International Journal of Research in Medical Sciences
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Ectopic pregnancy in a non-communicating rudimentary uterine horn: a ticking bomb in a closed room
Get PDFUnicornuate uterus with rudimentary horn is a rare Müllerian anomaly occurring in 2.5-13% of cases, resulting from incomplete midline unification of Müllerian ducts during organogenesis. Pregnancy in a non-communicating rudimentary horn occurs in approximately 1 in 76,000-150,000 pregnancies and poses significant risks, including uterine rupture and severe haemorrhage. A 26-year-old woman presented at 8 weeks of gestation with her first pregnancy. Ultrasound revealed a right non-communicating horn pregnancy of 7 weeks with a gestational sac diameter of 24.9 mm and absent cardiac activity. β-hCG was 1,35,066 IU/l. MRI confirmed a unicornuate uterus with a non-communicating uterine horn pregnancy showing yolk sac presence and fetal pole absence. The patient was treated with systemic methotrexate 70 IU. Following an inadequate initial response (β-hCG: 89,344 IU/l after 7 days), a second dose was administered. Subsequently, β-hCG showed a declining trend: 1400, 457, 268.25, and 54 IU/l over consecutive weeks, confirming successful treatment. The patient later conceived naturally, achieving left horn intrauterine pregnancy and is currently at 24 weeks gestation with normal antenatal progress including normal nuchal translucency and anomaly scan. Early diagnosis and management of ectopic pregnancy in non-communicating uterine horns prevents fatal maternal complications. High clinical and radiological suspicion is essential for timely diagnosis. Systemic methotrexate represents an effective conservative treatment option, allowing preservation of fertility and subsequent successful pregnancy outcomes in the functional uterine horn
Rising trend of oral cancers in India: a comprehensive review
Get PDFOral cancer, encompassing malignancies of the lip, tongue, buccal mucosa and oropharynx, is a major public health concern in India, accounting for approximately one-third of the global burden with 77,000 new cases and 52,000 deaths annually. This comprehensive review examines the rising trend of oral cancers in India, focusing on epidemiology, risk factors, clinical characteristics, diagnostic challenges, management strategies and preventive approaches. The age-standardized incidence rate is 10.4 per 100,000, with higher prevalence among men and in regions like Uttar Pradesh, Bihar and the north eastern states. Key risk factors include tobacco use (smoked and smokeless), betel quid chewing, alcohol consumption, HPV infection and genetic predispositions, with squamous cell carcinoma dominating (>90% of cases). Advanced-stage diagnosis, limited access to screening and advanced diagnostics and reliance on Western treatment protocols contribute to poor outcomes. Preventive strategies, such as tobacco cessation, HPV vaccination and community-based screening, show promise in reducing incidence. This review emphasizes the need for region-specific research, affordable diagnostics and enhanced healthcare infrastructure to address the growing burden of oral cancers in India
Fear experienced by patients and their caregivers while performing tracheostomy suctioning: a comprehensive review
Get PDFTracheostomy suctioning is an essential procedure to prevent airway obstruction, yet it often triggers significant fear and anxiety in both patients and their caregivers. This comprehensive review analyzes the psychological and physical challenges associated with the procedure, drawing from peer-reviewed studies, case reports, and clinical guidelines. Patients frequently report profound fear linked to sensations of choking, breathlessness, pain, and a loss of control, which can contribute to long-term anxiety and depression. Concurrently, caregivers experience intense stress, fearing they might cause harm, complications like hypoxia or infection, or manage the procedure incorrectly due to inadequate training. This shared emotional burden can lead to burnout and negatively impact adherence to care. The findings confirm that fear associated with tracheostomy suctioning has significant psychological and clinical implications. Addressing these concerns through comprehensive caregiver training, patient reassurance, integrated psychological support, and adherence to standardized, gentle techniques is critical. Healthcare providers play a pivotal role in creating a supportive environment that empowers both patients and caregivers, ultimately reducing anxiety and improving the safety and efficacy of tracheostomy care
NTM beyond the lungs: a case series of non-tuberculous mycobacterial infection at extrapulmonary sites
Get PDFBackground: In this case series, the results of documented non-tuberculous mycobacteria (NTM) infections, which have emerged as important pathogens, mainly among individuals with immunocompromised status have been studied. The report showcases the clinical presentation, diagnostic modality, treatment as well as outcome and results regarding the 8 patients who were diagnosed with NTM infection at extrapulmonary locations via molecular techniques.
Methods: It involves retrospective analysis of patients who were diagnosed with NTM infection at the Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, in the last 2 years, who were diagnosed using molecular tests. The specific details of clinical presentation, diagnostic methods and treatment regimens, along with outcomes, were reviewed retrospectively and summarized.
Results: The outcomes comprised 8 patients (5 females and 3 males) between 19 and 79 years. The signs and varied symptoms included fever, headache, cough and weakness. The confirmatory diagnosis was followed by Polymerase chain reaction (PCR) for NTM, biopsy from the site, such as abdominal and vertebrae and pleural fluid analysis. Most patients showed significant clinical improvement after the diagnosis and appropriate treatment.
Conclusions: This case series highlights the diverse clinical manifestations of NTM infections at extrapulmonary sites, emphasizing the importance of early diagnosis and appropriate management. Clinicians should maintain a high index of suspicion for NTM infections, especially in atypical presentations and immunocompromised patients
Supporting caregivers of autistic children
Get PDFI read with great interest the article by Abed et al on “Quality of life disparities among mothers of autistic children and mothers having normal children in Baghdad city-2024”. The study effectively demonstrated that mothers of autistic children face significantly poorer quality of life (QOL) compared to controls, with the greatest disparities noted in physical and psychological domains. These results highlight the immense caregiving burden borne by mothers, affecting their health, emotions, and daily functionin
Comprehensive management of rotator cuff tendinopathy in diabetic patients with Ayurveda and myofascial release
Get PDFShoulder disorders are markedly more common in individuals with diabetes than in the general population. Rotator cuff tendinopathy, a form of persistent tendon pain and dysfunction from mechanical loading, arises when tendon regeneration fails, leading to structural disorganization, thickening, and potential rupture. Its etiology involves intrinsic factors such as aging, altered tendon biology, vascular compromise, and overload, as well as extrinsic factors including impingement from structural variations, soft-tissue tightness, muscle imbalance, and overuse, all of which contribute to compromised tendon integrity and function. A 49-year-old male patient who is a known case of Diabetes mellitus was admitted to Kayachikitsa IPD of Vaidyaratnam Ayurveda College, Ollur on 09 July 2024 with bilateral shoulder joint pain more at right side with stiffness and limited range of motion. He underwent a treatment protocol of vatavyadhi and myofascial release with an effort to keep diabetes under control. The patient got relief from pain (VAS score 6 to 1) and stiffness and range of movements were improved. There is remarkable functional restoration (SPADI 57.69 to 10). In rotator cuff tendinopathy of diabetic patients, a combined use of pramehahara oushadha, vatavyadhi chikitsa and myofascial release can be effective
Effectiveness of repetitive transcranial magnetic stimulation on hypomimia induced sialorrhea among Parkinsons: a case study
Get PDFExcessive drooling (sialorrhea) in Parkinson’s disease (PD) affects quality of life, often linked to hypomimia. Conventional treatments have limitations, while repetitive transcranial magnetic stimulation (rTMS) shows promise but remains understudied for sialorrhea. A 74-year-old male with PD underwent rTMS and exercise therapy for eight weeks. Pre-treatment scores were 63 in sialorrhea clinical scale for PD and 7 on the Radboud oral motor inventory for PD (ROMP), improving to 48 and 5. Surface electromyography (SEMG) showed increased zygomaticus major activity (10.5 µV to 16.2 µV) and corrugator supercilii (17.3 µV to 22.7 µV), suggesting rTMS may improve sialorrhea and orofacial function in PD
Narrative review on recent outbreaks of monkeypox: a global public health emergency
Get PDFSeveral cases of monkeypox have been reported since July 2022 and was hence declared a global public health emergency (GPHE). Recent reports from WHO indicate a rise in mpox cases over 2 years, even when vaccination is considered a protective measure. In this review, we discussed the recent spread of cases worldwide from 1st January 2024 to 1st October 2024, providing updated evidence on clinical features of different strains, epidemiology, diagnosis, treatment, and preventive measures. Ever since the 2022 outbreak, monkeypox virus has been undergoing novel mutations, leading to different strains at an alarming rate. According to the Ministry of Health, India has reported a total of 30 cases to date with the most recent case reported in September 2024. Recent outbreaks from Clade Ib were reported among young males with a median age of 34 years and sexual contact being a common mode of transport. Mpox commences with prodromal flu-like symptoms and a maculopapular rash with centrifugal distribution followed by fever. Diagnosis is confirmed by PCR testing of the lesions. Prompt vaccination after exposure might reduce the risk of disease progression. However, antiviral treatments and symptomatic care should be considered for severe patient populations. This review gives an insight into the current mpox scenario by educating people on emerging global endemics and their preventive strategies. Unlike other neglected diseases, we now have treatment and prevention options for mpox, but access to treatment is limited in most parts of the world. Identification and spread of new cases can be tracked more efficiently with the help of improved surveillance methods
Clinical outcomes of subcutaneous methotrexate in the management of chronic plaque psoriasis
Get PDFBackground: Chronic plaque psoriasis, also known as psoriasis vulgaris, is the most common form of psoriasis. Subcutaneous methotrexate has been utilized in the management of chronic plaque psoriasis, offering an alternative route of administration to the traditional oral method. The aim of this study was to evaluate the clinical outcomes of subcutaneous methotrexate in the management of chronic plaque psoriasis.
Methods: This cross-sectional observational study was conducted in department of dermatology, Bangabandhu Sheikh Mujib medical university, Dhaka, Bangladesh, during the period from November 2023 to May 2024. Total 70 participants were included in this study.
Results: The average age of participants was 42.3±11.8 years, with 52.9% males and 47.1% females. Baseline PASI scores averaged 18.5±4.2, indicating moderate-to-severe psoriasis. Mean psoriasis duration was 7.2±3.5 years. Depression (34.3%) was the most common comorbidity, followed by diabetes (15.7%) and hypertension (8.6%). Majority of the participants, 62.86% (n=44), had moderate psoriasis. Nausea (58.9%) was the primary reason for switching from oral to subcutaneous methotrexate, which led to progressive PASI reductions: 32.9% at Week 4, 53.0% at week 8, 69.7% at week 12, and 84.9% at week 16 (p<0.001). Adverse events were mild, with nausea (11.4%) and fatigue (8.6%) being most common.
Conclusions: This study demonstrated that subcutaneous methotrexate is a highly effective, safe, and well-tolerated treatment for moderate-to-severe chronic plaque psoriasis
Recent advances in diagnosis and management of chronic cholestatic liver diseases: expert consensus
Get PDFChronic cholestatic liver diseases (CCLD), primarily including primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC), are characterized by impaired bile flow, leading to systemic complications such as pruritus, jaundice, fat soluble vitamin deficiencies and progressive liver damage. Recent advances in diagnostics, particularly the use of non-invasive tests like FIB-4, APRI and transient elastography, have significantly improved the early detection and assessment of liver fibrosis. Ursodeoxycholic acid (UDCA) remains the cornerstone treatment for PBC, effectively improving biochemical markers and delaying disease progression. In contrast, the treatment options for PSC remain limited. Emerging therapies targeting bile acid synthesis and gut microbiota modulation are under investigation, offering potential future solutions for PSC. In the Indian clinical setting, other causes of intrahepatic cholestasis, such as alcoholic liver disease (ALD) and drug-induced liver injury (DILI), are more prevalent. ALD with cholestasis is seen in 10-30% of patients, while DILI, often driven by tuberculosis medications and complementary and alternative medicines, accounts for a significant proportion of cases. Infectious causes like hepatitis A and fibrosing cholestatic hepatitis in hepatitis C patients post-liver transplantation also contribute to the disease burden. Experts recommend ongoing UDCA use in cholestatic conditions, regular non-invasive fibrosis assessments, and further research into new pharmacological agents for both PBC and PSC