International Journal of Medical Research & Review (IJMRR)
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Methotrexate Induced Toxic Epidermal Necrolysis: A Case Report
Get PDFMethotrexate continues to be one of the most widely used systemic immunosuppressive agents in dermatology. We describe a case of low-dose methotrexate (MTX) toxicity in a patient with chronic plaque psoriasis occurring during long-standing methotrexate therapy. This case report emphasizes the fact that co-medications like NSAIDS may exacerbate MTX toxicity. This patient had a rare methotrexate-induced toxic epidermal necrolysis including cutaneous ulceration. Hence, careful consideration of concomitant medication is required to avoid drug interactions for safe long-term methotrexate treatment
Case report of sertoli-leydig cell tumor of bilateral ovaries in a woman with 46XYkaryotype
Get PDFSertoli-Leydig Cell Tumors are rare constituting less than 0.5% of ovarian neoplasms and usually unilateral. Average age of presentation is 25 years.We report the case of a 23-year-old unmarried woman who presented with primary amenorrhea and 8 months history of intermittent pain over left lower abdomen. Transvaginal scan revealed rudimentary uterus with left ovarian cyst with mural nodules. Cytogenetic study revealed 46XY karyotype. Histopathological examination of specimen received after surgeryshowed well-differentiated Sertoli-Leydig Cell Tumor in sections from bilateral ovaries and Serous Surface Papilloma in a section from left ovary.Diagnosis is based on morphological features. Prognosis depends on stage and degree of differentiation
Assessing effectiveness of telemedicine intervention for creating awareness of pain education in rural areas of Central India
Get PDFIntroduction: Pain and palliative care is a growing need of the current healthcare system. This is because of the changing trends of disease related morbidity and mortality from acute communicable disease to chronic non communicable diseases. Development and easy availability of telecommunication mediums may be useful for creating awareness of pain and palliative care education in rural Indian setting.
Material and Method: We tried to assess effectiveness of telemedicine intervention for creating awareness of pain education in rural area of Central India. Total of five villages were connected through high speed broadband services to a tertiary care centre (LN Medical College Bhopal). This medical college acted as a nodal centre for the peripheral rural areas for providing telemedicine intervention.
Results: Telemedicine appears to be an effective and acceptable mode of creating awareness of pain and palliative care in rural population of Central India.
Conclusion: Telemedicine interventions may be able to bridge the gap between rural and urban part of Central India and may prove to be useful in low resource setting
hsTropI: an early biomarker of acute coronary syndrome & MI
Get PDFIn the Emergency Department cardiac troponins are the preferred biomarkers for the diagnosis of acute myocardial infarction (MI) and are useful for risk stratification of patients with acute coronary syndrome (ACS) and stable ischemic heart disease. The introduction of ‘high sensitivity’ Troponins (hscTn) in many tertiary care centers has transformed the diagnostic scenario, wherein, the time from onset of chest pain to its diagnosis has significantly been reduced. With the advent of new hsTnI assays, which have a low limit of detection, low imprecision and low reference limits, the possibility of more patients with unstable angina being classified as having non-ST-elevation myocardial infarction (NSTEMI) will now increase. Its use will identify more high-risk patients with undifferentiated chest pain, that will help ‘rule-in’ or ‘rule-out’ acute myocardial infarction. In conclusion, it may be said that hsTropI is a sensitive, albeit less specific marker of MI. In patients of mildly elevated hsTropI and without evidence of ST elevation, a serial assessment of the biomarker is suggested. This will likely translate into more improved outcomes in this difficult patient population when ECG findings and clinical presentation do not suggest a clear diagnosis
Coarctation of aorta presenting as hypertensive encephalopathy in a young female
Get PDFCoarctation of Aorta (CoA) is a congenital cardiac defect which can present in adults. The usual presentation is hypertension. Though it has subtle clinical signs but they can go undetected if not sought for. One of the most catastrophic presentations can be severe hypertension with its complications. We report a case of a 40 year old female who presented to us with hypertensive encephalopathy and finally diagnosed as Co
Comparative study of low dose magnesium sulphate regime with Pritchard regime in eclampsia
Get PDFIntroduction: Eclampsia is still a leading cause of maternal mortality and morbidity. Magnesium sulphate despite being an anticonvulsant of choice remains underutilized due to fear of toxicity. Average weight of Indian women is less than the western women due to which lower dose of magnesium sulphate can be used in treatment of eclampsia. The aim of the study was to compare the efficacy of low dose magnesium sulphate regimen with Pritchard regimen, in the control of convulsion in eclampsia. We also compared neonatal and maternal outcome in these two group.
Methodology: This randomized control study was carried out at Emergency Labour room, Government Medical College, Nagpur. 160 patients of eclampsia were divided randomly into study group (n=80) receiving low dose MgSO4 and control group (n=80) receiving Pritchard regimen. The recurrence of convulsion, toxicity profile and maternal and fetal outcome was studied.
Results: Majority of patients 73.75% were primigravida and 77.5% unbooked cases. 91.5% had antepartum/intrapartum eclampsia. 6 (7.5%) patients in study group had recurrence of convulsion as compared to 11 (13.75%) in Pritchard regimen group (p =0.31). Toxicity of MgSO4 in the form of lost tendon reflexes and respiratory depression was significantly less in those receiving Low dose of MgSO4 (p<0.001). Respiratory depression developed in one patient in control group and none in study group. Maternal mortality was 2.5% in both the groups. Perinatal mortality was 28.75% in the study group and 33.73% in control group.
Conclusions: Low dose Magnesium sulphate regimen was equally effective in the control of convulsions in eclampsia and can be safely used in Indian women
A study of clinico-hematological profile of pancytopenic patients in Central India
Get PDFBackground: To segregate the causes of pancytopenia which are easily treatable, from those requiring sophisticated investigations & vigorous treatment, based on clinico-hematological profile of the patients and affordable diagnostic mathods.
Materials and Methods: 180 Pancytopenic patients were evaluated clinically along with hematological parameters, peripheral smears and bone marrow aspiration in the Department of Pathology, GMC, Bhopal for 3 years.
Result: Age range was 5 months-70 years (mean- 26.6 years), with Male preponderance (M: F: 1.76:1). Commonest symptoms were weakness (97.8%), breathlessness (75%) and signs were pallor (98.3%) and splenomegaly (25.5%). Patients who presented with per rectal bleeding, in 46.2% diagnosis was dimorphic anemia thus per rectal bleeding was cause of associated iron deficiency. Commonest peripheral smear finding was microcytic hypochromic picture (27.22 %) & bone marrow was hypercellular (70.00%). Bone marrow aspiration revealed commonest cause was megaloblastic anemia (25%) followed by dimorphic anemia (17.2%) and infections (17.2%). In our study MCV was <100 fl in 12/45 (26.66%) cases of megaloblastic anemia so even if a patient presents with MCV < 100 fl megaloblastic anemia should not be ruled out only on this basis. Sensitivity of peripheral smear for dimorphic anemia was very low 35.48% and specificity was 82.55%, so bone marrow examination should be investigation of choice for inconclusive peripheral smears.
Conclusion: Common causes of pancytopenia were easily treatable and reversible & can be detected by early and affordable diagnostic methods therefore should be considered at higher order in differential diagnosis of pancytopenia
Prevalence of overweight and obesity among rural early adolescents in central part of Vidarbha, Maharashtra- A Cross Sectional study
Get PDFBackground: According to W.H.O number of over-weight children under the age group of five was estimated to be over 42 million and nearly close to 35 million of these were living in developing countries. Obesity in children and adolescents is defined as a BMI greater than the 95th percentile.
Objective: To find out the prevalence of overweight and obesity in school going early adolescents. 2) To find out the factors contributing to early adolescent overweight/obesity.
Method: School-going children between 11-15yrs. A cross-sectional (observational) study was carried out in middle- schools (5th to 7th standard) and high-schools (8th to 10th standard) of Alphonsa High School of Sawangi.
Result: Prevalence of over-weight in early adolescent was found to be 15.83% and obese was 11.18%. Obese school going students who watched television for 1 hour were 02.48%, those watching TV for 2 hours were 03.72% and more than 2 hours were 04.96%. Obesity was found to be more in children watching television for longer duration.
Conclusion: Overweight/obesity among children are progressing towards epidemic level. Eating habit of junk food is on rise
Assessing the pattern of usage of smartphone in clinical practice among clinicians of city of Bhopal
Get PDFIntroduction: Smartphone have become essential part of our lifestyle and hold a promise to be used for variety of purposes. Its widespread availability and popularity has grown its usage in general population in various fields other than just in telecommunication alone. The usage of Smartphone among clinicians is also very common. We tried to study the current pattern of usage of Smartphone in clinical practice among clinicians in Bhopal city.
Material and method: We had done survey among around 200 clinicians of Bhopal city using a predesigned semi structured questionnaire.
Results: Smartphone usage among practicing doctors was very high. The opinion of majority of clinicians was that it is useful in clinical practice and hold potential of becoming important tool in clinical practice.
Discussion: Smartphone hold potential to serve many needs of clinicians and may be an essential tool for future clinical practice. It is also associated with some limitations and hazards which might be reduced with adequate precautions
Two Cases of Isolated ACTH Deficiency Presenting As Hyponatremia - Case Report
Get PDFNon-specific symptoms such as asthenia, anorexia, unintentional weight loss, nausea/vomiting particularly in the elderly population are often overlooked both by caretakers and physicians. Deteriorating general health and neuro-psychiatric symptoms are often attributed to depression in the elderly population. The most common electrolyte abnormality, hyponatremia is again more common in the elderly population. Often neglected chronic hyponatremia remains asymptomatic in many cases. Once hyponatremia is detected clinicians should establish a proper diagnosis before supplementation. Failure to diagnose such cases will lead to repeated hospitalization, poor quality of life, wastage of resources and even death. Isolated ACTH deficiency (IAD) is a rare disorder and potentially fatal. IAD can present rarely as hyponatremia and diagnosis can easily be missed if not suspected. IAD may not be as rare as earlier thought as more and more such cases are been reported. Here we report two cases of generalized weakness and nausea; they were repeatedly hospitalized and treated for hyponatremia and ultimately diagnosed as IAD in our hospital