International Journal of Research in Medical Sciences
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Pattern of stroke patients admitted at a tertiary Hospital in Bangladesh
Get PDFBackground: Stroke is one of the most common causes of mortality and morbidity in Bangladesh. The purpose of the study was to understand the pattern of stroke in a tertiary care hospital in Bangladesh.
Methods: This cross-sectional study was carried out from June to November 2023 among diagnosed stroke patients. Convenient sampling was used to select the 60 patients from Chattogram Maa O Shishu Hospital, Bangladesh. A face-to-face interview was conducted using a semi-structured questionnaire. Descriptive analysis and Chi-square test were performed by IBM SPSS software.
Results: Among 60 patients, almost half (48.3%) were in the 65–84 age group. Most of the patients had HTN (81.7%) and DM (55%). About 40% of ischemic and haemorrhagic patients had arrived at the hospital before 6 hours. This study also found that only 38% of ischemic stroke patients and 20% of haemorrhagic patients had a good (13–15) GCS score. The NIHSS score was very severe (21-42) among 36% of ischemic stroke patients and 40% of haemorrhagic stroke patients. Vomiting, GCS, headache, convulsion, pulse, and diastolic blood pressure had a significant (p≤0.05) association with stroke.
Conclusions: Ischemic stroke was the predominant form of stroke, and a large number of patients arrived at the hospital on time. Rapid initiation of treatment can decrease morbidity and mortality rates significantly. So, a stroke center should be established as soon as possible to save patients' lives
A comparative study on tumour response, intrathoracic symptom palliation and toxicities in locally advanced inoperable non-small cell lung cancer patients receiving palliative chemoradiation versus radiation alone
Get PDFBackground: Locally advanced unresectable non-small cell lung cancer (LA-NSCLC) is a key focus in research, as it presents significant treatment challenges, with low survival rates despite progress in radiotherapy and systemic therapies. This study compares two palliative regimen for LA-NSCLC, one with radiation alone the other arm as concurrent chemoradiation therapy (CCRT) with nab-paclitaxel.
Methods: A Randomised Controlled Trial was conducted in the Department of Radiation Oncology, Regional Institute of Medical Sciences, Imphal from July 2022 to June 2024. Sample size of 96 was calculated. In the Control Arm (Arm A), patients were treated with radiation alone at the dose of 36 Gy/12# and in the Study Arm (Arm B), CCRT was given at 40 Gy/20 with nab-paclitaxel given as a weekly dose. The primary endpoint is to see the tumour response, intrathoracic symptom palliation and treatment toxicities between the two arms. Secondary endpoints include progression-free survival (PFS).
Results: Our study has a better overall response rate in Arm B compared to Arm A and the most effectively palliated symptoms in our study were chest pain and shortness of breath. Arm B exhibited more pronounced acute and late radiation toxicities which were manageable. The median PFS was 8 months in Arm A and 13 months in Arm B.
Conclusions: Overall response rate after completion of treatment was higher in palliative concurrent chemoradiation group as compared to palliative radiation therapy group, but in totality, the two palliative lung cancer treatment regimens were almost equal in efficacy in terms of intrathoracic symptom palliation and toxicity
Estimation of serum potassium levels as a prognostic marker in acute organophosphorus poisoning in a tertiary care center
Get PDFBackground: Organophosphorus compound poisoning is primarily a problem of the developing countries. Its widespread use and easy availability have increased the likelihood of poisoning with these compounds. Serum cholinesterase levels are easier to estimate and usually depressed after OP poisoning. Peradeniya OP poisoning scale has not been studied much in Indian scenario. Hypokalaemia is one of the most common electrolyte abnormalities associated with organophosphorus poisoning It could be a simple and effective system to determine the need for ventilatory support early on in the course. The data are scarce especially in central India regarding the OP poisoning and the consequent role of serum potassium in assessing the severity. Hence this study was undertaken to assess the severity of organophosphorus compound poisoning clinically by estimating serum potassium levels.
Methods: A prospective study was performed among 100 cases of OP poisoning, from September 2022 to September 2024. On patient’s fulfilling inclusion criteria were investigated with serum Potassium at the time of admission and estimation of serum acetylcholinesterase were done on the day of admission.
Results: Serum potassium levels were significantly low in subjects who required mechanical ventilation compared to those with normal potassium levels serum potassium levels and Potassium levels were significantly low in patients who developed respiratory failure and thus strongly correlated with clinical severity.
Conclusions: Serum potassium levels show a strong degree of positive correlation with the severity of poisoning and can be used as a predictor of outcome in organophosphorus poisoning
Telmisartan-induced lichenoid drug eruption: a case report
Get PDFLichenoid drug eruption (LDE) is a rare adverse reaction to various medications, including antihypertensives like telmisartan. Early identification and withdrawal of the offending agent are key to management. A 52-year-old hypertensive male on telmisartan developed pruritic, violaceous lesions over the scalp and extremities, later spreading to the face, neck, and back, with oral involvement. Initial treatment offered partial relief. A diagnosis of telmisartan-induced lichenoid eruption was made, and the drug was replaced with amlodipine. Betamethasone mini-pulse therapy and azathioprine were initiated, leading to full resolution of lesions, leaving only post-inflammatory hyperpigmentation. Although uncommon, telmisartan can cause LDEs. Timely discontinuation and appropriate immunosuppressive therapy ensure favourable outcomes
Experience with a synthetic bilayer biodegradable temporising matrix in complex wounds
Get PDFBilayer Biodegradable Temporising Matrix (BTM) is a synthetic polyurethane dermal matrix used to reconstruct complex wound with exposed bone and tendon, chronic wound. We hope to further explore its potential applications in this series. Patients who received BTM application across our centres over a 12-months period were included. Patients were followed up to assess BTM and graft take, substitute for flap in small wound, stable coverage, cover in trophic ulcer and prevent recurrence. A total 15 patients with wounds were identified with a range of aetiologies. wounds had 100% integration of BTM at the time of sealing membrane removal. Two wounds had partial graft loss that later healed by secondary intention. BTM offers a safe and reliable reconstructive option in challenging wounds that would otherwise require more complex operations
Sludge or serpent? Unmasking hepatobiliary ascariasis in a young adult female
Get PDFHepatobiliary ascariasis (HBA) is an uncommon but significant cause of biliary obstruction, particularly in regions where Ascaris lumbricoides is endemic. We report a case involving a 21-year-old female who presented with severe epigastric pain and vomiting. Initial evaluation indicated biliary sludge and possible pancreatitis, but her symptoms worsened despite conservative management. Repeat ultrasonography revealed a coiled echogenic structure in the right hepatic and common bile ducts, raising suspicion for parasitic infestation. Magnetic resonance cholangiopancreatography (MRCP) confirmed a tubular filling defect, and endoscopic retrograde cholangiopancreatography (ERCP) enabled extraction of a live Ascaris worm. The patient was treated with albendazole and scheduled for elective cholecystectomy due to persistent gallbladder sludge. This case highlights the importance of considering parasitic infections in the differential diagnosis of biliary symptoms in endemic regions. Early imaging and prompt endoscopic intervention are crucial to prevent complications. Preventive strategies, including improved sanitation, health education, and regular deworming, are essential to reduce the burden and recurrence of ascariasis.
Vancomycin intermediate and vancomycin resistant Staphylococcus aureus: an upcoming threat
Get PDFBackground: Either community or hospital settings, Staphylococcus aureus is a significant pathogen that causes mild localized infections of the skin to potentially fatal systemic infections. The increasing evidence of reduced vancomycin susceptibility (RVS) and vancomycin resistance in clinical MRSA isolates is troubling. There aren't many therapeutic options available for such isolates. We have identified the most current pattern of antimicrobial resistance and specifically evaluated Staphylococcus aureus's susceptibility profile to vancomycin. vancomycin-intermediate Staphylococcus aureus and isolates of Staphylococcus aureus that are resistant to vancomycin.
Methods: Non-duplicate, consecutive isolates of S. aureus obtained from January 2021 to June 2022 were subject to antimicrobial susceptibility testing using standard disk diffusion tests or epsilometer tests according to the clinical laboratory standards institute 2021 requirements.
Results: The total of 315 S. aureus were isolated during study period. Swab and pus sample shows highest isolation followed by other sample types. A total of 202 (64.1%) isolates were MRSA, while 111 (35.2%) were Inducible clindamycin positive ( ICR Positive). Antibiotic resistance observed is, penicillin (303/315, 96.1%), Ofloxacin (266/315, 84.4%), levofloxacin (255/315, 80.9%), Azithromycin (190/315, 60.3%) followed by other class of antibiotic groups. In our study Vancomycin , Linezolid and Teicoplanin are 100% sensitive. Vancomycin resistance is not noted in any isolates but we have 7 Vancomycin intermate isolates.
Conclusions: Gate keeping in advent use of antibiotic is paramount importance to control the antibiotic resistance. As well as continuous laboratory monitoring of various antibiotic resistance pattern is needed
A case of Sjogren’s syndrome presenting as hypokalaemia secondary to renal tubular acidosis
Get PDFRenal tubular acidosis (RTA) is a known but relatively rare presentation of Sjogren’s syndrome. It requires a high level of clinical suspicion to be diagnosed. We report a 38-year-old female who presented with respiratory arrest that was later found to be caused by hypokalemia secondary to renal tubular acidosis. Further work up proved a diagnosis of Sjogren’s syndrome. The patient improved with correction of electrolytes and hydroxychloroquine. This case highlights the importance of consideration of Sjogren’s syndrome as a probable cause of RTA as renal complications of Sjogren’s syndrome have a good prognosis if identified and treated promptly
Hypothyroidism in pregnancy current guidelines, prevalence, and implications for maternal and fetal health
Get PDFHypothyroidism during pregnancy is a common endocrine disorder that can drastically impact the mother and fetus in the process of development. The two types of hypothyroidism in pregnancy are distinguished as overt and subclinical, with the latter being more prevalent. Subclinical hypothyroidism (SCH) is commonly caused by autoimmune thyroid disorders and iodine deficiency. In iodine-sufficient areas, hypothyroidism is caused by Hashimoto’s thyroiditis, whereas, in iodine-deficient areas, hypothyroidism is primarily caused by iodine deficiency. Diagnosing hypothyroidism during pregnancy is often challenging because its symptoms often mimic those of normal pregnancy. During pregnancy, thyroid function undergoes significant alterations. The disruption of the normal functioning of the hypothalamic-pituitary-thyroid axis causes fluctuations in both thyroid stimulating hormone (TSH) and thyroxine (T4) levels. Elevated human chorionic gonadotropin (hCG) and estrogen levels trigger the thyroid gland to increase hormone production. If hypothyroidism is not managed properly throughout pregnancy, it could lead to preeclampsia and premature delivery and neurodevelopmental concerns in the baby. It is recommended to consider hypothyroidism screening for women with autoimmune conditions or an existing history of thyroid disease due to their increased risk. The main treatment for pregnant women with hypothyroidism is levothyroxine, whose dosage is regulated to meet the increased demand for thyroid hormones. Continuous monitoring of free T4 levels and TSH is crucial in maintaining hormonal balance. The present review explores the prevalence of hypothyroidism during pregnancy, physiological changes, maternal and fetal complications, and the evidence-based guidelines for the management. Following current recommendations and proper treatment minimizes the risks for the mother and the baby
Digital eye strain among university students: a cross-sectional study from Hyderabad, India
Get PDFBackground: Digital eye strain (DES) or computer vision syndrome (CVS) represents a growing public health concern as digital device usage increases globally, particularly among university students. This study aimed to assess the prevalence and characteristics of digital eye strain among university students in Hyderabad, India.
Methods: A descriptive cross-sectional study was conducted among 112 university students in Hyderabad, India, from November to December 2024. Data was collected using a self-administered questionnaire. Non-probability convenience sampling was employed, and statistical analysis included calculation of percentages and means using statistical package for the social sciences (SPSS).
Results: All participants (100%) owned smartphones, while 60.7% owned laptops. The mean age was 22.3±2.5 years, with 65.2% female participants. The most common symptoms reported were headache (75.0%), burning or itching sensation in eyes (50.0%), and watering from eyes (49.1%). Significant increases in screen time were observed over the preceding three years.
Conclusions: Digital eye strain symptoms are highly prevalent among university students, with headaches being the predominant complaint. Preventive measures and awareness programs are essential to mitigate the effects of prolonged digital device usage on ocular health