Pub Date : 2023-07-26DOI: 10.18203/2349-3933.ijam20232215
Fouqia Mahnaz Khanam
Alzheimer's disease (AD) first identified as Alois Alzheimer in 1907, is a slowly progressing dementia that affects cognition, behaviour and functional status. There is no cure for AD since precise pathophysiological mechanisms underlying it is not completely known. Drugs may temporarily reduce the symptoms associated with disorder, but condition is ultimately fatal. Objective of treatment of AD is to reduce behaviour issues associated with memory loss and improve cognition. Single acetylcholinesterase inhibitors donepezil and galantamine, as well as the dual AChE and butyrylcholinesterase (BuChE) inhibitor rivastigmine, are now utilized in treatment of AD. Cholinesterase inhibitors have shown dose-dependent impact on cognition and functional activities in clinical trials. Memantine NMDA receptor antagonist is used to minimize neurotoxicity that's suspected to contribute to conditions like Alzheimer's and other neurodegenerative disorders. Estrogen administration post menopause can result in modulation of synaptogenesis, enhanced cerebral blood flow, mediation of crucial neurotransmitters and hormones, protection against apoptosis. Aducanumab is 1st disease modifying drug and monoclonal antibody that targets beta-amyloid clusters in mild AD. Recent advancement in therapy, lecanemab, a recombinant IgG1 monoclonal antibody is targeted against aggregated soluble and insoluble forms of amyloid beta, thereby minimizing Aβ plaques and preventing Aβ deposition in the brain. As research advances, molecular basis of disease becomes more apparent leading to the advent of plausible targeted therapy.
{"title":"Donepezil to lecanemab-advancements in targeted therapy of Alzheimer’s disease so far","authors":"Fouqia Mahnaz Khanam","doi":"10.18203/2349-3933.ijam20232215","DOIUrl":"https://doi.org/10.18203/2349-3933.ijam20232215","url":null,"abstract":"Alzheimer's disease (AD) first identified as Alois Alzheimer in 1907, is a slowly progressing dementia that affects cognition, behaviour and functional status. There is no cure for AD since precise pathophysiological mechanisms underlying it is not completely known. Drugs may temporarily reduce the symptoms associated with disorder, but condition is ultimately fatal. Objective of treatment of AD is to reduce behaviour issues associated with memory loss and improve cognition. Single acetylcholinesterase inhibitors donepezil and galantamine, as well as the dual AChE and butyrylcholinesterase (BuChE) inhibitor rivastigmine, are now utilized in treatment of AD. Cholinesterase inhibitors have shown dose-dependent impact on cognition and functional activities in clinical trials. Memantine NMDA receptor antagonist is used to minimize neurotoxicity that's suspected to contribute to conditions like Alzheimer's and other neurodegenerative disorders. Estrogen administration post menopause can result in modulation of synaptogenesis, enhanced cerebral blood flow, mediation of crucial neurotransmitters and hormones, protection against apoptosis. Aducanumab is 1st disease modifying drug and monoclonal antibody that targets beta-amyloid clusters in mild AD. Recent advancement in therapy, lecanemab, a recombinant IgG1 monoclonal antibody is targeted against aggregated soluble and insoluble forms of amyloid beta, thereby minimizing Aβ plaques and preventing Aβ deposition in the brain. As research advances, molecular basis of disease becomes more apparent leading to the advent of plausible targeted therapy.","PeriodicalId":13827,"journal":{"name":"International Journal of Advances in Medicine","volume":"44 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87450492","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 : 2023-07-26DOI: 10.18203/2349-3933.ijam20232214
Wirama Putra I. Dewa Agung, Suryana Ketut
Epigastric pain is the most significant symptom and a major clinical challenge in chronic pancreatitis. Pancreatic pain is characteristically described as a constant, severe, dull, epigastric pain that often radiates to the back and typically worsens after high-fat meals. However, many different pain patterns have been described, ranging from no pain to recurrent episodes of pain and pain free intervals, to constant pain with clusters of severe exacerbations. A 30-years old female inpatient with complaints of abdominal pain located on epigastric since 7 days ago. Patients also complain of nausea and vomiting, decreased appetite. The patient has a history of acute pancreatitis and was treated 6 months ago and is hyperthyroid. Physical examination within normal limits. On abdominal examination, there was tenderness in the epigastric part. Abdomen ultrasound examination revealed widening of the pancreatic duct. While hospitalized the patient was treated with meropenem 1 gram IV every 8 hours, pantoprazole 40 mg IV every 12 hours, ondansetron 8 mg IV every 12 hours, Kaltrofen supp if needed, Propranolol 5 mg PO every 12 hours and thyrozol 10 mg PO every 12 hours. Acute pancreatitis is an acute, non-bacterial inflammation of the pancreas organ. Radiographic examination must be done to establish diagnose beside anamnesis and laboratorium examination. To diagnose acute pancreatitis, at least 2 of 3 criteria must be met. Management of patients with acute pancreatitis includes non-operative and surgical. Antibiotics therapy in management of acute pancreatitis in the early stages is still controversial.
{"title":"Diagnosis of epigastric pain: a case report","authors":"Wirama Putra I. Dewa Agung, Suryana Ketut","doi":"10.18203/2349-3933.ijam20232214","DOIUrl":"https://doi.org/10.18203/2349-3933.ijam20232214","url":null,"abstract":"Epigastric pain is the most significant symptom and a major clinical challenge in chronic pancreatitis. Pancreatic pain is characteristically described as a constant, severe, dull, epigastric pain that often radiates to the back and typically worsens after high-fat meals. However, many different pain patterns have been described, ranging from no pain to recurrent episodes of pain and pain free intervals, to constant pain with clusters of severe exacerbations. A 30-years old female inpatient with complaints of abdominal pain located on epigastric since 7 days ago. Patients also complain of nausea and vomiting, decreased appetite. The patient has a history of acute pancreatitis and was treated 6 months ago and is hyperthyroid. Physical examination within normal limits. On abdominal examination, there was tenderness in the epigastric part. Abdomen ultrasound examination revealed widening of the pancreatic duct. While hospitalized the patient was treated with meropenem 1 gram IV every 8 hours, pantoprazole 40 mg IV every 12 hours, ondansetron 8 mg IV every 12 hours, Kaltrofen supp if needed, Propranolol 5 mg PO every 12 hours and thyrozol 10 mg PO every 12 hours. Acute pancreatitis is an acute, non-bacterial inflammation of the pancreas organ. Radiographic examination must be done to establish diagnose beside anamnesis and laboratorium examination. To diagnose acute pancreatitis, at least 2 of 3 criteria must be met. Management of patients with acute pancreatitis includes non-operative and surgical. Antibiotics therapy in management of acute pancreatitis in the early stages is still controversial.","PeriodicalId":13827,"journal":{"name":"International Journal of Advances in Medicine","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73519632","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 : 2023-07-26DOI: 10.18203/2349-3933.ijam20232211
F. P. Marthadinata, I. D. G. Amara Putra Wibawa, I. W. Sunaka
Diabetes has become a global pandemic and is believed to be one of the most common risk factors for chronic kidney disease, which leads to end-stage renal disease, of which a significant number will develop, requiring renal replacement therapy. Uremic encephalopathy is the most frequent complication of untreated chronic kidney disease, is defined as cerebral dysfunction due to toxin accumulation. If this occurs, renal replacement therapy, which is urgent dialysis, is essential for lowering the patient's mortality. We report a 48-year-old female patient with uncontrolled type 2 diabetes who presented with delirium, poor physical performance and muscle mass loss.
{"title":"Successful treatment of an urgent dialysis patient with uremic encephalopathy","authors":"F. P. Marthadinata, I. D. G. Amara Putra Wibawa, I. W. Sunaka","doi":"10.18203/2349-3933.ijam20232211","DOIUrl":"https://doi.org/10.18203/2349-3933.ijam20232211","url":null,"abstract":"Diabetes has become a global pandemic and is believed to be one of the most common risk factors for chronic kidney disease, which leads to end-stage renal disease, of which a significant number will develop, requiring renal replacement therapy. Uremic encephalopathy is the most frequent complication of untreated chronic kidney disease, is defined as cerebral dysfunction due to toxin accumulation. If this occurs, renal replacement therapy, which is urgent dialysis, is essential for lowering the patient's mortality. We report a 48-year-old female patient with uncontrolled type 2 diabetes who presented with delirium, poor physical performance and muscle mass loss.","PeriodicalId":13827,"journal":{"name":"International Journal of Advances in Medicine","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84668404","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}
Background: Patients with variceal gastrointestinal bleeding are very susceptible to bacterial infections. This study was designed to examine the effectiveness of ciprofloxacin and ceftriaxone in controlling in-hospital morbidity, mortality, and infection in variceal bleeding patients. Methods: From August 2010 to August 2012, an interventional randomized controlled clinical trial was conducted in the Department of Gastroenterology, East Medical Ward, Mayo Hospital, Lahore. Adult patients who were diagnosed to have gastroesophageal variceal bleeding after endoscopic examination were included. These patients were randomly distributed to 2 groups. Group ceftriaxone: receiving injection Ceftriaxone 1000 mg intravenously 12 hourly for 7 days, Group ciprofloxacin: receiving injection ciprofloxacin 200 mg intravenously 12 hourly for 7 days. Results: Most common viral etiology was Hepatitis C in both the study groups. It was observed that in the ceftriaxone group, 4.8% had rebleeding, while in the ciprofloxacin group 5.6% had rebleeding (p=0.77), one case each had porto-systemic encephalopathy (p=0.99), 0.8% in ceftriaxone group and 3.2% in ciprofloxacin group had spontaneous bacterial peritonitis (p=0.39) and 4.8% in ceftriaxone group and 8% in ciprofloxacin group had systemic inflammatory response syndrome (p=0.31). No patients died during one week follow up. Conclusions: From our study, it was concluded that ciprofloxacin and ceftriaxone had same efficacy when used intravenously for prevention of bacterial infection and improvement in mortality and morbidity in patient of variceal bleeding. Future multicentric studies are required with a longer patient follow to support our findings.
{"title":"Comparison of intravenous ceftriaxone and ciprofloxacin in prevention of infection in cirrhosis patients with variceal bleeding","authors":"Ramgobind Chaudhary, Ommara Jamil, Sandeep Raj Kunwar, M. Ayub, Shahid Sarwar, Tahira Murtaza Cheema","doi":"10.18203/2349-3933.ijam20232206","DOIUrl":"https://doi.org/10.18203/2349-3933.ijam20232206","url":null,"abstract":"Background: Patients with variceal gastrointestinal bleeding are very susceptible to bacterial infections. This study was designed to examine the effectiveness of ciprofloxacin and ceftriaxone in controlling in-hospital morbidity, mortality, and infection in variceal bleeding patients.\u0000Methods: From August 2010 to August 2012, an interventional randomized controlled clinical trial was conducted in the Department of Gastroenterology, East Medical Ward, Mayo Hospital, Lahore. Adult patients who were diagnosed to have gastroesophageal variceal bleeding after endoscopic examination were included. These patients were randomly distributed to 2 groups. Group ceftriaxone: receiving injection Ceftriaxone 1000 mg intravenously 12 hourly for 7 days, Group ciprofloxacin: receiving injection ciprofloxacin 200 mg intravenously 12 hourly for 7 days.\u0000Results: Most common viral etiology was Hepatitis C in both the study groups. It was observed that in the ceftriaxone group, 4.8% had rebleeding, while in the ciprofloxacin group 5.6% had rebleeding (p=0.77), one case each had porto-systemic encephalopathy (p=0.99), 0.8% in ceftriaxone group and 3.2% in ciprofloxacin group had spontaneous bacterial peritonitis (p=0.39) and 4.8% in ceftriaxone group and 8% in ciprofloxacin group had systemic inflammatory response syndrome (p=0.31). No patients died during one week follow up.\u0000Conclusions: From our study, it was concluded that ciprofloxacin and ceftriaxone had same efficacy when used intravenously for prevention of bacterial infection and improvement in mortality and morbidity in patient of variceal bleeding. Future multicentric studies are required with a longer patient follow to support our findings.","PeriodicalId":13827,"journal":{"name":"International Journal of Advances in Medicine","volume":"82 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76482681","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 : 2023-07-26DOI: 10.18203/2349-3933.ijam20232205
B. C. Pratikto, K. Suryana
Background: Acquired immunodeficiency syndrome (AIDS) is a syndrome of an opportunistic infectious disease due to decreased immune system by human immunodeficiency virus (HIV) infection. Neutrophil-lymphocyte ratio (NLR) and viral load were used to assess inflammatory status and the amount of HIV virus in the blood. This study aims to determine the association between NLR and viral load in HIV/AIDS patients with the opportunistic pulmonary infections. Methods: This study is an analytic observational study with a cross-sectional design. Data was collected through the medical records of HIV/AIDS patients at Wangaya General Hospital from January 2018 - April 2023. The data analysis method used was the Chi square test as bivariate tests. Results: A total of 139 subjects, the majority of HIV/AIDS patients who had opportunistic pulmonary infections were Balinese ethnicity (45.3%), female (37.6%), age ≥36 years old (54.7%), used ART for ≥3 months (41.5%), viral load <40 copies/ml, NLR ≥2.81 (47.9%), had adherence (43.7%), types of ART were used combination of tenofovir lamivudine efavirenz (45.2%), and private employed (42.5%). A statistically significant association was found between age with opportunistic pulmonary infections (p=0.003; PR=3.082; 95% CI=1.516-6.266). NLR showed a significant association with the incidence of opportunistic pulmonary infections (p=0.003; PR=8.274; 95% CI=1.838-37.249). This study also showed pulmonary tuberculosis (42.37%) as the most common opportunistic pulmonary infections. Conclusions: There is a significant association between NLR levels in HIV/AIDS patients with opportunistic pulmonary infections at Wangaya General Hospital, which the higher NLR levels correlates with higher opportunistic pulmonary infections.
背景:获得性免疫缺陷综合征(AIDS)是由于人类免疫缺陷病毒(HIV)感染导致免疫系统下降而引起的一种机会性传染病综合征。中性粒细胞-淋巴细胞比率(NLR)和病毒载量用于评估炎症状态和血液中HIV病毒的数量。本研究旨在确定HIV/AIDS伴机会性肺部感染患者NLR与病毒载量之间的关系。方法:本研究采用横断面设计的分析观察性研究。数据是通过Wangaya总医院2018年1月至2023年4月期间艾滋病毒/艾滋病患者的医疗记录收集的。数据分析采用卡方检验作为双变量检验。结果:139例受试者中，发生机会性肺部感染的HIV/AIDS患者以巴厘族(45.3%)、女性(37.6%)、年龄≥36岁(54.7%)、使用抗逆转录病毒治疗≥3个月(41.5%)、病毒载量<40拷贝/ml、NLR≥2.81(47.9%)、有依从性(43.7%)、抗逆转录病毒治疗类型为替诺福韦、雷米夫定、依非韦伦联合使用(45.2%)和私营企业(42.5%)。年龄与机会性肺部感染之间有统计学意义的关联(p=0.003;公关= 3.082;95% CI = 1.516 - -6.266)。NLR与机会性肺部感染发生率显著相关(p=0.003;公关= 8.274;95% CI = 1.838 - -37.249)。本研究还显示肺结核(42.37%)是最常见的机会性肺部感染。结论:Wangaya总医院HIV/AIDS患者的NLR水平与机会性肺部感染存在显著相关性，NLR水平越高，机会性肺部感染越高。
{"title":"Association between neutrophil-lymphocyte ratio and viral load with opportunistic pulmonary infections in human immunodeficiency virus/acquired immunodeficiency syndrome patients","authors":"B. C. Pratikto, K. Suryana","doi":"10.18203/2349-3933.ijam20232205","DOIUrl":"https://doi.org/10.18203/2349-3933.ijam20232205","url":null,"abstract":"Background: Acquired immunodeficiency syndrome (AIDS) is a syndrome of an opportunistic infectious disease due to decreased immune system by human immunodeficiency virus (HIV) infection. Neutrophil-lymphocyte ratio (NLR) and viral load were used to assess inflammatory status and the amount of HIV virus in the blood. This study aims to determine the association between NLR and viral load in HIV/AIDS patients with the opportunistic pulmonary infections.\u0000Methods: This study is an analytic observational study with a cross-sectional design. Data was collected through the medical records of HIV/AIDS patients at Wangaya General Hospital from January 2018 - April 2023. The data analysis method used was the Chi square test as bivariate tests.\u0000Results: A total of 139 subjects, the majority of HIV/AIDS patients who had opportunistic pulmonary infections were Balinese ethnicity (45.3%), female (37.6%), age ≥36 years old (54.7%), used ART for ≥3 months (41.5%), viral load <40 copies/ml, NLR ≥2.81 (47.9%), had adherence (43.7%), types of ART were used combination of tenofovir lamivudine efavirenz (45.2%), and private employed (42.5%). A statistically significant association was found between age with opportunistic pulmonary infections (p=0.003; PR=3.082; 95% CI=1.516-6.266). NLR showed a significant association with the incidence of opportunistic pulmonary infections (p=0.003; PR=8.274; 95% CI=1.838-37.249). This study also showed pulmonary tuberculosis (42.37%) as the most common opportunistic pulmonary infections.\u0000Conclusions: There is a significant association between NLR levels in HIV/AIDS patients with opportunistic pulmonary infections at Wangaya General Hospital, which the higher NLR levels correlates with higher opportunistic pulmonary infections.","PeriodicalId":13827,"journal":{"name":"International Journal of Advances in Medicine","volume":"42 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81688046","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 : 2023-07-26DOI: 10.18203/2349-3933.ijam20232204
M. Mazumder, Homayra Tahseen Hossain, T. Chowdhury, Ishrat Binte Reza, Quazi Audry Arafat, H. Ahasan
Background: COVID-19 emerged as one of the worst pandemics in human history in December 2019. Despite a relatively low infection rate in Bangladesh for seven weeks from mid-January, there were still 287 deaths in February, marking the lowest monthly death toll since May 2020. This study aimed to analyze the infection and outcomes of COVID-19 patients during the first and second waves in Bangladesh. Methods: This cross-sectional observational comparative study conducted at the Popular medical college hospital, 190 COVID patients were enrolled during the first wave (Mid-June to Mid-August 2020), and 179 COVID patients were enrolled during the second wave (Mid-March to Mid-April 21). Result: Mean age was 52.85±15.36 years in the first wave and 55.42±14.20 years in the second wave (p=0.097). Male patients predominated in both waves (p=0.082). Common symptoms, such as fever, cough, and respiratory distress, were similar. The second wave had a higher percentage of patients with diabetes. CRP levels increased in the first wave, while D-dimer levels were higher in the second wave. HRCT reports indicated minimal COVID-19 involvement. Most patients were discharged, with a small percentage referred to higher centers, and the mortality rate was not significant (p=0.600). Conclusions: The study highlights the differences in various factors related to COVID-19 between the first and second waves of COVID-19 in Bangladesh. Although the demographic status was similar in both waves, it provides valuable insights for medical consultations.
{"title":"Infection and outcome of COVID-19 affected patients during 1st and 2nd waves in Bangladesh: a hospital based comparative study","authors":"M. Mazumder, Homayra Tahseen Hossain, T. Chowdhury, Ishrat Binte Reza, Quazi Audry Arafat, H. Ahasan","doi":"10.18203/2349-3933.ijam20232204","DOIUrl":"https://doi.org/10.18203/2349-3933.ijam20232204","url":null,"abstract":"Background: COVID-19 emerged as one of the worst pandemics in human history in December 2019. Despite a relatively low infection rate in Bangladesh for seven weeks from mid-January, there were still 287 deaths in February, marking the lowest monthly death toll since May 2020. This study aimed to analyze the infection and outcomes of COVID-19 patients during the first and second waves in Bangladesh.\u0000Methods: This cross-sectional observational comparative study conducted at the Popular medical college hospital, 190 COVID patients were enrolled during the first wave (Mid-June to Mid-August 2020), and 179 COVID patients were enrolled during the second wave (Mid-March to Mid-April 21).\u0000Result: Mean age was 52.85±15.36 years in the first wave and 55.42±14.20 years in the second wave (p=0.097). Male patients predominated in both waves (p=0.082). Common symptoms, such as fever, cough, and respiratory distress, were similar. The second wave had a higher percentage of patients with diabetes. CRP levels increased in the first wave, while D-dimer levels were higher in the second wave. HRCT reports indicated minimal COVID-19 involvement. Most patients were discharged, with a small percentage referred to higher centers, and the mortality rate was not significant (p=0.600).\u0000Conclusions: The study highlights the differences in various factors related to COVID-19 between the first and second waves of COVID-19 in Bangladesh. Although the demographic status was similar in both waves, it provides valuable insights for medical consultations.","PeriodicalId":13827,"journal":{"name":"International Journal of Advances in Medicine","volume":"205 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90369853","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 : 2023-07-26DOI: 10.18203/2349-3933.ijam20232208
M. S. Visnudas, J. Edwin, T. Viswanathan
Background: Premature coronary artery disease (PCAD) is associated with a high rate of ischemic recurrence and mortality, causing a significant impact on public health. The present study focuses on the assessment of the risk factors, clinical presentation, angiographic profiling considering severity, and management of extremely young adults (aged ≤45 years) affected with first ST elevation acute myocardial infarction (STEMI). Methods: The current study (cross-section) was carried out among 94 consecutive patients with STEMI. The study on patients was carried out between January 2022 and June 2022 at Tirunelveli Medical College Hospital, department of cardiology. Results: This study involved 94 patients with a mean age of 37.80 years, 8.5% <25, and 84.9% male patients. Risk factors included smoking, being overweight, diabetes, hypertension, chest pain, syncope, and obstructive coronary artery disease (CAD). The most common symptom was chest pain (98.9%). Left anterior descending (LAD) was the most common culprit artery (26.1%), and ostial LAD was (3.2%). Percutaneous coronary intervention (PCI) was done in 53.2% of patients, elective PCI was 26.6%, pharma co-invasive PCI was 24.5%, and primary PCI was 2.1%. The patient was referred to coronary artery bypass grafting was 10.6%. 23.4% of patients had recanalized and normal coronaries, and 36% received medical management. No mortality occurred in this study. Conclusions: Most commonly, AMI is found in very young male adults, and smoking is the commonly associated risk factor. LAD artery involvement was the leading cause of AWMI and the most common presentation observed.
{"title":"Clinical and coronary angiographic profiling in young patient with acute ST-elevation myocardial infarction admitted in cardiac critical care unit of tertiary care centre at south Tamil Nadu","authors":"M. S. Visnudas, J. Edwin, T. Viswanathan","doi":"10.18203/2349-3933.ijam20232208","DOIUrl":"https://doi.org/10.18203/2349-3933.ijam20232208","url":null,"abstract":"Background: Premature coronary artery disease (PCAD) is associated with a high rate of ischemic recurrence and mortality, causing a significant impact on public health. The present study focuses on the assessment of the risk factors, clinical presentation, angiographic profiling considering severity, and management of extremely young adults (aged ≤45 years) affected with first ST elevation acute myocardial infarction (STEMI).\u0000Methods: The current study (cross-section) was carried out among 94 consecutive patients with STEMI. The study on patients was carried out between January 2022 and June 2022 at Tirunelveli Medical College Hospital, department of cardiology.\u0000Results: This study involved 94 patients with a mean age of 37.80 years, 8.5% <25, and 84.9% male patients. Risk factors included smoking, being overweight, diabetes, hypertension, chest pain, syncope, and obstructive coronary artery disease (CAD). The most common symptom was chest pain (98.9%). Left anterior descending (LAD) was the most common culprit artery (26.1%), and ostial LAD was (3.2%). Percutaneous coronary intervention (PCI) was done in 53.2% of patients, elective PCI was 26.6%, pharma co-invasive PCI was 24.5%, and primary PCI was 2.1%. The patient was referred to coronary artery bypass grafting was 10.6%. 23.4% of patients had recanalized and normal coronaries, and 36% received medical management. No mortality occurred in this study.\u0000Conclusions: Most commonly, AMI is found in very young male adults, and smoking is the commonly associated risk factor. LAD artery involvement was the leading cause of AWMI and the most common presentation observed.","PeriodicalId":13827,"journal":{"name":"International Journal of Advances in Medicine","volume":"97 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85058776","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 : 2023-07-26DOI: 10.18203/2349-3933.ijam20232212
Uzzawal Kanti Das, A. Sohrabuzzaman
Arrhythmogenic cardiomyopathy (ACM) is a progressive genetic disease of the myocardium characterized by loss of myocardial cells and replacement by fibrofatty tissue in the right and/or left ventricle (RV/LV), clinically manifested by syncope, palpitations, heart failure, or sudden cardiac death (SCD). We presented a case where the patient suffered from palpitations for the previous three to four years, which resolved spontaneously each time and lately presented with persistent palpitations and chest discomfort. ECG showed a widening of the QRS complexes during sinus rhythm and premature complexes (PVCs) of various patterns. After initial evaluation cardiac MRI was done which revealed typical features of arrhythmogenic right ventricular dysplasia/ cardiomyopathy. The patient was continuing amiodarone 100 mg daily and doing well.
{"title":"Arrhythmogenic right ventricular cardiomyopathy or dysplasia: a case report","authors":"Uzzawal Kanti Das, A. Sohrabuzzaman","doi":"10.18203/2349-3933.ijam20232212","DOIUrl":"https://doi.org/10.18203/2349-3933.ijam20232212","url":null,"abstract":"Arrhythmogenic cardiomyopathy (ACM) is a progressive genetic disease of the myocardium characterized by loss of myocardial cells and replacement by fibrofatty tissue in the right and/or left ventricle (RV/LV), clinically manifested by syncope, palpitations, heart failure, or sudden cardiac death (SCD). We presented a case where the patient suffered from palpitations for the previous three to four years, which resolved spontaneously each time and lately presented with persistent palpitations and chest discomfort. ECG showed a widening of the QRS complexes during sinus rhythm and premature complexes (PVCs) of various patterns. After initial evaluation cardiac MRI was done which revealed typical features of arrhythmogenic right ventricular dysplasia/ cardiomyopathy. The patient was continuing amiodarone 100 mg daily and doing well.","PeriodicalId":13827,"journal":{"name":"International Journal of Advances in Medicine","volume":"135 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76684491","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 : 2023-07-26DOI: 10.18203/2349-3933.ijam20232213
Sonia E. Salim, K. Suryana
Hiccup known as innocuous symptom and usually self-limiting within seconds or minutes. The process of hiccup related to involuntary movement, intermitent and repetitive contractions of diaphragm and lead to abrupt early closure of glottis. We report a case of 57-year-old man with 5 days chronic hiccup, following with coughing, nausea, vomiting and seizure. Patient was hospitalized 4 days and getting better after given antibiotic, proton pump inhibitor (PPI) therapy and symptomatic drug due to hiccup.
{"title":"What to do when hiccups are coming? A case report","authors":"Sonia E. Salim, K. Suryana","doi":"10.18203/2349-3933.ijam20232213","DOIUrl":"https://doi.org/10.18203/2349-3933.ijam20232213","url":null,"abstract":"Hiccup known as innocuous symptom and usually self-limiting within seconds or minutes. The process of hiccup related to involuntary movement, intermitent and repetitive contractions of diaphragm and lead to abrupt early closure of glottis. We report a case of 57-year-old man with 5 days chronic hiccup, following with coughing, nausea, vomiting and seizure. Patient was hospitalized 4 days and getting better after given antibiotic, proton pump inhibitor (PPI) therapy and symptomatic drug due to hiccup.","PeriodicalId":13827,"journal":{"name":"International Journal of Advances in Medicine","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75880128","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 : 2023-07-07DOI: 10.18203/2349-3933.ijam20232150
Rajeev Garg
Management of hypertension is complex in patients with comorbid conditions and in those who are at high cardiovascular risk. Multiple guidelines recommend different treatment goals and therapeutic approaches for hypertension. In this review, we take an individualized management approach for hypertension with comorbidities mainly diabetes and chronic kidney disease (CKD), coronary artery disease, and for young patients and the elderly. Current evidence indicates a blood pressure goal of <130/80 mmHg for most patients with comorbidities except for the elderly aged >75 years in whom systolic pressure of 130-139 mmHg and diastolic pressure of 70-80 mmHg may be considered. For patients with diabetes and CKD, renin angiotensin aldosterone system (RAAS) inhibitors remain the initial choice of agents whereas in the young or elderly, any class including RAAS inhibitors, calcium channel blockers, and thiazide diuretics may be preferred. Special consideration is necessary for the elderly concerning the possible side effects of each drug class. In the presence of additional risk factors, an individualized approach is necessary to tailor the most effective therapy as per patient needs. Thus, in treating hypertension, a multipronged but individualized approach is necessary to optimize blood pressure control and clinical outcomes in the real-world setting.
{"title":"Individualization of hypertension treatment: an expert review","authors":"Rajeev Garg","doi":"10.18203/2349-3933.ijam20232150","DOIUrl":"https://doi.org/10.18203/2349-3933.ijam20232150","url":null,"abstract":"Management of hypertension is complex in patients with comorbid conditions and in those who are at high cardiovascular risk. Multiple guidelines recommend different treatment goals and therapeutic approaches for hypertension. In this review, we take an individualized management approach for hypertension with comorbidities mainly diabetes and chronic kidney disease (CKD), coronary artery disease, and for young patients and the elderly. Current evidence indicates a blood pressure goal of <130/80 mmHg for most patients with comorbidities except for the elderly aged >75 years in whom systolic pressure of 130-139 mmHg and diastolic pressure of 70-80 mmHg may be considered. For patients with diabetes and CKD, renin angiotensin aldosterone system (RAAS) inhibitors remain the initial choice of agents whereas in the young or elderly, any class including RAAS inhibitors, calcium channel blockers, and thiazide diuretics may be preferred. Special consideration is necessary for the elderly concerning the possible side effects of each drug class. In the presence of additional risk factors, an individualized approach is necessary to tailor the most effective therapy as per patient needs. Thus, in treating hypertension, a multipronged but individualized approach is necessary to optimize blood pressure control and clinical outcomes in the real-world setting.","PeriodicalId":13827,"journal":{"name":"International Journal of Advances in Medicine","volume":"115 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76147383","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}
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