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- Hyperglycaemia in predicting severe COVID-19 at Tabanan general hospital,
Bali
Authors: Manik Parmelia, I. Made Juliana
Pages: 806 - 812
Abstract: Background: Hyperglycaemia has been shown to be associated with disease progression and poor prognosis in Corona virus disease 2019 (COVID-19) patients. This study aims to find the effect of hyperglycaemia on disease severity and investigate whether high blood glucose levels on admission can predict severity of COVID-19 infection Methods: in this cross-sectional study, a total of 286 COVID-19 patients in Tabanan general hospital, Bali were retrospectively analysed. Data were obtained from medical records from January 1 to December 31, 2021. Hyperglycaemia was defined as random blood glucose (RBG) >140 mg/dl. The severity of COVID-19 was determined according to the 4th edition of the Indonesian COVID-19 management guidelines. Clinical and biochemical characteristics of COVID-19 patients with or without diabetes were compared. Receiver operating characteristic (ROC) analysis was used to identify optimal admission plasma glucose levels to predict COVID-19 severity. Results: 47.2% of subjects had hyperglycaemia at admission, 67.5% experienced severe COVID-19, of which 68.4% died. Admission RBG values were positively correlated with leukocyte and NLR values. In ROC analysis, admission RBG >145 mg/dl can predict severe COVID-19 with sensitivity of 56% and specificity of 76% (AUC 0.663, p<0.01). Conclusions: Hyperglycaemia is an independent predictor of severe COVID-19 and impose a significantly higher mortality rate compared to normoglycemic patients regardless of diabetic status. Early measurement of plasma glucose levels upon admission can help identify patients who are likely to experience a worse clinical course.
PubDate: 2023-11-24
DOI: 10.18203/2349-3933.ijam20233564
Issue No: Vol. 10, No. 12 (2023)
- Understanding functional dyspepsia and its subtypes and the role of
prokinetics in its management: a cross-sectional clinician-based survey
Authors: Shrikant Mukewar, Nitesh Pratap, Samit Jain
Pages: 813 - 822
Abstract: Background: This survey evaluated opinions of consulting physicians or gastroenterologists on functional dyspepsia (FD) in the Indian population and the management of FD with prokinetics, especially itopride. Methods: A total of 243 clinicians involved in the clinical practice of FD were invited to complete an internet-based, structured survey questionnaire. Questionnaire comprised 29 questions on the diagnosis and treatment options for FD. Results: Majority of the clinicians opined that females were more affected by FD than males in both hospital-based (53.4%) and community-based (56.6%) practices. As per 33.3% of clinicians each, the age group of 21-40 years and 41-60 years were the two most commonly affected groups. FD symptoms were present for >6 months before patients seek consultation as reported by 62.6% of the clinicians. The participating clinicians preferred using detailed patient history (77.7%) and ROME IV criteria (71.1%) for diagnosing FD. Prokinetics were regarded as the therapy of choice primarily because of their efficacy in reducing FD symptoms. Among all prokinetics used, itopride was most preferred for postprandial distress syndrome (64.2% clinicians) and for epigastric pain syndrome in combination with PPIs (66.7% clinicians). Itopride was reported by 93.6% clinicians to be well tolerated, with the leading advantage being absence of extrapyramidal or cardiac side effects according to 40% of clinicians. Conclusions: The clinicians considered itopride to be most preferred to reduce FD symptoms and to be well-tolerated when taken alone or in combination with PPIs.
PubDate: 2023-11-07
DOI: 10.18203/2349-3933.ijam20233520
Issue No: Vol. 10, No. 12 (2023)
- Prevalence of coronary artery disease and the associated risk factors
among the patients attending the medicine department in a tertiary care
teaching hospital in the North Eastern Zone in India
Authors: Naushad Akhtar, Pritama Paul, Tapas Kumar, Uttam K. Paul
Pages: 823 - 829
Abstract: Background: Coronary artery disease (CAD) is characterized by the narrowing or obstruction of coronary arteries, leading to inadequate blood supply to the heart. In India, CAD has become a major public health issue, particularly in the North Eastern Zone. This study aims to illuminate CAD, its causes, and its unique prevalence patterns within India, with a specific focus on the North Eastern Zone. Methods: A cross-sectional study was conducted over a year at a tertiary care teaching hospital in India's North Eastern Zone. A sample of 154 patients with coronary artery disease was selected through structured questionnaires, clinical examinations, vital signs assessments, and 12-lead ECGs. Data analysis was done with proper equipment. Results: The study revealed an overall CAD prevalence of 4.24% among 2468 patients attending the Medicine OPD. Males had a higher prevalence across age groups, except for the 20-30-year-olds, where no females participated. Urban areas exhibited a significantly higher CAD prevalence (68.83%) compared to rural areas (31.17%). Statistically significant gender differences were observed in several risk factors, with males more likely to exhibit hypertension, hyperlipidemia, diabetes mellitus, obesity, smoking, and ischemic heart disease. Urban residents also showed a higher prevalence of various CAD risk factors compared to rural residents, except for alcohol consumption, which was more common in rural areas. Conclusions: The findings corroborate existing literature, highlighting gender disparities and urban-rural differences in CAD prevalence and risk factors. This study contributes valuable insights into CAD epidemiology in India, particularly in the North Eastern Zone.
PubDate: 2023-11-24
DOI: 10.18203/2349-3933.ijam20233565
Issue No: Vol. 10, No. 12 (2023)
- Aetiological sub-classification of thyrotoxicosis and relevance of TT3/TT4
ratio in sub-classification of patients with thyrotoxicosis: an Indian
cross-sectional study
Authors: Shailendra Kumar Singh, Rina Singh, Santosh Kumar Singh, Mir Asif Iquebal, Sarika Jaiswal, Pradeep Kumar Rai
Pages: 830 - 835
Abstract: Background: Thyrotoxicosis is a common endocrine problem. Sub-classification and rapid diagnosis of disease is crucial in the management. Methods: In this prospective cross-sectional study from India, newly diagnosed thyrotoxicosis patients were enrolled. All patients were sub classified into Graves’ disease, (GD), sub-acute thyroiditis (SAT) and toxic nodular goiter (TNG) based on diagnostic criteria. Clinical features were noted and TT3, TT4 and TSH level were measured. A thyroid scan was also done. Results: TNG, respectively. Mean± SD age for GD, SAT and TNG were 36.88±10.55, 37.44±5.96 and 61±11.36 years, respectively. Most of patients were female (77.63%). Goiter was present in 81.25%, 55.56% and 100% of GD, SAT and TNG patients respectively. Mean TT3/TT4 ratio was higher (20.15±5.45 verses 12.72±0.77) in GD as compared to SAT patients. The area under ROC curve of the TT3/TT4 for diagnosis of GD was 0.964. Cut off level of TT3/TT4 ratio >14.1 offered best sensitivity, specificity, PPV (positive predictive value) and accuracy. Conclusions: This first report from India on sub-classification of thyrotoxicosis shows that GD is the commonest cause of thyrotoxicosis. TT3/TT4 ratio of >14.1 may help in differentiating the cause of thyrotoxicosis.
PubDate: 2023-11-24
DOI: 10.18203/2349-3933.ijam20233566
Issue No: Vol. 10, No. 12 (2023)
- A randomized open-label study to compare iron content in the blood of
healthy subjects treated with Tasiron tablets containing ferric
di-phosphate as compared to tablets containing ferrous ascorbate
Authors: Prashant Kulkarni, Sasikumar Menon
Pages: 836 - 839
Abstract: Iron deficiency anemia (IDA) frequently affects reproductive-age women, pregnant women, and children of growing age, particularly in developing countries like India. Traditional oral iron supplementation has various side effects, and therefore, liposomal technology has been introduced. This study compared serum iron levels in healthy adult female subjects treated with Tasiron tablets containing 30 mg (elemental iron) of micronized liposomal ferric di-phosphate, with those administered with tablets containing 100 mg (elemental iron) of ferrous ascorbate, over 15 days. The test group (n=7) received 30 mg of micronized liposomal ferric di-phosphate and the control group (n=7) received 100 mg of ferrous ascorbate. Serum levels of iron, hemoglobin, ferritin, and transferrin were measured from samples collected on days 1, 8, and 16 of the treatment periods. Higher iron content and hemoglobin levels were found at day 16 (p<0.05) and day 8 (p<0.05) as compared to day 1 in both groups. The test group received one-third the dose of iron that was administered to the control group. The group receiving 100 mg ferrous ascorbate had higher ferritin levels at day 8 (p<0.01) and day 16 (p<0.01) as compared to day 1. In the group receiving ferrous ascorbate, transferrin levels decreased on day 8 and 16. In contrast, there was an increase in transferrin levels in the group receiving liposomal iron. Oral liposomal iron effectively increases iron content and hemoglobin levels at one-third the concentration as compared to ferrous ascorbate. Further studies on larger numbers with a longer follow-up are required.
PubDate: 2023-11-24
DOI: 10.18203/2349-3933.ijam20233567
Issue No: Vol. 10, No. 12 (2023)
- Tarlov cysts among sportspersons: a case series
Authors: Adarsh S. Sagolsem, Joy S. Akoijam, Nandabir S. Yumnam, Ningthemba S. Yumnam, Bhupes Pheiroijam, Rajankumar Lisham, Purnimala C. Kongkham, Sobhasini D. Laimujam, Ramkumar R.
Pages: 840 - 844
Abstract: Tarlov cysts (also known as meningeal cysts or perineural cysts) are fluid-filled sacs that are usually found at the bottom of the spine (the sacrum). The cysts appear in the roots of the nerves that grow out of the spinal cord. Majority of the tarlov cysts are often asymptomatic and hence not considered as part of the differential diagnosis for the treatment of low back pain. However, in some cases, tarlov cysts may be large enough to be symptomatic and as a result be a cause of disability and distress especially in physically active individuals. We report 5 cases of symptomatic tarlov cysts in physically active individuals with clinical presentations of persistent disabling low back pain with radiating pain in some individuals. In the first 3 cases, the tarlov cysts were large enough and the patients had to undergo ultrasound guided aspiration of the cysts while the other 2 cases were treated with epidural injections and conservative management.
PubDate: 2023-11-24
DOI: 10.18203/2349-3933.ijam20233568
Issue No: Vol. 10, No. 12 (2023)
- A rare case: evaluation of chronic hypoklemia in patient with Gitelman
syndrome
Authors: I. Gusti Sri Agung Jaya Kusumadewi, Putu Nindya Ayu Ningrum Subadra, Ketut Suryana
Pages: 845 - 848
Abstract: Gitelman syndrome (GS) is inherited in a recessive manner and is caused by inactivating mutations in the SLC12A3 gene characterized by the loss of salt, leading to hypokalemic metabolic alkalosis with concurrent hypomagnesemia and hypocalciuria. Hypokalemia is defined as a plasma potassium concentration of less than 3.5 mmol/l. A 24-year-old woman came with weakness and numbness in both lower limbs for the past 1 day and later extended to all four extremities. This patient had been admitted to hospital twice in the last 2 months with similar complaints. Laboratory results showed hypokalemia, hypocalcemia, hypomagnesemia, and metabolic alkalosis accompanied by elevated eGFR, anemia and increased potassium secretion in the distal tubules. Gitelman syndrome is the rare case and does not have specific symptoms, so the diagnosis depends on the accuracy of high clinical suspicion, especially those experiencing hypokalemia.
PubDate: 2023-11-24
DOI: 10.18203/2349-3933.ijam20233569
Issue No: Vol. 10, No. 12 (2023)
- Ictal epileptic headache in young female
Authors: Priyal Tiwari, Pushpendra Nath Renjen, Dinesh Mohan Chaudhari
Pages: 849 - 851
Abstract: The establishment of a temporal association between a hybrid of headache and epilepsy is essential for correct diagnosis and management of headache. Epilepsy-associated headaches (such as migralepsy, hemicrania epileptica, post ictal headache and ictal epileptic headaches) may be similar to the patients' usual headache or may be a new type of headache. The location of headaches is unrelated to the EEG localization of epileptic aura or ictal discharges. The only established association of location of headaches and epilepsy is seen in cases of migraine with a visual aura which seems to precede few instances of occipital epilepsy. EEG helps to distinguish epileptic headache from non-epileptic headache during ictus (convulsive or non-convulsive). Hemicrania epileptica is a rare type of EEG-demonstrated ictal epileptic headache characterized by migrainous features (such as unilateral, throbbing pain associated with nausea, vomiting, scintillating scotomas, and flashing lights) occurring during an ictal EEG. We should watch for migrainous visual auras (flashing lights and scintillating scotomas) and distinguish them from occipital lobe seizures (aura including visual hallucinations) with the help of clinical features and simultaneous demonstration of ictus on EEG. We report a case of a 28-year-old female presenting with a new headache as a sole feature of posterior lobe non-epileptic seizure. Early diagnosis of painful seizures leads to timely treatment of the episodic headaches using anti-epileptic therapy.
PubDate: 2023-11-24
DOI: 10.18203/2349-3933.ijam20233570
Issue No: Vol. 10, No. 12 (2023)
- Liver abscess in patient with uncontrolled type 2 diabetes mellitus: a
case report
Authors: Luh Ayu Made Paramita Dwisari Putri, A. A. Istri Sri Kumala Dewi
Pages: 852 - 856
Abstract: Liver abscess is a form of infection in the liver, which is characterized by the presence of pus covered by fibrous tissue in the liver parenchyma. This condition is a rare, but potential life-threatening liver infection, especially if not treated properly. DM is one of the most predisposing factors for liver abscess, especially pyogenic liver abscess. Its prevalence reaches more than 25% of all cases of liver abscess. Pathophysiological mechanisms of DM that can cause liver abscess might include harmful effects of hyperglycemia, general diabetic angiopathy, and decreased immunity. We presented the case of an elderly male patient with multiple liver abscess who had a history of type 2 DM with poorly controlled. Through this case will shows multiple liver abscess patients with comorbid type 2 DM and hyperglycemic stage who received antibiotic treatment with good response of therapy.
PubDate: 2023-11-24
DOI: 10.18203/2349-3933.ijam20233571
Issue No: Vol. 10, No. 12 (2023)
- A case report: the undescended testis present with inguinal hernia in
adolescence, how can be diagnosed and treated early'
Authors: I. Gusti Agung Brama Wijaya, A. A. Ngr. Jaya Kesuma
Pages: 857 - 859
Abstract: Undescended testis or cryptorchidism describe as one or more testicles are missing from the scrotum. Cryptorchidism may occur on one or both sides but more commonly affects the right testicle. To make the diagnosis, testicular examination followed by a laparoscopy to check for testes that hard to feel on physical examination. To avoid pathological alterations, surgical treatment for UDT should be administered prior to two years. A 16-year-old male patient come to the surgical department of Prima Medika Hospital complained of a lump in the right thigh fold and a non-palpable right testicle for 2 weeks and was unaware of the existence of his right testicles. On the abdominal examination, a non-reducible tumor was discovered during examination in the right groin with no lymphadenopathy in the left inguinal and left testicles. The testicular ultrasonography present, the right inguinal-proximal testis is undescended. Based on the patients complain, orcidopexy dextra with herniotomy was performed. In underdeveloped nations, UTD is common in adulthood, and the late identification of UDT might be problematic. Therefore, early diagnosis and immediate treatment are essential to prevent the complication and pathologic alterations that leading to subfertility and malignant transformation.
PubDate: 2023-11-24
DOI: 10.18203/2349-3933.ijam20233572
Issue No: Vol. 10, No. 12 (2023)
- Eight-and-a-half syndrome in pontine cavernoma: a rare presentation
Authors: Shruti M. Nair, Nirupama Kasturi, Jayasri P., Mary Stephen
Pages: 860 - 861
Abstract: Cavernous vascular anomalies are varied in form, and cavernomas are very rare lesions commonly found in the supra-tentorial region. Eight-and-a-half syndrome includes horizontal gaze palsy, internuclear ophthalmoplegia, and facial nerve palsy, which is rare in clinical practice. Etiologies are commonly infarct and demyelination. Cavernomas are space-occupying lesions that can lead to life-threatening complications due to haemorrhage, and cavernomas resulting in "eight-and-a-half syndrome" are extremely rare. We report a case of pontine cavernoma presenting as "eight and half syndrome," which worsened systemically, but with timely intervention, the patient recovered completely with good follow-up and an intact permanent tarsorrhaphy.
PubDate: 2023-11-24
DOI: 10.18203/2349-3933.ijam20233573
Issue No: Vol. 10, No. 12 (2023)
- A case report on intrapleural administration of antibiotic in tuberculous
empyema
Authors: Aditya S. Bhushan, Shashi Bhushan B. L., Anupama R.
Pages: 862 - 865
Abstract: A 34-year-old male came with complaints of cough with copious yellowish expectoration, hemoptysis, difficulty in breathing and constitutional symptoms like fever, loss of weight and anorexia. Contrast enhanced computed tomography was done which showed left sided empyema likely secondary to rupture of left upper lobe lung abscess. The case was proceeded with fiber-optic bronchoscopy and bronchoalveolar lavage which showed narrowed bronchial openings on both sides. BAL analysis showed total cell count of 1500 cells/mm3 with 70% neutrophils, 5% lymphocytes and 25% of epithelial cells and macrophages. Culture showed Klebsiella species and antibiotics were escalated according to sensitivity pattern. Intercostal drain with under water seal was inserted on left side and thick pus was drained and sent for analysis. Anti-tubercular treatment was started. Due to persistent drainage of pus, intra pleural administration of Streptomycin was done for 30 days. Patient was monitored with serial chest X-rays and relevant blood investigations. Good clinicoradiological resolution was noted.
PubDate: 2023-11-24
DOI: 10.18203/2349-3933.ijam20233574
Issue No: Vol. 10, No. 12 (2023)
- Craniopharyngioma in adults: a case report
Authors: Avtar Singh Dhanju, Nisha Narang, Manavdeep Kaur, Rishabh Rikhye, Pankaj Jassal, Adab Alwinder Singh
Pages: 866 - 868
Abstract: We are discussing a case report of 70-year-old male patient with craniopharyngioma who presented with complaint of high grade fever and altered sensorium with presence of meningeal irritation signs and papilledema in fundus examination. MRI 3D brain showed elongated lobulated mass lesion in the suprasellar region. It mostly occurs in young age before 20 years of age with features of headache, projectile vomiting and signs of raised intracranial pressure but there is possibility of its occurrence in older age group. It arises from embryologic squamous epithelial remnants of the craniopharyngeal duct or Rathke’s pouch. It develops near the hypothalamus near the pituitary gland that controls growth and many body functions. Usually, they are benign but can be malignant sometimes as they can cause serious problems by interfering with neuroendocrine structures or neuropsychological complications. There are only few cases of craniopharyngioma in old age patients worldwide.
PubDate: 2023-11-24
DOI: 10.18203/2349-3933.ijam20233575
Issue No: Vol. 10, No. 12 (2023)
- Case of nasopharyngeal metastases presenting with multiple atypical
cranial nerve deficits
Authors: Priyal Tiwari, Pushpendra Nath Renjen, Dinesh Mohan Chaudhari
Pages: 869 - 871
Abstract: Jugular foramen syndrome is an uncommon condition with a wide range of possible causes. We present a rare case of Villaret syndrome as an example of jugular foramen syndrome and illustrate a clinical-radiological approach for diagnosing jugular foramen syndrome. The morphological similarities between mesenchymal tumors such as rhabdomyosarcoma and phyllodes seen in our patient make immuno-histochemical (IHC) characterization essential for a definitive diagnosis. Jugular foramen syndromes, including Vernet syndrome, Collet Sicard, Villaret, Tapia, Jackson, and Schmidt, can manifest with multiple cranial nerve deficits in contiguous areas. In our case, the patient exhibited palate paralysis, pharyngeal anesthesia, and Horner's syndrome, thereby highlighting the differential diagnoses of Villaret syndrome and Tapia syndrome.
PubDate: 2023-11-24
DOI: 10.18203/2349-3933.ijam20233576
Issue No: Vol. 10, No. 12 (2023)
- Review of best treatment option in heart failure 2023
Authors: Gerardo Garcia Santiago, Andrea Marin Gomez, Guillermo Avalos Gonzalez, Oscar Jesus Leal Ramos, Alejandra Arias Castro, Mariano Belisario López Pere
Pages: 872 - 878
Abstract: Congestive heart failure is a clinical condition in which the heart is unable to pump enough blood to meet the metabolic needs of the body because of pathological changes in the myocardium. The three main causes of CHF are coronary artery disease, diabetes mellitus, and hypertension. US hospitalizations for heart failure decreased up until 2012; however, from 2013 to 2017, an increase in HF hospitalizations was observed. In 2017, there were 1.2 million HF hospitalizations in the United States among 924 000 patients with HF. This represents a 26% increase in HF hospitalizations and number of patients hospitalized with HF. For this reason, as a team, we have decided to conduct a review of the best treatment options for heart failure based on multiple articles.
PubDate: 2023-11-04
DOI: 10.18203/2349-3933.ijam20233512
Issue No: Vol. 10, No. 12 (2023)
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