International Journal of Research in Medical Sciences
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Peroxisome proliferator-activated receptors in metabolic and renal health: a comprehensive review
Full text linkPeroxisome Proliferator-Activated Receptors (PPARs), including α, β/δ and γ isoforms, play crucial roles in regulating metabolic and renal health. This study explores their involvement in lipid metabolism, inflammation, chronic kidney disease (CKD) and diabetic nephropathy, emphasizing the therapeutic potential of both synthetic and natural PPAR agonists. A comprehensive literature review was conducted using PubMed, Scopus and Google Scholar, with search terms such as "Peroxisome Proliferator-Activated Receptors," "PPAR agonists," "lipid metabolism," "chronic kidney disease," and "diabetic nephropathy." Boolean operators and MeSH terms were applied and studies from 2000 to 2024 were included. Eligibility criteria focused on experimental, clinical and review articles detailing PPAR mechanisms, physiological roles and therapeutic applications. Findings indicate that PPARs are critical in lipid and glucose metabolism, oxidative stress reduction and fibrosis mitigation. Synthetic ligands such as thiazolidinediones and fibrates demonstrate therapeutic efficacy in CKD and metabolic syndrome, though challenges such as side effects and variability persist. While PPAR-targeted treatments offer promise in metabolic and renal disorders, their clinical application requires further refinement through selective modulators, combination therapies and biomarker-guided strategies
Dose and time-dependent effect of orange juice on the antimalarial efficacy of artemether-lumefantrine, haematological, and antioxidant parameters
Full text linkBackground: Orange juice (OJ) contains ascorbic acid, which has antioxidant properties that would be expected to protect against haemolytic effects and possibly interfere with the antimalarial mechanism of the artemisinin-based combination therapy. This study was designed to investigate the dose and time-dependent effect of OJ on the anti-malarial efficacy of artemether-lumefantrine (AL).
Methods: Malaria was induced by inoculating plasmodium berghei parasite through the intraperitoneal route to albino mice. The infection was allowed to establish for 3 days, followed by treatment with AL alone, and its combination with graded doses of OJ. Separate doses of OJ were also administered to different groups.
Results: Treatment with AL alone produced total parasite clearance (100%) in days 3 and 4 post-treatment. Co-administration of AL with graded doses of OJ showed significant (p<0.05) increase in parasitemia at OJ combination doses of 10, 8, and 6 ml/kg. Unlike antagonistic combination interaction exhibited by higher combination doses of OJ, lower combination doses of 4 and 2 ml/kg potentiated the antiplasmodial activity of AL. Compared to vehicle (malaria) control group, a significant (p<0.05) increase in PCV was achieved at combination OJ doses of 10, 8, 6, and 4 ml/kg. Combination doses of OJ at 10, 8, 6 ml/kg restored the catalase enzyme activity to the level that exist in uninfected naïve control group.
Conclusions: OJ showed both antagonistic and beneficial interactions with AL at higher and lower doses, respectively. Combination of OJ with AL also has a beneficial effect in reducing both parasite and AL-induced oxidative stress
Jejunal perforated gastrointestinal stromal tumor as a rare cause of acute abdomen: case report and review of literature
Full text linkGastrointestinal stromal tumors (GIST) are the most common mesenchymal tumor of the GI tract. Most cases are asymptomatic, or present as an abdominal mass. Less frequently, they can present as an upper GI bleed or acute abdomen. We hereby present the case of a 47-year-old male who visits the ER department complaining of abdominal pain and melena, with physical exploration findings of acute abdomen. An abdominal computed tomography (CT) scan was performed, where a free intra-abdominal fluid was seen in left upper quadrant and a tumor like mass was detected in small intestine causing bowel obstruction for which he underwent exploratory laparotomy, finding a perforated jejunal GIST. An emergency exploratory laparotomy was performed due to the clinical findings of acute abdomen, upon organ examination, hemoperitoneum was found and intestinal leakage due to a mass in a segment of jejunum 25 cm from Treitz angle, an intestinal resection and anastomosis was performed. GISTs are common tumors that rarely present to the emergency room as an acute abdomen. It is important to the surgeon to bear this in mind and have knowledge of the specifics of management of these type of patients to provide an adequate surgical resection and postoperative risk specific follow up
Gender differences in depression, anxiety, stress and quality of life among paramedical students
Full text linkBackground: Understanding the gender differences in depression, anxiety, stress and quality of life among paramedical students with special reference to the Indian context. To study the gender differences in depression, anxiety, stress and quality of life among paramedical students. The present study followed a cross-sectional study design and was conducted at a private medical university in Ghaziabad, Uttar Pradesh, India.
Methods: Purposive sampling technique was used to collect data from 218 paramedical students. Standardized tools General Health Questionnaire, Depression Anxiety Stress Scale and World Health Organization Quality of Life BREF were administered as physical forms. Ethical clearance and informed consent were obtained. Descriptive statistics (frequencies, mean and standard deviation) along with inferential statistics of t-test and Chi Square test were computed in the current study, to understand the gender difference in variables of study.
Results: Stress showed a statistically significant difference between male and female participants (χ²=11.151, p=0.025 significant) with females scoring a higher score as compared to males. No statistically significant difference were shown in depression, anxiety and quality of life between the genders despite slight score differences.
Conclusions: There is a gender difference as well as a relationship between depression, anxiety, stress and quality of life among paramedical students. These findings suggest the importance of how mental health differs in terms of gender and how it affects the quality of life among the students, specifically with reference to the Indian context
A study of clinico pathological evaluation of acute scrotum and its management in adults in a tertiary care hospital
Full text linkBackground: The acute scrotum is a surgical emergency. It is defined as scrotal pain, swelling, and redness of acute onset. Scrotal abnormalities can be divided into three groups, which are extra-testicular lesion, intra-testicular lesion and trauma. Acute scrotal pain, once diagnosed, can be treated appropriately with either conservative or surgical measures. The appropriate management pathway is determined by proper history taking, clinical examination and investigations in a restricted time frame. Objectives were to evaluate clinical presentation, diagnosis, management, complications, and short-term outcomes of acute scrotum, including hospital stay and mortality.
Methods: A descriptive cross-sectional study was conducted at Dhaka medical college hospital from January to September 2013, including 210 adult patients (≥18 years) with acute scrotal pathology. Purposive sampling was used. Data on demographics, clinical features, investigations [complete blood count (CBC), urine routine examination (R/E), ultrasonography (USG)], management, and outcomes were collected prospectively. Statistical analysis was performed using SPSS, with results expressed as mean, standard deviation, and percentages.
Results: Among 210 patients with acute scrotum, acute epididymitis (24.28%) was the most common diagnosis, followed by epididymo-orchitis (13.80%) and testicular torsion (12.38%). Most patients were aged 21-30 years (27.76%) with normal body mass index (BMI) (85.07%). Scrotal swelling (79.52%) and fever (64.76%) were predominant symptoms, while only 15.23% presented within 6 hours. Surgical intervention was required in 53% of cases, with debridement (22.86%) being the most common. The mean hospital stay was 1.34 weeks, with 66.70% discharged within a week.
Conclusions: Acute scrotum requires urgent diagnosis and treatment; surgery for torsion and trauma, conservative care for infections ensures better outcomes
Ayurvedic insights into the early pathogenesis and management of ankylosing spondylitis: a case report
Full text linkAnkylosing spondylitis is a chronic seronegative inflammatory arthritis that mainly affects the sacroiliac joints and spine, potentially leading to spinal fusion. Conventional treatments like NSAIDs, DMARDs, and TNF-α inhibitors help manage pain and inflammation but do not provide a cureIn this case 37year old male patient admitted in kayachikitsa inpatient department of vaidyaratnam ayurveda college, ollur on 02/01/24 with pain and restricted movements of neck, swelling with pain on right knee joint and low back ache. He was diagnosed as ankylosing spondylitis (Sandhigata vata) as per Modified New York Criteria for Ankylosing spondylitis (AS) and including the clinical presentation, physical examination, laboratory tests. He underwent treatment protocol of vatavyadhi chikitsa. Ayurvedic preparations like chitrakadi kashayam, maharasnadi kashayam, chandrapraba gulika, vettumaran gulika, shaddharanam choornam were given internally. Dhanyakizhi, lepanam, dhanyamla dhara, abhyangam were given as external therapy. Visual analogue scales for pain, range of movements, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score using ESR (ASDAS-ESR), AMA assessment tool were used to evaluate the effectiveness of the treatment. After the treatment patient got relief of pain, considerable improvement in range of motion of cervical spine, swelling and pain on right knee joint reduced. This case study highlighted that within 2 weeks restricted movements of neck got considerable improvement and ankylosing spondylitis disease activity score using ESR (ASDAS-ESR) decreased significantly by conservative ayurvedic management only
Discordance between histopathology and immunohistochemistry and pattern of lymphoma in northern part of Bangladesh
Full text linkBackground: Even in this modern era, many lymphoma patients are getting treatment based on histopathology diagnosis. The treatment plan and overall survival (OS) of lymphoma patients are adversely affected by either misdiagnosis or overdiagnosis. This study is intended to evaluate the degree of discordance between IHC and histopathological investigations, the pattern of lymphoma and various factors related to it.
Methods: This cross-sectional study was conducted in the Department of Hematology, Shaheed Ziaur Rahman Medical College Hospital, Bogura and private practice from 2019 to 2024 until 100 cases were available. Variation in diagnosis was assessed and factors such as cellular origin of lymphoma, status of CD20 positivity, any role of expert variation and justification of histopathology as a tool of treatment were assessed. Data were collected by reviewing investigation reports and documented in a checklist.
Results: Diagnostic discordance, regarding confirmed diagnosis, between histopathology and IHC was identified in 78% of patients. In 58% of cases, morphological diagnosis even failed to clarify broadly if it is malignant or not, if it is lymphoma whether it is HL or NHL. In 75% of lymphoma cases, peripheral lymph node involvement was found, about 10% of cases NHL involved bone marrow rather than peripheral LNs. CD20 was positive in 62% of lymphomas, 10% of HD and 72% of NHL.
Conclusions: Lymphoma is a potentially curable malignancy having a wide variety of treatment options depending on the type of disease. This typing is not possible without IHC. No lymphoma patient should be treated without IHC diagnosis
Impact of prophylactic biliary stenting on stone recurrence and post-endoscopic retrograde cholangiopancreatography complications in patients awaiting cholecystectomy: a randomized controlled trial
Full text linkBackground: Recurrence of common bile duct (CBD) stones and post-endoscopic complications remain clinical concerns in patients awaiting elective cholecystectomy. The use of prophylactic biliary stents after complete stone clearance is debated, with conflicting evidence regarding their efficacy and safety. This study aimed to evaluate whether biliary stent placement after duct clearance reduces recurrence or contributes to procedural complications.
Methods: A prospective, randomized controlled trial was conducted over one year at a tertiary care center in Bihar, India. Patients with confirmed choledocholithiasis who achieved complete CBD clearance through endoscopic retrograde cholangiopancreatography (ERCP) were randomized into two arms: Group A received prophylactic biliary stents (n=42), and group B did not receive stents (n=38). Patients were monitored for three months through clinical reviews and imaging (endoscopic ultrasound or MRCP). The primary outcome measured was recurrence of CBD stones. Secondary outcomes included incidence of post-procedure complications and need for repeat ERCP.
Results: Of the 80 participants, 42 were allocated to the stent arm and 38 to the no-stent arm, all of whom completed the study. Recurrent common bile duct stones developed in 8 patients (19.0%) in the stent group versus 3 patients (7.9%) in the non-stent group. The stent cohort demonstrated a higher overall complication rate (11.9%), with events such as post-ERCP pancreatitis and acute cholecystitis, whereas no complications were recorded in the non-stent cohort. Although repeat ERCP was required more often among those who received stents, the difference was not statistically significant.
Conclusions: The findings suggest that prophylactic biliary stenting after successful CBD clearance does not reduce recurrence risk and may increase the likelihood of complications. These results call for careful reconsideration of routine stent use in patients awaiting cholecystectomy
Neuropsychological dysfunction in schizophrenia: a study of executive functioning, vigilance and abstraction
Full text linkBackground: Schizophrenia is a chronic psychiatric disorder characterized by profound disturbances in cognition, perception and behaviour. This study examines neuropsychological dysfunctions in adult schizophrenic patients, specifically focusing on executive functioning, vigilance and abstraction. To assess deficits in neuropsychological domains among adult schizophrenic patients and compare them with healthy controls.
Methods: A prospective, matched control group design was used, comprising 30 adult schizophrenic patients and 30 healthy controls matched for socio-demographic variables. neuropsychological assessments included Bhatia’s short battery of performance test for intelligence, symbol cancellation test and the similarity Test. Descriptive statistics, t-tests and correlation analyses were used for data interpretation.
Results: Schizophrenic patients demonstrated significant impairments in executive functioning, vigilance and abstraction compared to healthy controls. Deficits were evident in working memory, cognitive flexibility, problem-solving, sustained attention and abstract reasoning, reinforcing the role of frontal lobe dysfunction in schizophrenia. Conclusions: The study highlights marked neuropsychological deficits in schizophrenia, emphasizing the need for targeted cognitive rehabilitation strategies. Addressing these impairments through structured interventions may improve functional outcomes and overall quality of life in patients
Navigating the storm: a young woman’s battle with refractory lupus nephritis complicated by pulmonary tuberculosis: a detailed case report
Full text linkSystemic lupus erythematosus (SLE) is an autoimmune disease that is commonly treated with high dose of corticosteroids and other immunosuppressive medications. Patients with SLE are thus more likely to become infected with a variety of pathogens, including Mycobacterium tuberculosis. There are no established guidelines for treatment of tuberculosis in SLE patients with high disease activity due to a lack of relevant studies and management based on physician expertise. This article presents a case report of a 31 years old female with underlying SLE and refractory lupus nephritis previously treated with IV methylprednisolone pulse therapy and 6 doses of cyclophosphamide and Rituximab presented with Fever, cough with expectoration, pain abdomen and loose stools for a 15 days duration. Mini-BAL CBNAAT detected TB. She was treated with intravenous methylprednisolone and anti-tuberculous therapy, but the result was a fatal outcome