International Journal of Research in Medical Sciences
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Phenotypic changes in Salmonella typhi: observations during the recent upsurge in typhoid cases in Vadodara, Gujarat
Full text linkBackground: Salmonella enterica serotype typhi is a causative agent of enteric fever (typhoid). The study was aimed at seeing why the S. typhi showing in vitro susceptibility to ceftriaxone required longer treatment for defervescence. We observed phenotypic change characterized by bipolar staining (safety-pin appearance) in the bacilli. We also observed bacilli forming elongated (filamentous forms). We hypothesize a possible association between this structural change in the cell-wall and the resistance pattern of S. typhi.
Methods: The study was conducted in a rural hospital with tertiary care facilities. Blood cultures were performed in cases of all the patients with suspected sepsis. The blood cultures were performed on an automated BACT/Alert 3D system. Identification and drug susceptibility of the bacterial isolates are done on VITEK 2. The study comprised 25 blood culture-positive typhoid cases in the last three months.
Results: We observed that gram-stained smears made from positive blood culture bottles revealed conspicuous changes in staining pattern of the bacilli. The bacilli showed Bipolar staining (safety pin appearance) of Salmonella enterica serotype typhi under the oil immersion objective.
Conclusion: This is the first observational study to investigate the phenotypic change in the staining properties of S. typhi. We hypothesize that this change in staining pattern is associated with structural changes in the bacterial cell wall, which is responsible for S. typhi altered response to antibiotic therapy
Paracecal appendicitis in a rare anatomical position: a case report describing a modified laparoscopic approach
Full text linkAnatomical variations of the appendix, such as a paracecal adherent position, are uncommon and may complicate both diagnosis and surgical management. While laparoscopic appendectomy remains the gold standard, this variant poses challenges in mobilization, vascular control, and cecal protection. We describe a 47-year-old female presenting with acute appendicitis, where contrast-enhanced computed tomography (CT) revealed a retrocecal appendix with paracecal adherence. At laparoscopy, necrotizing appendicitis in an unusual paracecal position was confirmed. A modified surgical strategy was applied, combining retrograde appendectomy with a lateral-to-medial dissection. This approach facilitated early vascular control, safe mobilization of the appendix, and secure division of the base without the use of staplers or endoloops. The operative time was 60 minutes, with minimal blood loss, and the patient had an uneventful recovery, being discharged on postoperative day three. Paracecal adherence represents a rare but technically demanding variant. Our combined retrograde and lateral-to-medial approach provided advantages in hemostasis, cecal protection, and operative efficiency. Compared to conventional methods, it minimized the risk of bleeding and avoided cecal injury, while also being cost-effective. This case highlights the feasibility and safety of a modified laparoscopic technique for paracecal adherent appendicitis. Broader validation in larger cohorts is warranted, but this strategy may represent a valuable alternative for surgeons encountering rare anatomical variants
Correlation between mean thrombocyte volume and microalbuminuria in type 2 diabetes mellitus patients
Full text linkBackground: The determination of microalbuminuria is beneficial in detecting cases of type 2 diabetes mellitus (T2DM), which can result in renal and cardiovascular diseases. A few studies correlating mean thrombocyte volume (MTV) with microalbuminuria have shown positive results; however, data remain limited in the Indian population. The present study evaluated the association between MTV and microalbuminuria in patients with (T2DM).
Methods: This hospital-based cross-sectional study was conducted from February 2023 to January 2024 in Maharashtra, India. Sixty patients of either sex, aged 18 years or older, with a duration of T2DM greater than four years and diagnosed according to American Diabetes Association criteria, were included. The duration of diabetes mellitus (DM), HbA1c, and urine microalbumin were noted. The primary objective was to determine the relationship between MTV and microalbuminuria, while the secondary objectives were to assess the associations between MTV and the duration of T2DM and between MTV and HbA1c. The sample size was statistically powered to detect a significant correlation between MTV and microalbuminuria, aligning with findings from prior research.
Results: The mean MTV was significantly elevated in patients with a duration of diabetes greater than ten years, HbA1c >7%, and urine microalbumin levels >30 mg/g. A significant positive correlation of 0.936, 0.552, 0.875 and 0.433 was observed between MTV and urine microalbumin levels, the duration of DM, HbA1c and age, respectively.
Conclusions: MTV serves as a simple and cost-effective marker for assessing glycemic control and early detection of renal involvement in T2DM. The study reinforces the potential role of MTV as a supportive tool for monitoring disease progression and guiding preventive care in diabetic patients
Correlation of serum C-reactive protein level with severity of preeclampsia
Full text linkBackground: Preeclampsia is a hypertensive disorder unique to pregnancy, characterized by elevated blood pressure and proteinuria after 20 weeks of gestation. It is associated with systemic inflammation and generalized endothelial dysfunction. C-reactive protein (CRP), a sensitive marker of inflammation, has been implicated in the pathophysiology of preeclampsia. This study aims to assess serum CRP levels in preeclamptic women and determine its correlation with disease severity.
Methods: A case-control study was conducted over a two-month period at the department of biochemistry and department of obstetrics and gynaecology, Gauhati medical college and hospital. A total of 60 pregnant women were enrolled-30 preeclamptic patients (15 mild, 15 severe) and 30 normotensive pregnant controls-based on strict inclusion and exclusion criteria. Serum CRP levels were measured using the Vitros 5600 integrated system. Data were analyzed using the independent t test and Pearson’s correlation coefficient. A p<0.05 was considered statistically significant.
Results: The mean serum CRP level in preeclamptic patients was significantly higher (14.63±1.99 mg/l) than in normotensive controls (5.98±1.86 mg/l) (p<0.001). Among the preeclamptic group, severe cases had significantly higher CRP levels (16.23±1.06 mg/l) compared to mild cases (13.03±1.28 mg/l) (p<0.001). CRP levels showed a strong positive correlation with both systolic and diastolic blood pressures (DBP) in both mild (r=0.97 and r=0.98, respectively) and severe (r=0.95 and r=0.93, respectively) preeclampsia groups.
Conclusions: Serum CRP levels are elevated in preeclampsia compared to normal pregnancy and increase further with disease severity
A clinical case of multiple myeloma complicated by renal amyloidosis
Full text linkMultiple myeloma is a hematological malignancy effecting multiple organ systems. One of the commonly effected organs are the kidneys leading to renal amyloidosis and nephrotic syndrome. This article describes a clinical case of a patient presenting with end-stage renal failure. It mainly discusses the investigations used to come to a clinical diagnosis of multiple myeloma and renal amyloidosis and the treatment strategies used in managing the patient
Psychiatric manifestations in ulcerative colitis: a North Indian cohort study
Full text linkBackground: Ulcerative colitis (UC) is a chronic inflammatory bowel disease that causes results in gastrointestinal and other health issues. Psychiatric problems are being recognized more often but are still often missed, particularly in India. Aim of the study was to examine the demographics, disease characteristics, and psychiatric symptoms of UC patients in North India.
Methods: A prospective observational study of 100 UC patients was carried out from September 2021 to September 2023. Demographics, disease extent, severity, and psychiatric outcomes were recorded, and all patients were assessed for depression and anxiety using PHQ-9 and GAD-7 scores.
Results: The mean age of the study cohort was 38.6±12.4 yrs, with 58% being male. Pancolitis was found in 48% of the patients. Clinically significant depression (PHQ-9 ≥10) and anxiety (GAD-7 ≥10) were seen in 28% and 26%, respectively. Sleep disturbances affected 44% of the patients, and fatigue was reported by 47%. Steroid-related psychiatric events occurred in 3%.
Conclusions: Psychiatric symptoms are common in UC and can negatively impact quality of life. Comprehensive care requires regular screening and a team-based approach
Study of understanding, awareness and compliance to treatment in patients of hypertension at tertiary care center, SSG Hospital, Vadodara: a descriptive cross-sectional study
Full text linkBackground: Hypertension represents a major health issue, significantly contributing to the prevalence of cardiovascular diseases worldwide. Effective hypertension management is largely dependent on patients’ understanding, awareness, and adherence to prescribed treatments. This study aimed to assess the levels of understanding, awareness, and compliance with treatment among hypertensive patients at SSG Hospital, a tertiary care center in Vadodara.
Methods: This descriptive cross-sectional study involved 300 hypertensive patients from the outpatient department of SSG Hospital, Vadodara. Data were gathered using a structured questionnaire that included demographic details, understanding about hypertension, awareness of its complications, and adherence to medications and lifestyle adjustments. Blood pressure measurements confirmed hypertension status. Statistical analyses were conducted using SPSS software to identify significant factors influencing treatment compliance.
Results: Among the 427 participants, 62% demonstrated sufficient understanding of hypertension, its risk factors, and complications. Awareness was high, with 75% of patients recognizing the importance of regular medication and lifestyle changes. However, only 54% of patients were fully compliant with their treatment regimens. Higher education levels, consistent follow-up visits, and family support were significantly associated with better compliance.
Conclusions: Although the majority of hypertensive patients at SSG Hospital, Vadodara, have substantial knowledge and awareness of their condition, treatment compliance remains suboptimal. Improving patient education, providing ongoing support, and addressing barriers to adherence are essential for better management of hypertension
Definitive role of surgery in management of acromegaly due to ectopic growth hormone secretion: review of literature
Full text linkAcromegaly, characterized by excessive growth hormone (GH) secretion, typically arises from pituitary adenomas. Ectopic GH production from non-pituitary tumors, such as carcinoid tumors, is exceedingly rare, <1%. The majority of the growth hormone-releasing hormone (GHRH) - secreting tumors are bronchial carcinoids. Other GHRH-secreting tumors in decreasing order of occurrence are pancreatic adenomas, gastro-intestinal tumors, thymic tumors, and tumors associated with the MEN-I syndrome. We present a case of a 43-year-old female who presented with features consistent with acromegaly and was found to have an ectopic source of GH from a mediastinal tumor. Diagnostic evaluation included biochemical testing, imaging studies, and histopathological confirmation. Surgical intervention led to complete resolution of clinical symptoms and normalization of GH levels. This case highlights the diagnostic challenges posed by ectopic GH secretion and emphasizes the critical role of surgery in achieving favorable outcomes in such rare presentations of acromegaly
Unclogging the heart: the potential of statins to reverse coronary artery blockage
Full text linkAcute coronary syndrome (ACS) comprises three life-threatening cardiovascular conditions-unstable angina, non-ST elevation myocardial infarction (NSTEMI), and ST elevation myocardial infarction (STEMI)-all characterized by reduced myocardial blood flow leading to ischemia and potential cardiac tissue damage. Established risk factors for ACS include age over 50, smoking, obesity, diabetes mellitus, and hypertension. Statins, a cornerstone in cardiovascular disease management, function by inhibiting HMG-CoA reductase, a key enzyme in hepatic cholesterol synthesis. Beyond lipid-lowering, emerging evidence supports their role in stabilizing and regressing atherosclerotic plaques. This narrative review explores the impact of statin therapy on arterial blockages associated with ACS. Data from multiple clinical trials and studies indicate that statins significantly reduce both morbidity and mortality in ACS patients. Notably, intensive statin regimens, particularly with rosuvastatin, have demonstrated greater efficacy in inducing plaque regression and improving plaque stability compared to standard therapy. In summary, statins are integral to the acute and long-term management of ACS, offering both anti-inflammatory and plaque-stabilizing effects. Their ability to reverse atherosclerosis, especially with high-intensity therapy, underscores their essential role in reducing adverse cardiovascular outcomes. The robust evidence supporting their use highlights the necessity of early initiation and sustained administration in ACS patients to improve prognosis and survival.
Recurrent atrial fibrillation with fast ventricular rate in an elderly lady: old records reveal cause of the malady
Full text linkAmiodarone is an iodinated benzofuran derivative and is prescribed widely in management of arrythmias- ventricular and supraventricular alike. Excellent efficacy, minimal negative inotropic activity and less rate of ventricular pro arrhythmia makes it the choice of drug in heart failure. Side effects however, make it a drug to be used with caution and they range from pulmonary toxicity to thyroid dysfunction. 15-20% of patients treated with amiodarone are believed to develop some thyroid dysfunction. It can cause amiodarone induced hypothyroidism (AIH) or amiodarone induced thyrotoxicosis (AIT). AIT usually is seen in areas with low uptake of iodine and AIH in areas with sufficient iodine uptake. We report a case of 58-year-old lady with rheumatic heart disease who was started on amiodarone for atrial fibrillation and later presented with recurrent atrial fibrillation (AF) with fast ventricular rate (FVR) and diagnosed as AIT. The challenges in diagnosis and management are discussed