Background: According to the Global Burden of Disease 2018, chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, and in India, COPD is the second leading cause of death among noncommunicable diseases. Among India's 1.31 billion people, about 6% of children and 2% of adults have bronchial asthma. Infective exacerbations of both COPD and Bronchial asthma are common. However, there are some differences in the bacterial spectra between the two conditions, and profiling the bacteria responsible for the exacerbations will help in choosing appropriate antibiotics and also to combat the issue of drug resistance. Aims: (1) To analyze the bacteriological profile of patients with infective exacerbation of COPD and bronchial asthma. (2) To study the outcomes among these patients. Subjects and Methods: The study was a prospective observational study conducted from November 2019 to May 2020 in Bangalore Medical College and Research Institute on 50 patients diagnosed with acute exacerbation of COPD and 50 patients diagnosed with an exacerbation of bronchial asthma. Detailed history, physical examination, and standard laboratory tests were done on admission. Sputum samples were collected from the patients and analyzed by Gram staining and microscopy and also by culture. The differences between the two groups were analyzed. The progression of the disease and the outcomes were observed. Results: 100 patients were included in our study, 50 each in COPD and bronchial asthma. The study was conducted in hospitals attached to BMCRI. Bacteriological profile was assessed by sputum culture and antibiotic sensitivity in the COPD and asthma groups, respectively. In our study, in the COPD group, majority (80%) of patients were males, the mean age was 64.34 ± 9.876, and 80% were smokers with 20% having exposure to biomass. The most common growth in COPD exacerbation was Streptococcus pneumoniae (18%) followed by Haemophilus influenzae and Klebsiella pneumoniae. Mortality in COPD exacerbation was 12%. In the asthma group, female preponderance was seen (54%), mean age was 40.64 ± 13.11. Majority of patients were cases of childhood asthma. Growth was seen in 32% of exacerbations and the most common organism was Streptococcus pneumoniae. Mortality was 4% and importantly due to comorbidities. Conclusions: Bacterial exacerbations are more common in COPD, while it is not so in bronchial asthma. Viral exacerbations and atypical bacterial exacerbations are more common and asthma associated with pneumonia is the cause for culture growth. Mortality is considerably low in the asthma group compared to COPD exacerbations.
{"title":"A comparative study of bacteriological profile and outcomes in infective exacerbation of chronic obstructive pulmonary disease and bronchial asthma","authors":"B. Nagaraja, A. Chandrashekar, Anindita Menon","doi":"10.4103/ajim.ajim_7_22","DOIUrl":"https://doi.org/10.4103/ajim.ajim_7_22","url":null,"abstract":"Background: According to the Global Burden of Disease 2018, chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, and in India, COPD is the second leading cause of death among noncommunicable diseases. Among India's 1.31 billion people, about 6% of children and 2% of adults have bronchial asthma. Infective exacerbations of both COPD and Bronchial asthma are common. However, there are some differences in the bacterial spectra between the two conditions, and profiling the bacteria responsible for the exacerbations will help in choosing appropriate antibiotics and also to combat the issue of drug resistance. Aims: (1) To analyze the bacteriological profile of patients with infective exacerbation of COPD and bronchial asthma. (2) To study the outcomes among these patients. Subjects and Methods: The study was a prospective observational study conducted from November 2019 to May 2020 in Bangalore Medical College and Research Institute on 50 patients diagnosed with acute exacerbation of COPD and 50 patients diagnosed with an exacerbation of bronchial asthma. Detailed history, physical examination, and standard laboratory tests were done on admission. Sputum samples were collected from the patients and analyzed by Gram staining and microscopy and also by culture. The differences between the two groups were analyzed. The progression of the disease and the outcomes were observed. Results: 100 patients were included in our study, 50 each in COPD and bronchial asthma. The study was conducted in hospitals attached to BMCRI. Bacteriological profile was assessed by sputum culture and antibiotic sensitivity in the COPD and asthma groups, respectively. In our study, in the COPD group, majority (80%) of patients were males, the mean age was 64.34 ± 9.876, and 80% were smokers with 20% having exposure to biomass. The most common growth in COPD exacerbation was Streptococcus pneumoniae (18%) followed by Haemophilus influenzae and Klebsiella pneumoniae. Mortality in COPD exacerbation was 12%. In the asthma group, female preponderance was seen (54%), mean age was 40.64 ± 13.11. Majority of patients were cases of childhood asthma. Growth was seen in 32% of exacerbations and the most common organism was Streptococcus pneumoniae. Mortality was 4% and importantly due to comorbidities. Conclusions: Bacterial exacerbations are more common in COPD, while it is not so in bronchial asthma. Viral exacerbations and atypical bacterial exacerbations are more common and asthma associated with pneumonia is the cause for culture growth. Mortality is considerably low in the asthma group compared to COPD exacerbations.","PeriodicalId":8012,"journal":{"name":"APIK Journal of Internal Medicine","volume":"11 1","pages":"112 - 124"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45222697","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}
Vivek R. Krishna, P. Mylarappa, S. Rathnakar, Rakesh K Janna, K. Priyatam
Objectives: To study the clinical features, diagnostic methods, and management of genitourinary tuberculosis (GUTB). Methods: This retrospective study included 117 patients with GUTB admitted over a period of 10 years. The analysis of the patients was done in terms of presentation, organ involved, diagnostic methods, and management. The 6-month anti-tubercular treatment (ATT) was given to all patients, which included isoniazid, rifampicin, and ethambutol/pyrazinamide. Follow-up period was 1–10 years. Results: The mean age of the patients was 32.5 ± 6.4 years with a male: female ratio of 1:1.51. The majority of the patients presented with irritative voiding symptoms (66.47%) and hematuria (47.6%). The common infected organs were kidney (64.9%), ureter (27.35%), urinary bladder (17.09%), prostate (3.4%), and epididymis (5.19%). 25.6% of patients had positive chest X-ray, and 61.2% of the patients had positive Mantoux test. The diagnostic positivity rate for polymerase chain reaction, urine Mycobacterium tuberculosis culture test, and urine acid-fast bacilli test was 67.7%, 35.4%, and 21.6%, respectively. 71 (60.13%) of the patients needed surgical intervention. After medical therapy, the adverse reactions noted were abnormal liver function in four cases, pruritus in three cases, and skin eruption in one case. Among the total of 117 patients followed over a period of 1 year to 10 years, none recurred. Conclusion: In a retrospective study of 117 patients with GUTB, majority had bladder symptoms, 60.13% needed surgery, and all were treated with 6-month course of ATT regimen consisting of isoniazid, rifampicin, and ethambutol/pyrazinamide, with none showing recurrence during the period of 1–10 years of follow-up.
{"title":"A retrospective observational study of presentation, diagnosis, and management of patients with genitourinary tuberculosis in a tertiary care hospital of India","authors":"Vivek R. Krishna, P. Mylarappa, S. Rathnakar, Rakesh K Janna, K. Priyatam","doi":"10.4103/ajim.ajim_52_22","DOIUrl":"https://doi.org/10.4103/ajim.ajim_52_22","url":null,"abstract":"Objectives: To study the clinical features, diagnostic methods, and management of genitourinary tuberculosis (GUTB). Methods: This retrospective study included 117 patients with GUTB admitted over a period of 10 years. The analysis of the patients was done in terms of presentation, organ involved, diagnostic methods, and management. The 6-month anti-tubercular treatment (ATT) was given to all patients, which included isoniazid, rifampicin, and ethambutol/pyrazinamide. Follow-up period was 1–10 years. Results: The mean age of the patients was 32.5 ± 6.4 years with a male: female ratio of 1:1.51. The majority of the patients presented with irritative voiding symptoms (66.47%) and hematuria (47.6%). The common infected organs were kidney (64.9%), ureter (27.35%), urinary bladder (17.09%), prostate (3.4%), and epididymis (5.19%). 25.6% of patients had positive chest X-ray, and 61.2% of the patients had positive Mantoux test. The diagnostic positivity rate for polymerase chain reaction, urine Mycobacterium tuberculosis culture test, and urine acid-fast bacilli test was 67.7%, 35.4%, and 21.6%, respectively. 71 (60.13%) of the patients needed surgical intervention. After medical therapy, the adverse reactions noted were abnormal liver function in four cases, pruritus in three cases, and skin eruption in one case. Among the total of 117 patients followed over a period of 1 year to 10 years, none recurred. Conclusion: In a retrospective study of 117 patients with GUTB, majority had bladder symptoms, 60.13% needed surgery, and all were treated with 6-month course of ATT regimen consisting of isoniazid, rifampicin, and ethambutol/pyrazinamide, with none showing recurrence during the period of 1–10 years of follow-up.","PeriodicalId":8012,"journal":{"name":"APIK Journal of Internal Medicine","volume":"11 1","pages":"107 - 111"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46409637","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 : 2023-04-01DOI: 10.4103/ajim.ajim_123_22
R. Mungmunpuntipantip, V. Wiwanitkit
{"title":"COVID lockdown and malaria incidence: A note from the tropical endemic area","authors":"R. Mungmunpuntipantip, V. Wiwanitkit","doi":"10.4103/ajim.ajim_123_22","DOIUrl":"https://doi.org/10.4103/ajim.ajim_123_22","url":null,"abstract":"","PeriodicalId":8012,"journal":{"name":"APIK Journal of Internal Medicine","volume":"11 1","pages":"137 - 138"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46284180","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. Seth, Nucksheeeba Bhat, R. Sheikh, Puja Keshwani, Pranav Mehta
Background: Acute kidney injury (AKI) associated with acute pyelonephritis (APN) is considered rare. This study is conducted to find out the occurrence and risk factors for AKI in patients hospitalized with acute pyelonephritis and their clinical outcomes. Materials and Methods: All inpatients with APN from December 2018 to May 2020 were included. Results: A total of 95 patients were included. Escherichia coli was the most common organism grown. At presentation, 79/95 (83.2%) patients had renal dysfunction. 31/79 (39.2%) patients required hemodialysis. AKI was 2.4 times common in men; P = 0.013. The mean duration of fever in patients with and without renal dysfunction was 8.30 ± 2.72 and 5.31 ± 0.91 days, respectively; P < 0.001. 73/79 (92.4%) patients with AKI had anemia as against 2/14 (14.2%) patients without AKI; P < 0.001. AKI developed in 100% of the patients with known chronic kidney disease (CKD) at baseline and 41.6% of the patients with normal baseline kidney function; P < 0.001. Diabetes mellitus was present in 29/79 (36.7%) patients with AKI and 6/16 (37.5%) patients without AKI; P = 0.31. Hospital stay in days was 11.65 ± 5.9 and 5.81 ± 0.91, respectively, in patients with and without renal dysfunction; P < 0.001. 6/95 (6.3%) patients died. All six patients had renal dysfunction. At 3 months, renal functions normalized in 38/79 (48.1%) patients and 8/31 (25.8%) patients remained dialysis-dependent. Conclusions: AKI is a common complication of APN. It is usually reversible with early and appropriate management. Male gender, anemia, bilateral pyelonephritis, baseline CKD, and delayed presentation to hospital are associated with increased risk of AKI. It is associated with an increased risk of dialysis, hospitalization days, and mortality.
{"title":"Occurrence and risk factors for acute kidney injury in patients hospitalized with acute pyelonephritis, and their clinical outcomes: A single center study from Northern India","authors":"S. Seth, Nucksheeeba Bhat, R. Sheikh, Puja Keshwani, Pranav Mehta","doi":"10.4103/ajim.ajim_38_22","DOIUrl":"https://doi.org/10.4103/ajim.ajim_38_22","url":null,"abstract":"Background: Acute kidney injury (AKI) associated with acute pyelonephritis (APN) is considered rare. This study is conducted to find out the occurrence and risk factors for AKI in patients hospitalized with acute pyelonephritis and their clinical outcomes. Materials and Methods: All inpatients with APN from December 2018 to May 2020 were included. Results: A total of 95 patients were included. Escherichia coli was the most common organism grown. At presentation, 79/95 (83.2%) patients had renal dysfunction. 31/79 (39.2%) patients required hemodialysis. AKI was 2.4 times common in men; P = 0.013. The mean duration of fever in patients with and without renal dysfunction was 8.30 ± 2.72 and 5.31 ± 0.91 days, respectively; P < 0.001. 73/79 (92.4%) patients with AKI had anemia as against 2/14 (14.2%) patients without AKI; P < 0.001. AKI developed in 100% of the patients with known chronic kidney disease (CKD) at baseline and 41.6% of the patients with normal baseline kidney function; P < 0.001. Diabetes mellitus was present in 29/79 (36.7%) patients with AKI and 6/16 (37.5%) patients without AKI; P = 0.31. Hospital stay in days was 11.65 ± 5.9 and 5.81 ± 0.91, respectively, in patients with and without renal dysfunction; P < 0.001. 6/95 (6.3%) patients died. All six patients had renal dysfunction. At 3 months, renal functions normalized in 38/79 (48.1%) patients and 8/31 (25.8%) patients remained dialysis-dependent. Conclusions: AKI is a common complication of APN. It is usually reversible with early and appropriate management. Male gender, anemia, bilateral pyelonephritis, baseline CKD, and delayed presentation to hospital are associated with increased risk of AKI. It is associated with an increased risk of dialysis, hospitalization days, and mortality.","PeriodicalId":8012,"journal":{"name":"APIK Journal of Internal Medicine","volume":"11 1","pages":"101 - 106"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41862534","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}
Roopa Suresh, A. Reddy, P. Sreelatha, Y. Reddy, P. Dhananjaya, Arshiya Hashmath
Background: Worldwide health-care personnel are dealing with coronavirus disease 2019 (COVID-19) at various levels. From fears of protecting themselves and their family while treating COVID patients to succumbing to COVID infection themselves, they are at the receiving end of divergent ramifications of COVID infection. One such aspect that is less known is the long-haul manifestations of COVID infection in health-care workers (HCWs). Aims: The aim of this study was to assess the persisting symptoms in HCWs who had recovered from COVID-19 and to investigate the associated factors contributing to the persistent symptoms. Settings and Design: It was a longitudinal, follow-up study of HCWs who had recovered from acute COVID infection but have lingering symptoms workers in a medical college hospital. Materials and Methods: HCWs were evaluated using standardized questionnaires that included sociodemographic, clinical variables, and persistence of post-COVID symptoms. Health-Related Quality of Life Scale was used to evaluate the quality of life. After detailed clinical evaluation, appropriate and relevant investigations were done where necessary. The data were statistically analyzed using Microsoft Excel Sheet and Stata 14.1 version. Results: The most common manifestations were fatigue, generalized weakness, fever, shortness of breath, chest pain, and palpitations. In the majority, health-related quality of life was affected. Respiratory and cardiovascular systems were most affected, followed by the central nervous system. Conclusion: Patients with COVID 19 infection develop diverse set of symptoms that evolve over time, with infected HCWs being no exception. Recognizing these persisting and ongoing symptoms is the first step taken toward addressing and alleviating them. This highlights that care of COVID patients does not conclude at hospital discharge. Long-term follow-up of these cases is essential in identifying and managing the sequelae of COVID infection. With the growing population recovering from COVID infection, it is imperative to focus on the prolonged effects of COVID infection.
{"title":"Long COVID 19 – Persistent and longitudinal symptoms in covid infected health care personnel","authors":"Roopa Suresh, A. Reddy, P. Sreelatha, Y. Reddy, P. Dhananjaya, Arshiya Hashmath","doi":"10.4103/ajim.ajim_27_22","DOIUrl":"https://doi.org/10.4103/ajim.ajim_27_22","url":null,"abstract":"Background: Worldwide health-care personnel are dealing with coronavirus disease 2019 (COVID-19) at various levels. From fears of protecting themselves and their family while treating COVID patients to succumbing to COVID infection themselves, they are at the receiving end of divergent ramifications of COVID infection. One such aspect that is less known is the long-haul manifestations of COVID infection in health-care workers (HCWs). Aims: The aim of this study was to assess the persisting symptoms in HCWs who had recovered from COVID-19 and to investigate the associated factors contributing to the persistent symptoms. Settings and Design: It was a longitudinal, follow-up study of HCWs who had recovered from acute COVID infection but have lingering symptoms workers in a medical college hospital. Materials and Methods: HCWs were evaluated using standardized questionnaires that included sociodemographic, clinical variables, and persistence of post-COVID symptoms. Health-Related Quality of Life Scale was used to evaluate the quality of life. After detailed clinical evaluation, appropriate and relevant investigations were done where necessary. The data were statistically analyzed using Microsoft Excel Sheet and Stata 14.1 version. Results: The most common manifestations were fatigue, generalized weakness, fever, shortness of breath, chest pain, and palpitations. In the majority, health-related quality of life was affected. Respiratory and cardiovascular systems were most affected, followed by the central nervous system. Conclusion: Patients with COVID 19 infection develop diverse set of symptoms that evolve over time, with infected HCWs being no exception. Recognizing these persisting and ongoing symptoms is the first step taken toward addressing and alleviating them. This highlights that care of COVID patients does not conclude at hospital discharge. Long-term follow-up of these cases is essential in identifying and managing the sequelae of COVID infection. With the growing population recovering from COVID infection, it is imperative to focus on the prolonged effects of COVID infection.","PeriodicalId":8012,"journal":{"name":"APIK Journal of Internal Medicine","volume":"11 1","pages":"82 - 87"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41980834","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}
B. Prusty, K. Ramineni, G. Reddy, S. Annavarajula, M. Momin
Thrombotic thrombocytopenic purpura (TTP) is a nonimmune, microangiopathic hemolytic anemia, associated with thrombocytopenia, fever, neurologic, or renal dysfunction. Plasma exchange (PEX) with or without steroids constitutes first-line therapy in TTP. However, a subset of the patients may be refractory to PEX. Rituximab appears to be an alternative effective therapy for refractory or relapsing TTP. Here, we report a case of TTP in a 43-year-old female presented with fever, generalized weakness, headache, vomiting, and ecchymotic patches over forearms and upper chest for 7 days along with one episode of seizure. The laboratory evaluation revealed severe thrombocytopenia, anemia, and indirect hyperbilirubinemia with peripheral blood smear showing schistocytes (fragmented red blood cells). Initial therapy with multiple PEXs along with parenteral corticosteroids resulted in only minimal improvement of platelet count. Subsequently, rituximab was administered which helped in normalization of platelet count and overall clinical improvement. This case highlights the importance of timely utilization of second-line drugs such as rituximab in refractory TTP.
{"title":"Refractory thrombotic thrombocytopenic purpura treated successfully with monoclonal antibody (rituximab)","authors":"B. Prusty, K. Ramineni, G. Reddy, S. Annavarajula, M. Momin","doi":"10.4103/ajim.ajim_56_21","DOIUrl":"https://doi.org/10.4103/ajim.ajim_56_21","url":null,"abstract":"Thrombotic thrombocytopenic purpura (TTP) is a nonimmune, microangiopathic hemolytic anemia, associated with thrombocytopenia, fever, neurologic, or renal dysfunction. Plasma exchange (PEX) with or without steroids constitutes first-line therapy in TTP. However, a subset of the patients may be refractory to PEX. Rituximab appears to be an alternative effective therapy for refractory or relapsing TTP. Here, we report a case of TTP in a 43-year-old female presented with fever, generalized weakness, headache, vomiting, and ecchymotic patches over forearms and upper chest for 7 days along with one episode of seizure. The laboratory evaluation revealed severe thrombocytopenia, anemia, and indirect hyperbilirubinemia with peripheral blood smear showing schistocytes (fragmented red blood cells). Initial therapy with multiple PEXs along with parenteral corticosteroids resulted in only minimal improvement of platelet count. Subsequently, rituximab was administered which helped in normalization of platelet count and overall clinical improvement. This case highlights the importance of timely utilization of second-line drugs such as rituximab in refractory TTP.","PeriodicalId":8012,"journal":{"name":"APIK Journal of Internal Medicine","volume":"11 1","pages":"128 - 131"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47745441","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: Herpes zoster and postherpetic neuralgia (PHN) results from reactivation of varicella-zoster virus. Pain increases sharply with advancing age and the elderly are more inclined to suffer. If herpes zoster is not treated early, patients may develop PHN. For some, it can persist for 1–2 years. Botulinum toxin injection (BTX-A) has been useful for patients suffering from PHN pain. Objective: The objective of this study was to study the effect of botulinum toxin on pain severity and quality of life in patients with PHN. Methods: A hospital record-based follow-up study was carried out among 30 PHN patients treated with hypodermic injection of BTX-A. Before injection, we measured Visual Analog Score (VAS) for pain severity and the Quality of Life (QOL) Scale using short form survey-36 (SF-36) score. BTX-A injections were given, and patients were followed every month for 6 months. During follow-up, VAS, QOL, pain frequency, and analgesic use were measured. Results: Majority were 60–69 years (40%). The proportion of males and females was not much different. Mean pain severity reduced significantly from 8.9 to 5.8 at 6 months. QOL improved significantly in 6 months. Pain frequency decreased significantly from 22.33 to 18.56 at 6 months. Mean analgesics use was 87.43 which reduced significantly to 7 at 2 weeks after BTX-A and then slowly increased to 7.66 at 4 weeks, to 8.23 at 12 weeks, and 10.4 at 24 weeks. Conclusion: Using BTX-A for treating PNH is promising and gives long-lasting results. It can be considered a valid approach in the treatment of PNH, especially in nonresponsive patients.
{"title":"Effect of botulinum toxin injection on pain severity and quality of life among patients with postherpetic neuralgia","authors":"R. Prasuna, Ajay Aeerabolli","doi":"10.4103/ajim.ajim_44_22","DOIUrl":"https://doi.org/10.4103/ajim.ajim_44_22","url":null,"abstract":"Background: Herpes zoster and postherpetic neuralgia (PHN) results from reactivation of varicella-zoster virus. Pain increases sharply with advancing age and the elderly are more inclined to suffer. If herpes zoster is not treated early, patients may develop PHN. For some, it can persist for 1–2 years. Botulinum toxin injection (BTX-A) has been useful for patients suffering from PHN pain. Objective: The objective of this study was to study the effect of botulinum toxin on pain severity and quality of life in patients with PHN. Methods: A hospital record-based follow-up study was carried out among 30 PHN patients treated with hypodermic injection of BTX-A. Before injection, we measured Visual Analog Score (VAS) for pain severity and the Quality of Life (QOL) Scale using short form survey-36 (SF-36) score. BTX-A injections were given, and patients were followed every month for 6 months. During follow-up, VAS, QOL, pain frequency, and analgesic use were measured. Results: Majority were 60–69 years (40%). The proportion of males and females was not much different. Mean pain severity reduced significantly from 8.9 to 5.8 at 6 months. QOL improved significantly in 6 months. Pain frequency decreased significantly from 22.33 to 18.56 at 6 months. Mean analgesics use was 87.43 which reduced significantly to 7 at 2 weeks after BTX-A and then slowly increased to 7.66 at 4 weeks, to 8.23 at 12 weeks, and 10.4 at 24 weeks. Conclusion: Using BTX-A for treating PNH is promising and gives long-lasting results. It can be considered a valid approach in the treatment of PNH, especially in nonresponsive patients.","PeriodicalId":8012,"journal":{"name":"APIK Journal of Internal Medicine","volume":"11 1","pages":"97 - 100"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49367401","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}
Muscular tuberculosis is one of the rare types of tuberculosis, with an incidence of around 0.01%–1%. Muscular tuberculosis can be primary or secondary. Primary muscular tuberculosis can be due to direct trauma or direct inoculation of tuberculous bacilli. Secondary muscular tuberculosis is a part of disseminated tuberculosis. Our patient was initially diagnosed with pyogenic abscess and treated, but the patient failed to respond and later presented with multiple abscess cavity. Biopsy from the cavity wall proved as muscular tuberculosis and the patient responded well to anti-tuberculous treatment. Muscular tuberculosis must be considered one of the differential diagnoses for the patient with multiple gluteal discharging sinuses. The best investigation to confirm muscular tuberculosis is histopathological confirmation of granuloma.
{"title":"A case of isolated primary muscular tuberculosis of the gluteal region","authors":"Jayapal Pandiaraja, Arumugam Shalini","doi":"10.4103/ajim.ajim_93_20","DOIUrl":"https://doi.org/10.4103/ajim.ajim_93_20","url":null,"abstract":"Muscular tuberculosis is one of the rare types of tuberculosis, with an incidence of around 0.01%–1%. Muscular tuberculosis can be primary or secondary. Primary muscular tuberculosis can be due to direct trauma or direct inoculation of tuberculous bacilli. Secondary muscular tuberculosis is a part of disseminated tuberculosis. Our patient was initially diagnosed with pyogenic abscess and treated, but the patient failed to respond and later presented with multiple abscess cavity. Biopsy from the cavity wall proved as muscular tuberculosis and the patient responded well to anti-tuberculous treatment. Muscular tuberculosis must be considered one of the differential diagnoses for the patient with multiple gluteal discharging sinuses. The best investigation to confirm muscular tuberculosis is histopathological confirmation of granuloma.","PeriodicalId":8012,"journal":{"name":"APIK Journal of Internal Medicine","volume":"11 1","pages":"132 - 134"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44894357","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: Drug-induced parkinsonism (DIP) is important as it is reversible if identified and treated early. We present herewith various clinical patterns and drugs commonly causing DIP. Materials and Methods: This is a retrospective study with done at the outpatient neurology services of Aarogyam Neuroclinic, from Durgapur, West Bengal, during January 1, 2021–July 31, 2021. In this study, consecutive patients satisfying the inclusion criteria for DIP were included in the study. The inclusion criteria were: 1. All patients with two of the four cardinal features of parkinsonism – bradykinesia, tremor, rigidity, and postural imbalance. 2. There should be a temporal relationship of intake of medications before the onset of symptoms. 3. Exclusion of other causes of parkinsonism. The age, sex, and other demographic characteristics of study population were studied. The pattern of parkinsonism – symmetric, asymmetric, tremor-dominant, or rigidity-dominant was noted. Results: Out of 52 patients studied, 34 (65.38%) were male and 18 (34.61%) were female. The most common age group involved was 60–70 years (30.76%), followed by 70–80 years (26.92%) and 50–60 years (19.23%). The mean age was 60.61 years with a standard deviation of 13.44 years. On analysis of the clinical patterns of parkinsonism, the most common type was tremor-dominant symmetric parkinsonism (53.84%), followed by asymmetric parkinsonism (25%) and akinetic-rigid parkinsonism (21.12%). Orofacial dyskinesias were seen in 17.3% along with parkinsonism. Common drugs associated with DIP were gastrointestinal motility agent levosulpiride (25%), calcium channel blockers such as flunarizine (19.23%), aripiprazole (11.53%), amisulpiride (7.69%), sodium valproate (7.69%), olanzapine (3.8%), and itopride, flupenthixol, and risperidone (1.72%). Forty patients were followed up for 6 months, of which, majority (50%) showed complete recovery, whereas 25% each showed partial or persistent symptoms. Conclusion: DIP is a common disorder with varied presentations. Early diagnosis is crucial for complete recovery.
{"title":"Study on drug-induced parkinsonism and its clinical patterns in Eastern Indian population","authors":"Pamelle Yadav","doi":"10.4103/ajim.ajim_24_22","DOIUrl":"https://doi.org/10.4103/ajim.ajim_24_22","url":null,"abstract":"Background: Drug-induced parkinsonism (DIP) is important as it is reversible if identified and treated early. We present herewith various clinical patterns and drugs commonly causing DIP. Materials and Methods: This is a retrospective study with done at the outpatient neurology services of Aarogyam Neuroclinic, from Durgapur, West Bengal, during January 1, 2021–July 31, 2021. In this study, consecutive patients satisfying the inclusion criteria for DIP were included in the study. The inclusion criteria were: 1. All patients with two of the four cardinal features of parkinsonism – bradykinesia, tremor, rigidity, and postural imbalance. 2. There should be a temporal relationship of intake of medications before the onset of symptoms. 3. Exclusion of other causes of parkinsonism. The age, sex, and other demographic characteristics of study population were studied. The pattern of parkinsonism – symmetric, asymmetric, tremor-dominant, or rigidity-dominant was noted. Results: Out of 52 patients studied, 34 (65.38%) were male and 18 (34.61%) were female. The most common age group involved was 60–70 years (30.76%), followed by 70–80 years (26.92%) and 50–60 years (19.23%). The mean age was 60.61 years with a standard deviation of 13.44 years. On analysis of the clinical patterns of parkinsonism, the most common type was tremor-dominant symmetric parkinsonism (53.84%), followed by asymmetric parkinsonism (25%) and akinetic-rigid parkinsonism (21.12%). Orofacial dyskinesias were seen in 17.3% along with parkinsonism. Common drugs associated with DIP were gastrointestinal motility agent levosulpiride (25%), calcium channel blockers such as flunarizine (19.23%), aripiprazole (11.53%), amisulpiride (7.69%), sodium valproate (7.69%), olanzapine (3.8%), and itopride, flupenthixol, and risperidone (1.72%). Forty patients were followed up for 6 months, of which, majority (50%) showed complete recovery, whereas 25% each showed partial or persistent symptoms. Conclusion: DIP is a common disorder with varied presentations. Early diagnosis is crucial for complete recovery.","PeriodicalId":8012,"journal":{"name":"APIK Journal of Internal Medicine","volume":"11 1","pages":"14 - 18"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45624426","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}
Patients with chronic kidney disease can have many dermatological manifestations. One of the very rare conditions is porphyria cutanea tarda (PCT), which manifests with hyperpigmentation of skin and photosensitivity along with painful bullae in sun-exposed areas. It is due to deficiency of uroporphyrinogen III decarboxylase enzyme which takes part in heme synthesis. The deficiency could be genetic or sporadic. Iron therapy and hepatitis C infection are known to precipitate these lesions. We report a case of PCT in a woman undergoing chronic maintenance hemodialysis, review the literature, and discuss the problems with management specific to the dialysis population.
{"title":"Porphyria cutanea tarda: An uncommon condition in a patient on chronic hemodialysis","authors":"Yedabettu Anupama, Y. Parameshwara","doi":"10.4103/ajim.ajim_65_21","DOIUrl":"https://doi.org/10.4103/ajim.ajim_65_21","url":null,"abstract":"Patients with chronic kidney disease can have many dermatological manifestations. One of the very rare conditions is porphyria cutanea tarda (PCT), which manifests with hyperpigmentation of skin and photosensitivity along with painful bullae in sun-exposed areas. It is due to deficiency of uroporphyrinogen III decarboxylase enzyme which takes part in heme synthesis. The deficiency could be genetic or sporadic. Iron therapy and hepatitis C infection are known to precipitate these lesions. We report a case of PCT in a woman undergoing chronic maintenance hemodialysis, review the literature, and discuss the problems with management specific to the dialysis population.","PeriodicalId":8012,"journal":{"name":"APIK Journal of Internal Medicine","volume":"11 1","pages":"53 - 55"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44423349","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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