: Leptospirosis is a disease of outbreak potential and has high case fatality rate. Timely identification of cases and institution of preventive measures is very important in preventing outbreaks. The surveys conducted in the area did not reveal any signs of an imminent or ongoing outbreak of leptospirosis.
  Citation: Indian Journal of Clinical Medicine
  PubDate: 2022-01-11T03:35:05Z
  DOI: 10.1177/26339447211067580