Indian Journal Of Clinical Practice
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A Case of Idiopathic Autoimmune Hemolytic Anemia: Every Anemia – First Type It and Then Treat It
Get PDFAutoimmune hemolytic anemia (AIHA) is a medical disorder where the immune system erroneously targets and destroysred blood cells (RBCs), causing a reduction in their longevity. This results in an inadequate supply of RBCs to carry oxygen,leading to symptoms like fatigue, weakness and jaundice. AIHA is categorized into warm and cold types based on theoptimal temperature for antibody activity. A comprehensive grasp of the immunological mechanisms involved is essentialfor accurate diagnosis and effective management of this autoimmune condition. AIHA is a frequently missed diagnosis aspatient are not fully investigated, and treated with vitamin B12, folic acid and iron in outpatient department
A Review of Diabetic Foot Osteomyelitis: Focus on Diagnosis, Clinical Presentation, Management and Outcomes
Get PDFDiabetic foot osteomyelitis (DFO) affects around 38.5 lakh patients in India. It is diagnosed using clinical and radiologicalapproaches. Polymicrobial etiology, peripheral artery disease (PAD) and peripheral neuropathy are commonly observed. Ahigh degree of clinical vigil is required to avoid underestimation of the extent of damage due to speed and spread of infectionand prevent chances of lower extremity amputation. ‘Time is Tissue’ (time taken to access multidisciplinary care) aptlyrepresents one of the critical factors affecting outcomes, along with anatomical location and presence of gangrenous tissues.Traditionally, DFO treatment is the most complex and controversial aspect of managing diabetic foot infections (DFIs). Thetherapeutic paradigm has evolved from high-level surgical resection of all necrotic and infected bone to the more refined andindividualized surgical interventions along with appropriate antibiotics and topical antimicrobials. It is necessary to have asurgeon available with diabetic foot expertise. The surgical outcome is facilitated with strict off-loading, wound management,agitation (freshening and scrapping of wound edges), biofilm disruption and negative pressure wound therapy (NPWT) toaccelerate healing. Formal protocol-driven treatment can be provided by a multidisciplinary team involving surgical, medicaland podiatric specialties to reduce hospital stay and the need for repeat debridement.This review aims to present a completeoverview of the diagnosis, clinical presentation, management and outcomes of DFO according to scientific recommendationsand our experience, along with few illustrative case reports
Subarachnoid Hemorrhage as a Rare Presentation of Gestational Trophoblastic Neoplasia
Get PDFGestational trophoblastic neoplasia (GTN) is a rare group of malignancy that has varied clinical presentations. Hence, diagnosis is difficult, but if diagnosed on time, it has an excellent prognosis. Case summary: Here we present the case of a 24-year-old female who presented with recurrent intracranial hemorrhages. She was earlier misdiagnosed as tubercular cerebral vasculitic hemorrhage, but in her subsequent presentation after a thorough history, examination and investigation, she was diagnosed as GTN-choriocarcinoma. Conclusion: Subarachnoid hemorrhage is a rare complication of choriocarcinoma and any female in the reproductive age group with a prior history of abortion and who presents with bleeding manifestations of any organ system, should be suspected for choriocarcinom
Medication Reconciliation
Get PDFThe Institute of Medicine (IOM) stated that preventable medication errors are the mostcommon type of errors in healthcare. It is of fundamental significance when building a safercare continuum, as it highlights the reason for continuous and more vigilant medicationreconciliation and required effort at all interfaces of care, including community. Without arobust medication reconciliation process, the potential for catastrophic outcomes remains aconstant concern. Prevention of medication errors is essential through strategies that are basedin evidence of medication reconciliation strategies on medication errors in communit
Study of Thyroid Function Tests in Patients with Metabolic Syndrome
Get PDFThe metabolic syndrome is a constellation of clinical and metabolic abnormalitiesincluding abdominal obesity, hypertension, dyslipidemia and impaired fasting glucose orimpaired glucose tolerance. Metabolic syndrome and thyroid dysfunction are independentrisk factors for cardiovascular disease. Aims and objectives: To study the prevalence,symptomatology of thyroid dysfunction and fine needle aspiration cytology (FNAC) findingsof thyroid in the patients having metabolic syndrome. Material and methods: The study wascarried out in 60 cases of metabolic syndrome (according to NCEP ATP III criteria) selectedfrom the medicine outdoor clinic (including diabetic clinics, thyroid clinics) and medicineindoor wards in Post Graduate Department of Medicine, SN Medical College and Hospital,Agra. Diagnosis of thyroid dysfunction was made by history, examination and serum FT4and TSH. Result and observations: Out of 60 patients of metabolic syndrome, 30 patients(50%) were euthyroid, 13 patients (21.66%) had subclinical hypothyroid and 12 patients (20%)had overt hypothyroid. Five patients (8.33%) of metabolic syndrome had hyperthyroidism.Truncal obesity was most prevalent (80.0%) component of metabolic syndrome, followedby hypertriglyceridemia (70%). Diabetes mellitus was equally prevalent in both males aswell as females and was present in about 40.0% patients and 53% of patients with metabolicsyndrome were hypertensive. Conclusion: This study shows that 50% metabolic syndromepatients had thyroid dysfunction. About 21.66% had subclinical hypothyroidism, 20% hadovert hypothyroidism and 8.33% were having hyperthyroidism. The most common symptomin metabolic syndrome patients with hypothyroidism was lethargy/sleepiness followed bydry and coarse skin. The most common symptom in hyperthyroid patients was nervousness(100%) followed by sweating, heat intolerance and palpitation in 80% of the patients
An Interesting Case of Pulmonary Tuberculosis with Hypoxemic Respiratory Failure Mimicking Interstitial Lung Disease
Get PDFHypoxemic respiratory failure is a rare presentation of active pulmonary tuberculosis (TB). Though tuberculous acuterespiratory distress syndrome (ARDS) is well documented in medical literature, non-ARDS respiratory failure is seldomreported in active pulmonary TB. We herein report a case, which posed a diagnostic dilemma as it clinically mimickedinterstitial lung disease. Imaging showed unilateral localized smooth interlobular septal thickening along with consolidationwithout significant mediastinal lymphadenopathy. To the best of our knowledge, this rare radiological finding has not beenreported in medical literature as being associated with hypoxemic respiratory failure in pulmonary TB patients
