International Journal of Research in Medical Sciences
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Surgical management of congenital sternal cleft in a pediatric patient with PHACES syndrome
Get PDFPHACES syndrome, first described in 1978 and named in 1996, is a rare disorder involving multiple malformations, including abnormalities of the posterior fossa, cervicofacial segmental hemangiomas, cerebrovascular arterial anomalies, cardiac or large vessel defects, ocular abnormalities and sternal defects such as the sternal cleft. It predominantly affects females, with a ratio of 9:1 and is seen in 2–3% of infantile hemangioma cases. Some patients may also present with thyroid disorders. The sternal cleft, one of the anomalies associated with PHACES syndrome, is a rare congenital malformation caused by a failure in the fusion of the sternal midline during embryonic development. It can be classified as partial or complete, with the superior partial cleft being the most common form. This defect compromises the protection of mediastinal organs and can result in varying degrees of respiratory distress. Diagnosis is typically straightforward through inspection and palpation at birth
The relative effectiveness of AI-based imaging and ultrasound in the navigation of cardiac procedures
Get PDFThe exponential growth in cardiovascular imaging investigations underlines a vital need to optimise clinical workflow efficiency and diagnostic accuracy. Artificial intelligence (AI), particularly machine learning, has emerged as a transformational technology in this sector, giving the potential to expedite cardiac imaging operations and enhance patient outcomes. This review investigates how well AI-based imaging navigates cardiac operations in comparison to traditional ultrasonography. We investigate AI's ability to automate picture segmentation, minimise operator-dependent variability, and combine multimodal data, such as cardiac magnetic resonance imaging, computed tomography, nuclear imaging, and echocardiography, for a whole cardiac evaluation. AI-enhanced imaging provides more accuracy in illness identification, prognosis, and clinical decision-making, even though conventional ultrasound is still a vital component of real-time procedure guidance. The article also identifies the main obstacles to the widespread use of AI in clinical practice, as well as current applications and developing technology. The study offers a critical viewpoint on the developing role of AI in improving cardiovascular care by contrasting different modalities
Comparison of percutaneous coronary intervention outcomes in diabetic patients with non-ST-elevation myocardial infarction having multivessel disease
Get PDFBackground: Diabetic patients with non-ST-elevation myocardial infarction (NSTEMI) and multivessel coronary artery disease (MVD) present unique challenges in revascularization strategy selection. This study compares the clinical outcomes of multivessel (MVR) versus single-vessel revascularization (SVR) using percutaneous coronary intervention (PCI) in such patients.
Methods: A prospective observational study was conducted at a tertiary center in Bangladesh including 110 diabetic NSTEMI patients with angiographically confirmed MVD. Patients underwent either MVR (n=58) or SVR (n=52). Outcomes assessed over a 6-month follow-up included major adverse cardiovascular and cerebrovascular events (MACCE), left ventricular ejection fraction (LVEF), functional capacity (METS), and survival.
Results: Baseline characteristics were comparable between groups. The MVR group had significantly more stents (2.36±0.49 vs. 1.17±0.38; p<0.01) and longer stent length (58.76±10.22 mm vs. 33.46±10.93 mm; p<0.01). MACCE was significantly lower in the MVR group (6.89% vs. 30.77%; p=0.001), with reduced myocardial infarction and revascularization rates. Both groups showed significant improvement in LVEF and METS post-PCI, with no significant intergroup difference. Kaplan–Meier analysis revealed superior event-free survival in the MVR group.
Conclusions: Multivessel PCI offers superior clinical outcomes and event-free survival in diabetic NSTEMI patients with MVD, without increasing periprocedural risks. Individualized risk-benefit assessment remains essential
Tubercular meningitis with altered sensorium in a chronic alcoholic patient: a case report
Get PDFA 35-year-old Indian male was referred to Vidhatha hospital, Vijayawada, Andhra Pradesh with history of fever, shortness of breath (Grade III), drowsiness, altered sensorium and generalized weakness for 20 days. The patient is chronic alcoholic and smoker. On examination, patient was disoriented and exhibited neck stiffness. Pleural fluid was positive for Mycobacterium tuberculosis. CT brain indicated vasogenic oedema, and mild hypodense areas in bilateral periventricular regions. MRI brain suggested mild leptomeningeal enhancement in cortical and sub-cortical regions. CSF analysis revealed lymphocytic pleocytosis (100), lowered glucose level (21 mg/dL) and markedly elevated protein level (312.5 mg/dl). Owing to, a diagnosis of tubercular meningitis was established and antitubercular medication with rifampcin, isoniazid, ethambutal, and pyrazinamide, as well as dexamethasone was initiated. Within two days of treatment, he showed signs of improvement, recognised the surroundings and responded to short conversations. The patient was sensitized regarding the adverse effects of smoking and alcoholism and was advised to continue treatment for additional six months
Central macular thickness changes following uncomplicated phacoemulsification surgery
Get PDFBackground: This study aims to evaluate changes in central macular thickness (CMT) following uncomplicated phacoemulsification cataract surgery using spectral-domain optical coherence tomography (SD-OCT).
Methods: A prospective observational study was conducted at the Department of Ophthalmology, GMC Srinagar, from January to July 2024. A total of 134 eyes from patients aged over 40 years with senile cataracts were included. Patients with pre-existing ocular conditions affecting macular thickness were excluded. Baseline and postoperative CMT measurements were recorded on day 1, 1 week, 1 month, and 6 months post-surgery. Statistical analysis was performed using paired t-tests.
Results: The mean preoperative CMT in patients without comorbidities was 248.0±21.3 μm. Postoperatively, CMT increased to 249.1±22.1 μm on day 1, 261.6±32.7 μm at 1 week, 266.1±28.1 μm at 1 month, and 252.6±21.9 μm at 6 months. A statistically significant increase in CMT was observed at 1 week and 1 month (p<0.005), followed by a reduction at 6 months. Similar trends were noted in patients with diabetic retinopathy and resolved retinal vein occlusion. No cases of postoperative cystoid macular edema (CME) or loss of best-corrected visual acuity (BCVA) were recorded.
Conclusion: Uncomplicated phacoemulsification leads to a transient increase in CMT, peaking at 1 month and returning toward baseline by 6 months, without affecting visual acuity or causing CME. The findings support the safety of the procedure, even in patients with mild diabetic retinopathy or prior retinal vein occlusion. Further research is recommended to explore long-term macular changes and risk factors for persistent macular thickening
Primary testicular diffuse large B-cell lymphoma (germinal centre B-cell type) masquerading as spermatocytic seminoma: a morphological conundrum
Get PDFDiffuse large B cell lymphoma is usually known for proliferation for medium to large abnormal lymphoid cells. Intermixed polymorphous cells may be seen in occasional cases. This type of morphology when seen in testicular lymphoma in an adult male may be misinterpreted as spermatocytic seminoma as seen in the reported case of a 48-year-old male with slow growing testicular mass. Immunohistochemistry is a must to confirm diagnosis and hence impart correct treatment in these type of cases. Spermatocytic seminoma is CD117, SALL 4 positive whereas DLBCL will display LCA, CD20, CD10, and/or bcl-6, MUM1 expression
Comparison of 25-hydroxy vitamin D with FBG and 2 hours postprandial glucose between type 2 diabetic and healthy normoglycemic individuals
Get PDFABSTRACT
Background: Vitamin D plays a crucial role in glucose metabolism and lipid regulation. This study aimed to evaluate the association between serum vitamin D levels and glycemic as well as lipid profiles in individuals with and without type 2 diabetes mellitus (T2DM).
Methods: This cross-sectional study was conducted at the Clinical Biochemistry and Biochemistry & Cell Biology Departments of BIRDEM General Hospital, Dhaka, from July 2014 to June 2015. A total of 200 participants aged between 30 and 70 years were selected from the outpatient department, including both type 2 diabetic patients and healthy, non-diabetic individuals. Participants were divided into two groups: Group A comprised 130 type 2 diabetic patients and Group B included 70 healthy normoglycemic controls. A purposive (convenient) sampling technique was used.
Results: The mean serum 25(OH)D level was significantly lower in T2DM patients (22.37±8.34 ng/ml) compared to controls (28.92±10.46 ng/ml; p<0.001). In the diabetic group, vitamin D levels showed significant inverse correlations with fasting glucose, HbA1c and postprandial glucose. Additionally, serum 25 (OH)D was negatively correlated with total cholesterol, LDL and triglycerides and positively with HDL cholesterol. No significant correlations were observed in the non-diabetic group.
Conclusions: Vitamin D deficiency is more prevalent in individuals with T2DM and is significantly associated with poor glycemic control and atherogenic lipid profiles. These findings highlight the potential role of vitamin D in the metabolic regulation of diabetic patients and suggest the need for further interventional studies
Prevalence of iron deficiency anaemia in chronic kidney disease patients not on renal replacement therapy: a cross-sectional observational study
Get PDFBackground: Chronic kidney disease (CKD) is a leading cause of mortality in India. Iron deficiency anaemia (IDA), both absolute and functional, is prevalent among CKD patients, especially in developing countries. Timely diagnosis and treatment are essential to reduce associated morbidity and mortality.
Methods: A cross-sectional observational study was conducted from August 2022 to July 2024 at Indira Gandhi Government Medical College, Nagpur. The study included 100 diagnosed CKD patients (stages 3–5) not on renal replacement therapy, fulfilling specific inclusion and exclusion criteria.
Results: Among the participants, 35% were in stage 4 and 38% in stage 5 CKD. The majority (37%) were aged 51–60 years. A significant association was observed between mean haemoglobin levels and CKD stages in males. All females were anaemic, indicating a significant link between gender and anaemia status. Regarding red blood cell morphology, 51% exhibited a normocytic normochromic pattern, while 29% had a microcytic hypochromic pattern. A statistically significant correlation was found between serum iron profile and CKD stages. Of the 91 anaemic patients, 31 (34.06%) had IDA.
Conclusions: CKD predominantly affects older adults, with the highest prevalence in the 51–60 age group and a male predominance. Serum iron profiles deteriorate as CKD stages advance, correlating with increased prevalence and severity of IDA
Gastroesophageal reflux to esophageal adenocarcinoma: pathogenesis, risk stratification, and precision surveillance
Get PDFGastroesophageal reflux disease (GERD) is a global public health burden with a rising prevalence driven by urbanization, aging populations, and modifiable lifestyle factors. This narrative review delineates the progression from GERD to Barrett’s esophagus (BE) and ultimately to esophageal adenocarcinoma (EAC), emphasizing the epidemiological trends, molecular mechanisms, and clinical implications. The global prevalence of GERD has surged by over 77% since 1990, affecting an estimated 800 million individuals, with notable geographic variability and underestimation in low- and middle-income countries owing to inconsistent diagnostic criteria and reporting. BE, a metaplastic transformation of the esophageal epithelium due to chronic reflux, is recognized as the only precursor of EAC. This progression involves a complex interplay between sustained inflammation, molecular dysregulation, and genetic mutations. Key signaling pathways, including NF-κB, IL6/STAT3, NOTCH, and Hedgehog, mediate epithelial remodeling and carcinogenic transformation. Dysplasia, particularly high-grade dysplasia (HGD), remains a key histopathological predictor of malignancy, complemented by molecular biomarkers such as TP53 mutations, aneuploidy, and gene expression alterations. This review also addresses clinical risk stratification, identifying high-risk cohorts based on segment length, obesity, smoking, symptom frequency, and genetic predisposition. Despite robust knowledge, gaps in surveillance persist, with current endoscopic screening failing to capture asymptomatic or under-recognized high-risk groups of patients. Non-endoscopic tools, such as Cytosponge and liquid biopsy, are promising adjuncts for bridging these gaps. A precision prevention approach, integrating molecular diagnostics, risk-based screening, and inclusive surveillance, is essential for mitigating the rising incidence of EAC and improving outcomes in at-risk populations
Prevalence of polypharmacy and its associated factors: a cross-sectional study among elderly population
Get PDFBackground: Polypharmacy is the concurrent use of multiple medications, defined as the routine use of five or more medications. With such a dynamically growing elderly population, concerns regarding polypharmacy and its effect on this geriatric population need to be studied. Hence, this study aims to estimate the prevalence of polypharmacy among elderly and its associated factors and impact.
Methods: A cross-sectional study was conducted in the outpatient department (OPD) of an Urban Health Training Centre affiliated to a tertiary health care hospital in Maharashtra among 150 elderly patients above 60 years of age. Association between polypharmacy and study variables were assessed using Chi-square test.
Results: Mean age of participants was 69.23±5.90 years. Prevalence of polypharmacy in our study was 76 (50.67%). It was observed that maximum patients 48 (32%) took 5 medicines and hypertension was the most common morbidity 68 (45.33%).
Conclusions: The associated factors with polypharmacy were found to be age, education, socioeconomic status, number of morbidities, number of doctors consulted, hospital admission in the last 3 months. The impact of polypharmacy on adverse drug reactions, out of pocket expenditures and adherence to medications were found to be significant