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   Table of Contents - Current issue
Coverpage
October-December 2017
Volume 6 | Issue 4
Page Nos. 201-258

Online since Tuesday, September 25, 2018

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EDITORIAL  

Mycobacterium tuberculosis: A perpetual health care challenge p. 201
S Ramakumar
DOI:10.15380/2277-5706.JCSR.17.09.007  
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ORIGINAL ARTICLES Top

Costs incurred by patients with diabetes mellitus in a tertiary care hospital - a cross sectional study Highly accessed article p. 203
VV Anupamaa, K Nagaraj
DOI:10.15380/2277-5706.JCSR.16.12.002  
Background: Diabetes mellitus has emerged as a disease with huge economic burden in developing countries. As sparse data are available from South India regarding the costs incurred by patients with diabetes mellitus the present study was conducted. Methods: In this cross-sectional study, a pre-structured questionnaire had been administered to 80 patients with diabetes mellitus admitted to our tertiary care teaching hospital to assess the direct and indirect costs incurred. Results: The median [inter quartile range (IQR)] total direct costs incurred by the study subjects was found to be 8145 (IQR 4600-12150) during hospitalization at the time of the study. The median (IQR) direct costs incurred during two years prior to the study were found to be 19050 (IQR 12020-55400). The median (IQR) indirect costs incurred due to hospitalization during the study period were 0 (0-2025). Conclusions: The present study provides a real-time measurement of the direct and indirect costs incurred by patients with diabetes mellitus. This information could be useful to health administrators to plan providing care for patients with diabetes mellitus.
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Drug-drug interactions: experience at a tertiary care hospital p. 208
S Radhika, M.V.S Subbalaxmi, P Usharani
DOI:10.15380/2277-5706.JCSR.17.01.002  
Background: Drug-drug interaction (DDI) is one important factor that influences relationship between prescribed dose and drug-effects by interfering with either pharmacokinetics or pharmacodynamics of the co-administered drug. DDIs can cause toxicity or inhibit the drug effect, both of which have deleterious effect on patient care. This study was done to report the impact of prevention of DDIs. Methods: In this retrospective study, demographic details, relevant clinical information of the cases with suspected DDIs and the opinion given regarding suspected DDIs, with anticipated outcomes and further management were recorded and analyzed. Results: Of the 124 cases, 21 (16.9%) cases had suspected DDIs, among them 5 (23.8%) were pharmacodynamic and 13 (61.9%) were pharmacokinetic. Of the 21 DDIs, in 38.1% interactions, concomitant administration of interacting drugs was to be avoided and in 33.3% interactions, monitoring of effect was necessary to guide dosage adjustment. In ten (47.6%) cases, the DDIs were identified on day one and necessary action was taken to prevent the deleterious outcome and in rest of the 11 (52.4%) cases, adverse events have occurred due to DDIs, for which most of the patients were hospitalized. Conclusion: The present demonstrated that early identification of DDIs on day one, could prevent undesired consequences in 10 cases (47.6%). As DDIs is an important factor that can be prevented, if identified early, clinicians should be vigilant regarding DDIs when more than two drugs are prescribed.
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Incidence of infections in hospitalized subjects with diabetes mellitus p. 216
Naval Chandra, K Premkumar, M.V.S Subbalaxmi, P Umabala, Y.S.N Raju
DOI:10.15380/2277-5706.JCSR.17.02.001  
Background: The risk of infection is higher in patients with diabetes mellitus (DM) compared to those without DM and significantly affects morbidity and mortality when these patients are admitted to a hospital. Hence, this study was undertaken to determine the type of infections, presentation of illness and to correlate with the severity of diabetes. Method: We studied 115 patients with DM (60 males) admitted in acute medical ward of our Institute with subacute, acute and chronic illnesses in all of them. Blood glucose and glycosylated haemoglobin were (HbA1c) determined by the standard methods. The type of organisms isolated from blood/urine/ pus /sputum and drug sensitivity pattern was determined. Results: Coronary artery disease (CAD) was seen in 22.6%, retinopathy in 2.6% and nephropathy in 9.6% of cases. Eighty six of the 115 patients (75%) had infections. Of these, acute, subacute and chronic presentation were seen in 67, 12 and 7 patients respectively; 76 had community acquired infections and nosocomial infection were seen in 10 cases. Pulmonary infections were most common (29.1%) followed by urinary tract infection (26.7%). Of the 86 patients with infection 9 had HbA1c < 7%, 56 had HbA1c of 7%-10%, and 21 patients had HbA1c of >10%. The mean HbA1c in patients with sepsis/multiorgan dysfunction syndrome (MoDS) was 11.3 ±2.8% as against 8.4% ± in the non sepsis group. Conclusion: We observed that infections were a common cause of hospital admissions in patients with uncontrolled DM.
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REVIEW ARTICLES Top

Breast cancer diagnosis – role of biomarkers p. 225
G Sarvari. B Sandya Rani, Aparna R Bitla
DOI:10.15380/2277-5706.JCSR.17.08.005  
Current routinely used serum biomarkers have limited usefulness for diagnosis and screening of breast cancer. Triple test is an accurate diagnostic test for breast cancer based on which treatment is initiated. However, the accuracy of mammography and fine-needle aspiration cytology (FNAC) when applied alone is less. Also, each of the test has its own limitations. This review attempts to highlight the current and novel markers available for diagnosis of breast cancer with special emphasis on the role of biomarkers in breast cancer diagnosis.
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CASE REPORTS Top

Evans' syndrome- haemolytic anaemia with thrombocytopenia - a rare autoimmune disorder p. 237
Majed Momin, Anamika Aluri, Santhosh Reddy, Nanda Kishore Pasupala
DOI:10.15380/2277-5706.JCSR.17.08.004  
Evans syndrome is an uncommon condition defined as the combination (either simultaneously or sequentially) of immune thrombocytopenia (ITP) and autoimmune haemolytic anaemia (AIHA) with a positive direct antiglobulin test (DAT) in the absence of known underlying aetiology. It poses great diagnostic dilemma due to its variable presentation. We present a case of a 56-year-old female who had similar difficulty as it was not diagnosed initially when she presented with anaemia and thrombocytopenia and was treated by packed cell transfusion and platelet concentrate transfusion respectively. However, the patient showed repeated thrombocytopenia and low a haemoglobin and referred to us and diagnostic work-up confirmed Evans's; syndrome. This case stresses on the diagnostic importance of peripheral blood picture, reticulocyte count and direct antiglobulin test in every patient presenting with anaemia and / or thrombocytopenia to rule out haemolytic anaemia and thrombocytopenia of autoimmune etiology and thus help in arriving at right diagnosis.
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Acute tension gastrothorax in an adult p. 241
K Gowrinath, M Gayatri, G Varaprasada Rao
DOI:10.15380/2277-5706.JCSR.17.10.002  
Tension gastrothorax is a rare life threatening condition and may occur as an unusual complication of Bochdalek's hernia (BH) in an adult. We report the rare occurrence of acute tension gastrothorax in a 21-year-old male with BH. The tension gastrothorax was due to acute organo-axial volvulus and the diagnosis was established by the computed tomography (CT) of chest. The risk of misdiagnosis is high when air and fluid in the dilated stomach simulates hydropneumothorax clinically and is interpreted through postero-anterior chest radiograph alone. In our case, percutaneous fine needle aspiration of fluid within the dilated stomach facilitated nasogastric tube insertion decompressing the stomach and allowed surgery to be done electively.
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A rare case of autoimmune hypoglycaemia p. 245
Srinivasa P Munigoti, CV Harinarayan
DOI:10.15380/2277-5706.JCSR.17.11.002  
We report the rare case of a female who presented with episodes of spontaneous hypoglycaemia. Although she had high baseline insulin and C-peptide levels during the time she was symptomatic, she tested negative on hypoglycaemia provocation test with ‘72 hour extended fast’. Patient was later found to have very high titres of insulin antibodies suggestive of insulin antibody syndrome (IAS). She developed this autoimmune antibody response with no known triggering factor. Her symptoms subsided completely after a short course of oral corticosteroid treatment.
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An unusual case of sphenoid wing meningioma and adenocarcinoma of the caecum p. 249
Sachin Ranganatha Goudihalli, Ashis Pathak, Rahat Brar, Rajeev kapoor, Meenakshi Malhotra
DOI:10.15380/2277-5706.JCSR.16.10.001  
Background: Sphenoid wing meningiomas are common in females and association with colon cancer in females is known. An unusual case of meningioma with co-existant caecal cancer is being reported in a male patient. Case description: A 76-year-old male patient diagnosed with left lateral sphenoid wing meningioma underwent total excision of the tumour. Post-operatively he developed intestinal obstruction due to perforation of colonic growth. Histopathology confirmed the lesion as adenocarcinoma. The patient succumbed to septic shock. Conclusion: The uniqueness of male presentation and a perforated colonic cancer manifesting post-operatively has not been reported in the past. The possibility of syndromic presentation should always be kept in mind.
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SPECIAL FEATURE Top

A child with chronic glomerulonephritis with Beau's lines p. 253
G Sindhu, A Sunnesh, N Sai Sameera, V Sarat Chandra, N Praveen, B Sangeetha Lakshmi, Ram , V Siva Kumar
DOI:10.15380/2277-5706.JCSR.17.06.002  
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CORRESPONDENCE Top

Adenosine deaminase activity in type 2 diabetes mellitus p. 254
S Aruna, MM Suchitra, V Suresh
DOI:10.15380/2277-5706.JCSR.17.09.002A  
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JOURNAL SCAN Top

Journal scan p. 257
V Suresh, AR Bitla
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