Pub Date : 2023-01-01DOI: 10.5455/ijmrcr.172-1651084828
Kamran Chaudhary, Amrita Swati, M. Sen, R. Sachdeva, Avinash Kumar
Introduction: Acute Lung Injury (ALI) and the Acute Respiratory Distress Syndrome (ARDS) are severe respiratory diseases that have a very poor prognosis and have numerous causes. Here we are reporting a very unusual case of chemical inhalation induced ARDS due to exposure to holi colours A 24-year-old female patient, known case of Bronchial Asthma (poorly compliant to inhaler therapy) presented with sudden onset respiratory distress After extensively excluding other plausible causes, diagnosis of exclusion was made as Bronchial Asthma with Inhalational Injury due to colour dust. Patient responded on steroid therapy, there was an improvement in oxygenation and NIV support was gradually tapered off
{"title":"HOLI COLOUR INHALATION CAUSING ARDS: A LIFE THREATENING ASTHMA EXACERBATION","authors":"Kamran Chaudhary, Amrita Swati, M. Sen, R. Sachdeva, Avinash Kumar","doi":"10.5455/ijmrcr.172-1651084828","DOIUrl":"https://doi.org/10.5455/ijmrcr.172-1651084828","url":null,"abstract":"Introduction: Acute Lung Injury (ALI) and the Acute Respiratory Distress Syndrome (ARDS) are severe respiratory diseases that have a very poor prognosis and have numerous causes. Here we are reporting a very unusual case of chemical inhalation induced ARDS due to exposure to holi colours A 24-year-old female patient, known case of Bronchial Asthma (poorly compliant to inhaler therapy) presented with sudden onset respiratory distress After extensively excluding other plausible causes, diagnosis of exclusion was made as Bronchial Asthma with Inhalational Injury due to colour dust. Patient responded on steroid therapy, there was an improvement in oxygenation and NIV support was gradually tapered off","PeriodicalId":13694,"journal":{"name":"International Journal of Medical Reviews and Case Reports","volume":"47 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84771568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.5455/ijmrcr.172-1670651639
Pooja Mannela, Srinivas Pamarthi
Background: Epidural narcotic agonists like fentanyl, and morphine has been studied as an adjunct to Bupivacaine for intraoperative and to provide epidural postoperative analgesia. Side effects like pruritus, nausea, vomiting, respiratory depression, and urinary retention occur with their use. The search for an effective analgesic with no or low incidence of side effects is continuing. Aims and objective: To evaluate the onset of anaesthesia, duration of analgesia with epidural administration of Butorphanol and fentanyl in 2 groups. Observe and compare side effects between these groups during post-operative period. Material and Methods: We had done this study on 60 patients with Orthopaedic fractures (lowerlimb), which are treated with IM IL nailing femur and tibia distributed to two groups of 30 each. Surgery was done under CSE technique, with Group A receiving butorphanol and Group B Fentanyl as adjuvant. The onset, duration of analgesia and side effects were recorded in each group. Results: The onset of analgesia was rapid in Fentanyl group (3.26+/- 0.95) than Butorphanol group (6.54 +/-1.10). Duration of analgesia was longer in Butorphanol group (330 +/- 62 minutes) in comparison to Fentanyl group (210 +/- 32 minutes). Quality of analgesia is better in Butorphanol group (80%) than Fentanyl group (43 %). Side effects were more in Group B than Group A. Conclusion: Epidural Fentanyl has faster onset of analgesia. Epidural Butorphanol has longer duration of analgesia with better quality of analgesia. Epidural butorphanol has fewer side effects when compared to Fentanyl.
{"title":"A Comparative Study of Epidural Butorphanol and Epidural Fentanyl for Postoperative pain relief in Lower Limb Orthopaedic Surgeries.","authors":"Pooja Mannela, Srinivas Pamarthi","doi":"10.5455/ijmrcr.172-1670651639","DOIUrl":"https://doi.org/10.5455/ijmrcr.172-1670651639","url":null,"abstract":"Background: Epidural narcotic agonists like fentanyl, and morphine has been studied as an adjunct to Bupivacaine for intraoperative and to provide epidural postoperative analgesia. Side effects like pruritus, nausea, vomiting, respiratory depression, and urinary retention occur with their use. The search for an effective analgesic with no or low incidence of side effects is continuing. Aims and objective: To evaluate the onset of anaesthesia, duration of analgesia with epidural administration of Butorphanol and fentanyl in 2 groups. Observe and compare side effects between these groups during post-operative period. Material and Methods: We had done this study on 60 patients with Orthopaedic fractures (lowerlimb), which are treated with IM IL nailing femur and tibia distributed to two groups of 30 each. Surgery was done under CSE technique, with Group A receiving butorphanol and Group B Fentanyl as adjuvant. The onset, duration of analgesia and side effects were recorded in each group. Results: The onset of analgesia was rapid in Fentanyl group (3.26+/- 0.95) than Butorphanol group (6.54 +/-1.10). Duration of analgesia was longer in Butorphanol group (330 +/- 62 minutes) in comparison to Fentanyl group (210 +/- 32 minutes). Quality of analgesia is better in Butorphanol group (80%) than Fentanyl group (43 %). Side effects were more in Group B than Group A. Conclusion: Epidural Fentanyl has faster onset of analgesia. Epidural Butorphanol has longer duration of analgesia with better quality of analgesia. Epidural butorphanol has fewer side effects when compared to Fentanyl.","PeriodicalId":13694,"journal":{"name":"International Journal of Medical Reviews and Case Reports","volume":"2013 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86486537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.5455/ijmrcr.172-1669772235
Sakshi Agarwal, Uma Pandey
Introduction: Postpartum hemorrhage (PPH) is one of the commonest causes of maternal morbidity and mortality. Serious adverse outcomes mostly occur due to delays in the recognition and management of massive PPH. Shock index (SI) has been proposed as an early diagnostic indicator to monitor PPH women. Aims and objectives: To study SI as a predictor of maternal outcome in PPH patients. Patients and methods: This retrospective study was conducted over a duration of 1year (January 2021- December 2021) on the cohort of patients having PPH at the department of obstetrics and gynecology at a tertiary care hospital in northern India. The Age, parity, number of pregnancies, booked/unbooked pregnancy, singleton/multiple pregnancies, mode of delivery (vaginal or caesarean section), SI, blood transfusions, type and severity of PPH, type of management- medical/surgical, ICU admissions and maternal outcomes were recorded. Results: This study included a total of 105 women with PPH for analysis. 43.8% of patients had severe PPH and required massive blood transfusion > 4 units while 40% required ICU admission. 68 patients had S.I>0.9 while 46 patients had S.I>1.1. The value of S.I>1.1 correlated significantly with all studied adverse outcomes like ICU admission, massive blood loss, massive blood transfusion, and need for surgical intervention(p value<0.05). SI value of ≥1.1 had maximum sensitivity and specificity. Conclusion: The shock index seems to be an easy, practical, and effective clinical method for predicting adverse outcomes objectively in postpartum hemorrhage patients. Our study suggests a cut-off value of 1.1 for predicting adverse clinical outcomes.
{"title":"Shock index as a predictor of maternal outcome in postpartum hemorrhage: an experience from a tertiary care centre in Northern India","authors":"Sakshi Agarwal, Uma Pandey","doi":"10.5455/ijmrcr.172-1669772235","DOIUrl":"https://doi.org/10.5455/ijmrcr.172-1669772235","url":null,"abstract":"Introduction: Postpartum hemorrhage (PPH) is one of the commonest causes of maternal morbidity and mortality. Serious adverse outcomes mostly occur due to delays in the recognition and management of massive PPH. Shock index (SI) has been proposed as an early diagnostic indicator to monitor PPH women. Aims and objectives: To study SI as a predictor of maternal outcome in PPH patients. Patients and methods: This retrospective study was conducted over a duration of 1year (January 2021- December 2021) on the cohort of patients having PPH at the department of obstetrics and gynecology at a tertiary care hospital in northern India. The Age, parity, number of pregnancies, booked/unbooked pregnancy, singleton/multiple pregnancies, mode of delivery (vaginal or caesarean section), SI, blood transfusions, type and severity of PPH, type of management- medical/surgical, ICU admissions and maternal outcomes were recorded. Results: This study included a total of 105 women with PPH for analysis. 43.8% of patients had severe PPH and required massive blood transfusion > 4 units while 40% required ICU admission. 68 patients had S.I>0.9 while 46 patients had S.I>1.1. The value of S.I>1.1 correlated significantly with all studied adverse outcomes like ICU admission, massive blood loss, massive blood transfusion, and need for surgical intervention(p value<0.05). SI value of ≥1.1 had maximum sensitivity and specificity. Conclusion: The shock index seems to be an easy, practical, and effective clinical method for predicting adverse outcomes objectively in postpartum hemorrhage patients. Our study suggests a cut-off value of 1.1 for predicting adverse clinical outcomes.","PeriodicalId":13694,"journal":{"name":"International Journal of Medical Reviews and Case Reports","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135534447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.5455/ijmrcr.172-1676535311
Anastasios Tzenalis, Sofia Kleisiari, Kipourgos George, E. Albani, George Elesnitsalis
ABSTRACT Introduction: The process of weaning from MV involves a methodical practice, during which certain conditions should be met. Critical care nurses play a key role in the ongoing assessment and monitoring of the patient weaned from MV, using a thorough 'Airway, Breathing and Circulation' approach. Adjusting weaning parameters requires a high level of skill and training, as well as a good knowledge of cardiorespiratory physiology and pathophysiology. The purpose of this study is to investigate the role of ICU nurses and the level of knowledge they possess regarding the process of weaning patients from MV. Materials and Methods: The research was conducted in a sample of 90 employees in the ICU of a General Hospital. A quantitative survey was conducted with a questionnaire, during the time-period July-September 2021. The questionnaire used for data collection consists of 43 questions categorised as follows: a) Demographic data; b) Overview of mechanical ventilation recovery; c) Mechanical ventilation weaning methods and methods; d) Evaluation criteria weaning readiness; e) Spontaneous respiration test, g) Causes of intubation failure; h) Weaning protocols and suppression. Results: Most nurses did not answer all the questions correctly, meaning nurses do not have the required knowledge and skills to successfully manage patient intubation. Two more key findings of this research were: a) protocols can help in the successful intubation of the patient; b) nurses need training in successfully ossifying patients. Conclusions: There is a need for nurses to participate in continuing education programs, as well as a need to create an interdisciplinary team. However, further research on a larger sample of respondents is necessary in order to extract results that can be generalized.
{"title":"Initiation of mechanical weaning of ICU patients and investigation of nurses' knowledge and role.","authors":"Anastasios Tzenalis, Sofia Kleisiari, Kipourgos George, E. Albani, George Elesnitsalis","doi":"10.5455/ijmrcr.172-1676535311","DOIUrl":"https://doi.org/10.5455/ijmrcr.172-1676535311","url":null,"abstract":"ABSTRACT Introduction: The process of weaning from MV involves a methodical practice, during which certain conditions should be met. Critical care nurses play a key role in the ongoing assessment and monitoring of the patient weaned from MV, using a thorough 'Airway, Breathing and Circulation' approach. Adjusting weaning parameters requires a high level of skill and training, as well as a good knowledge of cardiorespiratory physiology and pathophysiology. The purpose of this study is to investigate the role of ICU nurses and the level of knowledge they possess regarding the process of weaning patients from MV. Materials and Methods: The research was conducted in a sample of 90 employees in the ICU of a General Hospital. A quantitative survey was conducted with a questionnaire, during the time-period July-September 2021. The questionnaire used for data collection consists of 43 questions categorised as follows: a) Demographic data; b) Overview of mechanical ventilation recovery; c) Mechanical ventilation weaning methods and methods; d) Evaluation criteria weaning readiness; e) Spontaneous respiration test, g) Causes of intubation failure; h) Weaning protocols and suppression. Results: Most nurses did not answer all the questions correctly, meaning nurses do not have the required knowledge and skills to successfully manage patient intubation. Two more key findings of this research were: a) protocols can help in the successful intubation of the patient; b) nurses need training in successfully ossifying patients. Conclusions: There is a need for nurses to participate in continuing education programs, as well as a need to create an interdisciplinary team. However, further research on a larger sample of respondents is necessary in order to extract results that can be generalized.","PeriodicalId":13694,"journal":{"name":"International Journal of Medical Reviews and Case Reports","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73798949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.5455/ijmrcr.172-1650453121
Rupali R. Bavikar, Meesha Zaheer, A. Buch, Rajeshwari Raishankar, R. Khan, C. Gore
BACKGROUND: Over the years, different studies conducted have established the advantages of liquid based cytology(LBC) over conventional preparations(CP) in cervical smears screening. However, the high cost of machinery required for the preparations still limits its usage in low-resource countries. This study aims to evaluate the performance of a low cost LBC method, EziPREP™ technique against conventional preparations for cervical screening. MATERIALS & METHOD: This was a cross sectional study comprising of 300 consequtive cervical samples over a period of 2 year. CP smears were prepared as per the standard technique using ayre’s spatula while for LBC sample was obtained on endocervical brush followed by detaching the head of brush into the fixative vials of LBC. The LBC samples were processed as per the manufacturer's protocol. Both CP and LBC smears were stained using standard Papanicolaou stain & H & E stain protocol. Slides were analysed by two pathologists independently. RESULTS: The unsatisfactory rate for CP was 5%, main cause being obscuring haemorrhage and inflammation, whereas on LBC samples it was 1.4%, owing to inadequate cellular material. Uniform distribution was more in LBC smears, with minimal overlapping. The morphological details were comparable in both sets of smears. The pathogenic organisms, like Gardenella(31%) & Candida(20%) were detected in more CP smears, Trichomonas was seen equally in both smears(3%). There was a 98% concordance in cytologic diagnosis between CP and LBC smears. Screening time was notably reduced in LBC smears (3±1minutes vs 5±1 minutes for CP) CONCLUSION: This low-cost LBC method holds promise in providing monolayered cervical smears with a clear background. It might carve the way for inclusion of liquid based cytology methods for cervical cancer screening on a larger scale in the low resourse countries.
{"title":"CONVENTIONAL CYTOLOGY VERSUS LIQUID BASED CYTOLOGY FOR EVALUATION OF CERVICAL SMEARS – A STUDY OF 300 CASES","authors":"Rupali R. Bavikar, Meesha Zaheer, A. Buch, Rajeshwari Raishankar, R. Khan, C. Gore","doi":"10.5455/ijmrcr.172-1650453121","DOIUrl":"https://doi.org/10.5455/ijmrcr.172-1650453121","url":null,"abstract":"BACKGROUND: Over the years, different studies conducted have established the advantages of liquid based cytology(LBC) over conventional preparations(CP) in cervical smears screening. However, the high cost of machinery required for the preparations still limits its usage in low-resource countries. This study aims to evaluate the performance of a low cost LBC method, EziPREP™ technique against conventional preparations for cervical screening. MATERIALS & METHOD: This was a cross sectional study comprising of 300 consequtive cervical samples over a period of 2 year. CP smears were prepared as per the standard technique using ayre’s spatula while for LBC sample was obtained on endocervical brush followed by detaching the head of brush into the fixative vials of LBC. The LBC samples were processed as per the manufacturer's protocol. Both CP and LBC smears were stained using standard Papanicolaou stain & H & E stain protocol. Slides were analysed by two pathologists independently. RESULTS: The unsatisfactory rate for CP was 5%, main cause being obscuring haemorrhage and inflammation, whereas on LBC samples it was 1.4%, owing to inadequate cellular material. Uniform distribution was more in LBC smears, with minimal overlapping. The morphological details were comparable in both sets of smears. The pathogenic organisms, like Gardenella(31%) & Candida(20%) were detected in more CP smears, Trichomonas was seen equally in both smears(3%). There was a 98% concordance in cytologic diagnosis between CP and LBC smears. Screening time was notably reduced in LBC smears (3±1minutes vs 5±1 minutes for CP) CONCLUSION: This low-cost LBC method holds promise in providing monolayered cervical smears with a clear background. It might carve the way for inclusion of liquid based cytology methods for cervical cancer screening on a larger scale in the low resourse countries.","PeriodicalId":13694,"journal":{"name":"International Journal of Medical Reviews and Case Reports","volume":"67 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83851382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.5455/ijmrcr.172-1658980314
Marta Caldas, M. Pedro, A. Morais, A. Bicho
A previously healthy 4-year-old boy presented with a rash on his elbows and knees that over 3 weeks became pruritic and expanded to the posterior cervical region and hands. It appeared during the summer, while frequently wearing a thermal suit. The patient had no systemic symptoms and none of his cohabitants had a rash. Skin examination revealed flesh-colored to mildly erythematous flat-topped papules on the extensor surfaces of the elbows and knees, posterior cervical region and the dorsum of the hands (Figure 1). The findings were compatible with the diagnosis of frictional lichenoid dermatitis, no further studies were performed and the patient was treated with topical hydrocortisone during 2 weeks, with improvement. Frictional lichenoid dermatitis is probably underdiagnosed and it is a benign and self-limited disease with typical clinical presentation, so it is important to recognize it as not to prescribe unnecessary workup and medication.
{"title":"Frictional Lichenoid Dermatitis","authors":"Marta Caldas, M. Pedro, A. Morais, A. Bicho","doi":"10.5455/ijmrcr.172-1658980314","DOIUrl":"https://doi.org/10.5455/ijmrcr.172-1658980314","url":null,"abstract":"A previously healthy 4-year-old boy presented with a rash on his elbows and knees that over 3 weeks became pruritic and expanded to the posterior cervical region and hands. It appeared during the summer, while frequently wearing a thermal suit. The patient had no systemic symptoms and none of his cohabitants had a rash. Skin examination revealed flesh-colored to mildly erythematous flat-topped papules on the extensor surfaces of the elbows and knees, posterior cervical region and the dorsum of the hands (Figure 1). The findings were compatible with the diagnosis of frictional lichenoid dermatitis, no further studies were performed and the patient was treated with topical hydrocortisone during 2 weeks, with improvement. Frictional lichenoid dermatitis is probably underdiagnosed and it is a benign and self-limited disease with typical clinical presentation, so it is important to recognize it as not to prescribe unnecessary workup and medication.","PeriodicalId":13694,"journal":{"name":"International Journal of Medical Reviews and Case Reports","volume":"31 6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84170702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.5455/ijmrcr.2023-04-10
P. Punia, Savita Bhatiya, Aparna Parmar, D. Kumar
Abstract: Introduction: COVID-19 is a primary respiratory viral illness caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2). It has been a challenge to diagnose COVID-19-associated mucormycosis as the clinical and radiological findings are nonspecific and could overlap. This study was done to estimate the incidence of various fungal infections during the COVID 19 pandemic and to evaluate the merits of conventional microbiological diagnostic approach. Method: All the nasal swabs and endoscopic biopsy samples received for fungal diagnosis from suspected mucormycosis COVID positive or COVID suspected patients were included in the study and were processed as per conventional microbiological techniques including direct KOH mount and culture growth on LPCB. Results: A total of 434 samples from suspected mucormycosis patients were received during the study period including 214 nasal swabs and nasal biopsies each, 1 sample each of nasal fluid, BAL and pus along with 3 sputum samples. The positivity rate in direct microscopy of swabs was 38.3%, and for tissue samples was 72.4%. Culture positivity rate was 47.6% amongst swabs with 19 Mucorales, 41 Aspergillus spp., 22 dematiaceious and 20 Candida spp. Culture positivity rate amongst biopsy samples was 40.6% with 35 for Mucorales, 36 for Aspergillus spp., 8 for dematiaceious and 8 for Candida spp. Conclusion: In our study, tissue samples had a greater culture positivity rate as compared to the nasal swabs, so they should be the preferred samples to be sent to the laboratory. However, nasal swabs performed better in culture growth, so their value need not be underestimated. In countries like India where RT-PCR not available in all clinical setups conventional techniques such as KOH wet mounts from samples and culture findings hold a promising outcome to start the antifungal therapy.
{"title":"Conventional and rapid diagnosis of fungal infections including mucormycosis linked to COVID-19","authors":"P. Punia, Savita Bhatiya, Aparna Parmar, D. Kumar","doi":"10.5455/ijmrcr.2023-04-10","DOIUrl":"https://doi.org/10.5455/ijmrcr.2023-04-10","url":null,"abstract":"Abstract: Introduction: COVID-19 is a primary respiratory viral illness caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2). It has been a challenge to diagnose COVID-19-associated mucormycosis as the clinical and radiological findings are nonspecific and could overlap. This study was done to estimate the incidence of various fungal infections during the COVID 19 pandemic and to evaluate the merits of conventional microbiological diagnostic approach. Method: All the nasal swabs and endoscopic biopsy samples received for fungal diagnosis from suspected mucormycosis COVID positive or COVID suspected patients were included in the study and were processed as per conventional microbiological techniques including direct KOH mount and culture growth on LPCB. Results: A total of 434 samples from suspected mucormycosis patients were received during the study period including 214 nasal swabs and nasal biopsies each, 1 sample each of nasal fluid, BAL and pus along with 3 sputum samples. The positivity rate in direct microscopy of swabs was 38.3%, and for tissue samples was 72.4%. Culture positivity rate was 47.6% amongst swabs with 19 Mucorales, 41 Aspergillus spp., 22 dematiaceious and 20 Candida spp. Culture positivity rate amongst biopsy samples was 40.6% with 35 for Mucorales, 36 for Aspergillus spp., 8 for dematiaceious and 8 for Candida spp. Conclusion: In our study, tissue samples had a greater culture positivity rate as compared to the nasal swabs, so they should be the preferred samples to be sent to the laboratory. However, nasal swabs performed better in culture growth, so their value need not be underestimated. In countries like India where RT-PCR not available in all clinical setups conventional techniques such as KOH wet mounts from samples and culture findings hold a promising outcome to start the antifungal therapy.","PeriodicalId":13694,"journal":{"name":"International Journal of Medical Reviews and Case Reports","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85762277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.5455/ijmrcr.172-1679910876
Hager Barakizou, Mohamed Fareh, Syrine Guebila
{"title":"Type 1 diabetes control during transition from childhood to adulthood care","authors":"Hager Barakizou, Mohamed Fareh, Syrine Guebila","doi":"10.5455/ijmrcr.172-1679910876","DOIUrl":"https://doi.org/10.5455/ijmrcr.172-1679910876","url":null,"abstract":"<jats:p />","PeriodicalId":13694,"journal":{"name":"International Journal of Medical Reviews and Case Reports","volume":"90 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79503317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.5455/ijmrcr.172-1670878801
M. Bastos, André Machado, A. Monteiro, A. Dias, A. Moura, F. Mousinho, In Antunes
Hemophagocytic lymphohistiocytosis (HLH) is a rare and life-threatening clinical syndrome, caused by an unregulated activation of cytotoxic T cells and macrophages. In adult patients, it is generally triggered by an underlying disease, with a significant proportion of cases being associated with malignancies (mainly lymphoma). The triad of fever, cytopenias, and hepatosplenomegaly is usually present, but, in severe cases, most patients will have a syndrome resembling sepsis and multiple organ failure, requiring admission into a critical care unit. We present a case of a 33-year-old healthy male patient, who presented with fever, malaise, and lower gastrointestinal bleeding. Upon admission, he was hypotensive and had elevated inflammatory markers, pancytopenia, and liver damage. Due to worsening shock of presumed septic and hemorrhagic origin, he was admitted to our ICU. An extensive diagnostic work-up was performed, including a bone marrow aspirate that revealed active hemophagocytosis and pleural effusion analysis that revealed abundant NK-Cells, phenotypically compatible with aggressive NK-Cell lymphoma. Anti-inflammatory and neoplastic treatments were immediately initiated, with a partial and transient response. Nonetheless, he developed refractory shock and medullary aplasia and died twenty days after being admitted. Although it is uncommon in adults, HLH is an important sepsis differential diagnosis to be aware of because it necessitates specific and timely treatment. Further investigation to determine and treat the possible underlying causes, including occult malignancies, is of paramount importance.
{"title":"Lymphoma-associated Hemophagocytic Syndrome: Case Report of a Natural Killer","authors":"M. Bastos, André Machado, A. Monteiro, A. Dias, A. Moura, F. Mousinho, In Antunes","doi":"10.5455/ijmrcr.172-1670878801","DOIUrl":"https://doi.org/10.5455/ijmrcr.172-1670878801","url":null,"abstract":"Hemophagocytic lymphohistiocytosis (HLH) is a rare and life-threatening clinical syndrome, caused by an unregulated activation of cytotoxic T cells and macrophages. In adult patients, it is generally triggered by an underlying disease, with a significant proportion of cases being associated with malignancies (mainly lymphoma). The triad of fever, cytopenias, and hepatosplenomegaly is usually present, but, in severe cases, most patients will have a syndrome resembling sepsis and multiple organ failure, requiring admission into a critical care unit. We present a case of a 33-year-old healthy male patient, who presented with fever, malaise, and lower gastrointestinal bleeding. Upon admission, he was hypotensive and had elevated inflammatory markers, pancytopenia, and liver damage. Due to worsening shock of presumed septic and hemorrhagic origin, he was admitted to our ICU. An extensive diagnostic work-up was performed, including a bone marrow aspirate that revealed active hemophagocytosis and pleural effusion analysis that revealed abundant NK-Cells, phenotypically compatible with aggressive NK-Cell lymphoma. Anti-inflammatory and neoplastic treatments were immediately initiated, with a partial and transient response. Nonetheless, he developed refractory shock and medullary aplasia and died twenty days after being admitted. Although it is uncommon in adults, HLH is an important sepsis differential diagnosis to be aware of because it necessitates specific and timely treatment. Further investigation to determine and treat the possible underlying causes, including occult malignancies, is of paramount importance.","PeriodicalId":13694,"journal":{"name":"International Journal of Medical Reviews and Case Reports","volume":"39 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78890617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.5455/ijmrcr.172-1669610452
D. K, D. Pai, D. Raj
Gallstone ileus refers to mechanical obstruction of the small intestine due to impaction of one or more gallstones. It occurs as a complication of cholelithiasis, more in elderly females [1]. CECT is the best diagnostic tool and the definitive treatment of gallstone ileus is surgical removal. The prevalence of cholelithiasis among American Indians may reach upto 70% and is much lower in Asians[6]. However most cases of cholelithiasis are asymptomatic and are found as an incidental finding and it is reported that on an average 1-2.3% of patients experience complications[8]. Gallstone ileus occurs due to inflammation and erosion of any part of the biliary tree leading to enterobiliary fistula through which the stone passes. Patients usually present with non-specific symptoms and acute cholecystitis is present in 10–30% cases[9]. Diagnosis clinically poses a challenge due to vague presentation with nonspecific symptoms but a radiological diagnosis on CECT and MRCP can be made. Enterolithotomy is a definitive procedure with or without cholecystectomy, fistula closure. The ongoing inflammation may complicate cholecystectomy and fistula repair. Considering that most patients are older with multiple comorbidities with added physiological stress, multiple procedures are not done in the same setting. Though laparoscopic/ laparoscopy assisted surgeries have reported better efficiency and lesser complications, less availability of equipment and surgeon’s skills and training are often a limiting factor. As there are variabilities in the surgical approaches the patient factors and surgeon factors must be kept well in mind and then to proceed with the surgery of choice. With all these at the back of the mind, higher success rates with lesser hospital stay, perioperative events and mortalities are achievable.
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