International Journal of Research in Medical Sciences
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Recurrent gastrointestinal bleeding in a 16-year-old with enteric perforation peritonitis: a surgical challenge
Get PDFWe present a rare and complex case of recurrent lower gastrointestinal bleeding following emergency laparotomy for enteric perforation peritonitis in a 16-year-old boy. Despite initial surgical management with primary repair, the patient developed persistent rectal bleeding, leading to hemodynamic instability and necessitating extensive investigations. Upper gastrointestinal endoscopy and computed tomography (CT) angiography failed to localize the bleeding source. A second laparotomy revealed diffuse mucosal oozing in the terminal ileum, prompting a right hemicolectomy with ileo-ascending side-to-side anastomosis and diversion loop ileostomy. Histopathology confirmed typhoid enteritis. This case underscores the importance of early recognition, aggressive management, and consideration of diffuse mucosal pathology in postoperative gastrointestinal bleeding, especially when standard diagnostics are inconclusive. Multidisciplinary collaboration and timely surgical intervention were crucial in achieving a favorable outcome. The case highlights the need for individualized surgical strategies to manage refractory bleeding in pediatric patients with enteric perforation
Robinson’s cytomorphological grading for breast carcinoma and its correlation with modified Bloom-Richardson histopathological grading
Get PDFBackground: Rising incidence of breast cancer in India necessitates a deeper understanding of biological behaviour of tumor. Tumor grade has a pivotal role in understanding the same. Breast cytology provides a quick diagnosis and remains vital in resource limited settings. Although cytological grading systems have been in development for some time but lack sufficient evidence to validate its correlation with histopathological grading.
Methods: A prospective study over a period of 1 year, included 60 cases of invasive breast carcinoma, diagnosed on cytology (FNAC) with subsequent available histopathological examination. Robinson cytologic grading and Bloom Richardson Histologic grading was performed and correlation studied. Cytological grade was also correlated with regional node metastasis. Correlation between the two grading systems was studied using Spearman’s correlation coefficient. Association between Cytological grade and axillary lymph node metastasis was analysed by Pearson’s chi square test.
Results: All 60 cases were histotyped as invasive breast carcinoma, NST. Using Robinson’s cytological grading, 38 cases (63.33%) were assigned grade II while 37 (61.67%) cases were graded as grade II histologically. Robinson’s grading system showed an absolute concordance of 85.00% with histological grading system (p<0.001).
Conclusions: Cytological nuclear grade correlates precisely with the histological grade assigned to the tissue with high concordance
Investigation of the frequency of hyperuricemia and associated risk factors in patients with psoriatic arthritis
Get PDFBackground: This study aimed to determine the frequency of and clinical significance of hyperuricemia in psoriatic arthritis (PsA) patients.
Methods: The study included 63 PsA patients. Characteristics of the patients, psoriasis (Pso) and PsA duration, and co-morbidities such as hypertension, diabetes mellitus, dyslipidemia, hypothyroidism and coronary artery disease were collected. Moreover, serum uric acid (SUA) and C-reactive protein (CRP) levels at the time of diagnosis, psoriasis area and severity index (PASI) score, body surface area (BSA), Disease Activity index for Psoriatic Arthritis (DAPSA), and Bath Ankylosing Spondylitis Radiological Index (BASRI-total) score were also recorded.
Results: The mean age of the patients was 46.2±10.6 years. 28 (44.4%) had hyperuricemia, of which 23 (36.5%) were female and 5 (7.9%) were male. The mean SUA level was significantly higher in male patients (p=0.002), whereas hypertension was more prominent in female patients (p=0.010). There was no significant relationship between hyperuricemia and BSA, PASI and DAPSA score. PsA patients with hyperuricemia had a high significant difference in BMI (p=0.045) and hypertension (p=0.044). BASRI score was significantly related to age, body mass index, DAPSA score, plantar fascia, greater trochanter, and the Achilles enthesitis (p<0.001, p=0.005, p=0.001, p=0.015, p=0.016 and p=0.031, respectively). On regression analysis, only BMI was associated with SUA level (p=0.043).
Conclusions: The majority of PsA patients had asymptomatic hyperuricemia. Moreover, hyperuricemia was associated with BMI and hypertension. The higher rate of hyperuricemia in women than men seems to be due to their higher BMI values
High cortisol levels as a risk factor for athletes poor sleep quality in training centers
Get PDFBackground: Intense training in athletes may able to disrupt the HPA axis which leads to increased cortisol levels and low- level quality to sleep. This study investigates whether elevated cortisol levels are a risk factor for low-level sleep quality in athletes.
Methods: This case-control study was conducted from June to November 2017 at a training centre in Denpasar. Subjects included athletes are from athletics, badminton, and bicycle racing who are preparing for a national tournament. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI), and serum cortisol levels were assessed. Bivariate and multivariate analyses were performed to determine the relationship between cortisol levels and sleep quality.
Results: The study included 64 athletes. Cortisol levels were significantly higher in athletes with low-level sleep quality (270.86±93.43 nmol/l) compared to those with good sleep quality (195.84±61 nmol/l). High cortisol levels were strongly associated with low-level sleep quality (OR 7.67; 95% CI 2.52-23.28; p<0.001). Multivariate analysis confirmed high cortisol levels as an independent risk factor for low-level sleep quality (OR 8.19; 95% CI 2.59–25.89; p<0.001). Elevated cortisol levels are a significant independent risk factor for low-level sleep quality in athletes undergoing intense training.
Conclusions: Elevated cortisol independently predicted poor sleep-in athletes undergoing intense physical training
Wilkie syndrome as a cause of upper intestinal obstruction and its minimally invasive surgical management: a case report and review of the literature
Get PDFUpper bowel obstruction is a diagnostic and therapeutic challenge due to the proximity of vascular structures and the anatomical constraints imposed by the thorax. Wilkie syndrome, a rare cause of upper GI obstruction, is associated with severe aortomesenteric compression and is usually diagnosed in children and adolescents. We present the case of an 18-year-old male patient with postprandial fullness, recurrent vomiting and epigastric pain. Contrast tomography showed severe gastric dilatation, a reduced aortomesenteric angle (11°) and an aortomesenteric distance of 3 mm, confirming the diagnosis. Endoscopy showed signs of gastric ischaemia with suspected perforation. Emergency diagnostic laparoscopy was performed and gastric perforation with mediastinal communication and duodenal ischaemia was identified. A partial gastrectomy with latero-lateral duodeno-jejunal anastomosis was performed. The postoperative course was favourable with tolerance to diet on day 3 and no complications at 3 months follow-up. Laparoscopic surgery represents a safe and effective alternative in the management of Wilkie's syndrome, reducing morbidity and optimising postoperative recovery
Surgical strategies and perioperative management in patients with acute mesenteric ischemia: impact on survival and intestinal function - a systematic review
Get PDFAcute mesenteric ischemia (AMI) is a fetal condition caused by an acute diminution of mesenteric flow with subsequent bowel necrosis and extremely high mortality. Early identification and immediate action are essential in enhancing outcomes. This systematic review assesses surgery and perioperative care in patients with AMI, determining how they affect survival and bowel function. A systematic search was performed in PubMed, Embase, and Cochrane Library with the use of pertinent MeSH terms and keywords. Included were studies comparing surgical and endovascular treatments, postoperative complications, survival, and bowel viability. Data extraction and quality assessment adhered to PRISMA. Among the studies that were reviewed, endovascular treatments showed superior survival when compared to surgery, with mortality at 15.6% compared to 38.6% for surgery. Early diagnosis, multidisciplinary care, and revascularization greatly improved outcomes. Comorbidities, lactate levels, and age were excellent predictors of mortality. Reoperation within 30 days was observed in 30%, and prolonged hospital stay was seen in 14% of the patients. AMI still has high mortality and morbidity rate, despite these improvements and there needs to be further optimization of surgical methods and perioperative approaches. Early imaging integration, early surgical or endovascular treatment and multidisciplinary management can optimize AMI outcomes. Optimizing management protocols and predictive markers for improved patient stratification and treatment choice should be the focus of future research
Unpacking ketogenic diet impact on diabetes: a systematic review
Get PDFThis study used a literature review of various studies to examine the effects of VLC/KD on the level of glycated haemoglobin, body weight, blood sugar, lipid metabolism, and cardiovascular, renal, and neurological hazards in people with pre-diabetes or T2D. A thorough review of the literature was done with the assistance of expert librarians utilizing internet-based databases (Embase, PubMed, and the Cochrane Library). To provide a comprehensive overview of the study categories, methods, participants, the impact of the ketogenic diet on individuals with diabetes mellitus, and results, the gathered data were analyzed using descriptive statistics. According to review findings, the ketogenic diet considerably improves lipid profiles, glycaemic management, and weight loss when compared to controls. These results highlight the need to emphasise the significance of higher fibre, foods with a low glycaemic index, like legumes, vegetables and fruits, and entire grain cereals, as well as the replacement of monounsaturated fat sources for the consumption of saturated fat sources of information, in energy-balanced conditions, among individuals with diabetes
Significance of intramammary lymph node in multimodality imaging
Get PDFThe internal mammary lymphatic system, alongside the axillary lymphatic system, is a key pathway for lymphatic drainage from the breast and a significant route for metastatic spread in breast cancer. Internal mammary lymph node (IMLN) involvement is associated with poor prognosis, regardless of axillary lymph node status. Intramammary lymph nodes (IMLNs), often benign incidental findings, require accurate differentiation between normal and abnormal features to guide appropriate diagnostic and therapeutic measures. Multimodality imaging, including mammography, ultrasound, MRI, and PET-CT, is essential for characterizing IMLNs, offering complementary insights into morphology and function. Accurate evaluation of IMLNs aids in breast cancer staging, with the American Joint Committee on Cancer (AJCC) incorporating their status into staging systems, reflecting their prognostic importance. Emerging technologies, such as radiomics and artificial intelligence (AI), promise to enhance diagnostic precision, potentially reducing invasive procedures. This review highlights the clinical significance of IMLNs and the pivotal role of imaging in their evaluation
Bacterial analysis of high vaginal swabs from women of reproductive age at a tertiary hospital in Lucknow
Get PDFBackground: Vaginal infections are prevalent among women, often caused by disruptions in the vaginal microbiota, leading to symptoms like abnormal discharge, itching, and discomfort. Bacterial vaginosis (BV) is a common condition characterized by a shift from Lactobacillus dominance to anaerobic bacteria overgrowth, affecting reproductive-age women significantly. Understanding the microbial ecology and antibiotic susceptibility of vaginal pathogens is crucial for effective management. The study aims to identify bacterial profiles and antibiotic susceptibility patterns from high vaginal swabs. Objectives include determining prevalent pathogenic bacteria and analyzing their antibiotic susceptibility.
Methods: A cross-sectional study at Era’s Lucknow Medical College and Hospital over six months analyzed 73 high vaginal swabs from gynecological clinic attendees. Data collection covered demographics, clinical symptoms, and antibiotic history. Laboratory methods included Gram staining, culture on selective media, biochemical tests, and antibiotic susceptibility testing using the Kirby-Bauer disc diffusion method per CLSI guidelines.
Results: In this study at Era’s Lucknow Medical College and Hospital, 73 high vaginal swab samples were cultured, with 37 (50.7%) testing positive for various pathogens. Escherichia coli was the predominant organism (57%), followed by Enterococcus species (22%), Klebsiella pneumoniae (13%), Staphylococcus aureus (5%), and Pseudomonas aeruginosa (3%). Antibiotic susceptibility testing revealed high effectiveness against Gram-negative bacteria, particularly for imipenem, meropenem, and colistin, with rates exceeding 80%.
Conclusions: Escherichia coli was found to be the most common cause of abnormal vaginal discharge in women of the reproductive age group
Risk factors and prevalence of acute kidney injury among intensive care unit patients: a comprehensive study in a tertiary care setting
Get PDFBackground: Acute kidney injury (AKI) is a frequent and severe complication among critically ill patients in the intensive care unit (ICU), contributing to increased morbidity, mortality, and extended hospital stays. Identifying risk factors for AKI is crucial for effective prevention and management. Objectives were to determine the prevalence of AKI and identify associated risk factors among ICU patients at Bangabandhu Sheikh Mujib medical university (BSMMU), Dhaka, during a one-year period.
Methods: This cross-sectional study included 122 adult ICU patients admitted between December 2022 and November 2023. Patients with chronic kidney disease (CKD) or prior kidney transplantation were excluded. Data were retrospectively collected from medical records, including demographic details, comorbidities, AKI diagnosis based on kidney disease: improving global outcomes (KDIGO) criteria, treatments, and outcomes. Statistical analyses were performed to evaluate significant risk factors.
Results: AKI occurred in 60 patients (49.2%). Patients with AKI had a higher mean age (65.4 years) than non-AKI patients (58.6 years, p=0.001). Hypertension was more prevalent in the AKI group (50% vs. 29%, p=0.02), and sepsis was identified in 60% of AKI patients compared to 19.4% of non-AKI patients (p=0.001). The AKI group experienced higher mortality (46.7% vs. 16.1%, p=0.001) and longer ICU stays (14.8 vs. 8.9 days, p=0.001).
Conclusions: AKI is highly prevalent among ICU patients, with age, hypertension, and sepsis as significant risk factors. Early detection and tailored interventions are essential to improve outcomes in this high-risk population