International Journal of Research in Medical Sciences
Not a member yet
9900 research outputs found
Sort by
Outcome of decompression, correction and fusion for cervical spondylotic myelopathy with kyphotic deformity
Get PDFBackground: Cervical spondylotic myelopathy (CSM) with kyphotic deformity is a common degenerative spinal disorder that leads to progressive spinal cord compression and neurological deterioration. Objectives were to evaluate the outcome of decompression by laminectomy with correction by lateral mass fixation and fusion for CSM with kyphotic deformity.
Methods: Assessments were done pre-operatively and postoperatively at 1-, 2-, 3-, and 6-months using visual analogue score (VAS), modified Japanese orthopedic association (mJOA), Odom criteria, Nurick’s grading, and cervical curvature index. Data were analyzed using standard statistical methods via the statistical package for social sciences (SPSS) version 25 (IBM®, Armonk, USA). A p<0.05 was considered statistically significant.
Results: The mean VAS score significantly improved from 6.27±1.75 to 0.73±0.59 at 6 months. The mean mJOA score increased from 11.27±0.80 preoperatively to 16.53±0.74 at the final follow-up, indicating substantial neurological improvement. According to the modified Odom criteria, 33.3% of patients had excellent outcomes, 60.0% had good outcomes, and 6.7% had fair outcomes. Functional status measured by Nurick’s grading improved significantly, with 93.3% of patients in grade III preoperatively and 100% improving to either grade 0 or I by 6 months (p<0.001). The cervical curvature index showed marked radiological correction, improving from -8.24±2.59 preoperatively to 21.94±1.35 postoperatively (p<0.001).
Conclusions: Posterior decompression by laminectomy with lateral mass fixation and fusion is an effective and safe surgical technique for managing CSM with kyphotic deformity. It significantly improves neurological function, pain status, and cervical alignment
Predictors of mortality in heart failure patients: a retrospective cohort study at a tertiary care hospital in Vadodara
Get PDFBackground: Heart failure (HF) remains a leading cause of morbidity and mortality worldwide, particularly in low- and middle-income countries. Understanding the factors contributing to mortality in HF patients can inform clinical decisions and improve patient outcomes. This study aims to identify the predictors of mortality in HF patients admitted to a tertiary care hospital in Vadodara, Gujarat.
Methods: This retrospective cohort study included 250 consecutive HF patients admitted to SSG Hospital, Vadodara, between January 2022 and December 2023. Patient data, including demographic characteristics, clinical features, comorbidities, left ventricular ejection fraction (LVEF), laboratory values and mortality outcomes, were collected from hospital records. Multivariable logistic regression was used to identify independent predictors of mortality. Kaplan-Meier survival curves were generated to analyze survival rates over the study period.
Results: The cohort consisted of 250 patients, with a mean age of 62.7±10.5 years. Males accounted for 58.9% of the cohort. Overall mortality was 29.3% during the follow-up period. Predictors of mortality included lower LVEF (OR 2.7, 95% CI 1.8-4.2, p<0.001), elevated NT-proBNP levels (OR 3.2, 95% CI 2.0-5.1, p<0.001) and chronic kidney disease (OR 2.5, 95% CI 1.6-4.0, p=0.002). Kaplan-Meier analysis revealed a significant difference in survival rates between patients with LVEF<40% and those with LVEF≥40% (p<0.001).
Conclusions: This study identified several key predictors of mortality in HF patients, including reduced LVEF, elevated NT-proBNP levels and chronic kidney disease. These findings underscore the need for close monitoring and management of these high-risk factors to improve survival outcomes in HF patients
The hidden heart of autoimmunity: a scoping review of carditis in rheumatoid arthritis and IgG4-related disease
Get PDFCardiac involvement in autoimmune diseases is often more common and more serious than we tend to acknowledge. While most clinicians are familiar with the joint pain of rheumatoid arthritis or the organ swelling of IgG4-related disease, inflammation of the heart itself is frequently missed. This is partly because cardiac symptoms are subtle or mistaken for something else, and partly because cardiovascular issues simply aren’t top of mind when managing autoimmune patients. As a result, carditis whether it's myocarditis, pericarditis, or pancarditis remains underdiagnosed, underreported, and under-discussed, especially in the context of rarer conditions. This gap in recognition is particularly noticeable in IgG4-related disease, a condition known for causing fibrotic masses and multiorgan inflammation, but where cardiac involvement is poorly documented and often misclassified. Even in rheumatoid arthritis (RA), a disease much more common and much better studied, direct inflammation of the heart is often overshadowed by more visible symptoms like synovitis or systemic fatigue. Yet, evidence suggests that cardiac complications significantly contribute to both morbidity and mortality in autoimmune patients, often silently progressing until they become life-threatening. This scoping review sets out to bring more attention to this overlooked aspect of autoimmune disease. We aim to explore and organise the current literature on carditis in RA and IgG4-related disease, looking closely at how it presents, how it's diagnosed, what mechanisms might be driving it, and how it's treated. We’ve taken a wide lens to capture everything from well-documented case reports and cohort studies to emerging data on biomarkers and imaging techniques. In the end, this review is not just about summarising the science. It’s about bringing the heart back into the conversation, literally and figuratively when we talk about autoimmune diseases. Because if we want to improve outcomes for these patients, we need to start looking beyond the obvious and paying closer attention to what’s happening inside the chest
Epidemiology of pain disorders among outpatients at Joypurhat Sadar Hospital
Get PDFBackground: Pain disorders represent a significant public health concern, especially in low-resource settings where data on their epidemiology are limited. Understanding the patterns and burden of pain among outpatients can inform appropriate management strategies and healthcare planning.
Methods: This cross-sectional study was conducted at the Department of Medicine, 250 Bed Sadar Hospital, Joypurhat, Bangladesh, between January and July 2024. A total of 200 adult outpatients presenting with various pain disorders were enrolled consecutively. Sociodemographic data, anthropometric measurements, clinical diagnoses and duration of pain were recorded. Data were analyzed using SPSS version 26.
Results: Most of the participants were female (77.5%) with a mean age of 37.7±12.6 years. Most were housewives (67.5%) and the predominant age group was 31-45 years (47.5%). The average BMI was 23.75±3.52. The most common diagnosis was mechanical low back pain (81.0%), followed by musculoskeletal chest pain (5.5%) and cervical spondylosis (4.0%). in terms of chronicity, 36.5% reported acute pain (<1 month), 34.0% had subacute pain (1–3 months) and 29.5% had chronic pain (>3 months).
Conclusions: Mechanical low back pain emerged as the most prevalent pain disorder among outpatients, with a substantial portion experiencing chronic symptoms. These findings highlight the need for early diagnosis, targeted intervention and resource-appropriate pain management strategies in district-level healthcare settings
Dermatomyositis associated with malignancy: a case highlighting paraneoplastic syndrome
Get PDFDermatomyositis (DM) is a rare idiopathic inflammatory myopathy characterized by distinctive cutaneous manifestations and progressive, symmetric proximal muscle weakness. It affects both adults and children, with variable clinical presentations and disease severity. The pathogenesis involves autoimmune mechanisms, including complement-mediated microangiopathy, with a potential association with malignancies in adults. In this case study, we report a case of classical DM with incidence of malignancy. Timely diagnosis and administration of steroid led to better prognosis of the patient
Rising gastrointestinal malignancies in North India: a comprehensive review
Get PDFGastrointestinal (GI) malignancies, including cancers of the esophagus, stomach, colorectal region, gallbladder and liver, pose a significant public health challenge in North India, with rising incidence driven by unique regional factors. This comprehensive review synthesizes current literature to analyze the epidemiology, risk factors, clinical characteristics and management challenges of GI cancers in North India. Esophageal cancer, predominantly squamous cell carcinoma, exhibits high incidence in areas like Mizoram, while gastric cancer is prevalent in the Kashmir Valley. Colorectal cancer is increasing due to urbanization and lifestyle changes and gallbladder cancer is a major concern in the Ganges River belt. Liver cancer, primarily hepatocellular carcinoma, is linked to chronic hepatitis infections. Key risk factors include dietary habits (e.g., smoked meats, high-fat diets), tobacco use, Helicobacter pylori infection, hepatitis B and C and environmental carcinogens. Advanced-stage diagnosis, limited access to diagnostic tools and inadequate region-specific research hinder effective management. Preventive strategies, such as H. pylori eradication, hepatitis B vaccination and lifestyle modifications, alongside enhanced screening and genomic research, are critical for reducing the burden. This review underscores the need for collaborative efforts to improve early detection, treatment access and region-specific guidelines to address this growing epidemic
Challenges in managing a transgender adolescent with attention-deficit/hyperactivity disorder and multiple psychiatric comorbidities: a case report
Get PDFTransgender and gender-diverse (TGD) adolescents are individuals whose experienced gender differs from their biological sex. This group is particularly vulnerable to psychiatric disorders due to both biological factors and psychosocial stressors. Common comorbidities include attention-deficit/hyperactivity disorder (ADHD), mood, and substance use disorders. To date, numerous studies have examined the association between transgender incongruence and ADHD. However, the links with other psychiatric conditions, such as bipolar disorder, remain unclear. A 19-year-old transgender male presented with emotional instability, episodic mood swings, impulsivity, and difficulties related to gender identity. He came out to his friends as male at the age of 13. He had previously been diagnosed with depression, anxiety, and ADHD at the age of 16. The patient also experienced recurrent hypomanic episodes characterized by grandiosity and decreased need for sleep, followed by depressive phases marked by self-injurious behavior and suicidal ideation. He had a history of childhood sexual trauma perpetrated by a friend. Adopted in infancy, his relationship with his family deteriorated after he disclosed his gender identity. He was started on a mood stabilizer and an antipsychotic, with the addition of stimulants considered for later management. This case underscores the clinical challenges of managing psychiatric comorbidities in TGD adolescents, particularly the intersection of ADHD and bipolar disorder. Emerging neurobiological and psychosocial evidence suggests potential shared pathophysiological mechanisms between TGD status and psychiatric comorbidities, although definitive causal pathways remain uncertain. Comprehensive care must integrate individualized pharmacological strategies with psychosocial interventions to address the multifaceted influences
Efficacy and safety of empagliflozin (SGLT2 inhibitor) in Bangladeshi patients with type 2 diabetes mellitus
Get PDFBackground: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder requiring effective glycemic control to prevent complications.
Methods: This 8-month, randomized, open-label, interventional, single centered trial enrolled 86 Bangladeshi patients with poorly controlled T2DM (HbA1c ≥7.5%) on various antidiabetic regimens. Participants received Empagliflozin 10mg/25mg in addition to their ongoing therapy. Follow-ups at 6 weeks and 6 months evaluated glycemic control, lipid profile, renal parameters and adverse effects. Based on clinical response, the dosage was increased to 25 mg in selected cases. Statistical analyses included paired t-tests and Wilcoxon Signed Rank tests for normally and non-normally distributed variables.
Results: Hypertension was prevalent in 73.3% of cases, while chronic kidney disease (CKD), ischemic heart disease and dyslipidemia were observed in 12.8%, 14% and 37.2% of cases, respectively. Significant reductions in fasting blood sugar, postprandial blood sugar, systolic blood pressure (p<0.001 for all) and HbA1c (p<0.001) were observed at both 6-week and 6-month follow-ups. BMI reduction was significant at 6 months (p=0.03), while serum potassium increased significantly at both time points (p=0.02, p=0.01). Serum creatinine showed a significant decline at 6 months, while changes in LDL, triglycerides, HDL and total cholesterol were not statistically significant. Adverse effects were minimal, with 3.5% experiencing genital mycotic infections and 1.2% experiencing hypoglycemia.
Conclusions: Empagliflozin effectively improved glycemic control and systolic blood pressure reduction with minimal adverse effects in Bangladeshi T2DM patients while increasing serum potassium level
A rare gastric and peritoneal metastasis of cervical squamous cell carcinoma-an unusual breach and homing
Get PDFGastric metastasis is rare with a reported incidence of less than 1% with only a very few case reports in the literature to date. Gastric metastasis most commonly arises from malignant melanoma. We present a case of a 58-year-old female, a case of metastatic poorly differentiated squamous cell carcinoma of cervix. Radiology showed a circumferential asymmetric enhancing wall thickening in antrum of stomach and peritoneal carcinomatosis. Endoscopy showed circumferential thickening in proximal antrum, biopsy of stomach and peritoneum showed carcinoma-possibly poorly differentiated squamous cell carcinoma which on immunohistochemistry (IHC) was confirmed to be HPV associated poorly differentiated squamous cell carcinoma. The patient was started on palliative chemotherapy and is on follow-up
Post-operative rehabilitation following posterior superior labral repair to improve shoulder function in a manual labourer: a case study
Get PDFThis case study presents the post-operative physiotherapy rehabilitation of a 28-year-old male bike mechanic following arthroscopic repair of a type III superior labrum anterior to posterior (SLAP) lesion in the right shoulder. The rehabilitation program focused on restoring shoulder mobility, strength, and functional stability through a structured, phase-wise physiotherapy approach including passive and active-assisted range of motion exercises, neuromuscular stimulation, scapular stabilization, proprioceptive neuromuscular facilitation, and progressive strengthening. Over an eight-week period, the patient demonstrated significant improvements in pain, range of motion, and muscular strength, with the disabilities of the arm, shoulder and hand (DASH) score improving from 82% to 14%, the University of California, Los Angeles (UCLA) shoulder rating scale from 14/35 to 31/35, and pain on the numerical pain rating scale (NPRS) reducing from 9/10 to 2/10. The patient achieved full return to work without restrictions. This case highlights the importance of early, structured, and individualized physiotherapy intervention in optimizing post-surgical outcomes and restoring functional independence following superior labral repair