International Journal of Research in Medical Sciences
Not a member yet
9900 research outputs found
Sort by
Prevalence and co-infection of acute hepatitis A virus and hepatitis E virus infections in patients with acute viral hepatitis
Get PDFBackground: Viral hepatitis constitutes a significant global health burden, with hepatitis A virus (HAV) and hepatitis E virus (HEV) causing approximately 1.34 million deaths annually. This study aimed to determine the prevalence of acute HAV and HEV infections, evaluate co-infection patterns, and assess liver dysfunction among suspected acute viral hepatitis cases.
Methods: This cross-sectional study was conducted from July 2023 to July 2024 at a tertiary care hospital. A total of 165 patients with clinically suspected acute viral hepatitis were included. Serum samples were tested for IgM antibodies against HAV and HEV using ELISA. Clinical severity was assessed using standardized grading criteria.
Results: Among 165 patients with suspected acute viral hepatitis, HAV IgM seropositivity was 23.6% (39/165), HEV IgM seropositivity was 10.9% (18/165), and co-infection rate was 2.4% (4/165). HAV mono-infections comprised 21.2% (35/165) and HEV mono-infections 8.5% (14/165). Co-infected patients were significantly younger (mean age 15.8±4.2 years) compared to HAV (30.2±13.8 years) and HEV (25.6±11.4 years) mono-infections (p=0.042). Severe disease occurred in 50% of co-infected patients compared to <9% in mono-infections. Seasonal clustering was highly significant (p < 0.001) with 47.2% of cases during monsoon period.
Conclusions: This study demonstrates significant HAV and HEV disease burden with young adults being most susceptible. Co-infected patients showed more severe clinical presentation requiring enhanced monitoring. Seasonal clustering emphasizes the environmental influence on transmission patterns
Comparison of day wise maturity and failure rates of radio-cephalic and brachiocephalic fistulas using Color Doppler ultrasound in chronic kidney disease patients
Get PDFBackground: Arteriovenous fistula is an autogenous connection between Artery and a vein which is created in patients of chronic kidney disease which need frequent hemodialysis as it allows adequate blood flow during the process and has high patency rates and lower complications.
Methods: This prospective study was conducted in tertiary care centre medical college in patients of age group 18-60 yrs. involving both genders with chronic kidney disease and hemodialysis with radio cephalic or brachiocephalic fistula.
Results: In our study out of 63 patients in 38 patients radio cephalic fistula was made in (60.3%), brachiocephalic in 11 patients (17.5%) and 14 cases were not fit for the surgery. In a comparison of day wise maturity of brachiocephalic and radio cephalic fistulas the maturity at day 1 for brachiocephalic fistula was ~37% and ~32% for radio cephalic fistulas.
On day 14; 8 of the 11 brachiocephalic fistula (72%) and 19 of the 38(50%) of the patients with radio cephalic had maturity. On day 42; 81% of the brachiocephalic fistula and radio cephalic fistula 27(71%) had maturity. Out of 11 total brachiocephalic 9 were mature at the end of study with failure rate of 18.2% and out of the 38-radio cephalic fistula 27 patients were mature with failure rate of 28.9%.
Conclusions: In our study involving 63 patients the most common fistula was radio cephalic fistula followed by brachiocephalic fistula, even though the brachiocephalic fistulas had an earlier maturity rate; long term complications of brachiocephalic fistula were more
Comparison between Bethesda and thyroid imaging reporting and data system scoring in patients of thyroid swelling at a tertiary care hospital
Get PDFBackground: Accurate diagnosis of thyroid swellings is crucial to differentiate benign from malignant lesions. The Bethesda system for reporting thyroid cytopathology (TBSRTC) and the thyroid imaging reporting and data system (TIRADS) are standardized tools used for cytological and ultrasonographic risk stratification, respectively. Objective was to compare the diagnostic performance of Bethesda and TIRADS scoring systems in evaluating thyroid nodules.
Methods: A prospective observational study was conducted over 18 months at a tertiary care hospital on 150 patients with thyroid swellings. All patients underwent ultrasound-based TIRADS scoring and FNAC using the Bethesda classification. The correlation of both scores with histopathological diagnosis was analyzed.
Results: Of 150 cases, 47 (31%) were malignant. TIRADS TR4-TR5 categories showed a strong correlation with Bethesda V-VI and histologically confirmed malignancies. Sensitivity, specificity, and diagnostic accuracy for TIRADS were 92.5%, 99.1%, and 97.3%, respectively. Combined TIRADS and Bethesda correlation further improved diagnostic confidence.
Conclusions: TIRADS scoring showed high concordance with Bethesda categories and histopathology. Combining both systems offers a robust preoperative risk stratification tool
An unusual presentation of inverted papilloma in the nasopharynx
Get PDFInverted papilloma is a benign epithelial ingrowth into the underlying stroma of the nasal cavity and paranasal sinuses. Even though inverted papilloma is a common lesion within the nasal cavity, it rarely presents primarily in the nasopharynx. This patient presented with clinical features of a nasopharyngeal mass, which on imaging of nose and paranasal sinuses revealed a well-defined polypoidal soft tissue density lesion seen arising from the posterolateral wall of nasopharynx. Total surgical excision of the mass was done and histopathological examination was indicative of inverted papilloma with features suggestive of carcinoma in situ. The importance of early identification of this lesion lies in the fact that the tumor is well known for its invasiveness, tendency to recur and association with malignancy. Hence this requires close surveillance and regular follow up with endoscopy and imaging. This case is rare of its type due to its unusual presentation as an isolated nasopharyngeal mass without extension to nasal cavity
A case report and insightful review of congenital insensitivity to pain with anhidrosis
Get PDFWe present a case of a 9-month-old male, born to a third-degree consanguineous marriage, presenting with a month-long history of mild to moderate fever occurring 3-4 times daily. The child remained active during afebrile periods and exhibited no associated symptoms. Physical examination revealed pallor and multiple abrasions on bilateral fingers, with stable vital signs. Extensive investigations for infectious and hematological conditions were negative. Notably, the child did not cry during IV insertion and the fever developed after sun exposure. A detailed CNS examination revealed an absence of sensation to crude touch, pain and temperature, leading to further tests which confirmed the diagnosis of congenital insensitivity to pain with anhidrosis (CIPA). This case underscores the importance of considering CIPA in children with unexplained fevers and insensitivity to pain, particularly in consanguineous families and highlights the need for regular follow-ups and supportive management
A clinical study of plasma homocysteine levels in chronic kidney disease at a tertiary care center
Get PDFBackground: Chronic kidney disease (CKD) is associated with progressive loss of renal function and elevated plasma homocysteine levels, which may increase cardiovascular risk. This study aimed to assess the association between renal function decline and homocysteine levels in CKD patients.
Methods: A single-center, prospective observational study was conducted over 18 months involving 50 CKD patients. Demographic, clinical, and biochemical data including plasma homocysteine, serum creatinine, blood urea nitrogen (BUN), urea, glomerular filtration rate (GFR), and albumin levels were collected. Patients were stratified by homocysteine levels (normal <15 µmol/l, elevated >15 µmol/l), and associations with renal parameters were analyzed.
Results: Elevated homocysteine was observed in 38 (76%) patients. Patients with elevated homocysteine had significantly higher plasma homocysteine levels (21.98±7.52 µmol/l) compared to the normal group (12.22±1.83 µmol/l, p=0.001). Serum creatinine was higher in the elevated group (8.30±4.68 mg/dl) versus normal (4.68±2.17 mg/dl, p=0.001). Similarly, BUN (57.89±15.41 mg/dl versus 42.18±6.22 mg/dl, p=0.001) and urea (121.58±32.37 mg/dl versus 88.58±13.06 mg/dl, p=0.001) were elevated. The mean GFR was significantly lower in the elevated homocysteine group (11.68±6.30 ml/minute) compared to the normal group (16.44±7.93 ml/minute, p=0.03). Significant correlations were found between homocysteine and serum creatinine (r=0.305, p=0.03), BUN (r=0.335, p=0.01), urea (r=0.345, p=0.01), and GFR (r= -0.412, p=0.01).
Conclusions: Elevated homocysteine levels may serve as a useful biomarker and potential therapeutic target to mitigate cardiovascular risk and disease progression in CKD
Post-operative rehabilitation following posterior cruciate ligament reconstruction on manual labourer
Get PDFInjuries to the posterior cruciate ligament (PCL) are less common than injuries to the anterior cruciate ligament (ACL), but they make the knee much less stable and functional. Post-operative complications such as stiffness, muscle inhibition, and gait dysfunction often require an intensive and structured rehabilitation program. This case study highlights the role of comprehensive physiotherapy following delayed PCL reconstruction and medial meniscus repair. A 32-year-old male was done with imaging after his motorcycle accident, it revealed that a near-complete PCL tear, medial meniscus tear. He underwent arthroscopic PCL reconstruction and meniscus repair followed by 3 months immobilized in a brace at 30-degree flexion. After that the patient came with a complaint of a swelling, reduced range of motion (ROM), muscle wasting, inability to flex or extend his left knee. The patient went through a 12-week rehab program that included manual therapy, electrotherapy (faradic and Russian current), progressive strength training, gait training, and cryotherapy. Significant improvements were recorded over 12 weeks: pain reduced from 8/10 to 2/10 numerical pain rating scale (NPRS), active knee flexion improved from 40° to 128°, extensor lag resolved from 27° to 0°, and IKDC score increased from 40.2%/100% to 85.1%/100%. Muscle strength across the quadriceps, hamstrings, and gluteal muscles also showed notable gains while achieving all the short- and long-term goals. This case illustrates the importance of delayed referral, week-wise rehabilitation, and individualized physiotherapy for optimal recovery following PCL reconstruction. The integration of neuromuscular stimulation, targeted strengthening, and functional re-training proved effective in restoring joint mechanics and return to daily activities. Delayed mobilization and immobilization complications underscore the need for timely, evidence-based rehabilitation protocols
The usefulness of various subjective and objective measures of circadian phase in sleep medicine diagnostics
Get PDFCircadian rhythm sleep disorders (CRSDs)can be difficult to diagnose as they usually present with a wide array of complaints ranging from insomnia to excessive sleepiness or impairment in the quality of life. Malalignment of the endogenous circadian clock to the external day-night cycle leads to these disorders. There are various subjective and objective methods for assessing these disorders. Both individual subjective and objective measures of circadian phase have their own merits and limitations and a combination of both- especially sleep logs and questionnaires along with actigraphy usually suffice for diagnosing most cases. Dim light melatonin onset (DLMO) and core body temperature (CBT) minimum are also very useful in some cases. Recent advances in the knowledge of neurobiology and genetics of the circadian rhythm should hopefully lead us to improved diagnostic tools and provide us with evidence base practical guidelines for diagnosis and treatment of CRSDs.
Circadian Rhythm Sleep Disorders (CRSDs)can be difficult to diagnose as they usually present with a wide array of complaints ranging from insomnia to excessive sleepiness or impairment in the quality of life. Malalignment of the endogenous circadian clock to the external day-night cycle leads to these disorders. There are various subjective and objective methods for assessing these disorders. Both individual subjective and objective measures of circadian phase have their own merits and limitations and a combination of both- especially sleep logs and questionnaires along with actigraphy usually suffice for diagnosing most cases. Dim light melatonin onset(DLMO) and Core body temperature(CBT)minimum are also very useful in some cases. Recent advances in the knowledge of neurobiology and genetics of the circadian rhythm should hopefully lead us to improved diagnostic tools and provide us with evidence base practical guidelines for diagnosis and treatment of CRSDs.
Role of CT and MR enterography in the evaluation of inflammatory bowel disease
Get PDFBackground: Inflammatory bowel disease (IBD) requires accurate diagnosis and assessment of disease activity for effective management. CT Enterography (CTE) and MR Enterography (MRE) are key imaging modalities for evaluating small bowel involvement in IBD. This study compares their diagnostic performance in detecting IBD, assessing disease activity, and identifying complications.
Methods: A prospective observational study was conducted on 48 patients with suspected or confirmed IBD. All patients underwent both CTE and MRE, followed by ileo-colonoscopy within two weeks to maintain consistency in disease status. Endoscopy served as the reference standard. Sensitivity, specificity and accuracy were calculated for each modality, with statistical analysis performed using IBM SPSS version 29.0. Interobserver agreement was evaluated using Cohen’s kappa coefficient (κ).
Results: For diagnosing IBD, MRE showed a sensitivity of 86.6%, specificity of 92.7%, and accuracy of 89.65% (κ=0.73), while CTE demonstrated a sensitivity of 87.1%, specificity of 90.6%, and accuracy of 88.85% (κ=0.79). In detecting active disease, MRE achieved 84.5% sensitivity and 94.2% specificity (accuracy 89.35%, κ=0.76), whereas CTE showed 88.9% sensitivity and 83.7% specificity (accuracy 86.30%, κ=0.84). For chronic disease, MRE had 87.5% sensitivity and 91.2% specificity (accuracy 89.82%, κ=0.72), while CTE reported 88.3% sensitivity and 87.9% specificity (accuracy 88.10%, κ=0.77).
Conclusion: Both CTE and MRE provide high diagnostic accuracy for IBD. MRE is preferred in younger patients due to the absence of radiation, while CTE remains useful for rapid evaluation in acute or elderly cases
Management strategy of post-operative spinal infection
Get PDFBackground: This study aims to evaluate the outcomes of different management strategies in PSIs, with a focus on infections caused by S. epidermidis and TB organisms. Specific emphasis is placed on the role of antimicrobial and anti-TB drug therapies, as well as revision surgical procedures.
Methods: Analysis was conducted on 31 patients diagnosed with PSI at Bangladesh Medical University between 2015 and 2023. 14 patients received targeted antimicrobial therapy for pyogenic infections 5 patients received anti-TB therapy for tubercular infections. Revision surgical management, 7 patients underwent debridement only, 3 patients underwent debridement with fusion and 2 patients underwent debridement with fixation. Assessment were done at 1st, 3rd, 6th and 12th monthly by VAS, Odom Criteria, Nurick’s grading. Data were analyzed via the Statistical Package for Social Sciences (SPSS). A p value <0.05 was considered statistically significant.
Results: The mean VAS score significantly improved from 6.27±1.75 to 0.73±0.59 at 12 months (p < 0.001). According to the Modified Odom Criteria, 33.3% of patients had excellent outcomes, 60.0% had good outcomes and 6.7% had fair outcomes. Functional status measured by Nurick’s grading improved significantly, with 93.3% of patients in Grade III preoperatively and 87% improving to either Grade 0 or I by 12th months (p<0.001).
Conclusions: Effective management of PSIs depends on early diagnosis, appropriate antimicrobial or anti-TB therapy and timely surgical intervention. Staphylococcus epidermidis infections respond well to targeted antimicrobial therapy and debridement, whereas TB infections require prolonged anti-TB regimens and often more extensive surgical stabilization