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   2019| October-December  | Volume 8 | Issue 4  
    Online since February 7, 2020

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Study of clinical features and outcomes in patients presenting to the emergency department with acute abdomen
N Ratna Kumar, B Sivarama Krishna, V Satyanarayana, V Venkatrami Reddy, M Madhusudhan, P Subramanyam
October-December 2019, 8(4):172-176
Background: Abdominal pain is one of the most common reasons for an emergency department (ED) visit. The present study, evaluated the clinicodemographic profile of patients presenting with acute abdomen to the ED in a tertiary care institute, South India. Methods: A prospective, observational study was done in patients presenting with non-traumatic acute abdomen to the ED at our teaching tertiary Care hospital between March 2016 and April 2017. Demographic profile, detailed history, physical examination, management and outcome were noted. Results: Of 200 patients, 56% were males. Their mean age was 46.2 years. Peptic ulcer disease (22%) was the most common presentation followed by surgical causes such as acute appendicitis (20%) and acute intestinal obstruction (11%). Diabetes mellitus was the most common co-morbid condition (25%) followed by hypertension (15%) and ischaemic heart disease (6%). Abdominal Ultrasonography was helpful in the diagnosis of 83% of the patients and 13% of the patients required computed tomography abdomen. Conclusion: Our observations suggest that peptic ulcer disease, acute appendicitis and acute intestinal obstruction were most common causes of acute abdomen. A high index of suspicion will help in early diagnosis and instituting effective treatment.
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Acute kidney injury, oral mucositis and gastritis as complications of ingestion of papaya leaf juice extract in a patient presenting with dengue fever
V Arun Raja, KM Bhargav, B Siddhartha Kumar, D Narayanamurthy, Suhrith Bhattaram, N Rukmangadha
October-December 2019, 8(4):204-206
The use of crude leaf preparations from Carica papaya for increasing platelet count in patients with dengue fever is a popular self-treatment that is increasingly being observed recently. We report the case of a 62-year-old male who presented to our outpatient department for the evaluation of 4-day fever. In hospital diagnostic testing revealed dengue NS1 antigen enzyme-linked immunosorbent assay was positive, thrombocytopenia (platelet count 66,000/mm3), normal serum creatinine (0.96 mg/dl). Thereafter, since he was told that he was diagnosed to have dengue fever with thrombocytopenia, as per the advice given by a neighbour, he had consumed juice extracted from papaya leaves to 'increase the platelet count.' Six hours after ingestion, he had developed severe mucositis of oral cavity and severe gastritis, vomiting and loose stools. He became drowsy and irritable. Arterial blood gas analysis revealed mild metabolic acidosis, serum creatinine increased to 3.69 mg/dL. He was treated symptomatically with intravenous fluids and was carefully monitored in-hospital. Over the next 2 days, fever subsided, serum creatinine and platelet count became normal and he was discharged in a stable condition. The present case highlights the life-threatening complications that can result with the use of papaya leaf extract in the self-treatment of dengue fever.
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A study of clinical presentation and outcome of patients with Guillain–Barré syndrome: A prospective observational study at a tertiary care teaching hospital
Bhargavi Thota, Madhusudan Mukkara, Aloka Samantaray, Alladi Mohan, Bhuma Vengamma
October-December 2019, 8(4):182-187
Background: Guillain–Barré syndrome (GBS) is an immune-mediated damage to the nerve roots and peripheral nerves which may require intensive care unit management and adequate techniques for airway protection and ventilation. Methods: Sixty four patients with GBS were studied from March 2017 to February 2018 with a detailed history of demographic and clinical data (age, gender, season, and antecedent events), functional disability bed on Hughes score, Medical Research Council (MRC) sum score at the time of admission. Final outcome was dichotomized to good (0–3) or bad (4–6) based on Hughes Disability Scale and was compared with different patient variables to find their association with patient outcome. Results: The mean age of the patients studied was 45.9 ± 15.9 years. There were 37 males. Axonal variety was predominant GBS variant (85%). Twenty-four patients required mechanical ventilation and nine patients underwent tracheostomy. In total, 7 patients expired and 15 patients were discharged from the hospital with severe disability. Twenty patients developed complications during their course of stay in hospital. In total, 12 out of 15 (80%) with low MRC score (0–20) and 22 out of 49 patients with high disability score (Hughes score 4 or 5) at admission had a bad outcome (P = 0.001 and P = 0.001), respectively. Conclusions: We concluded that, in our study, predictors of poor outcome at discharge were low MRC sum score at admission, high GBS disability score at admission, axonal variant GBS, longer duration of mechanical ventilator support, need for tracheostomy, and presence of complications, were associatedwith a poor outcome in patients with GBS.
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Study on the association of Vitamin D with glycaemic control in patients with type 2 diabetes mellitus
P Santosh Kumar, Kiranmayi S Vinapamula, MM Suchitra, Alok Sachan
October-December 2019, 8(4):188-192
Background: Type 2 diabetes mellitus (DM) is associated with increased morbidity and mortality due to the development of complications, especially due to poor glycaemic control. Besides its role in calcium homeostasis, Vitamin D is involved in the pathophysiology as well as glycaemic control of type 2 DM. Methods: Eighty patients diagnosed with type 2 DM were included. Vitamin D levels along with fasting blood sugar, post-prandial blood sugar, glycosylated haemoglobin and insulin were measured in all the individuals. Insulin resistance was calculated as homeostasis model for assessment of insulin resistance. Results: Vitamin D deficiency was observed in 52.5% of the patients. Vitamin D levels were not associated with markers of glycaemic control or insulin resistance. Conclusions: Hypovitaminosis D was observed in more than half of the patients with type 2 diabetes. suggesting a potential for vitamin D supplementation in type 2 DM patients.
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Ketogenic diet for weight loss
Kanchi Mitra Bhargav, S Lavanya, N Sai Ram
October-December 2019, 8(4):211-212
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A study of association of ankle–brachial Index with cardiovascular risk factors in type 2 diabetes mellitus
Chivukula Sridhar, Shubha Seshadri, Vaddera Sameeraja
October-December 2019, 8(4):177-183
Background: Ankle–Brachial Index (ABI) has a proven role in the baseline assessment of the individuals who are at a risk of cardiovascular diseases. Sparse data are available regarding the association of cardiovascular risk factors in type 2 diabetes mellitus (T2DM) and ABI from India. Material and Methods: A cross-sectional study was conducted at a tertiary teaching hospital in South India among patients with T2DM during the period October 2014–June 2016. ABI was measured using vascular Doppler-sphygmomanometer. Independent cardiovascular risk factors were assessed and their association with ABI was studied. Results: ABI was negatively correlated to cardiovascular risk factors such as age, body mass index, duration of T2DM, duration of hypertension and systolic blood pressure (SBP) and diastolic blood pressure (DBP) in the entire study population as well as in both genders separately. Among females, a statistically significant association of low ABI (<0.9) was observed with SBP and duration of hypertension only, whereas, in males, SBP, DBP and duration of T2DM were significantly associated with low ABI. Of note, among the individuals with proven coronary artery disease (CAD), statistically significant association with low ABI was also observed. Conclusions: In our study, low ABI has been observed with increasing age, obesity, high systolic and DBPs, increasing the duration of diabetes and hypertension, however, with a distinctive statistically significant association in males and females. Among the individuals with documented CAD, a significant proportion had a low ABI.
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Biochemical basis of novel antiplatelet drugs
Paresh P Kulkarni, Debabrata Dash
October-December 2019, 8(4):169-171
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An unusual case of recurrent pancreatitis in a human immunodeficiency virus patient
M VS Subbalaxmi, Kiranmayee Narapaneni, Radhika Soanker, Ramakrishna Narayana
October-December 2019, 8(4):207-210
Acute pancreatitis (AP) is a rare but life-threatening complication in human immunodeficiency virus (HIV) patients and poses great challenge in management. Drug toxicity and opportunistic infections (OIs) are the most frequently observed causes of pancreatitis in HIV patients in addition to the presence of comorbidities such as alcoholism, biliary disease and hypertriglyceridemia. Here, we report a case of acute-on chronic recurrent pancreatitis induced by nucleoside reverse transcriptase inhibitors and ritonavir which is successfully managed with unboosted atazanavir in combination with backbone regimen.
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High-density lipoprotein: Quality versus quantity in type 2 diabetes mellitus
Aparna R Bitla, S Naresh, Alok Sachan
October-December 2019, 8(4):193-200
Dyslipidaemia, inflammation and oxidative stress play an important role in the development of atherosclerosis and increased cardiovascular disease (CVD) risk in patients with type 2 diabetes mellitus (T2DM). High-density lipoprotein-cholesterol (HDL-C) correlates negatively with CVD risk. However, drugs aiming to increase HDL-C have failed to show a beneficial effect on CVD risk. Further research in this area showed the importance of HDL-associated proteins in relation to CVD risk. Diabetes mellitus leads to alteration in the quantity as well as the quality of HDL. The modifications in HDL proteins convert an antiatherogenic HDL to a proatherogenic HDL termed dysfunctional HDL. This review focuses on the normal functions of HDL-associated proteins and their alterations in T2DM.
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Rare presentation of sickle cell anaemia with marrow necrosis precipitated by Pandorea sp., infection
Prabhu Kiran Vanka, Naval Chandra, Shantveer G Uppin, Sohini Ganji, M VS Subbalaxmi
October-December 2019, 8(4):201-203
Bone marrow necrosis (BMN) is infrequently encountered in clinical practice and rarely reported in association with sickle cell disease (SCD). The occlusion of the bone marrow (BM) microcirculation with subsequent hypoxia and resulting cell injury has been thought to be the common underlying mechanism. Malignancy is the predominant cause in many studies. We present an unusual case of late-onset SCD whose initial presentation was BMN. The patient presented with fever with chills and bilateral thigh pain. Blood cultures grown Pandorea sp. Even after antibiotics according to sensitivity, fever continued. BM examination was done to send BM cultures. Cultures were sterile. Biopsy showed BMN which was an unexpected finding. As the patient was from tribal area, haemoglobinopathy was suspected and haemoglobin (Hb) electrophoresis was sent which suggested SCD. Thus, a high index of suspicion must be borne in mind, particularly in high SCD-prevalent areas, to identify and prevent this rare complication.
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Transoesophageal echocardiography and stroke: An overview
Jamir Pitton Rissardo, Ana Letícia Fornari Caprara
October-December 2019, 8(4):213-214
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Authors' response
Deshmukh Dnyaneswar Shivajirao, K Josehva Caleb, Bimal Prasad Padhy, H Radhakrishna, Vishanji Karani
October-December 2019, 8(4):215-215
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Journal scan
V Suresh, AR Bitla
October-December 2019, 8(4):216-217
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