Pub Date : 2023-01-01DOI: 10.4103/injms.injms_39_23
AnshuGupta Devra, Gurleen Gill
The COVID-19 pandemic has changed the entire perspective of health-care scenario globally. Our fight against this virus is to enable ourselves to recognize early warning signs or biomarkers in those infected so that they can be allocated adequate health-care resources to decrease mortality and morbidity. It was for this reason that we analyzed the hematological parameter neutrophil-to-lymphocyte ratio (NLR) and inflammatory biomarker cytokine interleukin (IL)-6 to evaluate whether they can be used to predict the severity of COVID-19 infection and also to study if any significant association exist between the two. These parameters can be easily analyzed even in primary health-care setting to effectively triage patients requiring tertiary care/L-3 facilities. This study was conducted on 100 reverse transcription–polymerase chain reaction confirmed COVID-positive patients. The patients were then categorized into mild, moderate, and severe COVID at the time of admission according to the criteria laid down by symptoms and SpO2 levels at room air as defined by ICMR COVID guidelines by the Ministry of Health and Family Welfare[1] (MOHFW), Government of India, revised on January 14, 2022 – Mild disease – Upper respiratory tract symptoms and/or fever without shortness of breath or hypoxia Moderate disease – Any one of: Respiratory rate ≥24/min, SpO2: 90% to ≤93% on room air Severe disease – Any one of: Respiratory rate >30/min, SpO2 <90% on room air. For ease of comparison and to effectively evaluate high-risk patients, mild and moderate categories were clubbed together into nonsevere as they can be managed in L-2 facility. However, those falling in the severe category require L-3 facilities with advanced infrastructure and ICU facilities and are, therefore, categorized separately. Levels of IL-6 and NLR were compared between the two groups. NLR was derived by dividing the percentage of neutrophils to the percentage of lymphocytes after calculating differential leukocyte count taking the normal upper limit of NLR as 3.5, as identified by Forget et al.[2] for the adult nongeriatric population in good health.[2] The mean value of NLR in mild, moderate, and severe categories was 3.9, 3.1, and 6.7, respectively. On combining mild and moderate categories as nonsevere, the mean values of NLR obtained were 3.7, almost half of the NLR mean values observed in the severe category, i.e., 6.7. On applying the analysis of variance (ANOVA) t-test, a significant statistical correlation (P = 0.016) of NLR was found with clinical severity. Cytokine IL-6 is an inflammatory cytokine that has a role in different pathological conditions such as infections, inflammations, and in cancers. IL-6 is also considered the main culprit responsible for hyperinflammation, causing lung damage and eventually death in severe cases of COVID-19. The normal upper limit for IL-6 was set as 7 pg/ml. Out of 100 patients, those in the mild category had mean IL-6 levels of 30.8 pg/ml, moderate pat
{"title":"Role of interleukin-6 levels in predicting COVID severity: A single-center experience","authors":"AnshuGupta Devra, Gurleen Gill","doi":"10.4103/injms.injms_39_23","DOIUrl":"https://doi.org/10.4103/injms.injms_39_23","url":null,"abstract":"The COVID-19 pandemic has changed the entire perspective of health-care scenario globally. Our fight against this virus is to enable ourselves to recognize early warning signs or biomarkers in those infected so that they can be allocated adequate health-care resources to decrease mortality and morbidity. It was for this reason that we analyzed the hematological parameter neutrophil-to-lymphocyte ratio (NLR) and inflammatory biomarker cytokine interleukin (IL)-6 to evaluate whether they can be used to predict the severity of COVID-19 infection and also to study if any significant association exist between the two. These parameters can be easily analyzed even in primary health-care setting to effectively triage patients requiring tertiary care/L-3 facilities. This study was conducted on 100 reverse transcription–polymerase chain reaction confirmed COVID-positive patients. The patients were then categorized into mild, moderate, and severe COVID at the time of admission according to the criteria laid down by symptoms and SpO2 levels at room air as defined by ICMR COVID guidelines by the Ministry of Health and Family Welfare[1] (MOHFW), Government of India, revised on January 14, 2022 – Mild disease – Upper respiratory tract symptoms and/or fever without shortness of breath or hypoxia Moderate disease – Any one of: Respiratory rate ≥24/min, SpO2: 90% to ≤93% on room air Severe disease – Any one of: Respiratory rate >30/min, SpO2 <90% on room air. For ease of comparison and to effectively evaluate high-risk patients, mild and moderate categories were clubbed together into nonsevere as they can be managed in L-2 facility. However, those falling in the severe category require L-3 facilities with advanced infrastructure and ICU facilities and are, therefore, categorized separately. Levels of IL-6 and NLR were compared between the two groups. NLR was derived by dividing the percentage of neutrophils to the percentage of lymphocytes after calculating differential leukocyte count taking the normal upper limit of NLR as 3.5, as identified by Forget et al.[2] for the adult nongeriatric population in good health.[2] The mean value of NLR in mild, moderate, and severe categories was 3.9, 3.1, and 6.7, respectively. On combining mild and moderate categories as nonsevere, the mean values of NLR obtained were 3.7, almost half of the NLR mean values observed in the severe category, i.e., 6.7. On applying the analysis of variance (ANOVA) t-test, a significant statistical correlation (P = 0.016) of NLR was found with clinical severity. Cytokine IL-6 is an inflammatory cytokine that has a role in different pathological conditions such as infections, inflammations, and in cancers. IL-6 is also considered the main culprit responsible for hyperinflammation, causing lung damage and eventually death in severe cases of COVID-19. The normal upper limit for IL-6 was set as 7 pg/ml. Out of 100 patients, those in the mild category had mean IL-6 levels of 30.8 pg/ml, moderate pat","PeriodicalId":43811,"journal":{"name":"Indian Journal of Medical Specialities","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135844878","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: 10.4103/injms.injms_28_23
Mansi Soni, Balaganapathy Muruganantham
Introduction: Physical activity is proven to have beneficial effects in the prevention and management of stroke. This makes it an important modifiable risk factor Stroke is a condition resulting in various functional deficits. The higher functional ability of stroke patients may result in their higher physical activity. Gait speed is a functional parameter to differentiate between the ability of mobility of patients with stroke. However, if it is reflected in the time spent in an activity needs to be explored. Objectives: This pilot study attempts to explore time spent in PA by ambulatory stroke patients and compare time spent in different activity levels based on gait speed. Subjects and Methods: This pilot study recruited 26 ambulatory patients with stroke after obtaining informed consent. Their PA was recorded with ActiGraph wGT3X-BT for 1 day. Differences in time spent in the different level of PA were compared between people with gait speed ≤0.49 m/s and >0.49 m/s. Results: The result of the study shows that patients with stroke having gait speed ≤0.49 m/s had higher time spent in sedentary (686.02 ± 80.35 min/day) and light activity (612 ± 69.84 min/day) as compared to those with >0.49 m/s (646.42 ± 137.52 min/day and 593.57 ± 119.95 min/day, respectively). While time spent in moderate activity was higher in patients with stroke having gait speed >0.49 m/s (199.73 ± 111.17 min/day) as compared to those whose gait speed was ≤0.49 m/s (141.84 ± 76.75 min/day). However, this difference failed to demonstrate statistical significance. Conclusion: Patients with stroke were less physically active as compared to recommendations. Gait speed-based comparison demonstrates a nonsignificant difference between both groups. This suggests that factors other than gait speed may contribute to ambulatory stroke patients’ time spent in PA.
{"title":"Time spent in physical activity by ambulatory stroke patients and its comparison based on gait speed – A pilot study","authors":"Mansi Soni, Balaganapathy Muruganantham","doi":"10.4103/injms.injms_28_23","DOIUrl":"https://doi.org/10.4103/injms.injms_28_23","url":null,"abstract":"Introduction: Physical activity is proven to have beneficial effects in the prevention and management of stroke. This makes it an important modifiable risk factor Stroke is a condition resulting in various functional deficits. The higher functional ability of stroke patients may result in their higher physical activity. Gait speed is a functional parameter to differentiate between the ability of mobility of patients with stroke. However, if it is reflected in the time spent in an activity needs to be explored. Objectives: This pilot study attempts to explore time spent in PA by ambulatory stroke patients and compare time spent in different activity levels based on gait speed. Subjects and Methods: This pilot study recruited 26 ambulatory patients with stroke after obtaining informed consent. Their PA was recorded with ActiGraph wGT3X-BT for 1 day. Differences in time spent in the different level of PA were compared between people with gait speed ≤0.49 m/s and >0.49 m/s. Results: The result of the study shows that patients with stroke having gait speed ≤0.49 m/s had higher time spent in sedentary (686.02 ± 80.35 min/day) and light activity (612 ± 69.84 min/day) as compared to those with >0.49 m/s (646.42 ± 137.52 min/day and 593.57 ± 119.95 min/day, respectively). While time spent in moderate activity was higher in patients with stroke having gait speed >0.49 m/s (199.73 ± 111.17 min/day) as compared to those whose gait speed was ≤0.49 m/s (141.84 ± 76.75 min/day). However, this difference failed to demonstrate statistical significance. Conclusion: Patients with stroke were less physically active as compared to recommendations. Gait speed-based comparison demonstrates a nonsignificant difference between both groups. This suggests that factors other than gait speed may contribute to ambulatory stroke patients’ time spent in PA.","PeriodicalId":43811,"journal":{"name":"Indian Journal of Medical Specialities","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135845190","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}
Hypotensive anesthesia in specific types of surgeries brings about certain advantages such as decreased blood loss as well as better surgeon satisfaction regarding the surgical field. Of the various modalities by which this can be achieved, one of the most popular is by introducing a hypotensive agent to bring about the desired hypotension. Here, we aim to review a few studies regarding the use of various hypotensive agents for hypotensive anesthesia and try to come to learn the various modes of action of these said drugs, their specific indications or situations where they may be preferred as well as the various advantages and disadvantages that accompany their use.
{"title":"Drugs for hypotensive anesthesia: A narrative review","authors":"TKrishna Prasad, RobinSajan Chacko, KSoundarya Priyadharsini","doi":"10.4103/injms.injms_18_23","DOIUrl":"https://doi.org/10.4103/injms.injms_18_23","url":null,"abstract":"Hypotensive anesthesia in specific types of surgeries brings about certain advantages such as decreased blood loss as well as better surgeon satisfaction regarding the surgical field. Of the various modalities by which this can be achieved, one of the most popular is by introducing a hypotensive agent to bring about the desired hypotension. Here, we aim to review a few studies regarding the use of various hypotensive agents for hypotensive anesthesia and try to come to learn the various modes of action of these said drugs, their specific indications or situations where they may be preferred as well as the various advantages and disadvantages that accompany their use.","PeriodicalId":43811,"journal":{"name":"Indian Journal of Medical Specialities","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135845192","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: 10.4103/injms.injms_98_22
Khyati Thapliyal, A. Garg, Vivek Singh
Nausea and vomiting constitute one of the most common presenting symptoms in a variety of diseases in clinical practice. Recurrent vomiting can be due to simple gastritis which may lead to dehydration and electrolyte disturbances to threatening intracranial hypertension. Prolonged recurrent vomiting can also lead to malnutrition. Esophageal dysmotility is usually associated with dysphagia but is infrequently associated with recurrent vomiting. We report a case of acute-onset intractable vomiting in a 50-year-old Indian female who presented with severe dehydration and hypernatremia. A timed barium esophagogram revealed dilated esophagus with a rat-tail appearance. Upper gastrointestinal endoscopy revealed dilated esophagus with a tight esophageal-gastric junction. With a diagnosis of achalasia cardia, the patient underwent peroral endoscopic myotomy with complete resolution of symptoms.
{"title":"Intractable vomiting: An interesting case","authors":"Khyati Thapliyal, A. Garg, Vivek Singh","doi":"10.4103/injms.injms_98_22","DOIUrl":"https://doi.org/10.4103/injms.injms_98_22","url":null,"abstract":"Nausea and vomiting constitute one of the most common presenting symptoms in a variety of diseases in clinical practice. Recurrent vomiting can be due to simple gastritis which may lead to dehydration and electrolyte disturbances to threatening intracranial hypertension. Prolonged recurrent vomiting can also lead to malnutrition. Esophageal dysmotility is usually associated with dysphagia but is infrequently associated with recurrent vomiting. We report a case of acute-onset intractable vomiting in a 50-year-old Indian female who presented with severe dehydration and hypernatremia. A timed barium esophagogram revealed dilated esophagus with a rat-tail appearance. Upper gastrointestinal endoscopy revealed dilated esophagus with a tight esophageal-gastric junction. With a diagnosis of achalasia cardia, the patient underwent peroral endoscopic myotomy with complete resolution of symptoms.","PeriodicalId":43811,"journal":{"name":"Indian Journal of Medical Specialities","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44760887","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}
Herpes simplex virus (HSV) encephalitis remains one of the more severe forms of childhood encephalitis. The clinical course of HSV encephalitis is usually monophasic but occasionally complicated by a clinical relapse, causing biphasic illness. Sometimes relapse may be due to secondary immune mechanisms. Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is an example of immune-mediated relapse following herpes encephalitis. This is still underrecognized, with probable grave consequences if not treated early. Our index case was an 8-year-old male child with severe generalized choreoathetosis and behavioral disturbances, presented 4 weeks after documented HSV encephalitis. Cerebrospinal fluid (CSF) was positive for anti-NMDA receptor antibodies. The diagnosis was confirmed and treated with intravenous (IV) immunoglobulins (2 g/kg) and IV pulse-dose methylprednisolone (30 mg/kg) for 5 days. Other supportive management included tablet revocon 25 mg (tetrabenazine) ¼ tablet BD, clonazepam 0.25 mg one tablet BD, and syrup sizodon (risperidone) 0.5 mg BD. The patient is on regular follow-up and is recovering well but slowly. Patients with relapsing symptoms following HSV encephalitis or prolonged atypical symptoms, with repeat CSF-negative polymerase chain reaction for HSV should routinely be tested for NMDA receptor immunoglobulin G antibodies in CSF and/or serum. It is important to be aware of this differential diagnosis because patients respond well to immunotherapy.
{"title":"Anti-N-methyl-D-Aspartate-Receptor encephalitis following herpes simplex virus encephalitis – Presenting as a pediatric patient with abnormal movements and psychiatric manifestation","authors":"Sravani Kolla, Lokeswari Balleda, Chandrasekhara Thimmapuram","doi":"10.4103/injms.injms_127_22","DOIUrl":"https://doi.org/10.4103/injms.injms_127_22","url":null,"abstract":"Herpes simplex virus (HSV) encephalitis remains one of the more severe forms of childhood encephalitis. The clinical course of HSV encephalitis is usually monophasic but occasionally complicated by a clinical relapse, causing biphasic illness. Sometimes relapse may be due to secondary immune mechanisms. Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is an example of immune-mediated relapse following herpes encephalitis. This is still underrecognized, with probable grave consequences if not treated early. Our index case was an 8-year-old male child with severe generalized choreoathetosis and behavioral disturbances, presented 4 weeks after documented HSV encephalitis. Cerebrospinal fluid (CSF) was positive for anti-NMDA receptor antibodies. The diagnosis was confirmed and treated with intravenous (IV) immunoglobulins (2 g/kg) and IV pulse-dose methylprednisolone (30 mg/kg) for 5 days. Other supportive management included tablet revocon 25 mg (tetrabenazine) ¼ tablet BD, clonazepam 0.25 mg one tablet BD, and syrup sizodon (risperidone) 0.5 mg BD. The patient is on regular follow-up and is recovering well but slowly. Patients with relapsing symptoms following HSV encephalitis or prolonged atypical symptoms, with repeat CSF-negative polymerase chain reaction for HSV should routinely be tested for NMDA receptor immunoglobulin G antibodies in CSF and/or serum. It is important to be aware of this differential diagnosis because patients respond well to immunotherapy.","PeriodicalId":43811,"journal":{"name":"Indian Journal of Medical Specialities","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42258618","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: 10.4103/injms.injms_99_23
FalahHasan Obayes Al-Khikani, AalaeSalman Ayit
Dear Editor, The pathogenic bacteria and fungi developed resistance to multiple antibiotics, making them difficult to treat with standard therapies. Hence, using alternative strategies such as strong carbol fuchsin (SCF) dye to treat them is urgent.[1] SCF is a red-colored dye commonly used in histology to stain biological tissues and microorganisms. SCF has a high affinity for acidic structures such as nucleic acids and polysaccharides, making it useful for staining cell nuclei and cartilage. It is also used in Gram staining to differentiate bacteria based on their cell wall composition. Gram-positive bacteria retain the stain, while Gram-negative bacteria do not.[2] Candida albicans were isolated from three sites (vagina, oral, and urine) in 30 patients and cultured in Sabouraud dextrose agar and confirmed by germ tube test. A total of 30 Staphylococcus aureus and Pseudomonas aeruginosa were isolated from wounds by culturing the specimens in three media (Blood Agar, MacConkey’s agar, and Mannitol Salt agar). The well diffusion method is used to evaluate the activity of SCF; the diameter of the inhibited growth is measured in millimeters. It is considered sensitive when the inhibition zone is >13 mm. All the statistical analysis was performed using SPSS 26 software (SPSS Inc., Chicago, USA). All 30 isolates of C. albicans showed 100% sensitivity to SCF, while 96.7% of bacterial isolates were sensitive to SCF [Figure 1]. The mean of the inhibition zone for C. albicans was 19.17 ± 2.37 mm, whereas for bacteria was 22.37 ± 5.63 mm with significant differences (P = 0.006) [Table 1]. That means bacteria are more susceptible to SCF than yeast with large inhibition zone.Figure 1: Antimicrobial activity of strong carbol fuchsinTable 1: The mean of inhibition zone of strong carbol fuchsin for bacteria and yeastAnother study found 100% efficacy of safranin against Gram-positive bacteria (S. aureus) but only 20% sensitivity against Gram-negative bacteria (P. aeruginosa).[3] Only a few researchers have looked at SCF’s antibacterial activity against microorganisms. On Fusobacterium nucleatum and Porphyromonas gingivalis, photodynamic therapy with Safranine O had a pronounced antibacterial effect. Streptococcus gordonii, on the other hand, was fully eradicated.[4] Another study, however, found that certain strains of bacteria could develop resistance to safranin over time when exposed to the dye in laboratory cultures.[5] The percentage of resistance and sensitivity of organisms differ depending on a number of factors, including the concentration of the dye, the strain of the pathogen being tested, and the conditions under which the microorganism are grown and tested.[6] CONCLUSION The bacteria (S. aureus and P. aeruginosa) 22.37 ± 5.63 mm are more susceptible to SCF than C. albicans 19.17 ± 2.37 mm significantly (P = 0.006). Financial support and sponsorship None. Conflicts of interest There are no conflicts of interest.
{"title":"Is there significant difference in the activity of strong carbol fuchsin against bacteria and fungi?","authors":"FalahHasan Obayes Al-Khikani, AalaeSalman Ayit","doi":"10.4103/injms.injms_99_23","DOIUrl":"https://doi.org/10.4103/injms.injms_99_23","url":null,"abstract":"Dear Editor, The pathogenic bacteria and fungi developed resistance to multiple antibiotics, making them difficult to treat with standard therapies. Hence, using alternative strategies such as strong carbol fuchsin (SCF) dye to treat them is urgent.[1] SCF is a red-colored dye commonly used in histology to stain biological tissues and microorganisms. SCF has a high affinity for acidic structures such as nucleic acids and polysaccharides, making it useful for staining cell nuclei and cartilage. It is also used in Gram staining to differentiate bacteria based on their cell wall composition. Gram-positive bacteria retain the stain, while Gram-negative bacteria do not.[2] Candida albicans were isolated from three sites (vagina, oral, and urine) in 30 patients and cultured in Sabouraud dextrose agar and confirmed by germ tube test. A total of 30 Staphylococcus aureus and Pseudomonas aeruginosa were isolated from wounds by culturing the specimens in three media (Blood Agar, MacConkey’s agar, and Mannitol Salt agar). The well diffusion method is used to evaluate the activity of SCF; the diameter of the inhibited growth is measured in millimeters. It is considered sensitive when the inhibition zone is >13 mm. All the statistical analysis was performed using SPSS 26 software (SPSS Inc., Chicago, USA). All 30 isolates of C. albicans showed 100% sensitivity to SCF, while 96.7% of bacterial isolates were sensitive to SCF [Figure 1]. The mean of the inhibition zone for C. albicans was 19.17 ± 2.37 mm, whereas for bacteria was 22.37 ± 5.63 mm with significant differences (P = 0.006) [Table 1]. That means bacteria are more susceptible to SCF than yeast with large inhibition zone.Figure 1: Antimicrobial activity of strong carbol fuchsinTable 1: The mean of inhibition zone of strong carbol fuchsin for bacteria and yeastAnother study found 100% efficacy of safranin against Gram-positive bacteria (S. aureus) but only 20% sensitivity against Gram-negative bacteria (P. aeruginosa).[3] Only a few researchers have looked at SCF’s antibacterial activity against microorganisms. On Fusobacterium nucleatum and Porphyromonas gingivalis, photodynamic therapy with Safranine O had a pronounced antibacterial effect. Streptococcus gordonii, on the other hand, was fully eradicated.[4] Another study, however, found that certain strains of bacteria could develop resistance to safranin over time when exposed to the dye in laboratory cultures.[5] The percentage of resistance and sensitivity of organisms differ depending on a number of factors, including the concentration of the dye, the strain of the pathogen being tested, and the conditions under which the microorganism are grown and tested.[6] CONCLUSION The bacteria (S. aureus and P. aeruginosa) 22.37 ± 5.63 mm are more susceptible to SCF than C. albicans 19.17 ± 2.37 mm significantly (P = 0.006). Financial support and sponsorship None. Conflicts of interest There are no conflicts of interest.","PeriodicalId":43811,"journal":{"name":"Indian Journal of Medical Specialities","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135844881","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: 10.4103/injms.injms_37_23
S Parthasarathy, BalasubramaniyanAmirtha Ganesh
Dear Editor, We report an asymptomatic pregnant woman with Chiari network defect in a routine echocardiogram. The intricacies are discussed. Hans Chiari explained abnormal fibrous lace-like strands spanning from the inferior vena cava (IVC) or coronary sinus valve margins to the crista terminalis region in 1897. He inspired the name of the network. The Chiari network is formed by the incomplete resorption of the right sinus venous valve. It is a congenital abnormality that occurs during fetal development and is relatively uncommon, affecting <2% of the general population.[1] Although it rarely causes symptoms or health problems, it can be observed during regular echocardiography. Antenatal maternal echocardiography is not recommended. However due to enlarging uterus and concomitant anemia, the mothers may have dyspnoea on exertion.[2] This prompts many obstetricians to recommend echocardiograms in otherwise normal mothers. A 27-year-old primigravida with 34 weeks of gestation came to us for a routine echocardiogram. Clinically she was normal with basic investigations within normal limits. We discovered a whip-like structure extending from the IVC opening and freely moving within the right atrial cavity [Figure 1]. There was a trivial mitral regurgitation. The left ventricular and right ventricular functions were normal with normal pulmonary pressure. There was neither an atrial aneurysm nor patent foramen ovale. A clinical diagnosis of the Chiari network was made and the essentially benign nature of the disease was clearly explained and any element of anxiety was taken care of [Video 1].Figure 1: Showing the chiari network(arrow) {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video Clip 1","caption":"","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_0lknfh8h"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} In most cases, the Chiari network causes no complications or health issues. However, it can increase the risk of certain conditions in some cases, such as: Blood clots: The Chiari network can start causing chaos in the blood flow, which could also lead to the formation of blood clots, leading to complications such as stroke or pulmonary embolism. Infective endocarditis: The presence of the Chiari network can make the heart more vulnerable to bacterial infection, leading to infective endocarditis, a potentially fatal condition. Cardiac arrhythmias: The Chiari network can disrupt the electrical activity of the heart, causing arrhythmias. Right heart valve or blood vessel obstruction: the Chiari network can cause the above complication resulting in symptoms such as dyspnoea, fatigue, and chest pain. It is worth noting that these side effects are uncommon and affect only a small percentage of people with Chiari network.[3] Most people with this condition have no major medical
亲爱的编辑，我们报告一位无症状的孕妇，在常规超声心动图中有基亚里神经网络缺陷。讨论了其中的复杂性。Hans Chiari在1897年解释了从下腔静脉(IVC)或冠状窦瓣膜边缘到终嵴区域的异常纤维花边状链。他启发了这个网络的名字。Chiari网络是由右窦静脉瓣的不完全吸收形成的。它是一种在胎儿发育过程中发生的先天性异常，相对罕见，影响不到2%的一般人群。[1]虽然它很少引起症状或健康问题，但可以在常规超声心动图中观察到。不建议进行产前超声心动图检查。然而，由于子宫扩大和伴随的贫血，母亲在用力时可能出现呼吸困难。[2]这促使许多产科医生建议在其他方面正常的母亲进行超声心动图检查。一位27岁妊娠34周的初产妇来做常规超声心动图检查。临床表现正常，基本检查在正常范围内。我们发现一个鞭状结构从下腔静脉开口延伸，并在右心房腔内自由移动[图1]。有轻微的二尖瓣反流。左、右心室功能正常，肺动脉压正常。无房动脉瘤，无卵圆孔未闭。对Chiari网络作出临床诊断，并清楚解释该疾病本质上是良性的，任何焦虑因素都得到了处理[视频1]。图1:显示chiari网络(箭头){"href":"Single Video Player"，"role":"media-player-id"，"content-type":"play-in-place"，"position":"float"，"orientation":"portrait"，"label":"Video Clip 1"，"caption":""，"object-id":[{"pub-id-type":"doi"，"id":"" "}，{"pub-id-type":"other"，"content-type":"media-stream-id"，"id":"1_0lknfh8h"}，{"pub-id-type":"other"，"content-type":"media-source"，"id":"Kaltura"}]}在大多数情况下，chiari网络不会引起并发症或健康问题。然而，在某些情况下，它会增加某些疾病的风险，比如:血栓:基亚里神经网络会开始导致血液流动混乱，这也可能导致血栓的形成，导致中风或肺栓塞等并发症。感染性心内膜炎:Chiari网络的存在使心脏更容易受到细菌感染，导致感染性心内膜炎，这是一种潜在的致命疾病。心律失常:Chiari神经网络可以扰乱心脏的电活动，导致心律失常。右心瓣膜或血管阻塞:Chiari网络可引起上述并发症，导致呼吸困难、疲劳和胸痛等症状。值得注意的是，这些副作用并不常见，只影响到一小部分有Chiari网络的人。[3]大多数患有这种疾病的人没有重大的医疗问题，也不需要治疗。在出现这种异常的情况下，任何形式的房内导尿都要谨慎进行。[4]在经皮心脏手术过程中，Chiari网络和耳咽管瓣的存在可能导致导管/装置卡压，特别是对于复杂的电生理(EP)导管、房间隔装置和起搏导联。虽然经皮入路通常是成功的，但手术干预可能是必要的。为了防止这种情况，在手术前和手术过程中识别这些结构是至关重要的。[5]轻度四室扩张，右侧变化较多，伴暂时性二尖瓣反流，生理性三尖瓣反流，肺反流是正常妊娠的常见经胸超声心动图观察结果。这些患者在整个孕期都处于促凝期，这种作用可能对房内血栓形成有影响。最后，在产前母亲发现任何阻塞性病理后，应该考虑到极度焦虑，我们对该病例进行了随访，以发现任何问题。[6]尽管有一些报道，这种缺陷，我们报告一个罕见的产前患者，这种结构缺陷。综上所述，无症状的良性心脏病孕妇需要适当的咨询和随访，在分娩期间和以后每年都需要随访。这种疾病本身不需要任何干预。患者同意声明作者证明他们已经获得了所有适当的患者同意表格。在此表格中，患者已同意她的图像和其他临床信息将在杂志上报道。患者明白姓名和首字母不会被公布，并将尽力隐藏身份，但不能保证匿名。财政支持和赞助利益冲突没有利益冲突。
{"title":"Chiari network: An incidental echocardiographic finding in an asymptomatic pregnant female","authors":"S Parthasarathy, BalasubramaniyanAmirtha Ganesh","doi":"10.4103/injms.injms_37_23","DOIUrl":"https://doi.org/10.4103/injms.injms_37_23","url":null,"abstract":"Dear Editor, We report an asymptomatic pregnant woman with Chiari network defect in a routine echocardiogram. The intricacies are discussed. Hans Chiari explained abnormal fibrous lace-like strands spanning from the inferior vena cava (IVC) or coronary sinus valve margins to the crista terminalis region in 1897. He inspired the name of the network. The Chiari network is formed by the incomplete resorption of the right sinus venous valve. It is a congenital abnormality that occurs during fetal development and is relatively uncommon, affecting <2% of the general population.[1] Although it rarely causes symptoms or health problems, it can be observed during regular echocardiography. Antenatal maternal echocardiography is not recommended. However due to enlarging uterus and concomitant anemia, the mothers may have dyspnoea on exertion.[2] This prompts many obstetricians to recommend echocardiograms in otherwise normal mothers. A 27-year-old primigravida with 34 weeks of gestation came to us for a routine echocardiogram. Clinically she was normal with basic investigations within normal limits. We discovered a whip-like structure extending from the IVC opening and freely moving within the right atrial cavity [Figure 1]. There was a trivial mitral regurgitation. The left ventricular and right ventricular functions were normal with normal pulmonary pressure. There was neither an atrial aneurysm nor patent foramen ovale. A clinical diagnosis of the Chiari network was made and the essentially benign nature of the disease was clearly explained and any element of anxiety was taken care of [Video 1].Figure 1: Showing the chiari network(arrow) {\"href\":\"Single Video Player\",\"role\":\"media-player-id\",\"content-type\":\"play-in-place\",\"position\":\"float\",\"orientation\":\"portrait\",\"label\":\"Video Clip 1\",\"caption\":\"\",\"object-id\":[{\"pub-id-type\":\"doi\",\"id\":\"\"},{\"pub-id-type\":\"other\",\"content-type\":\"media-stream-id\",\"id\":\"1_0lknfh8h\"},{\"pub-id-type\":\"other\",\"content-type\":\"media-source\",\"id\":\"Kaltura\"}]} In most cases, the Chiari network causes no complications or health issues. However, it can increase the risk of certain conditions in some cases, such as: Blood clots: The Chiari network can start causing chaos in the blood flow, which could also lead to the formation of blood clots, leading to complications such as stroke or pulmonary embolism. Infective endocarditis: The presence of the Chiari network can make the heart more vulnerable to bacterial infection, leading to infective endocarditis, a potentially fatal condition. Cardiac arrhythmias: The Chiari network can disrupt the electrical activity of the heart, causing arrhythmias. Right heart valve or blood vessel obstruction: the Chiari network can cause the above complication resulting in symptoms such as dyspnoea, fatigue, and chest pain. It is worth noting that these side effects are uncommon and affect only a small percentage of people with Chiari network.[3] Most people with this condition have no major medical ","PeriodicalId":43811,"journal":{"name":"Indian Journal of Medical Specialities","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135844885","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: 10.4103/injms.injms_77_22
N. Varun, A. Nigam, Nidhi Gupta, F. Mazhari, Varun Kashyap
Aim: The aim of this study was to evaluate the demographic and obstetrical factors affecting the chances of vaginal birth after cesarean (VBAC) delivery and to develop a scoring system for the prediction of same. Materials and Methods: It was a prospective observational study done over a period of 1 year. A total of 100 term pregnant women with previous one lower-segment cesarean section (LSCS) fulfilling the criteria for a trial of labor were recruited for the study. As 23 patients refused to undergo trial of labor after cesarean (TOLAC) in early labor, 77 women formed the study group. Parameters assessed to predict successful TOLAC were maternal age, body mass index (BMI), history of prior vaginal delivery, interdelivery interval, indication of previous cesarean section, gestational age, type of labor, Bishop's score, and expected baby weight. Scores 0–2 were given, and the mean score obtained was correlated with the outcome of TOLAC. Results: Successful vaginal delivery occurred in 57.14% (44/77) of women. BMI ≤30 kg/m2 (P = 0.004), parity ≤ 3 (P = 0.005), Bishop's score >4 (P = 0.000), spontaneous onset of labor at the time of admission (P = 0.001), and nonrecurrent indication of previous LSCS (P = 0.029) were found to be significantly associated with the VBAC. The probability of having a successful VBAC was 83.3% and 100%, with the VBAC score value of more than 18 and 20, respectively. Conclusion: The mean VBAC score of 18–20 by the current scoring system is beneficial in predicting the outcome. This can help in counseling the patient, relatives as well as health professionals to undergo labor trial to decrease the cesarean section rate in the current era.
{"title":"Vaginal birth after cesarean score for the prediction of successful vaginal birth after cesarean section – A prospective observational study","authors":"N. Varun, A. Nigam, Nidhi Gupta, F. Mazhari, Varun Kashyap","doi":"10.4103/injms.injms_77_22","DOIUrl":"https://doi.org/10.4103/injms.injms_77_22","url":null,"abstract":"Aim: The aim of this study was to evaluate the demographic and obstetrical factors affecting the chances of vaginal birth after cesarean (VBAC) delivery and to develop a scoring system for the prediction of same. Materials and Methods: It was a prospective observational study done over a period of 1 year. A total of 100 term pregnant women with previous one lower-segment cesarean section (LSCS) fulfilling the criteria for a trial of labor were recruited for the study. As 23 patients refused to undergo trial of labor after cesarean (TOLAC) in early labor, 77 women formed the study group. Parameters assessed to predict successful TOLAC were maternal age, body mass index (BMI), history of prior vaginal delivery, interdelivery interval, indication of previous cesarean section, gestational age, type of labor, Bishop's score, and expected baby weight. Scores 0–2 were given, and the mean score obtained was correlated with the outcome of TOLAC. Results: Successful vaginal delivery occurred in 57.14% (44/77) of women. BMI ≤30 kg/m2 (P = 0.004), parity ≤ 3 (P = 0.005), Bishop's score >4 (P = 0.000), spontaneous onset of labor at the time of admission (P = 0.001), and nonrecurrent indication of previous LSCS (P = 0.029) were found to be significantly associated with the VBAC. The probability of having a successful VBAC was 83.3% and 100%, with the VBAC score value of more than 18 and 20, respectively. Conclusion: The mean VBAC score of 18–20 by the current scoring system is beneficial in predicting the outcome. This can help in counseling the patient, relatives as well as health professionals to undergo labor trial to decrease the cesarean section rate in the current era.","PeriodicalId":43811,"journal":{"name":"Indian Journal of Medical Specialities","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43638457","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 : 2022-10-01DOI: 10.4103/injms.injms_52_22
Dilay Karabulut, G. Erdal, C. Yıldız, G. Hergünsel, Umut Karabulut, Elif Binboğa, N. Isiksacan
Background: Novel coronavirus disease-2019 (COVID-19) has become a public emergency that is characterized by a dysregulated immune response and hypercoagulable state. The purpose of the present study was to evaluate NOTCH and tumor necrosis factor-alpha converting enzyme (TACE) levels in COVID-19-infected patients and assess their predictive value on the severity of the disease. Methods: A total of 116 severe-critical COVID-19 patients who were interned intensive care were included in the study. The severity of the disease was evaluated according to the WHO classification system. Patients were divided into two groups according to their cTroponin T (cTnT) levels. Patients who had cTnT levels at least five times the upper limit of normal constituted Group 1 (n = 58); patients who had normal cTnT levels constituted Group 2 (n = 58). Besides, 62 age- and sex-matched healthy controls, who applied to cardiology outward clinic were taken as a control group (Group 3). All patients underwent echocardiographic examination. NOTCH and TACE levels were assessed using enzyme-linked immunosorbent assay. Results: The average age of the patients was 59.96 ± 15.46 years, 92 (51.7%) were female and 86 (48.3%) were male. The mean length of hospital stay was 16.35 ± 10.97 days. NOTCH levels were significantly higher in Group 1 patients compared to Group 2 and control group of patients P = 0.001). NOTCH levels of Group 2 were significantly higher compared to the control group (P = 0.002). Similarly, the TACE levels of Group 1 were significantly higher than that of Group 2 and the control group (P = 0.001). Mortality and length of hospital stay were significantly higher in Group 1 patients compared to Group 2 patients (P = 0.002 and P = 0.004, respectively). TACE levels of deceased patients were significantly higher than that of live patients (P = 0.004). There was a positive relationship between the length of hospital stay and NOTCH levels in Group 1 patients (r = 0.527, P = 0.003). TACE and NOTCH levels were positively correlated with troponin levels (r = 0.627 and r = 0.671, respectively P < 0.001 for both). NOTCH value of 0.34 nmol/L and TACE value of 6.53 μg/mL predicted inhospital mortality with a sensitivity of 90.30% and 63.6% and specificity of 91.5% and 78.6%, respectively. Conclusion: Measurement of NOTCH and TACE levels during severe acute respiratory syndrome coronavirus infection could be helpful for risk stratification.
{"title":"NOTCH and tumor necrosis factor-alpha converting enzyme levels could be used in COVID-19 for risk stratification","authors":"Dilay Karabulut, G. Erdal, C. Yıldız, G. Hergünsel, Umut Karabulut, Elif Binboğa, N. Isiksacan","doi":"10.4103/injms.injms_52_22","DOIUrl":"https://doi.org/10.4103/injms.injms_52_22","url":null,"abstract":"Background: Novel coronavirus disease-2019 (COVID-19) has become a public emergency that is characterized by a dysregulated immune response and hypercoagulable state. The purpose of the present study was to evaluate NOTCH and tumor necrosis factor-alpha converting enzyme (TACE) levels in COVID-19-infected patients and assess their predictive value on the severity of the disease. Methods: A total of 116 severe-critical COVID-19 patients who were interned intensive care were included in the study. The severity of the disease was evaluated according to the WHO classification system. Patients were divided into two groups according to their cTroponin T (cTnT) levels. Patients who had cTnT levels at least five times the upper limit of normal constituted Group 1 (n = 58); patients who had normal cTnT levels constituted Group 2 (n = 58). Besides, 62 age- and sex-matched healthy controls, who applied to cardiology outward clinic were taken as a control group (Group 3). All patients underwent echocardiographic examination. NOTCH and TACE levels were assessed using enzyme-linked immunosorbent assay. Results: The average age of the patients was 59.96 ± 15.46 years, 92 (51.7%) were female and 86 (48.3%) were male. The mean length of hospital stay was 16.35 ± 10.97 days. NOTCH levels were significantly higher in Group 1 patients compared to Group 2 and control group of patients P = 0.001). NOTCH levels of Group 2 were significantly higher compared to the control group (P = 0.002). Similarly, the TACE levels of Group 1 were significantly higher than that of Group 2 and the control group (P = 0.001). Mortality and length of hospital stay were significantly higher in Group 1 patients compared to Group 2 patients (P = 0.002 and P = 0.004, respectively). TACE levels of deceased patients were significantly higher than that of live patients (P = 0.004). There was a positive relationship between the length of hospital stay and NOTCH levels in Group 1 patients (r = 0.527, P = 0.003). TACE and NOTCH levels were positively correlated with troponin levels (r = 0.627 and r = 0.671, respectively P < 0.001 for both). NOTCH value of 0.34 nmol/L and TACE value of 6.53 μg/mL predicted inhospital mortality with a sensitivity of 90.30% and 63.6% and specificity of 91.5% and 78.6%, respectively. Conclusion: Measurement of NOTCH and TACE levels during severe acute respiratory syndrome coronavirus infection could be helpful for risk stratification.","PeriodicalId":43811,"journal":{"name":"Indian Journal of Medical Specialities","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42046758","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 : 2022-10-01DOI: 10.4103/injms.injms_73_22
Tariq Janjua, L. Moscote-Salazar
{"title":"Cerebral edema: Role of insulin and insulin signaling pathways in the brain","authors":"Tariq Janjua, L. Moscote-Salazar","doi":"10.4103/injms.injms_73_22","DOIUrl":"https://doi.org/10.4103/injms.injms_73_22","url":null,"abstract":"","PeriodicalId":43811,"journal":{"name":"Indian Journal of Medical Specialities","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44614614","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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