Abstract Aripiprazole, a novel neuroleptic and dopamine system stabilizer, is hailed as 3 rd generation neuroleptic by some and claimed to have partial agonistic activity at D2 receptors (D2R), distinguishing it from other antipsychotics-D2 dopamine receptor antagonists. Many studies have extensively described extrapyramidal syndrome (EPS) profiles of earlier atypical neuroleptics including clozapine, quetiapine, olanzapine, ziprasidone, and risperidone. Despite the claimed D2R agonistic mechanism, EPS due to aripiprazole is sporadically reported – here below we report two such cases across two different baselines. One in a patient with no baseline Parkinsonism, another in a patient with well controlled Parkinson’s disease.
{"title":"Aripiprazole “Induced” and Aripiprazole “Worsened” Parkinsonism","authors":"Nagashree V Sharma, Kuldeep S Shetty","doi":"10.4103/ajim.ajim_13_23","DOIUrl":"https://doi.org/10.4103/ajim.ajim_13_23","url":null,"abstract":"Abstract Aripiprazole, a novel neuroleptic and dopamine system stabilizer, is hailed as 3 rd generation neuroleptic by some and claimed to have partial agonistic activity at D2 receptors (D2R), distinguishing it from other antipsychotics-D2 dopamine receptor antagonists. Many studies have extensively described extrapyramidal syndrome (EPS) profiles of earlier atypical neuroleptics including clozapine, quetiapine, olanzapine, ziprasidone, and risperidone. Despite the claimed D2R agonistic mechanism, EPS due to aripiprazole is sporadically reported – here below we report two such cases across two different baselines. One in a patient with no baseline Parkinsonism, another in a patient with well controlled Parkinson’s disease.","PeriodicalId":8012,"journal":{"name":"APIK Journal of Internal Medicine","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135886263","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}
Abstract Ictal bradycardia (IB) is an uncommon and serious extraneural manifestation of epilepsy. We describe the case of a patient with temporal lobe epilepsy, who, despite appropriate antiepileptics, developed status epilepticus with pharmacologically refractory bradycardia. Electrocardiogram showed features of a complete heart block with the right bundle branch block and escape rhythms. A temporary pacemaker was inserted, in addition to antiepileptics for seizure control. He maintained intrinsic heart rhythm, and since discharge, has not suffered further seizures. IB probably result from massive parasympathetic discharge from the insula and limbic system. It occurs in <1% of seizures, usually in temporal lobe epilepsy, regardless of the presence of structural cardiac anomalies. Longer duration arrhythmias can cause asystole and syncope and could be fatal. Our report highlights the role of central autonomic centers in severe bradycardia, and adds to the body of the literature regarding this rare phenomenon.
{"title":"Double Trouble: A Case of Ictal Bradycardia Syndrome Complicating Temporal Lobe Epilepsy","authors":"Ganaraja Valakunja Harikrishna, Vivek Bhat, Suresha Kodapala","doi":"10.4103/ajim.ajim_27_23","DOIUrl":"https://doi.org/10.4103/ajim.ajim_27_23","url":null,"abstract":"Abstract Ictal bradycardia (IB) is an uncommon and serious extraneural manifestation of epilepsy. We describe the case of a patient with temporal lobe epilepsy, who, despite appropriate antiepileptics, developed status epilepticus with pharmacologically refractory bradycardia. Electrocardiogram showed features of a complete heart block with the right bundle branch block and escape rhythms. A temporary pacemaker was inserted, in addition to antiepileptics for seizure control. He maintained intrinsic heart rhythm, and since discharge, has not suffered further seizures. IB probably result from massive parasympathetic discharge from the insula and limbic system. It occurs in <1% of seizures, usually in temporal lobe epilepsy, regardless of the presence of structural cardiac anomalies. Longer duration arrhythmias can cause asystole and syncope and could be fatal. Our report highlights the role of central autonomic centers in severe bradycardia, and adds to the body of the literature regarding this rare phenomenon.","PeriodicalId":8012,"journal":{"name":"APIK Journal of Internal Medicine","volume":"68 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135980550","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}
Abstract Objectives: This study aims to determine the association of neutrophil-lymphocyte ratio (NLR) with sequential organ failure assessment (SOFA) score, ventilator use, duration of intensive care unit (ICU) stay, and mortality among patients with sepsis. Methods: This prospective observational study included 220 patients with sepsis admitted to the ICU. Details such as age, gender, comorbidities, complaints, SOFA score, diagnosis, and outcomes were collected. Routine investigations included complete blood count, C-reactive protein, and procalcitonin. NLR was derived using the Beckman Coulter DXH-800 Hematology Analyser. A cutoff of 9.11 was taken as high NLR. Patients were followed up till 28 days after treatment. The outcomes studied included 28-day mortality and ICU stay. Results: The mean SOFA score were 7.07 ± 2.56. Based on NLR cutoffs, 146 (66.36%) patients had high NLR while 74 (33.64%) cases had normal or low NLR. SOFA score showed no significant association with high NLR ( P = 0.62). Ventilator was used in 118 (53.6%) cases with median of 3.5 days’ duration. The overall ICU stay was 5.6 ± 4.9 days. Mortality was seen in 46 (20.9%) cases. Compared to those with normal NLR, patients with high NLR had significantly more ventilator use (60.9% vs. 39.1%, P = 0.0027) and mortality (30.14% vs. 2.7%, P = 0.0004). The duration of ventilator use and ICU stay was statistically comparable. Conclusion: High NLR shows a significant association with adverse outcomes of sepsis patients in terms of ventilator use and mortality. Since it is cheap and easy to use, it can be applied in more basic settings while monitoring sepsis patients.
摘要目的:本研究旨在确定中性粒细胞-淋巴细胞比率(NLR)与脓毒症患者序贯器官衰竭评估(SOFA)评分、呼吸机使用、重症监护病房(ICU)住院时间和死亡率的关系。方法:本前瞻性观察性研究纳入了220例ICU收治的脓毒症患者。收集了年龄、性别、合并症、投诉、SOFA评分、诊断和结果等详细信息。常规检查包括全血细胞计数、c反应蛋白和降钙素原。NLR使用Beckman Coulter DXH-800血液学分析仪得出。以9.11为截止点为高NLR。随访至治疗后28 d。研究结果包括28天死亡率和ICU住院时间。结果:SOFA平均评分为7.07±2.56分。根据NLR临界值，高NLR 146例(66.36%)，低或正常NLR 74例(33.64%)。SOFA评分与高NLR无显著相关性(P = 0.62)。118例(53.6%)患者使用呼吸机，中位持续时间为3.5 d。ICU总住院时间5.6±4.9天。死亡46例(20.9%)。与NLR正常的患者相比，高NLR患者的呼吸机使用率(60.9% vs. 39.1%， P = 0.0027)和死亡率(30.14% vs. 2.7%， P = 0.0004)显著增加。呼吸机使用时间与ICU住院时间具有统计学上的可比性。结论:高NLR与脓毒症患者呼吸机使用和死亡率的不良结局显著相关。由于它便宜且易于使用，因此可以在监测败血症患者时应用于更基本的环境。
{"title":"Association of Neutrophil-to-lymphocyte Ratio with Prognosis in Sepsis – An Observational Study from a Tertiary Care Center","authors":"Birjesh Kumar Thakran, Yogesh Kumar Chahar, Shikha Jain, Sundeep Jain","doi":"10.4103/ajim.ajim_23_23","DOIUrl":"https://doi.org/10.4103/ajim.ajim_23_23","url":null,"abstract":"Abstract Objectives: This study aims to determine the association of neutrophil-lymphocyte ratio (NLR) with sequential organ failure assessment (SOFA) score, ventilator use, duration of intensive care unit (ICU) stay, and mortality among patients with sepsis. Methods: This prospective observational study included 220 patients with sepsis admitted to the ICU. Details such as age, gender, comorbidities, complaints, SOFA score, diagnosis, and outcomes were collected. Routine investigations included complete blood count, C-reactive protein, and procalcitonin. NLR was derived using the Beckman Coulter DXH-800 Hematology Analyser. A cutoff of 9.11 was taken as high NLR. Patients were followed up till 28 days after treatment. The outcomes studied included 28-day mortality and ICU stay. Results: The mean SOFA score were 7.07 ± 2.56. Based on NLR cutoffs, 146 (66.36%) patients had high NLR while 74 (33.64%) cases had normal or low NLR. SOFA score showed no significant association with high NLR ( P = 0.62). Ventilator was used in 118 (53.6%) cases with median of 3.5 days’ duration. The overall ICU stay was 5.6 ± 4.9 days. Mortality was seen in 46 (20.9%) cases. Compared to those with normal NLR, patients with high NLR had significantly more ventilator use (60.9% vs. 39.1%, P = 0.0027) and mortality (30.14% vs. 2.7%, P = 0.0004). The duration of ventilator use and ICU stay was statistically comparable. Conclusion: High NLR shows a significant association with adverse outcomes of sepsis patients in terms of ventilator use and mortality. Since it is cheap and easy to use, it can be applied in more basic settings while monitoring sepsis patients.","PeriodicalId":8012,"journal":{"name":"APIK Journal of Internal Medicine","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135980846","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}
Abstract Objective: The objective of this study was to assess the Framingham Risk Score as well as the prevalence of coronary artery disease (CAD) in people living with HIV/AIDS (PLHA) male patients, in an Indian setting. Design: This descriptive pilot study was conducted in a multispecialty hospital which is a reference center for HIV/AIDS. Materials and Methods: The study included 50 HIV-positive male patients who underwent basic biochemical analysis, namely lipid profile, blood sugar (fasting), electrocardiogram, CD4 count along with basic personal history (including smoking habits and lifestyle), course of disease progression, and drug history. All were subjected to a two-dimensional echocardiogram and treadmill test (TMT). Subjects with a positive TMT underwent a confirmatory stress thallium/coronary angiography. Framingham Risk Scores were calculated, using standard scoring charts. Standard protocol forms were made for each patient. Results: The median diagnosed duration of HIV disease was 2.8 years (range: 0.5–7 years). The median 10-year risk of CAD (as calculated from the Framingham scores) was 1%. Major contributing risk factors were dyslipidemia, diabetes, and hypertension and were found to be greater as compared to published literature. Four patients had positive TMT, but all four had a negative, coronary angiogram. Conclusions: Biological plausibility suggests that CAD may be more common in PLHA due to the chronic inflammatory nature of the disease and the effects of the dyslipidemia effect of ART; however, our pilot study with the limitations could not substantiate this.
{"title":"Estimation of Risk and Proportion of Coronary Artery Disease in People Living with HIV/AIDS in Indian Setting: A Pilot Study","authors":"Anmol Sharma, Amitabh Sagar, Navreet Singh","doi":"10.4103/ajim.ajim_33_23","DOIUrl":"https://doi.org/10.4103/ajim.ajim_33_23","url":null,"abstract":"Abstract Objective: The objective of this study was to assess the Framingham Risk Score as well as the prevalence of coronary artery disease (CAD) in people living with HIV/AIDS (PLHA) male patients, in an Indian setting. Design: This descriptive pilot study was conducted in a multispecialty hospital which is a reference center for HIV/AIDS. Materials and Methods: The study included 50 HIV-positive male patients who underwent basic biochemical analysis, namely lipid profile, blood sugar (fasting), electrocardiogram, CD4 count along with basic personal history (including smoking habits and lifestyle), course of disease progression, and drug history. All were subjected to a two-dimensional echocardiogram and treadmill test (TMT). Subjects with a positive TMT underwent a confirmatory stress thallium/coronary angiography. Framingham Risk Scores were calculated, using standard scoring charts. Standard protocol forms were made for each patient. Results: The median diagnosed duration of HIV disease was 2.8 years (range: 0.5–7 years). The median 10-year risk of CAD (as calculated from the Framingham scores) was 1%. Major contributing risk factors were dyslipidemia, diabetes, and hypertension and were found to be greater as compared to published literature. Four patients had positive TMT, but all four had a negative, coronary angiogram. Conclusions: Biological plausibility suggests that CAD may be more common in PLHA due to the chronic inflammatory nature of the disease and the effects of the dyslipidemia effect of ART; however, our pilot study with the limitations could not substantiate this.","PeriodicalId":8012,"journal":{"name":"APIK Journal of Internal Medicine","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135981262","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}
Chennakesavulu Dara, Surendra Babu Darivemula, Triven Sagar Sandepogu, M. Saranya, N. Vijayalakshmi, S. Swetha
Abstract Introduction: Nosocomial infections are infections; patients acquire while admitted to a health-care facility and generally develop 48 h or later after admission. These infections can lead to serious problems such as sepsis and even death. Materials and Methods: A prospective observational study was conducted for 6 months to estimate the incidence of nosocomial infections acquired in the medical intensive care unit (MICU), their risk factors, the causative pathogens, and the outcome. The patients admitted for more than 48 h to the MICU and willing to give consent were included in the study. Of 496 patients in MICU, 216 patients stayed 48 h and Acute Physiology and Chronic Health Evaluation II (APACHE II) score during the first 24 h of admission to the MICU. Results: The incidence of nosocomial infections in MICU was 14.9% (32 out of 216). Age, APACHE II score >13, MICU stay >7 days, and comorbidities such as peripheral venous line, central venous catheter, duration of urinary catheterization, duration of endotracheal intubation, nasogastric tube, and mechanical ventilator of >7 days were found to be independent risk factors of acquiring nosocomial infections ( P < 0.05). Important causative organisms for nosocomial infections were Pseudomonas aeruginosa in 18 patients (32.72%), Escherichia coli in 11 (20.0%), Acinetobacter species in 8 (14.54%), and Klebsiella pneumoniae in seven patients (12.72%). Mortality among patients with nosocomial infections was 25% (8/32) and among those without nosocomial infections was 6.5% (12/184), P = 0.002. The length of ICU stay was higher in patients with nosocomial infections (15.42 ± 6.93 days) than in those without nosocomial infections (6.7 ± 5.14 days), P < 0.001. Conclusion: Nosocomial infections are common in ICU settings and contribute to significant mortality and morbidity. Infection control strategies are necessary to reduce nosocomial infection rates as well as ICU mortality and morbidity.
{"title":"Nosocomial Infection in MICU: An Observational Study","authors":"Chennakesavulu Dara, Surendra Babu Darivemula, Triven Sagar Sandepogu, M. Saranya, N. Vijayalakshmi, S. Swetha","doi":"10.4103/ajim.ajim_48_23","DOIUrl":"https://doi.org/10.4103/ajim.ajim_48_23","url":null,"abstract":"Abstract Introduction: Nosocomial infections are infections; patients acquire while admitted to a health-care facility and generally develop 48 h or later after admission. These infections can lead to serious problems such as sepsis and even death. Materials and Methods: A prospective observational study was conducted for 6 months to estimate the incidence of nosocomial infections acquired in the medical intensive care unit (MICU), their risk factors, the causative pathogens, and the outcome. The patients admitted for more than 48 h to the MICU and willing to give consent were included in the study. Of 496 patients in MICU, 216 patients stayed 48 h and Acute Physiology and Chronic Health Evaluation II (APACHE II) score during the first 24 h of admission to the MICU. Results: The incidence of nosocomial infections in MICU was 14.9% (32 out of 216). Age, APACHE II score >13, MICU stay >7 days, and comorbidities such as peripheral venous line, central venous catheter, duration of urinary catheterization, duration of endotracheal intubation, nasogastric tube, and mechanical ventilator of >7 days were found to be independent risk factors of acquiring nosocomial infections ( P < 0.05). Important causative organisms for nosocomial infections were Pseudomonas aeruginosa in 18 patients (32.72%), Escherichia coli in 11 (20.0%), Acinetobacter species in 8 (14.54%), and Klebsiella pneumoniae in seven patients (12.72%). Mortality among patients with nosocomial infections was 25% (8/32) and among those without nosocomial infections was 6.5% (12/184), P = 0.002. The length of ICU stay was higher in patients with nosocomial infections (15.42 ± 6.93 days) than in those without nosocomial infections (6.7 ± 5.14 days), P < 0.001. Conclusion: Nosocomial infections are common in ICU settings and contribute to significant mortality and morbidity. Infection control strategies are necessary to reduce nosocomial infection rates as well as ICU mortality and morbidity.","PeriodicalId":8012,"journal":{"name":"APIK Journal of Internal Medicine","volume":"68 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135980683","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}
Maria Nefeli Georgaki, Charalampos Georgakis, Marianna Charalambous, Katerina Mamisi, Sofia Karachrysafi
Abstract Introduction: Vitamin D plays a vital role as an essential nutrient for human health, but a significant number of people worldwide have a deficiency in this vitamin. Chronic Vitamin D deficiency has been linked to several adverse health outcomes, including musculoskeletal disorders, cardiovascular disease (CVD), cancer, and autoimmune disorders. Methodology: We conducted a comprehensive literature search using academic databases, including PubMed, MEDLINE, Scopus, and Google Scholar. The search terms included “Vitamin D deficiency,” “chronic disease,” “musculoskeletal disorders,” “cardiovascular disease,” “cancer,” and “autoimmune disorders.” We focused on articles that examined the link between chronic Vitamin D deficiency and various health outcomes. Results: Studies suggest that Vitamin D deficiency may contribute to several chronic diseases, including osteoporosis, osteoarthritis, hypertension, and CVD. Evidence indicates that inadequate levels of Vitamin D can increase the risk of certain types of cancer, such as colorectal and breast cancer. Studies have also found that people with autoimmune disorders, such as type 1 diabetes, multiple sclerosis, and rheumatoid arthritis, have lower levels of Vitamin D compared to healthy individuals. Conclusions: The findings of this literature review highlight the importance of identifying and treating chronic Vitamin D deficiency to prevent or manage associated health conditions. Strategies to prevent Vitamin D deficiency include increased sun exposure, dietary changes, and Vitamin D supplementation. Regular screening for Vitamin D deficiency may also be necessary, particularly in high-risk populations. Clinicians should consider Vitamin D status when evaluating patients with chronic diseases and take appropriate steps to address any deficiencies.
{"title":"Chronic Vitamin D Deficiency and its Effects on Human Health: A Literature Review","authors":"Maria Nefeli Georgaki, Charalampos Georgakis, Marianna Charalambous, Katerina Mamisi, Sofia Karachrysafi","doi":"10.4103/ajim.ajim_47_23","DOIUrl":"https://doi.org/10.4103/ajim.ajim_47_23","url":null,"abstract":"Abstract Introduction: Vitamin D plays a vital role as an essential nutrient for human health, but a significant number of people worldwide have a deficiency in this vitamin. Chronic Vitamin D deficiency has been linked to several adverse health outcomes, including musculoskeletal disorders, cardiovascular disease (CVD), cancer, and autoimmune disorders. Methodology: We conducted a comprehensive literature search using academic databases, including PubMed, MEDLINE, Scopus, and Google Scholar. The search terms included “Vitamin D deficiency,” “chronic disease,” “musculoskeletal disorders,” “cardiovascular disease,” “cancer,” and “autoimmune disorders.” We focused on articles that examined the link between chronic Vitamin D deficiency and various health outcomes. Results: Studies suggest that Vitamin D deficiency may contribute to several chronic diseases, including osteoporosis, osteoarthritis, hypertension, and CVD. Evidence indicates that inadequate levels of Vitamin D can increase the risk of certain types of cancer, such as colorectal and breast cancer. Studies have also found that people with autoimmune disorders, such as type 1 diabetes, multiple sclerosis, and rheumatoid arthritis, have lower levels of Vitamin D compared to healthy individuals. Conclusions: The findings of this literature review highlight the importance of identifying and treating chronic Vitamin D deficiency to prevent or manage associated health conditions. Strategies to prevent Vitamin D deficiency include increased sun exposure, dietary changes, and Vitamin D supplementation. Regular screening for Vitamin D deficiency may also be necessary, particularly in high-risk populations. Clinicians should consider Vitamin D status when evaluating patients with chronic diseases and take appropriate steps to address any deficiencies.","PeriodicalId":8012,"journal":{"name":"APIK Journal of Internal Medicine","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135981002","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}
M. Bhanukumar, Prakruthi Mohan, Nimrah Fathima, A. N. Venkatesh Darshan
Abstract Sjögren’s syndrome is well known to masquerade with varied presentations due to its propensity to produce multisystemic and extraglandular disease. We present the case of Sjögren’s syndrome manifesting as new onset, acute quadriparesis. The patient had no articular manifestations suggesting a primary connective tissue disease or obvious sicca symptoms. Laboratory tests revealed severe hypokalemia and metabolic acidosis and antinuclear antibodies profile was positive for anti-Ro/SS-A antibody. Clinical examination revealed long-standing dental caries. A minor salivary gland biopsy showed features of Sjögren’s disease. The patient was started on potassium supplements and immunomodulatory therapy which led to clinical improvement in a week.
{"title":"An Interesting Case of Sjögren’s Syndrome Presenting with Hypokalemic Quadriparesis and Distal Renal Tubular Acidosis","authors":"M. Bhanukumar, Prakruthi Mohan, Nimrah Fathima, A. N. Venkatesh Darshan","doi":"10.4103/ajim.ajim_28_23","DOIUrl":"https://doi.org/10.4103/ajim.ajim_28_23","url":null,"abstract":"Abstract Sjögren’s syndrome is well known to masquerade with varied presentations due to its propensity to produce multisystemic and extraglandular disease. We present the case of Sjögren’s syndrome manifesting as new onset, acute quadriparesis. The patient had no articular manifestations suggesting a primary connective tissue disease or obvious sicca symptoms. Laboratory tests revealed severe hypokalemia and metabolic acidosis and antinuclear antibodies profile was positive for anti-Ro/SS-A antibody. Clinical examination revealed long-standing dental caries. A minor salivary gland biopsy showed features of Sjögren’s disease. The patient was started on potassium supplements and immunomodulatory therapy which led to clinical improvement in a week.","PeriodicalId":8012,"journal":{"name":"APIK Journal of Internal Medicine","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135981263","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}
Ganaraja Valakunja Harikrishna, C. A. Jayashankar, Sukriti Arora, Kavya Mala, A. S. Shalini
Abstract Hansen’s disease is caused by an acid–fast bacillus – Mycobacterium leprae . Diagnosis of Hansen’s disease is mainly clinical. Hence, it is crucial to be aware of its diverse manifestations. We hereby report three such cases of Hansen’s disease with uncommon presentation. Case 1: A 26-year-old male presented with progressive numbness and multiple skin lesions over both upper and lower limbs in the past 3 years. Case 2: A 26-year-old male presented with tingling sensation of both upper limbs and lower limbs along with multiple skin lesions all over the body in the past 10 months. Case 3: A 39-year-old male presented with multiple joint pain, electric shock-like sensation of both upper limbs, and weakness of both hands along with skin rashes all over the body in the past 1 month. Skin examination of all these patients revealed multiple hypoanesthetic erythematous patches in the involved areas. Nerve conduction study was suggestive of asymmetric sensory motor axonal polyneuropathy. Skin biopsy from the lesions of the first patient revealed epithelioid granulomas suggesting borderline tuberculoid leprosy. Ziehl–Neelsen stain was positive for both fragmented and intact bacilli in the second and third cases, suggesting lepromatous leprosy. All of them were treated successfully with antileprosy drugs. It is essential to consider leprosy as a differential diagnosis in all patients presenting with symptoms of peripheral neuropathy, so that an early diagnosis and treatment is possible.
{"title":"Our Experience on Unusual Manifestations of Hansen’s Disease - A Case Series","authors":"Ganaraja Valakunja Harikrishna, C. A. Jayashankar, Sukriti Arora, Kavya Mala, A. S. Shalini","doi":"10.4103/ajim.ajim_9_23","DOIUrl":"https://doi.org/10.4103/ajim.ajim_9_23","url":null,"abstract":"Abstract Hansen’s disease is caused by an acid–fast bacillus – Mycobacterium leprae . Diagnosis of Hansen’s disease is mainly clinical. Hence, it is crucial to be aware of its diverse manifestations. We hereby report three such cases of Hansen’s disease with uncommon presentation. Case 1: A 26-year-old male presented with progressive numbness and multiple skin lesions over both upper and lower limbs in the past 3 years. Case 2: A 26-year-old male presented with tingling sensation of both upper limbs and lower limbs along with multiple skin lesions all over the body in the past 10 months. Case 3: A 39-year-old male presented with multiple joint pain, electric shock-like sensation of both upper limbs, and weakness of both hands along with skin rashes all over the body in the past 1 month. Skin examination of all these patients revealed multiple hypoanesthetic erythematous patches in the involved areas. Nerve conduction study was suggestive of asymmetric sensory motor axonal polyneuropathy. Skin biopsy from the lesions of the first patient revealed epithelioid granulomas suggesting borderline tuberculoid leprosy. Ziehl–Neelsen stain was positive for both fragmented and intact bacilli in the second and third cases, suggesting lepromatous leprosy. All of them were treated successfully with antileprosy drugs. It is essential to consider leprosy as a differential diagnosis in all patients presenting with symptoms of peripheral neuropathy, so that an early diagnosis and treatment is possible.","PeriodicalId":8012,"journal":{"name":"APIK Journal of Internal Medicine","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135980541","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}
S. Bala, S. Darivemula, Venkatesham Animalla, R. Bandaru
Long COVID is commonly encountered by many individuals during the coronavirus 2019 pandemic. It is best diagnosed by a history consistent with acute coronavirus disease 2019 (COVID-19) followed by a prolonged recovery. An attempt has been made to enlist the sequel of long COVID clinically and to assess their risk factors. Confirmed COVID-19 patients admitted to our hospital were enquired about their persistent symptoms following infection after 3– 12 weeks for acute symptoms and after 12 weeks for chronic symptoms through the predesigned questionnaire schedule about their manifestations and followed up every month for 6 months. A total of 152 patients were included in our study and found acute long COVID symptoms related to neurological (72.2%), respiratory (64.7%), and musculoskeletal (61.4%) system being most commonly affected. Chronic symptoms were comprised predominantly musculoskeletal (63.1%) followed by fatigue (43.4%) and neurological (29.6) manifestations. Risk factors estimate of postacute COVID-19 symptoms showed that females had increased risk with odds ratio (OR) (and 95% confidence intervals) (OR) of 2.412 (1.239–4.692), sedentary lifestyle OR 1.775 (1.345–2.762), body mass index (BMI) >23 OR 3.877 (1.613–6.144), and presence of comorbidities OR 2.526 (1.277–4.997). Similarly, risk factor estimate of Postchronic COVID-19 symptoms showed that females had increased risk with OR 1.879 (0.952–3.709), sedentary lifestyle OR 5.091 (2.853–9.085), BMI >23 OR 2.082 (1.005–4.134), and presence of comorbidities OR 1.851 (0.925–3.705). Long COVID symptoms noted were mainly related to musculoskeletal disorders, neurological, respiratory, and fatigue. This enumeration will help us to bring the further pathway to include this long COVID entity for preventive strategies in our regular setup at the primary care level.
{"title":"Long Coronavirus Disease 2019 Sequel among Cohorts Admitted to a Tertiary Care Hospital, Hyderabad","authors":"S. Bala, S. Darivemula, Venkatesham Animalla, R. Bandaru","doi":"10.4103/ajim.ajim_69_23","DOIUrl":"https://doi.org/10.4103/ajim.ajim_69_23","url":null,"abstract":"\u0000 \u0000 \u0000 Long COVID is commonly encountered by many individuals during the coronavirus 2019 pandemic. It is best diagnosed by a history consistent with acute coronavirus disease 2019 (COVID-19) followed by a prolonged recovery. An attempt has been made to enlist the sequel of long COVID clinically and to assess their risk factors.\u0000 \u0000 \u0000 \u0000 Confirmed COVID-19 patients admitted to our hospital were enquired about their persistent symptoms following infection after 3– 12 weeks for acute symptoms and after 12 weeks for chronic symptoms through the predesigned questionnaire schedule about their manifestations and followed up every month for 6 months.\u0000 \u0000 \u0000 \u0000 A total of 152 patients were included in our study and found acute long COVID symptoms related to neurological (72.2%), respiratory (64.7%), and musculoskeletal (61.4%) system being most commonly affected. Chronic symptoms were comprised predominantly musculoskeletal (63.1%) followed by fatigue (43.4%) and neurological (29.6) manifestations. Risk factors estimate of postacute COVID-19 symptoms showed that females had increased risk with odds ratio (OR) (and 95% confidence intervals) (OR) of 2.412 (1.239–4.692), sedentary lifestyle OR 1.775 (1.345–2.762), body mass index (BMI) >23 OR 3.877 (1.613–6.144), and presence of comorbidities OR 2.526 (1.277–4.997). Similarly, risk factor estimate of Postchronic COVID-19 symptoms showed that females had increased risk with OR 1.879 (0.952–3.709), sedentary lifestyle OR 5.091 (2.853–9.085), BMI >23 OR 2.082 (1.005–4.134), and presence of comorbidities OR 1.851 (0.925–3.705).\u0000 \u0000 \u0000 \u0000 Long COVID symptoms noted were mainly related to musculoskeletal disorders, neurological, respiratory, and fatigue. This enumeration will help us to bring the further pathway to include this long COVID entity for preventive strategies in our regular setup at the primary care level.\u0000","PeriodicalId":8012,"journal":{"name":"APIK Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44945505","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}
Priyal Contractor, P. Damor, Archana U. Gandhi, S. Bhowmick
Multiple system atrophy (MSA) is a progressive neurodegenerative disorder characterized by various combinations of autonomic dysfunction, parkinsonism, and cerebellar dysfunction. Autonomic dysfunction has a debilitating course in patients of MSA, compared to other neurodegenerative disorders presenting with parkinsonism or ataxia. We report a case of MSA presenting with recurrent syncope due to orthostatic hypotension. We highlight that if not recognized, such patients may receive potentially harmful interventions.
{"title":"Unusual Cause of Recurrent Syncope in an Elderly Patient: Multiple System Atrophy","authors":"Priyal Contractor, P. Damor, Archana U. Gandhi, S. Bhowmick","doi":"10.4103/ajim.ajim_65_23","DOIUrl":"https://doi.org/10.4103/ajim.ajim_65_23","url":null,"abstract":"\u0000 Multiple system atrophy (MSA) is a progressive neurodegenerative disorder characterized by various combinations of autonomic dysfunction, parkinsonism, and cerebellar dysfunction. Autonomic dysfunction has a debilitating course in patients of MSA, compared to other neurodegenerative disorders presenting with parkinsonism or ataxia. We report a case of MSA presenting with recurrent syncope due to orthostatic hypotension. We highlight that if not recognized, such patients may receive potentially harmful interventions.","PeriodicalId":8012,"journal":{"name":"APIK Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42211786","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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