International Journal of Medical Research & Review (IJMRR)
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Outcome of Different Endoscopic Modalities in Management of Large Proximal Ureteric Stone
Full text linkBackground: A urologist inserts a long, thin tube with a camera (ureteroscope) into your urethra (where pee leaves your body). They feed the ureteroscope through your bladder and into your ureter. Once they find your stone, they remove it or break it up with a laser. Percutaneous nephrolithotomy. Various techniques have been documented for the management of Large Proximal Ureteric Stones (LPUS), such as laparoscopy (LUL), antegrade approach, retrograde ureteroscopy (RURS), extracorporeal shockwave lithotripsy, and infrequently open surgery. The paper aimed to compare the overall results of treating patients with large proximal ureteric stones (15-20 mm) using transperitoneal LUL, RURS, and mini-percutaneous antegrade ureteroscopy.
Methods: This prospective, randomized trial involved 100 individuals of both sexes who were above the age of 18 and had a single, 15-20 mm LPUS. Patients were split into two equal groups at random: Group B received RURS combined with laser fragmentation, and Group A received LUL.
Results: 100 patients who were included in the trial were split evenly between the two groups based on similar demographic information and stone criteria. Regarding patient demographics and stone criteria, both groups were similar. Group A had a substantially greater stone-free percentage (100%) than Group B (72%). There was a significant difference (p<0.001) in the operating duration, hemoglobin deficit, and ultimate stone-free rate between groups A and B. There was little difference in the two groups\u27 conversation rates, mucosal injuries, ureteral perforations, complications, and length of hospital stay.
Conclusions: Compared to RURS, LUL is linked to a greater stone-free rate and fewer complications
Hand grip strength as a marker of functional impairment in chronic obstructive pulmonary disease patients
Full text linkBackground: COPD is a heterogeneous lung disease with multisystem involvement. COPD patients not only suffer from respiratory function impairment but also from peripheral muscle dysfunction which is an important manifestation that hinders day-to-day activities. Patients with a reduction in muscle strength should be detected early so that an early intervention through pulmonary rehabilitation can be done. pMDIs which is a common inhalation device in COPD require adequate hand strength for its actuation making the upper limb muscle strength an important parameter which is often ignored in COPD patients.
Objectives: To determine the hand grip strength of COPD patients objectively. To determine the association between hand grip strength with FEV1,6-minute walk distance and BODE index.
Methods: This is a cross-sectional followed by a prospective observational study conducted in the Department of Respiratory Medicine, Government Medical College, Trivandrum, Kerala. In 72 COPD patients, hand grip strength was assessed using a Camry Digital Dynamometer and was compared with the age and gender-adjusted values. Spirometry was done in all 72 patients and FEV1 measurement was recorded. A 6-minute walk distance was determined; the BODE index was calculated in these patients which comprises BMI, FEV1, Dyspnea on the MMRC scale and distance walked in 6 minutes.
Results: COPD patients were found to have a reduction in their hand grip strength compared to their age and gender-adjusted values. In COPD patients, hand grip strength was found to have a positive correlation with a 6-minute walk distance whereas grip strength was found to have a negative correlation with BODE INDEX.
Conclusion: Hand grip strength is impaired in COPD patients and it could be used as a marker of functional impairment
CORRELATION BETWEEN AIRWAY RESISTANCE AS DETERMINED BY R20 AND SEVERITY OF OBSTRUCTIVE SLEEP APNEA AS DETERMINED BY APNEA HYPOPNEA INDEX IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA”
Full text linkBackground: Polysomnography is the gold standard for the diagnosis of patients with obstructive sleep apnea, but its routine use is limited by its cost. R20 measures the resistance of large central airways while R5 corresponds to total airway resistance, in large airway obstruction (as in OSA) central airway resistance (R20) increases and total resistance (R5) increases. This study aims to assess the usefulness of impulse oscillometry in the diagnosis of patients with obstructive sleep apnea, as it is a cost-effective, easy-to-perform investigation.
Materials And Methods: The present cross-sectional study included 85 patients suspected to have obstructive sleep apnea. Initial screening was done using the STOP BANG score. Specifically, patients with a score of 0 - 2 are considered at low risk for moderate to severe OSA, while those with a score of 5 -8 are classified as high risk for moderate to severe OSA and in our study those with a score ≥3 was advised to perform sleep study with their AHI index noted and subsequently impulse oscillometry noting their R20, R5 and R5-R20.
Results: In our study majority of participants (64.3%) fell within the 51-60 age range, which aligns with typical findings indicating a higher prevalence in middle-aged adults. The majority of participants,70 individuals were obese. In our study hypertension was the most prevalent comorbidity associated with OSA Among the 84 study subjects 63.1% of the sample, reported having Type 2 Diabetes Mellitus. 60 participants, making up 71.4% of the sample, reported that they do snore and we demonstrated a good correlation between the severity of OSA and snoring.
Conclusion: Impulse oscillometry can be a useful,easy-to-perform test in the evaluation of patients with OSA though further studies are needed
Human Metapneumovirus (HMPV) - A Comprehensive Review of Clinical Impact, Epidemiology, and Management Approaches.: HMPV
Full text linkHuman Metapneumovirus (HMPV) is an important viral agent responsible for a range of respiratory diseases, especially among vulnerable populations such as young children, the elderly, and those with weakened immune systems. This review highlights the clinical features, epidemiology, diagnostic challenges, and therapeutic strategies related to HMPV infections. The absence of specific antiviral treatments and vaccines for HMPV represents a significant challenge in clinical practice. Understanding its pathogenesis, refining diagnostic methods, and advancing research into vaccines and therapeutics are essential to better manage and prevent this infection.
 
UNMASKING THE CULPRIT – PSEUDOANEURYSM OF PETROUS INTERNAL CAROTID ARTERY
Full text linkPseudoaneurysms of the petrous internal carotid artery are rare. This is the case of a patient who presented with intermittent episodes of profuse bleeding from left nostril and pulsatile tinnitus. Digital subtraction angiography (DSA) showed pseudoaneurysm from left petrous internal carotid artery and was promptly treated with balloon assisted coiling
Small bowel obstruction in Peutz Jeghers syndrome: case report
Full text linkIntroduction: Peutz-Jeghers syndrome (PJS) is a rare autosomal dominant congenital disorder characterised by the presence of hamartomatous polyps in the gastrointestinal tract and mucocutaneous lentiginosis. It is associated with an elevated risk of cancer and substantial morbidity related to polyps, notably intestinal intussusception during childhood.
Case report: We report the case of a 32-year-old man patient, who consulted for subocclusif syndrome with multiple pigmented spots on the face and lips. Abdominal computed tomography (CT) revealed an image of jejuno-jejunal intussusception and substenotic jejunal mass. The patient underwent a double-segmental small bowel resection, removing the intussusception and the jejunal mass. The pathologic examination confirmed the diagnosis of Peutz-Jeghers polyps with moderately differentiated, invasive adenocarcinoma.
Discussion: The diagnosis of SPJ can be established in patients presenting one or more polyps and at least two of the associated clinical criteria: labial melanin deposits, family history of the syndrome and polyposis of the small bowel. Half of the cases present with small bowel obstruction. PJS is associated with an increased risk of gastrointestinal and non-gastrointestinal malignancies. Endoscopic or surgical polypectomy remains the preferred treatment option to prevent complications.
Conclusion: Regular surveillance of the gastrointestinal tract is recommended both for cancer prevention and early detection, and to prevent polyp-related complications, and certainly improve prognosis in these patients
Six interesting case discussions of adult type 1 diabetes from Karnataka, South India
Full text linkType 1 diabetes can affect adults, although it is more common in children and young adults. We are presenting six cases of adult onset type 1diabetes. The etiology was autoimmune in five persons and idiopathic in one person. Two persons had diabetic ketoacidosis at presentation and four persons had symptoms of hyperglycemia. Fasting c-peptide was measured after blood glucose control and all six persons had very low c-peptide levels. Diabetes may present at any age so when there is strong clinical suspicion of type 1 diabetes in adults, physicians should do fasting C-peptide levels to diagnose type1 diabetes for management
Clinical, Radiological and Mutational Characteristics Of Lung Adenocarcinoma Among Never Smokers
Full text linkBackground: The percentage of non-smoking lung cancer appears to be high in Asia, where it is associated with onset at a young age, advanced stage, adenocarcinoma histology, female gender, and specific EGFR/ ALK/ ROS-1 gene alterations that can be treated with targeted therapeutics. The primary objective was to assess the clinical, radiological and mutational characteristics of our study samples. The secondary objective was to assess the 3-month outcome of our study samples.
Methods: This prospective cohort study included never-smoking patients diagnosed with adenocarcinoma lung over a period of one year. Clinical, radiological and mutational characteristics of patients were recorded and assessed. After 3 months following the initial assessment, outcomes were recorded.
Results: Out of 31 patients studied, the mean age was 60.68 years, with 80.9% females. Of the 54.8% homemakers, 77.4% reported using biomass fuel for cooking, and 3.2% had a family history of lung cancer. A combination of cough and breathlessness was present in 48.4%; a combination of cough, loss of weight, and loss of appetite was present in 16.1% and pallor was the most frequent sign observed in 16.1% of the cases. Chest x-ray showed a mass in 41.9%, and 38.7% showed consolidation in the chest x-ray. 38.7% show a combination of mass and mediastinal lymphadenopathy on CT chest. 58.1% showed Stage 3B, and 22.6% of patients showed an EGFR-positive status. After 3 months, 35.5% had stable disease, whereas 32.3% experienced disease progression. In total, the analysis included 31 samples, with a Chi-square value of 12.83 and a P-value of 0.04, indicating a statistically significant association between mutational status and the observed outcome.
Conclusion: Our study shows that biomass fuel exposure among homemakers was present predominantly among our study subjects. The predominant clinical features noted were cough/breathlessness and pallor. CT scan was found to be superior for a mass with mediastinal lymphadenopathy. 22.6% of our study subjects show an EGFR-positive mutation. Patients with EGFR mutation exhibited better disease outcomes
An Evaluating the Accuracy of Endoscopic diagnosis : A comparative analysis with Histopathology in Upper and Lower GI Tract Disorders
No full textABSTRACT
Background: Endoscopy and histopathology are complementary tools in diagnosing gastrointestinal (GI) disorders. While endoscopy provides macroscopic visualization, histopathology offers definitive microscopic diagnosis. This study aims to evaluate the correlation between endoscopic findings and histopathological results in upper and lower GI disorders.
Objectives:
To assess the diagnostic correlation between endoscopic impressions and histopathological diagnosis.
To determine the accuracy of endoscopy in detecting various upper and lower GI tract pathologies.
Methods: A retrospective study was conducted on 200 patients undergoing upper GI endoscopy (UGIE) and Colonoscopy for GI symptoms. Endoscopic findings were documented and correlated with histopathology reports of biopsy specimens.
Results: Endoscopic and histopathological findings were consistent in 92% of upper GI cases and 90.6% of lower GI cases. Among 125 upper GI cases, 115 were concordant, and among 75 lower GI cases, 68 were concordant. Highest correlation was observed in cases of gastric ulcers, esophagitis, colorectal polyps, and inflammatory bowel disease (IBD) and malignancy.
Conclusion: Endoscopy is a reliable initial diagnostic tool. However, histopathological confirmation is essential, especially in cases with subtle or ambiguous endoscopic findings.
Keywords: Endoscopy, Histopathology, GI Disorders, Upper GI, Colonoscopy.
 
To evaluate the relationship between BODE Index and CRP in COPD patients in a tertiary care centre : To evaluate the relationship between BODE Index and CRP in COPD patients in a tertiary care centre
No full textBackground: Chronic obstructive pulmonary disease (COPD) is a respiratory disease which is associated with abnormal inflammatory response of lungs to stimuli leading to a progressive airflow limitation that is not fully reversible. COPD is the third leading cause of death worldwide with an estimated burden of COPD about 37.8million cases. Of late, the disease is being discussed widely due to its systemic nature. A combined index of multiple mortality predictors for COPD known as the “BODE index” was developed to understand this aspect of the disease. The BODE index, which includes Body Mass Index (BMI), Airflow Obstruction (FEV1), Dyspnea (MMRC), and Exercise Capacity (6MWT), is a multidimensional tool for assessing disease severity. C-reactive protein (CRP), an acute-phase reactant, is commonly elevated in COPD and may reflect systemic inflammatory burden.Objective: This study aimed to evaluate the relationship between CRP levels and the BODE index in stable COPD patients.Methods: A cross-sectional study was conducted on 110 stable COPD patients. CRP levels and BODE index components were measured and analyzed using Pearson coefficient correlation.Results: A weak but statistically significant positive correlation was found between CRP and the BODE index (r = 0.258, p = 0.006). CRP was also significantly associated with lower FEV1, shorter 6MWT distance, and higher MMRC scores.Conclusion: CRP may be a useful marker for systemic inflammation and disease severity in stable COPD patients