Hungry bone syndrome (HBS) is a well-recognised complication after curative parathyroidectomy in primary hyperparathyroidism (PHPT), contributing to morbidity and prolonged hospitalisation. Reported predictors remain inconsistent, and data from Indian cohorts are limited, particularly in settings where vitamin D deficiency and advanced skeletal disease may modify risk. This retrospective observational cohort study was conducted at a tertiary surgical centre between January 2023 and December 2025. Twenty-five consecutive patients with biochemically proven PHPT who underwent curative parathyroidectomy were included. Preoperative variables included serum calcium, phosphate, parathyroid hormone (PTH), alkaline phosphatase (ALP), and 25-OH vitamin D. For this study, HBS was defined as postoperative hypocalcaemia persisting for more than 72 h after surgery and requiring clinically significant calcium supplementation; transient asymptomatic biochemical hypocalcaemia was not classified as HBS. Receiver operating characteristic (ROC) curves were constructed, and a three-point bedside score was evaluated in an exploratory manner. HBS developed in 7 patients (28
Diffuse alveolar hemorrhage (DAH) is a potentially fatal pulmonary condition caused by bleeding into the alveolar spaces due to disruption of the alveolar–capillary membrane. Although DAH is well recognized in antineutrophil cytoplasmic antibody–associated vasculitis and anti–glomerular basement membrane disease, its association with IgA nephropathy is extremely rare. Occurrence of DAH after progression of IgA nephropathy to dialysis-dependent end-stage renal disease (ESRD) is even more uncommon. We report a 35-year-old man with biopsy-proven IgA nephropathy who had progressed to ESRD and was receiving maintenance hemodialysis. He presented with hemoptysis, progressive dyspnea, and a decline in hemoglobin levels. Imaging revealed bilateral ground-glass opacities. Flexible bronchoscopy with bronchoalveolar lavage demonstrated sequentially hemorrhagic aliquots with hemosiderin-laden alveolar macrophages, confirming diffuse alveolar hemorrhage. Infectious workup, coagulation disorders and autoimmune serology were negative. The patient was treated with pulse methylprednisolone followed by oral corticosteroids, resulting in rapid clinical and radiological improvement. This case highlights that systemic IgA-mediated vasculitic activity may persist despite dialysis-dependent end stage renal failure. Clinicians should consider DAH in dialysis patients presenting with hemoptysis, anemia, and new pulmonary infiltrates, as early recognition and timely immunosuppressive therapy can be lifesaving.
BACKGROUND:Screening for latent tuberculosis (LTB) before initiating advanced therapy for inflammatory bowel disease (IBD) helps reduce the risk of tuberculosis (TB) development. However, there is limited data on screening practices from TB-endemic regions. AIM:To study the practices of screening for LTB and study the incidence of TB in patients with IBD on biological and small molecule inhibitors. METHODS:This retrospective multicentre study analyzed LTB screening practices in IBD patients starting advanced therapies between 2018 and 2022. We included patients who were initiated on biologics (infliximab, adalimumab, vedolizumab) or small molecule inhibitors (tofacitinib). We assessed compliance with LTB screening methods, including the tuberculin skin test, interferon-gamma release assay (IGRA), chest X-ray, and computed tomography chest, both at initiation and annually. We also evaluated the incidence of active TB and its predictors. RESULTS:Of 378 patients (mean age: 36.9 ± 14.9 years, males: 56.9%), 158 (41.8%) and 216 (57.1%) had ulcerative colitis and Crohn's disease, respectively. Advanced therapy used were anti-tumor necrosis factor in 309 (81.74%), tofacitinib in 41 (10.84%) and vedolizumab in 28 (7.40%). Standard screening and diligent screening strategy was employed in 59% and 33% of patients, respectively. Compliance with tuberculin skin test and IGRA was noted in 261 (69.04%) and 298 (78.83%) patients, respectively. Chest X-Ray and computed tomography chest were performed in 300 (79.36%) and 242 (64.02%), respectively. Annual screening in those on advanced therapy for > 1 year was performed in 27.2% (50/184). Active TB developed in 17 (4.49%); 15 (88.23%) were on anti-tumor necrosis factor. LTB was detected in 40 (10.72%), with most diagnosed on the basis of IGRA (21/40, 52.50%). Among 17 patients who developed active TB, LTB screen was negative in 12 (70.58%). CONCLUSION:Standard screening practices for LTB, prior to starting advanced therapy, remain suboptimal (< 60%) in India despite high TB endemicity.
Abstract Popliteal artery aneurysms (PAAs) are the second most common type of arterial aneurysm after abdominal aortic aneurysms. True popliteal aneurysms are typically clinically silent and are primarily degenerative in nature, often associated with repeated flexion movements of the knee. We describe a case of spontaneous rupture of a PAA in an elderly female patient with a known history of type II diabetes mellitus, hypertension, and Stage V chronic kidney disease on maintenance hemodialysis. She was admitted for generalized weakness and poor oral intake over the past month, with complaints of difficulty breathing for the last 3 days. She was also experiencing progressively worsening pain in her left calf, accompanied by noticeable swelling of the leg. On examination, she presented with swelling and erythema of the left leg, which, upon further evaluation, was diagnosed as a ruptured silent aneurysm of the popliteal artery. In conclusion, silent compartment syndrome of the leg in patients presenting with lower limb swelling can be diagnosed by maintaining a high index of suspicion and conducting a thorough clinical assessment along with appropriate imaging. To the best of our knowledge, such a case has not been reported in the existing literature.
Background: Prescribing errors are among the most common and preventable causes of medication-related patient harm in hospitals. These errors compromise patient safety, reduce treatment effectiveness, and increase healthcare costs. Although prescribing errors have been extensively studied in high-income countries, evidence from secondary-care hospitals in Sri Lanka remains limited. Understanding local prescribing practices is essential for developing context-specific quality improvement interventions.Objectives: To describe prescribing errors identified in handwritten discharge prescriptions from the general medical and surgical wards of Base Hospital Meerigama, to explore healthcare professionals' perceptions of factors contributing to prescribing errors, and to identify priority areas for quality improvement.Methods: A mixed-methods case study was conducted at Base Hospital Meerigama, Sri Lanka. Qualitative data were collected through key informant interviews with twelve purposively selected healthcare professionals involved in prescribing, dispensing, nursing, and hospital administration. Interview data were analysed using thematic analysis to identify factors influencing prescribing practices. Quantitative data were obtained through a desk review of 198 handwritten discharge prescriptions issued between 26 September and 4 October 2023. A structured checklist was used to identify prescribing errors. Pareto analysis was subsequently performed to prioritize the principal causes identified through the qualitative component.Results: A total of 198 discharge prescriptions were reviewed, identifying 717 prescribing errors, corresponding to an average of 3.6 errors per prescription. The most frequent documentation errors included omission of patient gender (20.5%), use of non-standard drug abbreviations (11.9%), omission of the prescription date (11.6%), and spelling errors (11.4%). Thematic analysis identified several organizational and system-level contributors to prescribing errors. Pareto analysis demonstrated that five principal factors accounted for approximately 83% of the identified causes: non-availability of standard H16 prescription forms, inadequate knowledge of rational prescribing standards, insufficient consultant supervision, absence of institutional prescribing guidelines, and lack of a structured feedback mechanism between prescribers and dispensers.Conclusions: Prescribing practices in the general medical and surgical wards demonstrated important deficiencies that may compromise medication safety. Addressing organisational factors through standardized prescription formats, continuous professional education, strengthened supervision, institutional prescribing guidelines, audit and feedback mechanisms, and progressive implementation of electronic prescribing systems could substantially improve prescribing quality and patient safety.
