International Journal of Research in Medical Sciences
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Association of socio-demographic factors with undernutrition in children under five with cleft palate: a cross-sectional study in a South Indian tertiary hospital
Get PDFBackground: Children with cleft palates face unique challenges that increase their risk of undernutrition. While feeding issues are well established, the role of sociodemographic factors in nutritional outcomes remains underexplored in low-resource settings. To estimate the prevalence of undernutrition and assess its association with sociodemographic factors in children with cleft palate.
Methods: A cross-sectional study was conducted at Sree Balaji Medical College and Hospital in Chennai over 19 months. A total of 218 children under five with cleft palates were enrolled. Nutritional status was assessed using the WHO anthropometric indicators. Associations between undernutrition and sociodemographic factors were analyzed using chi-square tests and odds ratios.
Results: Undernutrition was observed in 70.2% of the children. Most participants were below 3 years of age (and 54.5% were male. The majority belonged to lower-middle and middle-income socioeconomic classes. A higher proportion of undernourished children were born preterm (71.5%). Maternal education was low in a subset of mothers, with 5.5% being illiterate. Feeding difficulties such as nasal regurgitation were commonly reported.
Conclusions: Socioeconomic disadvantage and low maternal education significantly contribute to undernutrition in children with cleft palate. Early interventions targeting these factors are essential for improving nutritional outcomes
Rare case report on Acitrom induced coagulopathy with seizure disorder
Get PDFAcitrom (nicoumalone), a vitamin K antagonist, is widely used for the prevention of thromboembolic disorders. However, its narrow therapeutic index mandates vigilant monitoring to avoid complications like coagulopathy. This case report presents a 59-year-old female with a history of cerebral venous thrombosis, coronary artery disease, and seizures who developed Acitrom-induced coagulopathy. She was admitted with symptoms of headache, vomiting, burning sensation in the lower limbs, and later with bleeding from the gums and oral cavity, melena, and a generalized tonic-clonic seizure. Her past medication included Acitrom, Thyroxin, Atorvastatin, Aspirin, and several other supportive drugs. Investigations revealed deranged coagulation parameters, with INR elevated beyond the therapeutic range. MRI and MRV indicated partial recanalization of cerebral venous sinuses, with no evidence of infarction or hemorrhage. She was managed with intravenous vitamin K, fresh frozen plasma, and antiepileptics including phenytoin and levetiracetam. The offending agent, Acitrom, was discontinued. The patient responded well to treatment and was discharged on antiepileptic and supportive therapy. This case emphasizes the importance of close INR monitoring and patient education to identify early signs of bleeding. Seizure in the context of anticoagulant-induced coagulopathy is rare and requires immediate attention. Interdisciplinary collaboration among neurology, internal medicine, and hematology is critical for optimizing patient outcomes. Early recognition, timely reversal of anticoagulation, and individualized care can significantly reduce morbidity in such complex clinical presentations
Insights into neurologists’ practices and preferences in pharmacological management of paediatric epilepsy: a real-world survey-based study from India
Get PDFBackground: Epilepsy is a chronic brain disorder marked by recurrent seizures. Many children experience a mild form that resolves naturally, while others have persistent cases requiring lifelong medication. In India, prevalence of paediatric epilepsy is about 0.8%. The objective of this survey was to explore neurologist’s practices in the pharmacological management of paediatric epilepsy.
Methods: The cross-sectional, questionnaire-based, real-world survey was conducted amongst 245 neurologists across India from August 2024 to September 2024. The respondents were administered a validated 20-question survey. Analysis of the data was conducted in Microsoft Excel (365, Version 22502). Graphical representations were created to highlight significant trends and treatment preferences.
Results: In the survey, 43.7% of the neurologists reported that they examine around 5 to 10 cases per month, and majority (44.0%) of them also noted 2-to-6-year age group was most affected with the disease. Levetiracetam has emerged as the most preferred antiepileptic drug, with 42.1% of respondents using it for focal epilepsy, 42.4% for generalized epilepsy and 46.5% for myoclonic seizures. Syrup formulations were preferred by 93.9% of neurologists, with levetiracetam syrup at a dose of 10mg/kg twice a day being the most commonly preferred in the management of paediatric epilepsy.
Conclusions: The survey indicates rising trend in paediatric epilepsy cases in India. Levetiracetam was the frequently chosen drug for the treatment of focal, generalized and myoclonic seizures in children with epilepsy. In addition to its rapid onset of action and low frequency of drug-drug interactions, it was also favoured for its versatility in terms of dosage formulation, especially in the syrup form
A rare case of strontium induced dermatitis in an osteoporotic patient taking an over-the-counter supplement: a case study
Get PDFStrontium ranelate, a strontium salt, is used in osteoporosis treatment due to its dual mechanism of promoting bone formation and inhibiting resorption. Although it is effective, strict monitoring is recommended because of it adverse reactions particularly related to cardiovascular and cutaneous adverse reactions. We report the case of a 71-year-old woman with a 20-year history of osteoporosis who developed progressive dermatitis and generalized pruritus over 1.5 years. Extensive dermatologic and rheumatologic evaluations, including skin biopsies, were inconclusive. Upon detailed history, the patient disclosed long-term use of an over-the-counter (OTC) vitamin supplement containing strontium citrate. Performed laboratory testing revealed significantly elevated serum strontium levels (124.2 ng/ml; reference: 8.3-34.3). After discontinuation of the supplement, her symptoms gradually resolved without specific treatment. This case highlights strontium toxicity manifesting as cutaneous symptoms, potentially caused by chronic ingestion of OTC strontium. While adverse effects of prescription strontium ranelate are documented, reports of toxicity from non-prescription strontium citrate are rare. The patient’s clinical improvement and declining strontium levels after supplement cessation strongly support the diagnosis. This is a rare and possibly novel case of cutaneous strontium toxicity linked to an OTC supplement. Clinicians should consider strontium toxicity in patients presenting with unexplained dermatitis and a history of osteoporosis, particularly when supplement use is identified. Greater awareness and regulation of strontium-containing OTC products are warranted
A comprehensive review of oral hypoglycaemic drugs and their oral health correlates
Get PDFOral hypoglycaemic drugs (OHDs) are vital in the effective management of type 2 diabetes mellitus (T2DM), a widespread metabolic disorder that affects millions globally. While these medications excel at controlling blood glucose levels, they can also lead to significant oral health challenges. This article delves into the various pharmacological classes of OHDs and highlights their potential impacts on oral health, including issues such as dry mouth (xerostomia), periodontal disease, taste changes, delayed healing, and a higher susceptibility to oral infections. It is imperative for healthcare providers, especially dental professionals, to understand these connections, as recognizing the oral health implications of diabetes is essential for delivering comprehensive and effective care to diabetic patients. Proper awareness and proactive management can make a substantial difference in the overall well-being of those living with diabetes
The significance of Klebsiella pneumoniae spondylodiscitis in the Indian context
Get PDFA rare case of spontaneous spondylodiscitis caused by Klebsiella pneumoniae in a 37-years-old man who presented with radiating low back pain is described in this case report. Increased erythrocyte sedimentation rate and C-reactive protein level were pertinent laboratory findings. Magnetic resonance imaging revealed a paravertebral epidural collection at the L5–S1 level of the spine suggestive of spondylodiscitis. Repeated spinal surgeries and HBsAg seropositive status were the risk factors in this patient. Pus from the epidural abscess on culture grew Klebsiella pneumoniae. He was treated with an intravenous antimicrobial combination of meropenem and levofloxacin which resulted in disappearance of the pain. Extended infusion of meropenem played a key role in the prompt recovery. Two months later, MRI showed substantial improvement of the lesions
Hemodynamic effect of transcatheter patent ductus arteriosus closure on gradient across stenotic aortic valve in a patient with co-existing bicuspid aortic valve, severe aortic stenosis and patent ductus arteriosus: a rare case report
Get PDFBicuspid aortic valve is the commonest congenital heart disease. It progresses to aortic stenosis, aortic regurgitation and aortopathy. However, most of the patients remains asymptomatic. Patent ductus arteriosus is relatively common congenital heart disease presenting as left to right shunt and pulmonary over circulation. Co-existence of bicuspid aortic valve, severe aortic stenosis and Patent ductus arteriosus is rare. These diseases are amenable to transcatheter treatment. Transcatheter closure is recommended treatment for patent ductus arteriosus and balloon aortic valvotomy is used as temporizing measure in paediatric severe aortic stenosis to relieve left ventricular outflow tract obstruction. Hemodynamic effect of one disease can affect the severity of other co-existing disease. In this case report we tried to understand hemodynamic effect of transcatheter closure of patent ductus arteriosus on severity of aortic stenosis. We found that transcatheter closure of patent ductus arteriosus decreased the peak-to-peak gradient across aortic valve
Revolutionizing full-mouth rehabilitation: digital integration of Hobo’s philosophy with CAD/CAM multilayered zirconia crowns: a case report
Get PDFSevere occlusal wear disrupts function, aesthetics, and occlusal harmony. Hobo’s twin-stage philosophy offers a structured approach to full-mouth rehabilitation. Integrating this with CAD/CAM technology enhances precision and clinical outcomes. A 28-year-old male with generalized tooth wear and compromised function underwent full-mouth rehabilitation. Vertical dimension was increased by 2 mm following occlusal splint evaluation. Hobo’s twin-stage technique was applied using a semi-adjustable articulator. Digital impressions and CAD/CAM workflows facilitated the fabrication of multilayered zirconia crowns.The patient showed excellent adaptation to the increased vertical dimension. Functional occlusion with canine guidance and posterior disclusion was achieved. The final restorations demonstrated precise fit, esthetics, and occlusal stability, with high patient satisfaction. Digital integration of Hobo’s twin-stage protocol with CAD/CAM zirconia restorations offers a predictable, efficient, and esthetically superior solution for managing severe tooth wear.
Sheathless and fluoroscopy-free retrograde intrarenal surgery: a single center experience
Get PDFBackground: This study was done to evaluate the effectiveness and safety of minimally invasive approach to treating renal stones using sheathless and fluoroscopy-free flexible ureterorenoscopic laser lithotripsy (FURSL).
Methods: A prospective study was conducted on 270 patients who underwent FURSL between January 2023 and March 2024. The procedure involved a semi-rigid ureteroscopic assessment with 6 and 8 Fr ureteroscope. A 7.5 Fr flexible URS was inserted into the PCS by side of guidewire sheathless and fluoroscopy-free, followed by the use of a holmium laser to fragment and dust stones in situ.
Results: The study population consisted of 270 patients including 170 males (62.96%) and 100 females (37.04%) with a mean age of 40.65 years (range: 3-70 years) were evaluated. The mean stone size was 17.23 mm (range: 8-41 mm). Complete stone-free status was achieved in 244 (90.37%) patients and clinically insignificant residual fragments (CIRF) in 4 (1.48%), while residual stones were still present in 22 (8.15%) patients. Postoperative complications occurred in 46 (17.4%) cases and were mostly minor, including fever in 34 (12.6%), pyelonephritis in 8 (3.0%), subcapsular hematoma in 2 (0.7%) and steinstrasse in 2 (0.7%). These complications were Clavien I-II, GI in 34 (12.6%) patients, GII in 10 (3.7%), and Clavien IIIb in 02 (0.7%). No major complications were observed. Stone size ≥2 cm, operative time ≥30 minutes, and lasing time ≥20 minutes were significantly associated with a higher rate of complications and lower stone-free rates (p<0.05).
Conclusions: Sheathless and fluoroscopy-free FURSL are effective and safe for renal stone management, especially for stones under 2 cm in diameter. This process is a feasible option for avoiding sheath complications, which can protect surgeons from the negative effects of radiation
Pulmonary function tests in granite quarry workers in Kuppam, Andhra Pradesh
Get PDFBackground: Quarrying is the process by which rock, sand, gravel, or other minerals from the earth are removed to produce materials for construction work and other uses. During the process of quarrying, large amounts of dust particles of heavy metals, silica, and organic solvents are emitted from the earth’s surface. Kuppam region of Andhra Pradesh is famous for the green coloured granite stone which has global demand, which is specifically found in the Kuppam and surrounding villages, hence number of quarries are more and causing respiratory diseases of local quarry workers.
Methods: The study was conducted in the department of physiology with total of 50 quarry workers for more than or equal to 5 years duration of working, both gender is randomly selected between 25-55 years of age. 50 Apparently normal healthy individuals of both genders were chosen from 5 km away from the quarry area as the control group. Ethical approval for the study protocol was obtained from institutional ethical clearance committee (IECC). After inclusion and exclusion criteria, lung function tests were done in quarry and the normal healthy subjects.
Results: There was a statistically significant change in FEV1, FVC and PEFR among quarry workers.
Conclusions: Not only quarry workers but also nearby residing population were also at the risk of deterioration of lung function tests