International Journal of Medical Research & Review (IJMRR)
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Anaesthetic Management of a Patient With Varicella For Emergency Caesarean Section
Full text linkVaricella zoster (VZ) is highly contagious virus and it can cause two different diseases; chicken pox as the primary infection and later reactivates shingles or herpes zoster. Approximately 5–10% of pregnant women lack antibodies to VZV and may acquire varicella during pregnancy. We present a case of 20 year old woman with herpes zoster presented for emergency caesarean section in view of foetal distress while discussing the anaesthetic issues related to varicella in pregnancy
Prevalence Of the Adverse Drug Events Associated With Drug-Resistant Tuberculosis Treatment In South Kerala
Full text linkBackground: Patient adherence is critical for successful tuberculosis (TB) treatment, and adverse drug events (ADEs) remain a major barrier. Anticipating and managing these reactions is vital to prevent treatment default, drug resistance, and complications. Limited data exist from Kerala on ADEs related to drug-resistant tuberculosis (DR-TB), necessitating further investigation.
Materials and Methods: A cross-sectional study was conducted among patients enrolled at seven district TB centres during the first half of 2024. Participants were evaluated six months after treatment initiation through structured interviews.
Results: Adverse drug reactions (ADRs) were reported by 65.2% of patients: 30.3% mild, 27.0% moderate, and 7.9% severe. Gastrointestinal symptoms predominated—gastritis (40.4%) and nausea (38.2%)—followed by itching and vomiting (33.7% each), arthritis (27.0%), and peripheral neuropathy (16.9%). Severe ADRs such as hepatotoxicity (3.4%), nephrotoxicity (2.2%), and hearing loss (2.2%) were uncommon. Treatment adherence was high (85.4%), with no significant association between ADR occurrence and adherence (p=0.51). Older age (p=0.04), alcohol use (p=0.04), and diabetes (p=0.01) were significantly associated with ADRs, while gender, residence, smoking, and hypertension were not.
Conclusion: Adverse drug reactions are common among DR-TB patients in South Kerala. Focused monitoring of high-risk groups, proactive management of comorbidities, and strengthened pharmacovigilance systems are essential to optimise treatment outcomes
CORRELATION BETWEEN IMPULSE OSCILLOMETRY AND SPIROMETRY IN ASSESSMENT OF SMALL AIRWAY DYSFUNCTION IN ASYMPTOMATIC SMOKERS
Full text linkBACKGROUND: The traditional pulmonary function tests may be inadequate to detect Chronic Obstructive Pulmonary Disease (COPD) pathological damage and smoking-related lung disease. Therefore, more reliable methods for airway evaluation are required for patients with COPD. Impulse oscillation system (IOS) is a novel method for reactance and airway resistance measurements. It is a kind of forced oscillation, where sound waves oscillate at different frequencies, usually between 5 and 20 Hz, and propagate through the bronchial tree. It measures the proximal airway resistance (measured at 20 Hz [R20]), the peripheral airway resistance (measured at R5–R20), and the overall airway resistance (measured at 5 Hz [R5]). Resistance and reactance make up impedance. IOS provides more detailed information than spirometry on regional lung function and should be considered as being complementary to spirometry to comprehensively assess lung function in COPD. Also, small airway dysfunction (SAD), if detected early, can help in preventing progression of the disease with proper counselling and smoking cessation.
OBJECTIVES: The objective of our study is to assess the correlation between impulse oscillometry and spirometry parameters in small airway dysfunction in asymptomatic smokers in a tertiary care centre; to determine the association of smoking index with impulse oscillometry small airway dysfunction parameter R5-R20.
MATERIALS AND METHODS: Study was conducted in Department of Pulmonary Medicine, Medical college Hospital, Thiruvananthapuram. The present cross- sectional study included asymptomatic current smokers, eligible participants underwent spirometry and oscillometry and results compared.
RESULTS: Out of 45 patients studied, 44.4% (n=20), fell within the 45-60 age range. The majority of participants, comprising 37.8% (n=17), had a Smoking Index ranging from 300 to 399. Correlation analysis between FEF (25-75) vs (R5-R20) done by Pearson correlation test reported very mild negative correlation between them (r=-0.053, p=0.728). Chi square test reported significant association between smoking index & R5-R20 (p<0.05).
CONCLUSION: Impulse oscillometry is capable to detect SAD in asymptomatic smokers with preserved spirometry and with FEF(25-75) values in the normal range. We verify that IOS offers parameters that can contribute to conventional pulmonary function tests
The role of lactate to guide resuscitation: A clinician\u27s perspective
Full text link’Doctor, this patient’s lactate is raised at 4mmol/l, do you want to prescribe some fluid?’’. There have been many a time where we as clinicians have had similar encounters in our clinical journey. The reaction would be to prescribe intravenous crystalloids, however with time and recent emphasis on the importance of damage control/source control resuscitation this has been realised to be fraught with errors. The approach differs if the resuscitation is a medical or trauma based. The aim of this article is to explore some of the concerns that the emergency and critical care clinicians have from a raised lactate
Pulmonary and extrapulmonary tuberculosis, an inflammatory disease misdiagnosed as cancer : Tuberculosis misdiagnosed as cancer
Full text linkIntroduction: tuberculosis is a serious infection associated with high mortally rate if not treated. The clinical and imaging presentation are usually nonspecific and can mimic malignancy; therefore, extrapulmonary TB should be considered in the differential diagnosis of any suspicious extrapulmonary masses, particularly in immunocompromised patients.
Objective: the aim of this study is to analyzed 160 case of pulmonary and extra-pulmonary tuberculosis and correlate the pathological features with the clinical data and to find the most common differentiation diagnosis of both pulmonary and extrapulmonary tuberculosis
Methodology: a retrospective analysis of 160 case of pulmonary and extra-pulmonary tuberculosis was performed. The age, the gender, the site, and the symptoms of the lesion were collected, extrapulmonary sites were detected including rare and unusual sites and the differential diagnosis of these lesion was highlighted. The data were plotted in graphs and were analyzed
Result: in our study 63.6% were male and 36.4 were females. Majority of the patients were in the age group of 21-30 years followed by 31- 40-year, cough and hemoptysis were the most common symptoms followed by cervical swelling with 39% and 33% respectively. The most common sites were lung with (39%) and cervical swelling with (33%). The main differential diagnosis for many pulmonary and all extra-pulmonary tuberculosis was malignancy
Conclusion: tuberculosis is a serious young person disease that can affect almost every organ and tissue of the body and should be considered in the differential diagnosis of suspicious masses, as tuberculosis often misdiagnosed as cancer
keywords: Mycobacterium tuberculosis, cancer, malignancy, extrapulmonary.
 
Pharmacological therapy approaches for the treatment of knee osteoarthritis
Full text linkTo date, no effective treatment has been able to modify the pathological progression of osteoarthritis (OA). Current therapy can be broadly categorized into pharmacological and non-pharmacological approaches before considering surgical interventions. Non-pharmacological methods address lifestyle modifications, weight reduction and physical therapy, all aiming at alleviating mechanical stress on the affected joint. In this article, we focused on pharmacological treatment options, that primarily target pain reduction by reducing joint inflammation or restoring the altered synovial environment to a normal state. In this literature review, the main focus is on approved conservative therapies and examined emerging conservative strategies. Evaluating their advantages and limitations
Total colectomy of patients having synchronous lessons of five cases in Sylhet MAG Osmani Medical College, Bangladesh
No full textBackground: Synchronous colorectal lesions present unique challenges in diagnosis and treatment, particularly in resource-limited settings. This study aims to evaluate the outcomes of total colectomy for synchronous colorectal lesions in a regional medical center in Bangladesh.
Methods: A retrospective case series of five patients who underwent total colectomy for synchronous colorectal lesions at Sylhet MAG Osmani Medical College Hospital between January 2019 and December 2023 was conducted. Patient demographics, clinical presentation, operative details, histopathological findings, and short-term outcomes were analyzed.
Results: The median age was 62 years (range: 48-75), with a male-to-female ratio of 3:2. The median number of synchronous lesions was 3 (range: 2-5). Three patients underwent open surgery, while two had laparoscopic-assisted procedures. The median operative time was 285 minutes (range: 240-360), with a median estimated blood loss of 350 mL (range: 200-600). Histopathology revealed adenocarcinoma in at least one lesion in three patients. The median length of hospital stay was 10 days (range: 8-15). Postoperative complications included ileus (n=2) and wound infection (n=1). No mortality or anastomotic leaks were observed within 30 days postoperatively. At 30-day follow-up, all patients reported satisfactory bowel function with a median stool frequency of 4 times per day.
Conclusion: Total colectomy for synchronous colorectal lesions can be safely performed with acceptable short-term outcomes in a regional medical center in Bangladesh. However, challenges remain in terms of resource availability and long-term follow-up. Further research is needed to optimize patient selection and perioperative management in resource-constrained settings
Comparison of deferasirox and deferoxamine effects on iron overload in patients with blood transfusion-dependent β-thalassemia
Full text linkIntroduction: Beta-thalassemias is autosomal recessive hematological disorder prevalent in the
Mediterranean area due to defects in synthesis of β chains of hemoglobin. The aim of present study was to compare the effects of deferasirox and deferoxamine on iron overload in patients with blood transfusion-dependent β-thalassemia major and intermedia.
Patients And Methods: This study involved 100 patients with known cases of β-thalassemia major or intermedia that has been treated with blood transfusion and iron chelators from January 2020 to December 2023. Serum ferritin, serum iron, serum total iron binding capacity were assessed in deferoxamine and deferasirox-treated patients.
Results: In deferoxamine-treated patients, serum ferritin levels were high (4600.56 + 119.2ng/dL) compared to deferasirox-treated patients (3000.261 ± 121.2 ng/dL; P< 0.0001), also there were significant differences in serum iron and total iron-binding capacity (P< 0.0001) in deferasirox-treated patients compared to deferoxamine-treated patients.
Conclusion: This study indicated that deferasirox is more effective than deferoxamine regarding the iron overload in patients with blood transfusion-dependent β-thalassemia
Blue round cell tumors – Bone marrow metastasis
Full text linkObjective: Bone marrow involvement by solid tumor implicates advanced disease and bad prognosis.Bone marrow aspiration and biopsy , performed routinely for staging for small round cell tumors and unexplained cytopenia in other solid tumors .It is important to rule out bone marrow involvement before planning for any definitive ,curative treatment.Materials and Methods: This was a retrospective observational study of bone marrow involvement by , Small round cell tumors / solid tumors and their hematological manifestation, especially the neuroblastomas. Results: Evaluation of Bone marrow evaluation during past 5 years , in solid malignancies,revealed Out of 574, 240 were pediatric cases and 334 were adult cases. Bone marrow was involved in 65 patients. In children, bone marrow involvement was present in 34 cases, and in adults, bone marrow involvement was diagnosed in 31 cases. Neuroblastoma was the most common malignancy, which involved the bone marrow in pediatric cases, followed Ewing’s sarcoma& retinoblastoma .Among adult patients, neuroendocrine carcinoma involving bone marrow,primary malignancy in breast being common in women and prostatic carcinoma in men. Conclusion: small round blue cell tumors are the major cause of bone marrow involvement in pediatric,.Use of immunohistochemistry markers on bone marrow biopsies results in higher detection rat
Basophilic Blast crisis of CML- Barely encountered
Full text linkObjective: Chronic leukemias are rare and blastic phase of CML are even rare. Imunophenotyping/IHC studies have a limited role in the diagnosis of CML but are being used in CMl blast transformations. Purpose of this current study was to report the barely encountered basophilic blast crisis of CML .and to determine the clinical and laboratory and Flow immunophenotyping (FIC)/IHC features of blast crisis. Methods: 8 years analysis was done 688 cases of suspected CMI were studied . Patients were evaluated at KMIO between 2004 to 2012. 488 cases had Bone marrow diagnosis of CML. 42 cases peripheral smear was suggestive of blastic phase CML were selectively chosen for the study. Bone marrow , Karyotyping and Molecular confirmation was available . IHC /FIC was done in 15 cases. Results: adults and Male sex predilection was seen. Gender ratio was 1.6: 1.splenomegaly& Leucocyte count> 200X10° I was seen, in all cases bone marrorw aspiration confirmed the diagnosis,most cases of CML progressed to blastic phase from chronic phase during their course of treatment. Phildelphia chromosome was noted in most cases.and 6 cases revealed additional markers .PCR revealed p210 transcript in all cases. In 15 cases in the blastic phase Flow cytometry immunophenotype/IHC was done. 9 cases were myeloid blastic phase,2 cases were reported as basophilic blast crisis single case was mixed phenotype, 3 cases were lymphoid blastic phase. Conclusion: most treated cases attained remission with imatinib, continue to be in remission after a mean of 8 months.