International Journal of Research in Medical Sciences
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Study of clinical profile of acute kidney injury in medical intensive care unit in a tertiary care center: a prospective study
Full text linkBackground: Acute kidney injury (AKI) is a condition characterized by a sudden decline in renal function, which can lead to long-term complications including chronic kidney disease and increased mortality. In critically ill patients, particularly in intensive care units (ICU), AKI poses a significant health burden. The aim of the study was to evaluate the clinical profile of AKI in the medical ICU of a tertiary care center.
Methods: A prospective observational study was conducted over one year in the MICU of tertiary hospital. The study included 100 patients aged over 18 years, who developed AKI as per the acute kidney injury network (AKIN) criteria. Data on patient demographics, co-morbidities, clinical presentation, etiology, and treatment outcomes were recorded. Statistical analysis was performed using statistical package for the social sciences (SPSS) version 26.0.
Results: The majority of patients (62%) were aged between 18-40 years, with a male predominance (64%). Sepsis (30%), snake bites (23%) and drug induced (19%) were the leading causes of AKI. Of the patients, 54% were diagnosed with stage 3 AKI, and 31% required renal replacement therapy (RRT). The mortality rate was 26%, with significant associations found between RRT requirement, hyperkalaemia, metabolic acidosis, and increased mortality.
Conclusion: Sepsis especially pneumonia and snakebite were the predominant etiological factors for AKI. Comorbidities, stage of AKI, RRT, along with complications like hyperkaleamia and metabolic acidosis, are the key predictors of poor outcomes and higher mortality rate. This emphasizes the importance of early detection, effective management strategies and continuous monitoring to reduce mortality and improve patient outcomes in the ICU setting
Comparison of thoracic epidural analgesia and ultrasound guided erector spinae plane block for post operative pain control following laparoscopic cholecystectomy: a randomized clinical trial
Full text linkBackground: Effective management of postoperative pain is a cornerstone of modern perioperative care, critically influencing patient recovery and overall outcomes. Over the past several decades, significant advancements in regional anesthesia techniques have transformed the landscape of perioperative analgesia.
Methods: The study groups were divided into two, named group A and group B. The total sample size was 80 (40 patients in each group). In Group A, Thoracic epidural analgesia was given at T8-T9 epidural space via paramedian approach using 7.5ml of 0.75% Ropivacaine diluted with 7.5ml of Normal saline and 7.5mcg Dexmedetomidine, and in the Group B, Erector spinae plane block was given bilaterally at T9 transverse process level using 7.5ml of 0.75% Ropivacaine diluted with 22.5ml of Normal saline and 7.5mcg of Dexmedetomidine.
Results: Duration of analgesia was more in the Thoracic Epidural Analgesia (TEA) group with 894±115.93 mins. There was no significant difference in the dosage of rescue analgesic, however the TEA group needed lesser rescue dosages than those in ESPB group. Pain scores were similar across both groups at all time intervals. Hemodynamic parameters varied early on, with TEA maintaining higher heart rates and MAP values initially. Side effects were comparable between the groups.
Conclusions: This randomized clinical trial comparing Thoracic Epidural Analgesia (TEA) and Ultrasound-Guided Erector Spinae Plane Block (ESPB) for post-operative pain control following laparoscopic cholecystectomy found that TEA demonstrated a significantly longer duration of analgesia compared to ESPB
A rare case of double lumen in the fallopian tube
Full text linkMullerian duct anomaly is seldom reported in the literature. Isolated congenital anomalies of the fallopian tubes are uncommon and are often overlooked due to the limited data available about this entity. Various other anatomical variations to mention are accessory tubes, sacculations and atresia or segmental deletion of different regions of the tube. The double lumen fallopian tube was observed in a 45-year-old female admitted for complain of menorrhagia for one year. The patient had undergone hysterectomy with right tubal ligation and specimen was send for histopathology section. Histopathological examination revealed double lumen in right fallopian tube. Due to the limited data available and lack of awareness about this entity, it is often overlooked. This report presents a rare anatomical variation in the form of double lumen fallopian tube on the right side
A challenging case of severe sickle cell crisis: a case report on vaso occlusive crisis in sickle cell disease with multi organ failure
Full text linkSickle cell disease involves recurrent hemolysis and vaso occlusive crisis, which occurs mainly due to abnormal Hemoglobin S polymerization and sickling of erythrocytes. These sickled erythrocytes are prone for damage in micro capillaries, escalating into vaso occlusive crisis presenting as acute pain episodes and recurrent hospitalisations. Severe vaso occlusive crisis can precipitate multi organ dysfunction and failure, significantly increasing morbidity and mortality. This report presents a 19-year-old male with known sickle cell disease who developed a severe vaso occlusive crisis complicated by multi organ failure, including acute chest syndrome, renal impairment, and liver dysfunction. The patient presented with generalized joint pain, chest discomfort, dyspnea, and oliguria. Clinical evaluation revealed pallor, mild icterus, hypoxemia, and hemodynamic instability. Investigations demonstrated bilateral pulmonary infiltrates, pleural effusions, and deranged liver and renal function tests. Management included aggressive intravenous hydration, oxygen therapy, blood transfusion, hydroxyurea, broad spectrum antibiotics, anticoagulation, and supportive care. Despite clinical deterioration necessitating intensive care and non-invasive ventilation, the patient responded favourably to multidisciplinary intervention, with gradual resolution of organ dysfunction and return to baseline status. This case underscores the critical importance of early recognition, prompt resuscitation, and comprehensive management in sickle cell disease patients with vaso occlusive crisis and evolving multi organ failure. Timely intervention can be lifesaving and is essential for improving outcomes in high-risk sickle cell disease populations
The unseen threat: anti-PL7 anti-synthetase mediated interstitial lung disease
Full text linkAnti-synthetase syndrome (ASS) is a rare autoimmune disorder within the spectrum of idiopathic inflammatory myopathies, defined by the presence of anti-aminoacyl-tRNA synthetase antibodies, most commonly anti-Jo1. Less frequent antibodies, such as anti-PL7, are associated with predominant pulmonary involvement and minimal muscle symptoms. Interstitial lung disease (ILD) is the most serious complication and may be the initial or sole presenting feature. Due to its rarity and atypical manifestations, anti-PL7-associated ASS can be underdiagnosed, especially in elderly patients presenting with unexplained ILD. Herein this case reports the case of a 74-year-old woman who presented with exertional dyspnea and a persistent dry cough for three months. Examination revealed Raynaud’s phenomenon, hyperkeratotic skin changes on the hands (mechanic’s hands), and digital ulceration. Imaging confirmed bilateral ground-glass opacities consistent with ILD. Autoimmune serology showed a positive ANA (1:320, speckled pattern) and anti-PL7 antibody, with no evidence of myositis. Based on Connors et al's criteria, a diagnosis of anti-synthetase syndrome was made. The patient received high-dose intravenous corticosteroids and cyclophosphamide, with limited clinical improvement. She was discharged on request on long-term oxygen support and oral steroids for outpatient follow-up. This case highlights the diagnostic challenge of ASS, especially when classical myositis features are absent. Anti-PL7-positive patients often present with isolated ILD, carrying a poorer prognosis compared to anti-Jo1-positive patients, and may not respond to standard immunosuppression. Early recognition of dermatologic signs and prompt antibody testing are essential for diagnosis. Aggressive initial therapy may be required, and biologic agents should be considered for refractory cases
Dual-action hope: DeepSeek responses to Tirzepatide’s role in metabolic health
Full text linkDeepSeek is an artificial intelligence (AI) platform introduced on January 2025. It is built on deep learning and natural language processing (NLP) technologies. Its core products include the DeepSeek-R1 and DeepSeek-V3 models.1 A prominent feature of DeepSeek's framework is its support for offline deployment. This capability may enable healthcare institutions to adapt a local LLM (large language model) and operate the model without an internet connection, thereby enhancing data privacy and security.2 DeepSeek has set tremendous path by lower computational costs compared to other proprietary LLMs, making AI more accessible to everyone. In medical education, educators can create case simulations for tutoring students. The model's ability to process and generate human-like text enables the development of realistic patient interactions, enhancing the training of future healthcare professionals.3 Having large updated database, doctors and patients can now use this as new tool to update themselves in new innovations in field of medicin
Effectiveness of vestibular rehabilitation among post-stroke pusher syndrome
Full text linkBackground: Pusher syndrome is a post-stroke neurobehavioral disorder characterized by a distorted perception of upright posture and active pushing toward the hemiparetic side, leading to impaired balance, increased fall risk, and delayed rehabilitation.
Methods: This randomized clinical trial included 36 post-stroke patients diagnosed with pusher syndrome. Participants were randomly assigned to two groups for an 8-week intervention, conducted twice weekly with two sessions per day. Group A received vestibular rehabilitation therapy (VRT) focusing on gaze stabilization, dynamic balance, and proprioceptive training. Group B performed trunk and core stability exercises. Outcome measures included the scale for contraversive pushing (SCP) and postural assessment scale for stroke patients (PASS), assessed pre- and post-intervention.
Results: Both groups demonstrated significant improvement; however, group A showed a greater reduction in SCP scores (6.09±0.19 to 2.89±0.17, p<0.001) and a greater increase in PASS scores (11.6±1.1 to 25.8±1.0, p<0.001) compared to group B. Between-group analysis confirmed that VRT was significantly more effective in reducing contraversive pushing and improving postural control.
Conclusions: VRT is more effective than trunk stability exercises in improving postural alignment, reducing contraversive pushing, and enhancing functional independence in post-stroke pusher syndrome. Incorporating vestibular strategies into stroke rehabilitation may optimize recovery
Effect of pre and post badminton match on shoulder rotators strength and range of motion in recreational badminton players
Full text linkBackground: Badminton is recognized as the fastest racquet sport, with shuttle speeds during match play ranging from 50–75 m/s and post-smash velocities exceeding 100 m/s. Singles competition demands high levels of fitness, while doubles require sustained aggression and rapid reflexes. Players rely on aerobic endurance, agility, strength, speed, and precision. The biomechanics of badminton involve six rapid motion phases, with acceleration lasting just 0.05 seconds being the most injury-prone. Identifying early signs of shoulder dysfunction is essential to prevent long-term damage. This study aims to evaluate the effect of a single badminton match on shoulder rotator strength and range of motion (ROM) in recreational male players.
Methods: A total of 44 recreational male badminton players participated in the study. Shoulder rotator strength and ROM were assessed both before and after match play. Strength was measured using a handheld dynamometer, and ROM was evaluated using a goniometer. A p value of <0.01 was considered statistically significant.
Results: Post-match analysis revealed a significant decrease in internal rotator ROM and strength, alongside an increase in external rotator ROM. External rotator strength also showed a notable reduction. These changes were statistically significant (p<0.001), indicating acute biomechanical alterations following match play.
Unpaired t-test analysis revealed statistically significant differences in shoulder internal and external rotation ROM (p<0.001), internal rotator strength (p<0.001) and external rotator strength (p<0.05) between pre- and post-match assessments.
Conclusion: Post-match findings indicated a decrease in shoulder internal rotation ROM and external rotator strength, alongside an increase in external rotation ROM and internal rotator strength. These changes highlight the acute impact of match play on shoulder function and underscore the need for targeted conditioning and recovery strategies
Comparison of early outcome of stapler versus hand sewn closure of duodenal stump after gastrectomy in gastric cancer
Full text linkBackground: Gastric cancer (GC) remains a major global health challenge, ranking as the fifth most common malignancy and the fourth leading cause of cancer-related death worldwide. Surgery with gastrectomy remains the mainstay of curative treatment, but duodenal stump leakage (DSL) continues to be one of the most feared postoperative complications, associated with high morbidity and mortality. The choice between stapled and hand-sewn duodenal stump closure remains a debated topic, especially in resource-limited regions such as South Asia, where cost and accessibility are critical factors. The study aimed to compare the early outcomes of stapler versus hand-sewn closure of the duodenal stump after gastrectomy in gastric cancer patients.
Methods: This prospective comparative study included 40 gastric cancer patients undergoing elective gastrectomy, divided into stapler (n=20) and hand-sewn (n=20) duodenal stump closure groups. The study was conducted at Sylhet MAG Osmani Medical College and Hospital, Sylhet, Bangladesh, from July 2024 to June 2025. Patients with ASA class III–IV or prior neoadjuvant chemotherapy were excluded. Standardised operative and postoperative protocols were followed, and outcomes assessed included operative time, closure time, complications, hospital stay, and cost. Data were analysed using statistical package for the social sciences (SPSS) 26 with t-test, Chi-square, and multivariable logistic regression, considering p<0.05 as significant.
Results: Both groups were comparable in baseline demographics and type of gastrectomy. Stapler closure significantly reduced operative time (158±22 versus 177±25 min, p=0.007) and stump closure time (9±3 versus 18±5 min, p<0.001). Early postoperative complications, including duodenal stump blowout, were slightly lower in the stapler group but not statistically significant. Recovery was faster with stapler closure, with earlier oral intake (2.7±0.9 versus 3.8±1.2 days, p=0.009) and shorter hospital stay (8.2±2.0 versus 10.1±2.5 days, p=0.026). Stapler procedures incurred higher costs (p=0.01).
Conclusion: Stapled duodenal stump closure after gastrectomy offers faster surgery, earlier recovery, and shorter hospital stay than hand-sewn closure, without added complications. Despite higher costs, it represents a safe and effective option in selected gastric cancer patients
A rare case of ophiasis pattern of alopecia areata in a child: a case report with Unani insights
Full text linkAlopecia areata is a T cell–mediated autoimmune disease targeting hair follicles. Ophiasis is a rare subtype of alopecia areata with a snake-like hair loss pattern across the occipital, temporal, and parietal scalp. A 3-year-old Indian boy presented with a 4-month history of patchy scalp hair loss. Clinical and trichoscopic examination confirmed rare pattern of ophiasis type of alopecia areata. Ophiasis pattern of alopecia areata is considered one of the most challenging forms to treat, owing to its chronic and relapsing nature as well as its poor response to conventional therapies. In this context, the present paper attempts to provide a foundational perspective on the management of ophiasis through the Unani system of medicine