Indian Journal Of Clinical Practice
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Myocarditis with Unidigital Gangrene in Scrub Typhus Patient – Rare Case
Get PDFScrub typhus is a mite-borne infectious disease caused by Orientia tsutsugamushi, an obligate intracellularbacterium. The disease is of greatest public health importance in rural areas of Asia and the Western Pacific Islands. Theclinical manifestations range from subclinical disease to organ failure. The chief target of organism is the vascular endotheliumof various organs. There is inflammation in and around the blood vessels that causes endothelial damage resulting invascular leakage and organ dysfunction. Case report: A 70-year-old female patient, farmer by occupation, presented tous with features of acute febrile illness and shortness of breath and was diagnosed as scrub typhus with myocarditis. Shesubsequently developed gangrene of right little finger. The patient was investigated for infectious and noninfectious causesof vasculitis leading to gangrene. We established that the cause for gangrene was scrub typhus as evidenced by presence ofeschar and positive serology. Conclusion: We report for the first time a case of scrub typhus complicated by both myocarditisand gangrene. Both myocarditis and unidigital gangrene are unusual complications of scrub typhus. Hence, scrub typhusshould be ruled out in patients who present with these complications
Dyslipidemia – A Risk Factor for Osteoporosis in Women: A Cross-Sectional Study
Get PDFBackground: Osteoporosis has been extensively studied in postmenopausal women but there is a paucity of studies fordetection of osteoporosis in premenopausal women. Recent studies point out that dyslipidemia could be a risk factorfor osteoporosis in postmenopausal women. It is unclear whether dyslipidemia in premenopausal women is a riskfactor for osteoporosis after menopause. This study is an attempt to find whether dyslipidemia in premenopausal andpostmenopausal women is associated with decreased bone mineral density (BMD). Methods: The study was conductedfrom November 2013 to March 2014 at Lady Hardinge Medical College, New Delhi. Sixty patients (30 premenopausaland 30 postmenopausal) who were not having any comorbidity and not on any drug affecting lipid or bone metabolismwere evaluated for lipid profile and BMD. Result: In premenopausal women, there was a negative correlation between verylow-density lipoprotein cholesterol (VLDL-C), triglycerides (TGs), and BMD (lumbar vertebra) while a positive correlationwas observed between high-density lipoprotein cholesterol (HDL-C) and BMD, which was statistically significant (VLDLBMD r −0.363, p = 0.049; TRI-BMD r −0.363, p = 0.049; HDL-BMD r 0.359, p = 0.05). Similarly, in postmenopausal women,the negative correlation between VLDL, TG, and BMD was statistically significant (TG-BMD r −0.377, p = 0.04; LDL-BMDr 0.415, p = 0.02), as was the positive correlation between HDL and T-score (HDL-BMD r 0.366, p = 0.04). Conclusion: Thereis statistically significant correlation between BMD and serum lipid levels in both premenopausal and postmenopausalwomen. Lipid profile variables show a significant association with BMD and can be used as risk factors for osteoporosis
31st Annual Scientific Meeting of Indian National Association for Study of the Liver (INASL 2023)
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A Patient-centered Approach to Management of Migraine in Primary Care
Get PDFPrimary care physicians are in a prime position to enhance the diagnosis and treatment of migraine for a large number of patients since they see a large number of migraine patients for the first time in these settings. Case report: This is a case report of a young woman with a known history of migraine headaches with aura who presented to the Emergency Unit of a primary care facility with complaints of severe headaches, which were not improving after long-term use of herbal preparations. The onset of her symptoms was associated with generalized weakness, loss of appetite, nausea and seizure of the right side of the upper body lasting for 10 seconds, which was self-limiting. There was no associated vomiting or dizziness. The initial workup included a computed tomographic (CT) scan of the head and an electroencephalogram (EEG), which were unremarkable. The patient’s perspectives were explored and patient-centered approaches were employed to manage the patient with analgesics and oral amitriptyline and propranolol combination as a migraine prophylaxis. Conclusion: A patient-centered approach to care can be a crucial strategy for efficient migraine treatment once a patient has been diagnosed with the conditio
Hypothyroidism in Metabolic Syndrome
Get PDFMetabolic syndrome (Syndrome X/Insulin resistance syndrome) consistsof central obesity, hypertriglyceridemia, low high-density lipoprotein (HDL) cholesterol,hyperglycemia and hypertension as its major features. All of them can be influenced by thefunctioning of a 20 g endocrine organ, the thyroid gland. Aims and objectives: To studythe proposed association between metabolic syndrome and thyroid dysfunction. Materialand methods: Hundred subjects aged more than 18 years, willing to participate in the studyand fulfilling criteria of the National Cholesterol Education Program-Adult Treatment PanelIII (NCEP-ATP III) for diagnosis of metabolic syndrome were included. Detailed clinicalexamination and laboratory investigations of all subjects were done. Risk factors wereidentified and analyzed by comparing the subjects with and without thyroid dysfunction.Results: Eighty-one out of 100 subjects with metabolic syndrome belonged to the age groupbetween 41 and 70 years. Females comprised 60% of the total patient population with sedentarylifestyle as the major risk factor, whereas males comprising rest of the 40% had addictivebehaviors as major risk factors. Observation of individual parameters under NCEP-ATP IIIshowed that 57 patients fulfilled all 5 criteria, 34 patients fulfilled 4 and 9 patients fulfilled3 criteria. Obesity and dyslipidemia were common among female subjects, whereas impairedglucose tolerance and hypertension were common among males. Thyroid dysfunction inthe form of hypothyroidism was present in 30 subjects with females (23 patients) being thestatistically significant population (p < 0.0001). Hypothyroidism was of subclinical type in21 of these 30 subjects. None had hyperthyroidism. Left ventricular ejection fraction (mean± SD) was lowered to 42.67 ± 6.53 from 49.07 ± 7.48 in presence of thyroid dysfunction inthese subjects with metabolic syndrome (p < 0.0001). Conclusion: Metabolic syndrome andhypothyroidism (even subclinical) are both individual as well as combined risk factors fordevelopment of atherogenic dyslipidemia, diabetes mellitus and cardiovascular disease withelderly females comprising the high risk group
Role of Sodium Alginate in Gastroesophageal Reflux Disease: An Overview
Get PDFSodium alginate helps manage and treat heartburn and gastroesophageal reflux disease (GERD). This article discusses thestructure, mechanism of action and clinical application. A brief review of the literature is carried out
Efficacy and Safety of Combination of Noscapine and Chlorpheniramine in Management of Cold and Cough
Get PDFCough is one of the most common symptoms for which patients visit the doctor. Because of its broad differential diagnosis,cough is a challenging condition to manage. Antitussives or cough suppressants are indicated if cough interferes with dailyactivities. Cough suppressants not only provide symptomatic relief by decreasing cough, they also prevent the spread ofinfection. Noscapine is a non-narcotic cough suppressant, which relieves cough by acting at the level of the cough centerin the brain. It does not cause significant sedative, euphoric, or hypnotic effects, and other side effects such as respiratorysuppression and constipation that are typically associated with opioids. Hence, unlike other opioid antitussives such ascodeine, noscapine is nonaddictive
