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Frequency and Clinical Presentation of Asthma-COPD Overlap in COPD Patients
Full text linkBackground: Asthma-COPD Overlap (ACO) represents a unique clinical phenotype that poses significant diagnostic and therapeutic challenges. Despite its clinical importance, limited data exists regarding its prevalence and characteristics in single-center settings.
Objective: To investigate the frequency of ACO among COPD patients and characterize its clinical presentation in a single-center study.
Methods: This cross-sectional study enrolled 60 consecutive COPD patients. ACO was diagnosed based on GINA/GOLD consensus criteria. Comprehensive clinical assessment included spirometry with bronchodilator reversibility testing, blood eosinophil counts, and detailed symptom evaluation. Clinical characteristics, laboratory parameters, and healthcare utilization patterns were compared between ACO and non-ACO COPD patients. Results: ACO was identified in 18 patients (30% of the cohort). ACO patients were significantly younger (62.4 ± 8.3 vs. 68.7 ± 7.2 years, p=0.002) and demonstrated higher blood eosinophil counts (385 ± 158 vs. 182 ± 124 cells/μL, p<0.001) compared to non-ACO COPD patients. They exhibited greater bronchodilator reversibility (18.4 ± 5.2% vs. 8.7 ± 3.8%, p<0.001) and experienced more frequent exacerbations (2.8 ± 1.4 vs. 1.6 ± 1.2 per year, p=0.002). ACO patients also showed higher rates of emergency department utilization (1.9 ± 1.1 vs. 1.2 ± 0.9 visits per year, p=0.014). Conclusion: ACO affects a substantial proportion of COPD patients and is characterized by distinct clinical features, including enhanced bronchodilator reversibility and increased exacerbation frequency. These findings emphasize the importance of systematic screening for ACO features among COPD patients to facilitate appropriate management strategies
Rate and Pattern of Drug Reaction among Tuberculosis Patient During Antitubercular Drug Therapy
Full text linkBackground: Tuberculosis (TB) treatment often involves multi-drug regimens that can lead to adverse drug reactions (ADRs). These ADRs may affect treatment adherence and outcomes. In the treatment of tuberculosis (TB), the use of multi-drug regimens has been linked to unfavorable adverse drug reactions (ADRs). This study aims to evaluate the rate of ADRs and their effects on TB treatment at National Institute of Diseases of the Chest and Hospital with a focus on patients with risk factors.
Objective: To assess the rate and pattern of adverse drug reactions (ADRs) caused by anti-TB medications in the infectious disease department throughout 12 months. To identify known adverse drug reactions (ADRs) that are severe and avoidable.
Methods: A retrospective study was conducted to evaluate the rate and pattern of drug reactions in tuberculosis patients receiving antitubercular therapy. This cross-sectional study was conducted via retrospective review of outpatients’ medical records. Details regarding ADRs were identified by a pharmacist and verified by a consultant respiratory physician. Data were analyzed by SPSS software (version 25.0, IBM statistical product).
Results: Of the 50 patients, 88% were male with a mean age of 47.8 ± 14.18 years. Twenty percent of patients experienced ADRs, with gastrointestinal issues and skin rashes being the most common. Seventy percent of ADRs occurred within 3 weeks of starting the intensive phase of treatment. Diabetes mellitus was the most prevalent comorbidity (60% of patients). While not statistically significant, trends suggested higher ADR rates in smokers and long-term diabetics. All ADRs were managed symptomatically without discontinuing antitubercular therapy.
Conclusion: The ADR rate in this study population was comparable to that reported in patients without comorbidities. Gastrointestinal ADRs were most common, and most ADRs occurred early in treatment. While comorbidities didn\u27t significantly increase ADR risk, the high prevalence of diabetes underscores the need for integrated TB-diabetes care. Close monitoring for ADRs, especially during the initial weeks of treatment and in patients with risk factors, is crucial for successful TB management
Exploring The Unforeseen: Extrapulmonary tuberculosis (EPTB) With Rifampicin Resistance (Rr) In Cornelia De Lange Syndrome (Cdls) – A Rare Revelation
Full text linkTuberculosis (TB) remains a major global health concern, with extrapulmonary tuberculosis (EPTB) contributing significantly to its burden. This abstract discusses the clinical manifestations, diagnosis, and management of EPTB, focusing on tuberculous lymphadenitis (TBL), the most prevalent form of EPTB. Diagnostic challenges and the importance of molecular diagnostic tools like Xpert MTB/Rif Ultra are highlighted, emphasizing the need for prompt and accurate diagnosis to initiate appropriate treatment. Additionally, the abstract explores the coexistence of Cornelia de Lange syndrome (CdLS), a multisystem disorder, in a patient with EPTB with Rifampicin Resistance (RR), underscoring the complexity of managing multiple medical conditions. The significance of a multidisciplinary approach involving pediatricians, geneticists, and infectious disease specialists is emphasized in providing comprehensive care tailored to the patient\u27s unique needs. Long-term follow-up and supportive care are crucial for optimizing outcomes in complex medical conditions like TBL and CdLS, highlighting the importance of ongoing monitoring and intervention
Case report: Breast Cancer in a 57-year-old Obese Male
Full text linkMale breast cancer accounts for approximately 0.9% of all breast cancer cases, and its true etiology remains largely unknown. The recognized risk factors include age, Klinefelter syndrome, BRCA2 mutation, diabetes, and elevated estrogen levels. Some studies have also identified obesity as a risk factor. Here, we present a case of a 57-year-old obese male diagnosed with breast cancer. His medical and family history were unremarkable, with no apparent genetic risk factors contributing to his condition
Selective Neck Dissection in N0 Papillary Thyroid Carcinoma
Full text linkBackground: Papillary thyroid carcinoma is the most common form of well differentiated thyroid cancer and constitutes 1% of all solid tissue cancers with a female predominance. Surgical intervention helps in removal of lesion. Lymph node metastasis in cervical compartments is the main reason of recurrence of disease. Personalized risk stratified prophylactic neck dissection at initial thyroidectomy in Papillary thyroid carcinoma with no clinical, sonographic or per-operative evidence of lymph node metastasis has been advocated, though not unanimously. Compartment oriented lymph node dissection in patients with PTC reduces recurrence and improves survival. Objectives: The aim of this study is to determine the Role of selective neck dissection in case of N0 papillary thyroid carcinoma. Methods: A cross-sectional prospective study was conducted in the Dept of Otolaryngology and Head neck surgery, BSMMU, Dhaka for one and a half years from September/2021 to February/2023, with 35 patients underwent total thyroidectomy with selective neck dissection (level VI, III, IV, II) for N0 Papillary thyroid carcinoma. All patients were evaluated by complete clinical head & neck examination, thyroid hormone profile, ultrasonography finding, fine needle aspiration cytology, radiology and histopathology report were recorded. Data were analyzed statistically by using by Statistical Package for Social Scientist (SPSS-24). Results: The age was ranged from 22 to 70 years with mean age was 47.77±14.8 years. Male to female ratio was 1:2.2. 17.4% patients had multiple number of nodules and 82.86% patients had solitary nodule. 11.43 % patients had involvement of both lobes, 31.43 % had involvement of left lobe, 57.14% had involvement of right lobe. More than three-fourth (88.57%) patients, tumor size >4 cm and in case of 11.43% patients, tumor size is within 0- 4 cm. 8.6% patients had mixed echo consistency and 91.4% had solid echo consistency. Conclusion: Most of the patients were in 6th and above decade and female predominant. Solitary nodule, right lobe involvement, size more than 4cm and solid echo consistency were more frequent. Regarding selective neck dissection; 17.1% had metastasis at level VI and no metastasis at level II, III, IV. In brief, 17.1% patients had metastasis on histopathology after neck dissection and 82.9% patients had no metastasis on histopathology after neck dissection. It can be said that, Central compartment neck dissection has role in detecting metastasis at N0 stage of Papillary thyroid carcinoma but Lateral neck dissection has no role in detecting metastasis at N0 stage of Papillary thyroid carcinoma
A study of the complications in infants of diabetic mothers in a rural hospital in Western Maharashtra
Full text linkBackground: Diabetes Mellitus is a group of metabolic diseases characterized by chronic hyperglycaemia associated with disturbances of carbohydrate, fat and protein metabolism due to absolute or relative deficiency in insulin secretion and or action. Historically, infants of diabetic mothers (IDMs) have been at significantly greater risk for spontaneous abortion, still birth, congenital malformations and perinatal morbidity and mortality. IDMs have quadruple the incidence of admission to a new-born intensive care unit.
Aims and objectives: To know complications in infants of diabetic mothers.
Methods: This is a descriptive cross-sectional study that was conducted at the department of paediatrics, Dr. Vitthalrao Vikhe Patil Pravara Rural hospital Loni, Maharastra, India, performed on infants born to diabetic mothers from Feb 2022 to Dec 2023.
Results: 34 infants were included in the study. 2 infants were born of twin pregnancy. So total 33 mothers formed mothers of the sample size. Low birth weight (<2.5 Kg) was observed in 20.6 % of babies and macrosomia (>4 Kgs) was seen in 6% of the babies. 44.1 % weighed between 3-4 Kgs at birth. Hypoglycaemia was the commonest complication seen in 28 (84.8%) IDMs followed by respiratory distress in 11 (33.3%) and congenital anomalies in 11 (32.4%) IDMs. Hypocalcaemia was the least common complication seen in 1 (3%) IDM. None of the IDMs sustained any birth injuries. One baby with a major congenital malformation (sirenomelia) dies within 20 minutes of birth. Hypoglycaemia was more commonly observed in IDMs with birth weight <2.5 Kgs (83.3%) and >3 Kgs (100%) whereas this complication was least common in IDMs weighing 2.5-3 Kgs at birth (P<0.049). Hypoglycaemia was most commonly observed in IDMs at less than 6 hours of postnatal age whereas it was less common at 6-24 hours (12.1%) and 24-48 hours (9.1%) of postnatal age (P < 0.000). This observation was highly statistically significant. ASD was the most common cardiac anomaly observed in IDMs (27.3%) and only 1 (3.0%) IDM had a combination of ASD, VSD, and PDA (P < 0.01).
Conclusion: The neonatal complications commonly seen in infants of diabetic mothers are macrosomia, birth asphyxia, congenital anomalies, respiratory distress, hypoglycaemia, hypocalcaemia, hyperbilirubinemia, and polycythaemia. There are no significant differences in neonatal morbidity profiles of IDMs born to pre-gestational and gestational diabetic mothers. Management goals in pregnancies complicated by diabetes mellitus should be to achieve optimal glycaemic control, as neonatal complications are more common in women with suboptimal glycaemic control
A Study of Maternal Risk Factors and Investigative Profile in Neonatal Polycythemia in a rural tertiary care hospital in western Maharashtra
Full text linkAims and objectives: To Study the Maternal Risk Factors and Investigative Profile in Neonatal Polycythemia.
Materials and methods: This is hospital based descriptive longitudinal prospective study in Dr. Vitthalrao Vikhe Patil Pravara Rural Hospital, Loni. It was carried out over a period of 1 year that is from September 2022 to September 2023. All neonates with venous hematocrit >65% or venous hemoglobin concentration of more than 22g/dl were included in study. Neonates with venous hematocrit <65% and Neonates with dehydration are excluded from the study.
Results: The most common maternal risk factor observed was PIH(52.3%) followed by GDM(19.7%), Multiple pregnancy(5.8%) and APH(4.6%). In the present study, we observed that most of the symptomatic babies presented with Hypoglycemia(82%), 75% babies presented with Jaundice.
Conclusion: So, babies with maternal risk factors like Hypertension, Diabetes, APH and Multiple Pregnancy should be actively screened. As most common laboratory anomaly is hypoglycemia in polycythemia babies it is important to closely monitor these infants in an effort to reduce morbidity and promote better growth, development, and survival
Study of Clinical Profile in Urinary Tract Infections in Children Aged 1-12 Years
Full text linkUrinary tract infections (UTIs) are prevalent among pediatric patients, posing significant health risks if untreated. This retrospective study, conducted from January 2022 to December 2023 at the Department of Pediatrics, VVP PRH (DU), Loni,, involved 200 children aged 1-12 years. The research aimed to analyze the clinical profiles, risk factors, and treatment outcomes of UTIs in this population. Females (65%) were more commonly affected, particularly those aged 4-7 years. Fever (85%), dysuria (75%), and abdominal pain (60%) were the most frequent symptoms. Predisposing factors included poor perineal hygiene (30%), constipation (25%), and previous UTIs (15%). Laboratory findings confirmed Escherichia coli as the predominant pathogen (75%), followed by Klebsiella pneumoniae (15%) and Proteus mirabilis (5%). Ultrasound abdomen revealed abnormalities in 15% of cases, and voiding cystourethrogram (VCUG) was performed in 20% of patients with recurrent infections or abnormal ultrasound results. All patients received culture-sensitive antibiotic therapy; however, 30% required hospitalization, 20% experienced recurrence within a year, and 5% developed renal scarring. Statistical analysis indicated significant variations in demographic and clinical characteristics, with higher prevalence and symptom severity in females. The study underscores the importance of early diagnosis, appropriate management, and vigilant follow-up to prevent recurrence and complications. Emphasizing education on proper perineal hygiene and constipation management can significantly reduce UTI incidence. These findings align with existing literature, emphasizing the need for targeted preventive strategies and evidence-based clinical practices to optimize pediatric UTI management
Incidence of neonatal pneumothorax in rural tertiary care hospital in preHFOV era
Full text linkPneumothorax is a critical condition characterized by the presence of air in the pleural space, which can lead to significant morbidity in neonates. This descriptive longitude+,inal observational study was conducted to assess the incidence of neonatal pneumothorax in a rural tertiary care hospital during the pre-High-Frequency Oscillation Ventilation (HFOV) era. The study involved all neonates admitted to inborn and outborn Neonatal Intensive Care Units (NICUs) from December 2020 to December 2022 at Dr. Balasaheb Vikhe Patil Rural Medical College, Loni. A total of 27,954 inborn neonates were delivered during the study period, of which 38 developed pneumothoraxes, resulting in a prevalence of 0.2%. Among the total admitted NICU patients (7,395), 60 neonates developed pneumothorax, corresponding to a prevalence of 0.8%. Risk factors such as respiratory distress syndrome (RDS), mechanical ventilation, and meconium aspiration syndrome were evaluated. The study found that early detection via bedside transillumination tests followed by chest X-rays facilitated timely diagnosis. Treatment options varied from observation for small pneumothoraxes to CPAP, needle aspiration, and chest tube insertion for more severe cases. The study\u27s findings align with other research in the field but note lower incidence rates due to the limited study duration compared to others. The study concludes that neonatal pneumothorax remains a significant concern, with a call for future research involving larger sample sizes and advanced ventilation modalities such as HFOV to reduce the incidence and improve outcomes in rural settings. Limitations included the exclusive use of conventional mechanical ventilation during the study
Evaluation of Caesarean Section Rates at Sylhet MAG Osmani Medical College Hospital Using the Robson Ten Group Classification System
Full text linkBackground: The rising rates of Cesarean Section (CS) globally, and particularly in Bangladesh, have sparked concerns about the overuse of this surgical intervention, which may lead to adverse maternal and neonatal outcomes. The World Health Organization (WHO) recommends a population-based CS rate of 10-15%; however, the rates in many regions far exceed this threshold.
Objectives: The aim of the study was to evaluate the CS rates at Sylhet MAG Osmani Medical College Hospital (SOMCH) using the Robson Ten Group Classification System (TGCS), to identify the key factors contributing to the high prevalence of CS, and to provide evidence-based recommendations for reducing unnecessary procedures.
Methods: This cross-sectional observational study was conducted at SOMCH during July 2022 to June 2023. All pregnant women admitted for delivery at ≥28 weeks of gestation were included and categorized into ten groups according to the TGCS based on specific obstetric characteristics. Data were collected using a structured questionnaire and extracted from medical records. Descriptive statistics were used to analyze the distribution of women across the Robson groups, group-specific CS rates, and the contribution of each group to the overall CS rate. Statistical analyses of the results were be obtained by using window-based Microsoft Excel and Statistical Packages for Social Sciences (SPSS-24).
Results: The overall CS rates were reported at Sylhet MAG Osmani Medical College Hospital (SOMCH), 57.43% with 2849 CS cases among 4960 admitted women. The group size, CS rate, and absolute group contribution to overall CS were 24.29%, 36.29%, and 8.81%, respectively in group 1. Another important group includes nulliparous women with single cephalic pregnancies at 37 weeks or more who had induced labor or a CS before labor, which accounted for 11.85% of deliveries with a high CS rate of 72.61% and contributed 8.60% to the overall CS rate. Similarly, multiparous women without a previous CS who received induction or a CS before to labor (Group 4) have a CS rate of 75.83%, accounting for 5.06%.
Conclusion: The study highlights the need for targeted interventions to reduce unnecessary CS procedures at SOMCH. Key recommendations include promoting Vaginal Birth After Cesarean (VBAC), optimizing labor induction practices, and standardizing clinical decision-making processes. Continuous monitoring and evaluation using the TGCS will be essential to ensure that CS is used judiciously, ultimately improving maternal and neonatal health outcomes