International Journal of Research in Medical Sciences
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Resolution of allergic bronchopulmonary aspergillosis preceded by allergic fungal rhinosinusitis, without glucocorticoid therapy in an immunocompetent individual: a case report with narrative literature review
Get PDFAllergic bronchopulmonary aspergillosis (ABPA), seen predominantly in patients with uncontrolled bronchial asthma, cystic fibrosis, and immunocompromised patients, can uncommonly occur in an immunocompetent host. Rarely, an ABPA patient can have a preceding or concomitant history of its upper respiratory counterpart, allergic fungal rhinosinusitis (AFRS). The traditional mainstay of ABPA treatment is systemic glucocorticoids. We report a case of ABPA in a woman with a history of AFRS and recurrent atopic rhinitis, but with no previous definitive history of bronchial asthma or cystic fibrosis, that resolved without systemic glucocorticoid therapy. A 52-year-old female patient, a non-smoker, previously operated for AFRS, presented to the outpatient department with fever with chills, right-sided pleuritic type of chest pain, and cough with brown-black expectoration. The absolute eosinophil count was 1360. Serum baseline IgE was >2500. A chest X-ray revealed consolidation in the right middle zone. High-resolution computed tomography (HRCT) of the thorax revealed linear branching hyperdense content in a few of the dilated bronchi. Fiber-optic bronchoscopy confirmed thick mucus plugging at the lateral segment of the right middle lobe, pathognomonic of ABPA with high-attenuation mucus (ABPA-HAM). Oral Itraconazole monotherapy 200 mg twice daily for one day, followed by 100 mg twice daily for a total period of four months’ duration, had no significant adverse events during treatment. C-reactive protein decreased significantly by 2 weeks, total serum IgE levels by 2 months; and repeat chest X-ray at 6 months showed complete resolution of pulmonary infiltrates. This case report corroborates recent revised 2024 ISHAM-ABPA working group guidelines advocating Itraconazole monotherapy alone for treating acute ABPA
Polygeline: a comprehensive review of its role as a plasma volume expander in clinical practice
Get PDFPlasma volume expanders (PVEs) play a crucial role in emergency situations, such as trauma, shock, and major surgery, where rapid restoration of blood volume is essential. The choice between crystalloids and colloids as PVEs depends on various factors, including their pharmacokinetic properties. This review focuses on Polygeline, a synthetic colloid, and aims to discuss its development, physico-chemical properties, pharmacokinetics, clinical efficacy in different scenarios, safety profile, and its place in therapy. The development of polygeline dates to World War I, and its composition involves urea-linked gelatin, sodium chloride, and potassium chloride. The physico-chemical properties of polygeline, such as its average molecular weight, osmolality, and colloidal oncotic pressure, contribute to its unique characteristics, including prolonged intravascular presence and isotonicity with plasma. Compared to crystalloids like normal saline and Ringer's Lactate (RL), polygeline demonstrates a longer duration of action and higher maximum volume expansion, making it a valuable option in various clinical scenarios. The literature review includes studies on polygeline's clinical efficacy in critically ill patients, trauma cases, intra-operative use, haemodialysis, and large-volume paracentesis. Notable findings include its effectiveness in improving hemodynamic stability, especially in trauma patients, and its safe use in haemodialysis to lower catheter-related complications. The safety profile of polygeline appears favourable, with low incidences of anaphylactoid reactions and its safe administration in critically ill patients. In comparison to hydroxyethyl starch (HES), another synthetic colloid, Polygeline seems to have advantages in terms of safety, especially in patients with renal or hepatic impairment
Use of probiotics in vaginal infections
Get PDFVaginal infections are characterized by an overgrowth of microorganisms opportunistic and decreased levels of Lactobacillus. Vaginosis is common in women of childbearing age, perimenopausal women, women with polycystic ovary syndrome, pregnant women and adolescents. Vaginosis is often underestimated or misdiagnosed. Multiple studies mention that vaginosis detection tests should be performed on all high-risk pregnancies, women with significant obstetric history such as premature abortions and those who suffer from tuberculosis, because they are a risk factor for the development of abortions, premature rupture of membranes, choriomanionitis or preterm births. A challenge that is becoming more and more common revolves around the resistance of the microorganisms that cause vaginosis to the established treatments, generating recurrent and multi-resistant infections. For the treatment of different vaginosis, antibiotics and antifungals are prescribed. Studies point out the importance of prescribing antibiotics together with probiotics and thus avoiding dysbiosis in order to avoid recurrence of vaginal infections. Probiotics must be administered in the necessary dose and time so that they can generate a positive effect. More than 80% of Lactobacillus species must be present in a probiotic to ensure adequate acid and bactericidal production to prevent microfilm formation. The results of the use of probiotics will depend on the quality of the formula and the maintenance of the cold chain
Bilateral compressive neuropathy of the common peroneal nerve, secondary to multiple hereditary exostosis in an adolescent patient: a case report
Get PDFOsteochondroma is the most common bone tumor, accounting for 10-15% of all skeletal tumors and 20-50% of benign ones. These lesions can compress adjacent neurological structures, causing pain, paraesthesia, claudication, and progressive deficit. Common peroneal nerve (CPN) neuropathy is the third most frequent peripheral neuropathy in the lower extremity. Chronic nerve compression can lead to progressive symptoms and permanent neurological deficits if left untreated. Early diagnosis and proper follow-up are crucial. We present the case of a 16-year-old Mexican adolescent with compressive neuropathy of the common peroneal nerve secondary to multiple exostoses. The patient experienced tingling in both legs and dorsum of the feet, and progressive difficulty in dorsiflexion of the right foot. Physical examination revealed bilateral weakness in dorsiflexion, foot eversion, and hallux extension, as well as sensory alteration on the lateral aspect of both legs and dorsum of the feet. Electromyography confirmed decreased nerve conduction velocity in both common peroneal nerves. Surgical treatment with bilateral decompression of the common peroneal nerve and resection of the bony masses was decided. After three months of follow-up, the patient showed improvement in muscle strength and recovery of sensation. Timely surgical resection allows for functional recovery and avoids permanent sequelae. In patients with bilateral symptoms, early evaluation and treatment are critical to preserve motor function and improve quality of life
Small bowel perforation due to migration of a biliary stent: a case report
Get PDFEndoscopic placement of biliary stents is becoming more common every day, as it is currently one of the best options for the treatment of bile duct pathologies. One of the complications that can occur is the migration of the stent which in very rare cases can cause intestinal perforation. This is a 90-year-old female patient, who underwent endoscopic retrograde cholangiopancreatography (ERCP) a year ago for acute cholangitis and choledocholithiasis. She consulted due to abdominal pain with signs of peritoneal irritation secondary migration of biliary stent. The treatment of these rare complication can be endoscopic, laparoscopic or surgical in case of severe complication. In this occasion, a laparotomy was performed due to perforation of the jejunum secondary to migrated biliary stent. Patients who receive biliary stents require adequate follow-up to avoid complications
Exploring Lumacaftor: a novel antibacterial approach for treating E. coli-induced urinary tract infections
Get PDFBackground: Urinary tract infections (UTIs) are primarily caused by Escherichia coli (E. coli), among the most common bacterial infections internationally. Oxygen-insensitive NADPH nitro reductase (NFSA), a vital protein in E. coli, plays a major role in the development of UTIs. Present NFSA-inhibiting drugs, such as nitrofurantoin, have limitations, including adverse effects, reduced effectiveness, and confront against drug-resistant strains. This study suggests Lumacaftor as a potential lead compound to target NFSA, given its promising pharmacological profile.
Methods: The study recognized NFSA as the important target protein and performed virtual screening of compounds from the Drug Bank database via AutoDock Vina. The pharmacokinetics of the most excellent candidates were evaluated, and molecular dynamics simulations (100 ns) carried out using Desmond further validated the strength and binding efficacy of the preferred leads.
Results: The molecular docking study noted Lumacaftor as the most capable NFSA inhibitor, attained a docking score of -10.02 kcal/mol, indicating the strongest expected binding affinity among the screened compounds. The predicted pharmacokinetic properties of Lumacaftor, Phthalocyanine, and Nitrofurantoin exposed key differences that carry the suitability of Lumacaftor as a potential NFSA inhibitor. Furthermore, Lumacaftor revealed a relatively low average ligand RMSD in relation to the protein (5.146 Å) and itself (2.073 Å), suggestive of stable binding within the active site of the NFSA protein.
Conclusions: This study successfully acknowledged and validated NFSA as a therapeutic target for E. coli causing UTIs, addressing the limitations of current treatments, including antibiotic resistance and reduced pharmacological efficiency
Induction chemotherapy by cisplatin, 5-FU and leucovorin versus cisplatin and 5-FU followed by chemoradiotherapy in locally advanced head and neck cancer
Get PDFBackground: Head and neck squamous cell carcinoma (HNSCC) is a prevalent malignancy in Bangladesh, with many patients presenting in advanced stages. The study aimed to compare the therapeutic efficacy and safety profile of induction chemotherapy using Cisplatin, 5-fluorouracil (5-FU), and Leucovorin versus Cisplatin and 5-FU followed by chemoradiotherapy in patients with locally advanced HNSCC.
Methods: This quasi-experimental study was conducted at KYAMCH over 18 months, involving 80 patients divided into two treatment arms. Arm A received ICT with Cisplatin and 5-FU followed by CRT; Arm B received Cisplatin, 5-FU and Leucovorin followed by CRT.
Results: 80 patients were evenly randomized into Arm A and Arm B, with comparable baseline characteristics (mean age ~52 years, predominantly male, and similar ECOG performance status; all p>0.05). Tumor and disease profiles showed no significant differences between groups (all p>0.05), with Stage IVA and moderately differentiated tumors being most common. After induction chemotherapy, partial response was the predominant outcome in both arms, while complete response rates were higher in Arm B (27.5% vs. 17.5%), but this difference was not statistically significant (p=0.550). Longitudinal assessment at 6, 12, and 24 weeks showed increasing complete response rates in both arms, peaking at 24 weeks (60.0% Arm A, 65.0% Arm B), with no significant differences at any timepoint (p>0.85).
Conclusion: Both treatment arms showed comparable efficacy and safety, with slightly higher complete response rates and toxicity in the arm receiving chemoradiotherapy. No statistically significant differences were observed
Comparative study between 3 commercially available injectants for the treatment of trigger finger in the hand in Egyptian patients
Get PDFBackground: Introduction: The recent trend of using hyaluronic acid or platelet-rich plasma in injection of trigger finger rather than steroids in Egyptian population lacks a pragmatic comparative study. Pragmatic comparison of hyaluronic acid, platelet-rich plasma and steroids in the treatment of adult trigger fingers in hands.
Methods: Initially 431patients were evaluated for possible inclusion in the study between August 2022 and May 2024. The condition was classified according to the modified Quinnell classification and the patients completed the visual analog scale (VAS) and Michigan Hand Outcome questionnaire (MHOQ) at the pre-injection visit, 2 weeks after injection, 6 weeks after injection and 12 weeks after injection.
Results: In all groups, the 12 weeks post-injection VAS was better than the pre-injection VAS (p=0.001). The strongest statistical correlation with the final MHOQ was with the grade of the inflammation before the injection as classified by Quinnell (p<0.001). Age, gender and affection with diabetes didn’t affect the outcome. Injection with hyaluronic acid achieved better results with patients affected in their non-dominant hand with duration of symptoms less than 15 weeks and in the retiree and office-based workers subgroups.
Conclusions: There is no advantage of using either hyaluronic acid or platelet-rich plasma over corticosteroids in injection of trigger finger of the hand
Hemophagocytic lymphohistiocytosis wildfire kindled by a tropical spark: a case report on HLH secondary to typhoid fever
Get PDFHemophagocytic lymphohistiocytosis (HLH) is a rare and life-threatening disorder of immune regulation that can rapidly progress to end-organ damage and death. HLH is characterised by uncontrolled activation of cytotoxic T lymphocytes, natural killer cells, and macrophages that can lead to a cytokine storm. Primary HLH is a rare genetic disorder seen predominantly in the pediatric population, resulting from inherited defects in genes regulating immune function. Secondary HLH, on the other hand, can affect individuals of any age and is triggered by various conditions such as infections, autoimmune diseases, or malignancies. The problems in achieving successful outcomes are the variable clinical presentation and the lack of specificity of the clinical and laboratory findings. Clinical manifestations of HLH include persistent fever, splenomegaly, cytopenias, hyperferritinemia, and organ dysfunction. Prompt recognition and treatment, which may involve immunosuppressive therapy, chemotherapy, or hematopoietic stem cell transplantation, are crucial for improving outcomes. Here we present a case of Hemophagocytic lymphohistiocytosis triggered by Typhoid fever
A prospective, single centre, observational study to evaluate the perception, knowledge and awareness about anaesthesia and role of anaesthesiologists, preoperatively and postoperatively, among patients undergoing anaesthesia procedure in tertiary care hospital
Get PDFBackground: Anaesthesiologists play a vital role perioperatively. Little is known about this to the patients. Hence, we undertook the study to evaluate the perception, knowledge and awareness about anaesthesia and anaesthesiologists amongst patients coming for surgery.
Methods: This study was an observational, interview questionnaire based; single centre study carried over 18 months from March 2017. 260 participants were asked about their perception and knowledge of anaesthesia and anaesthesiologist. The numeric data was summarized by descriptive statistics.
Results: Study could be completed in 255 patients, out of which, 4.70% were illiterate, 53.72% were high-school graduates and 41.56% were graduates. Out of 243 literates, 39.6% were aware that anaesthesiologists are doctors and only 10.94% had the knowledge about anaesthesia. The fear factor about anaesthesia in illiterate, high school graduates and graduate groups were 27.82%, 26.81% and 26.87% respectively.
Conclusions: Though the literacy level was 95.29% among our surgical patients, still 60.4% of patients were unaware of the role of anaesthesiologist and 89.06% were ignorant about knowledge of anaesthesia. All patients had some fear factor about anaesthesia, with an average of 27.28%, irrespective of gender and education level. The post-surgery questionnaire revealed that 98.82% of patients felt protected and cared for all throughout the perioperative period due to counselling during pre-anaesthesia visit