International Journal of Research in Medical Sciences
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A study of snakebite cases in a tertiary care hospital in South India, Telangana
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Background: Snake bites pose a significant global health threat leading to substantial morbidity and mortality. According to WHO, approximately 11,000 deaths occur due to snake bite per annum in India. This study is done to know about common types of snakes in local areas, identify the clinical features, complications and mortality rates in snakebite victims attending RVM Charitable trust hospital.
Methods: A hospital-based cross sectional study done from 1st January 2024to 31st December 2024. Fifty patients enrolled during this period. Features during presentation and subsequent period were noted, anti-venom was given accordingly and outcome was recorded. Data was collected in a predesigned data sheet form and was analyzed accordingly.
Results: Among 50 snake bite patients, 70% were male and 56% cases were poisonous bites. The common victims were farmers (53%) and the bite was commonly encountered during rural foot walking (32%). Among 28 poisonous cases, 18 Poisonous cases developed neurological manifestations and 3 cases developed breathlessness which required mechanical ventilation support. Rest 10 Poisonous cases developed hematological manifestations and 6 cases developed Acute Kidney Injury of which 3 cases required hemodialysis support. Among the 28 venomous snake bite cases 25 (89%) recovered completely after getting polyvalent antivenom serum and 3 (11%) died after admission. Total 80% cases recovered with 10 vials of polyvalent antivenom serum. No reaction to anti-snake venom was noticed.
Conclusions: Snake bites cases are still a serious health problem for us. Treatment of poisonous snake bite with polyvalent antivenom serum is successful and safe. Awareness should be created among the rural people through mass media regarding the complications of snake bite and the need to visit a hospital as early as possible. Availability of snake venom kits should be made in rural health centres to identify the type of snake bite.
Effective short term Siddha treatment of filiform warts using Rasaganthi Mezhugu
Get PDFFiliform wart is a non-cancerous, contagious and outwardly growing skin lesion caused by the Human Papillomavirus (HPV). It is characterized by slender, finger-like projections from the squamous epithelium, a condition known as papillomatosis. These lesions are most commonly observed on the neck, eyelids, and fingers. If left untreated, filiform warts may spread to other parts of the body. The virus prompts the skin to produce an excess of keratin leading to the formation of long, narrow growths. Conventional treatments for warts include immunotherapy, laser therapy, phytotherapy, and topical medications. However, these methods are often time-consuming, expensive and may require multiple or repeated sessions due to recurrence. Warts may reappear if HPV remains in the surrounding skin. In the Siddha system of medicine, warts are referred to as Marul, classified under Thol Noikal (skin disorders). One effective remedy recommended is Rasagandhi Mezhugu (RGM), traditionally used for treating various skin ailments. A recent case study documented the successful treatment of a 36-year-old male patient with 19 filiform warts on his neck. He was administered 500 mg of RGM internally for 15 consecutive days following the intake of curd rice. No external applications were used. Within two weeks, the hyperkeratinized projections began to shrink, detach and completely disappear. The treatment reported no adverse effects and no recurrence of the warts till date. This case highlights the therapeutic potential of Rasagandhi Mezhugu in managing filiform warts caused by HPV. The outcome demonstrates its efficacy and safety as a natural alternative for wart treatment
A prospective study on outcome of dorsal versus ventral buccal mucosal graft urethroplasty for bulbar urethral stricture
Get PDFBackground: In urological practice, urethral stricture disease is a prevalent condition. In comparison to the other sites, the bulbar urethral stricture imposes a greater load. The buccal mucosal graft (BMG) has been considered an optimal kind of urethral replacement since 1941. A lifetime success rate of 92% is achieved with standard bulbar urethroplasty employing BMG. There exist several methodologies for BMG urethroplasty, namely dorsal, ventral, and lateral approaches, which depend on the discretion of the surgeon.
Methods: An observational study was done among 40 patients, divided into two groups each based on the procedure done. Age more than 18 years who are fit for the procedure, stricture length more than 2 cm on retrograde urethrogram (RGU) and patients who were willing to give informed consent were included in the study. Post operatively, all the patients were assessed at every 3-month interval up-to 18 months. The outcome parameters noticed were post voidal residual (PVR), Qmax, international prostate symptom score (IPSS) score.
Results: There was no difference between the pre-operative and post-operative Qmax, PVR, IPSS score between the study groups.
Conclusions: The findings of the present study concluded that there is no difference between dorsal and ventral onlay BMG urethroplasty in terms of increase in Qmax and decrease in PVR at the end of study period
Non-hemorrhagic stroke following venomous snakebite: a case series
Get PDFSnakebite envenomation remains a major public health issue in India, causing nearly 50,000 deaths annually. Hemotoxic venoms, particularly from viper bites, are well recognized for inducing coagulopathy and hemorrhagic complications; however, ischemic stroke following envenomation is a rare but important clinical entity. We present a case series of three patients who developed non-hemorrhagic ischemic strokes after Russell’s viper bites. All three had evidence of systemic envenomation with prolonged clotting times and received prompt treatment with anti-snake venom and fresh frozen plasma. Despite correction of coagulopathy, each developed focal neurological deficits. Neuroimaging revealed acute infarcts: right corona radiata infarct in Case 1, left middle cerebral artery territory infarction in Case 2, and multiple embolic infarcts in Case 3. All patients were managed with antiplatelet therapy, neuroprotective agents, and supportive care, with gradual neurological improvement. This series highlights that neurological deterioration after snakebite is not always attributable to neurotoxic effects or intracranial hemorrhage and should prompt evaluation for ischemic stroke. Early recognition, timely neuroimaging, and institution of stroke-specific management are critical in improving outcomes. Clinicians should maintain a high index of suspicion for ischemic stroke in snakebite victims presenting with new-onset focal deficits, as prompt intervention may prevent long-term morbidity and disability
Comparing surgical outcomes in end-bearing amputation stumps: a prospective cohort study of different surgical techniques
Get PDFBackground: Lower limb amputation outcomes are influenced by surgical technique, which impacts stump stability, prosthetic fitting, and complication rates. This study compared postoperative outcomes of fascia-to-fascia (including fascia-to-periosteum), myodesis, and myoplasty in below-knee amputations.
Methods: A five-year retrospective cohort study at two Nigerian tertiary centers included 96 adults who underwent unilateral below-knee amputation between January 2019 and December 2024. Data on patient characteristics, operative details, and outcomes were analyzed using Chi-square/Fisher’s exact tests and Kruskal-Wallis tests.
Results: Mean age was 46.9±12.8 years; 69.8% were male. Fascia to fascia achieved the best prosthetic fitting (48.4%) and stump stability (49.1%), with the lowest reoperation (6.7%) and infection rates (15.2%). Myodesis had the highest reoperation and infection rates, while myoplasty had the shortest surgery time and lowest pain. fascia-to-fascia (including fascia-to-periosteum), took longest to perform (125±15 minutes) and had the highest pain scores.
Conclusions: Fascia to fascia fixation appears superior for long term stump integrity and prosthetic function, which is particularly valuable in resource limited Nigerian settings. Nevertheless, its association with greater pain and longer operative time highlights the need for targeted strategies to optimise analgesia and surgical efficiency without compromising outcomes
Evaluating the safety of diverse extracorporeal membrane oxygenation technologies through the lens of intensive care unit nurses’ perspective
Get PDFBackground: Extracorporeal membrane oxygenation (ECMO) is a complex life-support technology increasingly utilized in intensive care units (ICUs). As ECMO devices diversify, ICU nurses are required to manage multiple platforms, posing potential challenges to care delivery and safety.
Methods: A cross-sectional, descriptive survey was conducted among ICU nurses at King Faisal Specialist Hospital and Research Center, Riyadh. A validated questionnaire by Kiekkas et al was used to assess perceptions of ECMO technology’s positive and negative effects on nursing care. Descriptive statistics were calculated, and inferential tests (t-tests and one-way ANOVA) examined associations between perceptions and demographic characteristics.
Results: A total of 97 ICU nurses participated. Respondents rated ECMO technology highly in enhancing patient safety (M=4.10, SD=0.92), improving nursing effectiveness (M=4.04, SD=0.97), and supporting professional development (M=4.10, SD=0.81). Negative perceptions included increased hospitalization costs (M=3.65, SD=1.16), nursing stress (M=3.35, SD=1.19), and mechanical risks (M=3.16, SD=1.19). No statistically significant differences in perceptions were observed based on gender, ICU experience, or educational level.
Conclusions: ICU nurses generally perceive ECMO technology as a positive contributor to care quality and nursing efficiency, though concerns persist regarding cost, stress, and safety. The uniformity of perceptions across demographic subgroups may reflect practical institutional training and standardized ECMO protocols. Findings highlight the importance of involving nurses in equipment evaluation, training design, and interdisciplinary collaboration to ensure patient safety and staff well-being
Common parlance English in an Indian medical undergraduate institution: teaching-learning methods for improvement
Get PDFBackground: Author’s experience/ Capstone Project (T2TM, Harvard University) approval.
Methods: Harrison’s Textbook of Internal Medicine was the vocabulary source. COCA corpus was purchased for ranking ‘usage frequency’ of words. Background (MCQ.1) versus summative (MCQ.2) assessment has already been published – ‘teaching learning methods’ applied meanwhile is elaborated hereby. After MCQ.1, in sensitisation, 5 glossary options were explained/ offered. Monthly improvement of 1000 COCA ranks were aimed through 5 monthly interim tests (MCQ.T.1-5). MCQ.2 was taken after 6 months. All 7 tests were followed by feedback enucleation. Finally, dictionaries were rated by the participants through 7 questions. Data normality (Shapiro Wilk test) without outliers (Tukey’s fence/ QQ plot) was affirmed. Repeated measure ANOVA was applied. After 6 months, 5000 ranks betterment was expected in MCQ.2 apropos MCQ.1 – in outcome, there was no underfitting/ overfitting (no significant bias/ variance).
Results: Sphericity (Mauchly’s test) was 0.85 – so adjusted F-tests (Greenhouse Geisser [eGG = 0.8497]/ Huynh Feldt [eGG = 0.8888] correction) were used. Effect size (h2) was 0.0035 (observed) and 0.0201 (partial). Despite monthly increase of usage frequency rank by 1000, participants’ ‘scores’ were not significantly different in the 5 monthly MCQ.Ts. Dictionary market was not congruent with post-awareness choices.
Conclusions: By such a 6-month training, improvement of at least 5000 COCA ranks can be achieved. Dictionaries require in-depth awareness before purchase. Dictionaries D.4 and D.5 could think of lowering the prices
A multidimensional evaluation of patients with idiopathic intracranial hypertension: associations across symptoms, imaging, cerebrospinal fluid findings and medical history
Get PDFBackground: Idiopathic intracranial hypertension (IIH) is a disorder characterized by elevated intracranial pressure without identifiable cause, predominantly affecting overweight women of reproductive age. Headache and visual disturbances are common but often show variable correlation with cerebrospinal fluid (CSF) pressure. This study aimed to evaluate the multidimensional associations among clinical symptoms, imaging, CSF findings and medical history in patients with IIH.
Methods: This cross-sectional study was conducted at the department of neuro medicine, National Institute of Neuro Sciences and Hospital, Dhaka, Bangladesh, from July 2022 to June 2025. A total of 100 patients aged 18-50 years with a confirmed diagnosis of IIH and neuro-ophthalmic symptoms were included. Data were collected through clinical evaluation, lumbar puncture, imaging (MRI/MRV), fundal photography and visual field testing. Statistical analysis was performed using SPSS version 25.0.
Results: The mean age was 26.16±7.49 years, with a strong female predominance (92%). Most patients were overweight or obese. Headache (97%), visual impairment (88%) and cranial nerve palsy (50%) were the predominant symptoms. Papilledema was bilateral in 93% of cases. Elevated CSF opening pressure (>25 cm H2O) was found in 75% of patients. Hormonal medication use was reported in 33% of cases. No significant association was observed between elevated CSF pressure and visual loss (p=0.02), double vision (p=0.96), or headache (p=0.53).
Conclusions: Symptom severity in IIH may not directly correlate with CSF pressure levels, underscoring the need for comprehensive, multidisciplinary assessment in clinical management
Prompt diagnosis and treatment of cutaneous mucormycosis: a challenging complication in post-renal transplant patients
Get PDFA 52 years old male cadaveric renal transplant recipient developed cutaneous mucormycosis, presenting with febrile toxicity and a rapidly growing black lesion. Diagnosis was confirmed by biopsy and treatment began with liposomal amphotericin B. Owing to the high mortality associated with mucormycosis, isavuconazole, a non-nephrotoxic antifungal, was added to Amphotericin B. The patient underwent surgical debridement and his condition subsequently stabilized, accompanied by improved renal function. He was discharged on a combination of isavuconazole and other medications, with good wound healing and a creatinine level of 1.6 mg/dl at one-month follow-up. This case highlights prompt diagnosis and treatment and maintenance with isavuconazole as a viable alternative for mucormycosis in transplant patients with renal impairment
Chronic myeloid leukemia from pathophysiology to treatment-free remission: new perspectives
Get PDFChronic myeloid leukemia (CML) is one of the most common leukaemia’s occurring in the adult population. The course of CML is divided into three phases: the chronic phase, the acceleration phase and the blast phase. CML is a chronic myeloproliferative neoplasm characterized by the presence of the chimeric BCR-ABL1 gene, resulting from the chromosomal translocation t (9;22) (q34;q11), which encodes a constitutively active tyrosine kinase. The advent of tyrosine kinase inhibitors (TKIs) has revolutionized the management of CML, significantly improving patient survival and quality of life. Recent studies have shown that a subgroup of patients can maintain deep remission even after treatment discontinuation, a phenomenon known as treatment-free remission (TFR) . This narrative review synthesizes the current evidence on the pathophysiology of CML, therapeutic advances with TKIs and the clinical and prognostic criteria associated with TFR, providing an integrated view that can guide clinical practice and future research.