International Journal of Research in Medical Sciences
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Study and compare the echocardiographic changes in anaemic and non-anaemic pregnant women
Full text linkBackground: AIM: To determine the effect of moderate to severe anaemia on the cardiovascular system of pregnant women. To compare the systolic function and diastolic function among pregnant women with moderate-severe anaemia with that of uncomplicated non-anaemic pregnant women.
Methods: 30-pregnant normotensive women with moderate-severe anaemia were recruited as cases(Group A) and the controls(Group B) were 30 normotensive non-anaemic pregnant women all in 3rd trimester (26-40weeks gestation). After written informed consent, every participant underwent a 2D-transthoracic echocardiography. The parameters measured were 1) LVEDD, 2) LVESD), 3) SWTd, 4) PWTd, 5) EF 6) E/e’ and E/A ratio.
Results: Mean Hb of group A participants was 7.47±1.06 g% and that of group B was 11.31±1.21 g%. Mean LVEDD of group A (4.393±0.154 cm) was higher than the group B (3.977±0.177 cm), with p value (0.0010) being statistically significant. The mean of SWTd among the group A was 1.28±0.265 cm and in group B was 1.139±0.538 cm, but their difference was not statistically significant (p value 0.2030). PWTd was significantly increased in group A (1.32±0.589 cm) than the controls (1.07±0.244 cm) with p value:0.0359. EF and Fractional shortening did not have significant difference among the two groups. The mean value of E/e’ among group A & B were, 7.42±2.1 & 7.9±2.4 respectively and the difference is not statistically significant (p value 0.4131). The E/A ratio, being an indicator of diastolic function, was higher in the cases (1.622±0.518 & 1.369±0.323 in group A & B respectively) and the difference was statistically significant (p value: 0.0269).
Conclusions: LVEDD, LVESD and PWTd are all significantly increased amongst pregnant women with moderate-severe anaemia compared to pregnant women with Hb≥10g/dl. E/A ratio suggestive of diastolic dysfunction is also increased in pregnant women with anaemia but systolic functions are not affected as indicated by EF and fractional shortening
The evaluation of sub clinical hypothyroidism in children and adolescents
Full text linkBackground: Sub clinical hypothyroidism is defined as thyroid stimulating hormone (TSH) >4.2 mIU/ml with a normal level of free T3 and free T4. The prevalence of sub clinical hypothyroidism in adults’ ranges from 1-10%, being higher in the elderly and in females. In children and adolescents, the prevalence is estimated to be less than 2%. Usually children and adolescents with sub clinical hypothyroidism have minimal signs and symptoms and the diagnosis is mostly made incidentally. Objective of the study was evaluation of clinical and etiological characteristics of children and adolescents with sub clinical hypothyroidism and to look at long term consequences in terms of progression to overt hypothyroidism.
Methods: Children in the age group of 5-18 years who were referred to the Department of Thyroid and Endocrine Research of Institute of Nuclear Medicine and Allied Sciences (INMAS), from April 2022 to October 2024 with the diagnosis of sub clinical hypothyroidism were recruited for the study. They were followed up for a period of two years.
Results: 52 cases of sub clinical hypothyroidism included 33 girls and 19 boys in the age group of 5-18 years. At the end of two year follow up period, in 67.3% of our patients, TSH reverted to normal range spontaneously without any treatment and only 17 patients (32.7%) progressed to overt hypothyroidism and were initiated levothyroxine replacement therapy.
Conclusions: Sub clinical hypothyroidism in children is a benign and self-limiting condition with low rate of progression to overt hypothyroidism
Clearing the circles: an unusual way
Full text linkA 66-year-old lady with no significant past medical history presented with gradual onset of annular erythematous raised border with central clearing and atrophy plaque on her left arm. Subsequently, she noticed further plaques on her left forehead, and extensor surfaces of her arms. A diagnostic skin punch biopsy was organised from the affected site on right arm. The histology showed multi-nucleated giant cells with surrounding fragmented elastic fibres and elastophagocytosis with no dermal mucinosis and no interface inflammation. A working diagnosis of annular elastolytic giant cell granuloma (AEGCG) was formulated. Initially this was treated with a potent topical steroid, followed with tacrolimus ointment but the dermatoses did not settle. She was then started on hydroxychloroquine 200 mg twice daily. A repeat follow-up in three months showed the plaques has started to flatten out and the treatment was continued for a further three months. The patient was happy with the improvement of the rash. AEGCG is an uncommon granulomatous skin reaction typically involving sun exposed areas of the body. Clinically, this presents as annular erythematous plaques with central clearing or atrophy. The gold standard for diagnosis is based on histopathology showing granulomatous inflammation, multinucleated giant cells with more than one area of elastophagocytosis and absence of necrobiosis. There is no standard treatment, but treatment can range from topical therapy with corticosteroids, to phototherapy including narrow band ultraviolet B to systemic medications including oral antimalarial such as hydroxychloroquine. This case illustrates that hydroxychloroquine can be used as a treatment option
Outcome of partial nail avulsion followed by partial matricectomy with 88% phenol in management of ingrown toe nail
Full text linkBackground: Ingrown toenail (onychocryptosis) is a common and painful condition where the toenail grows into the surrounding skin, often causing inflammation, pain, infection and frequent recurrence. The condition most frequently affects the great toe and is common in adolescents and young adults. The aim of this study was to evaluate the outcomes of partial nail avulsion followed by partial matricectomy with phenol (88%) in the management of ingrown toenails of stage 2 and 3.
Methods: This was an observational study and was conducted in the department of dermatology in Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh during the period from April 2023 to May 2024. In total 30 patients both male and female are included in the study. After surgery patients were followed up at 7th and 14th day for wound inspection and 4th and 6th week for post operative complication and then at 3 months interval for recurrence and late complication. Statistical analysis was done by using SPSS (statistical package for social science) version 23 for windows 10.
Results: In our study we found the mean age was 10±6.24 years. The participants, 36.67% had undergone previous surgery. Our results show, the (VAS) with a mean score of 1.8±1.7 on postoperative day 1, 1.2±1.4 on day 2, and 0.2±0.1 by the second postoperative week and the mean healing time was 12.3±3.1 days. We also found, 29 patients were completely recovered and the recurrence of ingrown toenails occurred in 3.3% of cases.
Conclusions: Partial nail avulsion with phenol matricectomy is an effective treatment for ingrown toenails, offering long-term relief with low recurrence rates
Advances in minimally invasive surgical techniques for the management of enterocutaneous fistula: a systematic review of clinical and postoperative outcomes
Full text linkWe aim to explore advancements in minimally invasive surgical techniques (MIS) through a systematic review for managing enterocutaneous fistulas (ECFs) from 2019 to 2023 focusing on clinical and postoperative outcomes to identify gaps and future directions in treatment strategies. We followed the PRISMA guidelines and systematic reviewed the literature from three databases namely PubMed, Scopus, and the Cochrane library in the steps described here. Papers were screened according to previously set following focus and clinical and postoperative MIS methods applied in ECF treatment. Surgical techniques evaluated included: laparoscopic, robotic assisted and a combination of the two termed hybrid approach. Both data extraction and synthesis were done based on Covidence software to maintain transparency and rigor. Of 112 papers initially identified, 30 papers were included in the analysis. Relevant research established that the adoption of the minimally invasive techniques like robotic and laparoscopic surgeries increases enhanced clinical results which outcome includes less morbidity, the number of days of hospital stay, and complications. Most of the announced procedures, such as vacuum-assisted closure (VAC) and extracellular matrix plug placement, demonstrated feasibility in selected cases. Interventions’ variability and the lack of high-quality evidence for some approaches suggest that replication should remain standardized. We conclude that advances in MIS have demonstrated improved outcomes for ECF management and are offering less invasive options with better recovery profiles
Health-related quality of life in TB patients: a narrative review
Full text linkTuberculosis (TB) continues to pose a substantial global health challenge, profoundly impacting patients' health-related quality of life (HRQoL). This narrative review provides a comprehensive analysis of published research comparing HRQoL in individuals diagnosed with pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (EPTB). It delves into the nuanced differences in HRQoL experienced by these two patient groups, exploring physical, psychological, and social dimensions. Beyond comparing HRQoL outcomes, the review identifies key factors that influence these differences, such as disease severity, treatment duration, presence of comorbidities, and socioeconomic status. Furthermore, it examines the implications of these findings for clinical practice, including personalized treatment approaches, targeted support services, and strategies to address specific HRQoL challenges. Finally, the review highlights critical gaps in the current research and proposes potential directions for future studies, emphasizing the need for longitudinal research, standardized HRQoL assessment tools, and interventions aimed at improving the well-being of all TB patients, irrespective of disease presentation. By synthesizing existing evidence, this review aims to deepen our understanding of the distinct challenges faced by individuals with different forms of TB and inform the development of tailored interventions to optimize their overall well-being.
Association of C-reactive protein to albumin ratio with angiographic severity of coronary artery disease in non-ST elevation myocardial infarction patients
Full text linkBackground: The C-reactive protein to albumin ratio (CAR) is a potential biomarker for inflammation and nutrition in cardiovascular diseases. Elevated CRP indicates inflammation, while albumin reflects nutritional status, offering insights into the pathophysiology and severity of coronary artery disease (CAD). This study aimed to investigate the relationship between the CRP to Albumin ratio (CAR) and the angiographic severity of CAD in non-ST elevation myocardial infarction (NSTEMI) patients.
Methods: This study was conducted at the National Institute of Cardiovascular Diseases (NICVD) Dhaka, Bangladesh from May 2018 to April 2019, involving 200 patients with NSTEMI undergoing coronary angiography (CAG). The patients were divided equally into two groups based on the CAR: Group I had a CAR of >11, and Group II had a CAR of ≤11. Data were analyzed by the SPSS version 26.0 program.
Results: The mean SYNTAX score (SS) was higher in Group I than in Group II (p<0.001). CAR>11 independently predicted intermediate-high SS (p<0.001). CAR and SS correlated significantly (p<0.001). The ROC curve showed an AUC of 0.878 for CAR (Sensitivity: 77.3%, Specificity: 70.0%).
Conclusions: CAR is significantly associated with the severity of CAD, as measured by the SYNTAX score, in patients with NSTEMI. CAR can be used as a reliable marker in the prediction of CAD severity in patients with NSTEMI
Beyond anti-GQ1b: unravelling atypical Miller Fisher syndrome
Full text linkAnti-GQ1b negative Miller Fisher syndrome (MFS) is an uncommon variant of the classic MFS, a condition that is typically characterized by a triad of ataxia, ophthalmoplegia and areflexia, often accompanied by the presence of anti-GQ1b antibodies. In patients with anti-GQ1b negative MFS, these characteristic clinical features are observed despite the absence of the hallmark antibodies, posing a diagnostic challenge. The pathophysiology underlying this variant remains poorly understood, though alternative immune mechanisms, such as the involvement of other ganglioside antibodies or T-cell mediated autoimmunity, are suspected. The absence of anti-GQ1b antibodies necessitates reliance on clinical presentation, neurophysiological evaluations, and the exclusion of other potential causes for diagnosis. Treatment strategies remain similar to those for the antibody-positive form, typically involving immunotherapies such as intravenous immunoglobulin (IVIG) or plasmapheresis. Recognizing anti-GQ1b negative MFS is essential for timely and effective management, as early intervention can improve patient outcomes despite the absence of the usual antibody marker. Further research is needed to elucidate the underlying immune mechanisms and refine diagnostic and therapeutic approaches for this rare variant of MFS.Here we are presenting case report of a 53 year old female presented with diplopia, unilateral ptosis, tingling sensation in all limbs and ataxia. The patient exhibited the classic triad of ataxia, areflexia and opthalmoplegia characteristic of MFS but negative anti-GQ1b antibody titre and the patient was successfully treated with IVIG
A rare beta chain variant hemoglobin Deer Lodge; a chance discovery in an Indian family while testing HbA1c by high-performance liquid chromatography
Full text linkThis case report documents the first reported instance of hemoglobin (Hb) Deer Lodge in an Indian family, discovered during routine HbA1c testing using high-performance liquid chromatography (HPLC). A 34-year-old clinically asymptomatic male (proband) showed an unexpected peak on HPLC, indicative of a Hb variant. Subsequent family screening revealed the same variant in the proband's mother. Multiple analytical platforms (HPLC and capillary electrophoresis) identified a Hb variant with migration patterns inconsistent with common variants. Genetic sequencing confirmed the HBB:c.8A>G mutation in the β-globin gene, corresponding to Hb Deer Lodge, a rare variant previously reported in non-Indian populations. Additional single nucleotide variants (SNVs), including HBB:c.9T>C, were identified in the family, with some showing high prevalence in the eastern Indian population. Functional analysis suggests that Hb Deer Lodge slightly alters oxygen affinity but remains clinically silent. This report emphasizes the importance of comprehensive analysis for Hb variants detected during routine screening, especially in regions with high genetic diversity. Furthermore, it highlights the potential for rare variants to complicate HbA1c measurements, necessitating confirmatory testing and cautious interpretation in clinical practice
Obesity in adults: a review
Full text linkObesity is a chronic complex disease that is caused by excessive fat deposits in the human body, and it is considered as one of the major causes of health impairment. It increases the risk of type 2 diabetes and heart diseases in addition to affecting bones and reproduction system that can increase the risk of certain types of cancer. Furthermore, it has a major impact on the quality of living, such as sleeping disorder or physical movement. Its early diagnostic procedure involves a regular monitoring of the human’s body mass index (BMI): weight (kg)/height2 (m2). The body mass index is an initial surrogate marker to confirm fatness and waist circumference that helps to diagnose obesity. It is an emerging and growing public health issue in the Western world as well as in the Middle East countries. More specifically, obesity in Qatar is the focus in this article which is among the top-ranked obese countries with a high obesity rate among its population and only a limited number of studies focused on the systematic identification of potential risk factors using multimodal datasets. This article aims to focus on the main causes of obesity, its diagnosis, management approach and pharmacological and non-pharmacological treatments