Guillain-Barre syndrome is an acute rapid-onset progressive neurologic disorder over days to 4 weeks. It presents with symmetric weakness often starting in the legs as an ascending paralysis. Reflexes are reduced or absent early in the disease. The condition is immune-mediated by affecting myelin or axons acutely often triggered by preceding infections. There is albuminocytologic dissociation in the cerebrospinal fluid. Electrodiagnosis exhibits acute demyelinating or axonal patterns. The condition must be treated with intravenous immunoglobulin or plasmapheresis and supportive care. There is a good prognosis with treatment.
Hyalohyphomycosis is an opportunistic infection of the subcutaneous tissue caused by hyaline fungi Hyphomycetes that form septate hyphae within tissue. Immunocompromised states and tropical climates are the main predisposing factors. Rhino-orbital hyalohyphomycosis involving the paranasal sinuses and orbit in an immunocompetent host is a very rare presentation. We report the case of a 27-year-old male crop surveyor who presented with left-sided proptosis and double vision. Based on clinical evaluation and imaging studies-contrast enhanced tomography CECT and magnetic resonance imaging MRI of the paranasal sinuses and orbits - the findings were suggestive of an orbital pseudotumour or fungal mass such as mucormycosis. The patient underwent endoscopic sinus surgery with excision of the orbital mass via Denkers approach under general anaesthesia. Histopathological examination confirmed the diagnosis of hyalohyphomycosis. Postoperatively the patient was treated with anti-fungal medication Itraconazole and advised regular nasal saline irrigation. Although rare in immunocompetent individuals rhino-orbital hyalohyphomycosis should be considered among the differential diagnoses for unilateral intraorbital mass or proptosis.
Eosinophilic cystitis EC is a rare inflammatory condition of the urinary bladder characterized by a predominant infiltration of eosinophils into the bladder wall. About 200 cases of eosinophilic cystitis have been reported till date. The pathogenesis of EC remains uncertain but it is often linked to allergic reactions parasitic infections and certain medications. The three patients described in this series presented with lower urinary tract symptoms LUTS and hematuria. Diagnosis was ascertained by cystoscopy and tissue biopsy. In all three cases the lesion was completely excised and submitted for histopathological examination. All three patients received oral antihistamines for three weeks and one patient received oral prednisolone. None of the patients showed recurrence during follow-up. A combination of imaging studies urinalysis and histopathological biopsy can effectively confirm the condition. In our case series early diagnosis and appropriate treatment led to favorable outcomes.
Background Suicide is one of the leading causes of death both globally and nationally yet it remains one of the most preventable causes. Substance use is among the most common risk factors for suicide attempts but it is also a modifiable one. Individuals with substance use disorders present particular challenges to suicide prevention including the possibility of developing a suicidal urge during alcohol intoxication and substance induced depression.Aim The aim of this study was to determine the prevalence of alcohol use and suicide attempts made under the influence of alcohol as well as to assess the intent of such attempts.Methods This was a cross-sectional study conducted at a tertiary care hospital in Chitradurga Karnataka. A total of 80 patients who had attempted suicide were included. Each participant was evaluated for alcohol use disorder harmful use or dependence according to the ICD-11 criteria. The intent of the suicide attempt was also assessed. Data were analyzed to evaluate the role of alcohol in suicide attempts.Results Of the 80 participants 35 41.25 reported a history of alcohol use 27 33.75 met criteria for alcohol dependence. Among those with alcohol dependence 9 11.25 of the total sample 33.33 of those with dependence attempted suicide under the influence of alcohol. Regarding the level of suicidal intent among patients with alcohol use disorder 14 had severe intent 14 had moderate intent and 7 had low intent.Conclusion Alcohol use emerged as a risk factor for suicide attempts. Targeted strategies are therefore required to minimize this risk.
Background Evidence suggests that gas insufflation during laparoscopic surgery may compromise diaphragmatic function potentially leading to postoperative respiratory challenges. The intraoperative use of positive end-expiratory pressure PEEP and pulmonary recruitment maneuvers could prevent atelectasis reducing respiratory complications. This study examined the effect of PEEP and recruitment maneuvers on diaphragmatic activity during laparoscopic procedures. Methods This randomized study involved patients undergoing laparoscopic abdominal surgery categorized into three groups via computer-generated selection Group A zero PEEP Group B PEEP at 5 cmH2O and Group C PEEP plus recruitment maneuvers. Measurements included diaphragmatic excursion peak inspiratory pressure hemodynamic parameters HR MAP and lung compliance. Results Average diaphragmatic excursion in cm was measured at several stages baseline pneumoperitoneum reverse Trendelenburg after extubation and at six hours postoperatively. In Group A values were recorded as 3.63plusmn0.28 3.04plusmn0.18 3.08plusmn0.008 2.88plusmn0.34 and 3.56plusmn0.33 respectively. Group B values were 3.65plusmn0.27 3.29plusmn0.30 3.13plusmn0.29 3.40plusmn0.37 and 3.65plusmn0.29 while Group C values were 3.75plusmn0.31 3.41plusmn0.28 3.20plusmn0.30 3.40plusmn0.34 and 3.74plusmn0.31. Notably Group A had significantly reduced compliance compared to Groups B and C while values in Group C were consistently higher despite no statistical difference between B and C. Conclusion The use of PEEP during laparoscopic surgeries supports diaphragmatic excursion. Furthermore recruitment maneuvers enhance diaphragmatic movement and dynamic compliance albeit with elevated peak inspiratory pressures compared to the other groups
Background Malaria continues to pose a significant health challenge in India despite ongoing control and elimination initiatives. The disease affects health systems economies and communities particularly in areas with favorable environmental conditions. While surveillance and vector control interventions have significantshyly lowered malaria incidence at both the state level and in Bangalore Urban persistent challenges continue to impede complete eradication. Aim To evaluate the effectiveness of vector control measures and the availability of essential resources for malaria elimination in Bangalore Urban. Methods A retrospective evaluation of vector control measures was conducted in low-coverage areas of Bangalore Urban from January 2018 to December 2022. Data were collected from the Regional Malaria Control Office and the District Vector Borne Disease Control Office. Information was gathered through semi-structured questionnaires and interviews with government health officials. The data were entered into MS Excel and analyzed using SPSS 26.0.Results The study found that essential vector control tools including Long-Lasting Insecticidal Nets LLINs adulticides Temephos 50 insecticides DDT 50 S.P. 10 amp 5 Malathion 95 Deltamethrin 2.5 and spray pumps were available. Various malaria medications such as Artemisinin-based combination thershyapy ACT Quinine sulphate Combi Pack CQPQ Chloroquine phosphate Primaquine phosphate Rapid Diagnostic RD kits Artesunate Artemether and Quinine injections were also accessible.Conclusion The findings indicate that Bangalore Urban possesses the essential resources and vector conshytrol tools required for malaria management. However continued efforts are necessary to address challenges and improve efficiency. Continuous monitoring adaptive strategies and collaborative efforts are critical to strengthening district-level preparedness and achieving sustainable malaria elimination in the region.
Background The kidneys play a critical role in blood filtration waste removal and fluid and electrolyte balance receiving approximately 20 of cardiac output through the renal arteries. These arteries divide into five segmental branches at the hilum apical upper middle inferior and posterior. Aim The present study aimed to analyze the anatomical patterns of the upper segmental renal arteries using the corrosion cast technique. Methods This observational study was conducted in the Department of Anatomy between September 2019 and February 2024. Thirty pairs of kidneys were obtained from cadavers during routine dissections conducted by medical students. Renal artery corrosion casts were prepared by injecting cellulose acetate butyrate into the abdominal aorta followed by solidification and maceration of the specimens. The observations were analyzed to identify the prevalence origin and variations of the upper segmental renal arteries. Statistical analysis was carried out using the Chi-square test. Results At the kidney hilum the renal artery divides into anterior and posterior branches. In 10 of cases the upper segmental artery originated directly from the renal artery. The anterior division was the most frequent source of the upper segmental artery 66.6 with a posterior division origin in 3 of cases. In 15 of specimens the upper segmental artery originated alongside the apical artery from the anterior division. Conclusion This morphological study of the origin course variations and distribution of the upper seg-mental renal arteries provides valuable insights for renal transplantation as well as for medical surgical and radiological applications.
Squamous cell carcinoma arising from the head and neck HNSCC is a challenging tumour with high rates of recurrence and limited therapeutic options in advanced stages. The Hedgehog Hh signalling pathway plays a significant role in embryonic tissue development and homeostasis of tissue. Disruption of this pathway has been associated with etiopathogenesis of various cancers including HNSCC. This paper is an attempt to explore the role of the Hh signalling pathway in HNSCC development and progression and to critically examine the efficacy and limitations of Hh pathway inhibitors as potential therapeutic agents for these tumours. In this paper we discuss the mechanisms and modes of action of these inhibitors summarize clinical trial data and discuss the limitations of their clinical application including mechanisms of resistance and the need for combination therapies.
West Nile virus infection may present as encephalitis and is transmitted through the bite of an infected mosquito. Clinically it is often indistinguishable from other causes of acute encephalitis syndrome. Since the condition is predominantly encountered in Kerala where Japanese encephalitis and Nipah virus infections are also common laboratory testing should include a viral panel for acute encephalitis syndrome. West Nile virus does not replicate in humans and is therefore not transmitted to other insects birds or persons.
Background Dermatological conditions significantly affect patients quality of life and are frequently associated with psychiatric comorbidities such as depression and anxiety. Understanding the sociodemographic dermatological and psychiatric profiles of the affected individuals is essential for providing holistic care.Aim To evaluate the sociodemographic characteristics dermatological profiles and psychiatric comorbidities of patients attending a dermatology outpatient department and examine the association between quality of life and psychiatric parameters.Methods This cross-sectional study included 114 patients with dermatological disease. Data were collected using validated tools including the Dermatology Life Quality Index DLQI Patient Health Questionnaire-9 PHQ-9 Hamilton Depression Rating Scale HAM-D Generalized Anxiety Disorder-7 GAD-7 and Patient Health Questionnaire-15 PHQ-15. Descriptive statistics were used to summarize the data and associations were analyzed using Chi-squared tests logistic regression and correlation analysis. Receiver operating characteristic ROC curve analysis was used to evaluate the predictive utility of PHQ-9 for high DLQI scores.Results The majority of the patients were young unmarried and urban residents with acne 36.0 and fungal infections 27.2 being the most common dermatological conditions. Psychiatric comorbidities were prevalent with 60.5 of participants experiencing depression and 44.7 reporting anxiety. Higher DLQI scores were significantly associated with the PHQ-9 P lt 0.05 HAM-D P lt0.05 and GAD-7 P lt0.05 scores. Logistic regression identified the PHQ-9 and HAM-D as independent predictors of high DLQI scores P lt0.05. ROC analysis of the PHQ-9 yielded an AUC of 0.72 suggesting moderate accuracy in predicting an impaired quality of life.Conclusion Dermatological conditions are associated with significant psychiatric comorbidities and quality-of-life impairments. Depression and anxiety are key predictors of poor quality of life. These findings emphasize the need for integrated dermatology and mental health care to address the holistic needs of patients.
Transverse myelitis is a rare neurological manifestation of antiphospholipid antibody syndrome. Most previously reported cases present with an acute or subacute onset whereas chronic presentations are extremely rare and pose a significant diagnostic challenge. We report a case of middle-aged female with a prior history of unprovoked deep vein thrombosis of the right lower limb who presented with gradually progressive symptoms suggestive of non-compressive cervical myelopathy. Blood investigations revealed a triple-positive antiphospholipid antibodies profile with no clinical or immunological evidence of the commonly associated systemic lupus erythematosus SLE. She was treated with high-dose steroids and mycophenolate mofetil and demonstrated mild to moderate clinical improvement after six months of follow-up.
Fetus in fetu is a rare congenital anomaly with an incidence of approximately 1 in 500000 live births. A 5-month-old pediatric patient presented with gross abdominal distension and respiratory distress. Contrast-enhanced CT of the abdomen revealed a well-encapsulated multiloculated solid-cystic lesion in the right retroperitoneum containing intralesional fatty components and calcifications forming appendiceal bones. Exploratory laparotomy was performed and the lesion was excised in toto. The patient remains under regular follow-up. Given the rarity of fetus in fetu we present this case to contribute to the literature and provide further insights into this unusual condition.
Background amp Objectives Cervical lymphadenopathy is assessed clinically radiologically and pathologically with accurate diagnosis being crucial for effective management. This study evaluates patients with cervical lymphadenitis clinically and pathologically to confirm the diagnosis assess clinical behavior and determine management outcomes.Methods This cross-sectional prospective study was conducted at a tertiary care center over two years. Patients over 10 years old with cervical lymphadenopathy persisting for more than three weeks were included. The collected data included age sex symptom duration constitutional symptoms and a history of tuberculosis TB contact. A thorough local and general physical examination was performed followed by a complete blood count CBC erythrocyte sedimentation rate ESR neck ultrasound fine-needle aspiration cytology FNAC and excisional biopsy. Treatment was initiated based on confirmed diagnoses.Results The study included 50 patients predominantly aged 31-40 years with a male-to-female ratio of 1.271. Fever was the most common symptom 42 followed by pain 26. Lymph nodes were firm in 42 patients 84 multiple in 26 52 and unilateral in 45 90. Clinically TB lymphadenitis was the most common diagnosis 62 followed by acute suppurative lymphadenitis 18 and malignant metastasis 6. FNAC identified TB lymphadenitis in 54 and acute suppurative lymphadenitis in 14. FNAC demonstrated a sensitivity of 71.05 and a specificity of 100 making it a highly reliable diagnostic tool.Conclusion Tubercular lymphadenitis acute suppurative lymphadenitis and malignancies were the most common causes of cervical lymphadenopathy in this study. FNAC proved to be a highly sensitive and specific investigation for early and accurate diagnosis.
Guillain-Barre syndrome is an acute rapid-onset progressive neurologic disorder over days to 4 weeks. It presents with symmetric weakness often starting in the legs as an ascending paralysis. Reflexes are reduced or absent early in the disease. The condition is immune-mediated by affecting myelin or axons acutely often triggered by preceding infections. There is albuminocytologic dissociation in the cerebrospinal fluid. Electrodiagnosis exhibits acute demyelinating or axonal patterns. The condition must be treated with intravenous immunoglobulin or plasmapheresis and supportive care. There is a good prognosis with treatment.
Background and Objectives Neonates admitted to the intensive care units are susceptible to developing electrolyte imbalances which can result in an increased mortality rate. Measuring electrolyte levels particularly sodium Na and potassium K is often necessary in seriously ill patients. The present study aimed to compare the concentration of sodium and potassium between the arterial blood sample and serum from the venous blood sample.Methods We retrospectively studied 100 hospitalized neonates in the Neonatal Intensive Care Unit NICU whose samples were taken for ABG and serum electrolytes simultaneously and both samples were processed on GEM PREMIER 3000 and Roche AVL 9180 Electrolyte Analyzer respectively. Statistical measures employed to compare the data included the Pearson correlation coefficient and Bland-Altman plots.Results The mean concentration of sodium Na was 135.05 mmolL SD 6.69 mmolL using the ABG and 135.36 mmolL SD 6.54 mmolL using the serum sample. The mean level of the K was 3.91 mmolL SD 0.86 mmolL using the ABG and 4.12 mmolL SD 0.91 mmolL using the serum sample. The associated correlation coefficients were 0.89 and 0.88 respectively.Conclusion We conclude that the results for Na and K are like those of the ABG sample and serum from the venous blood sample. So one can decrease the amount of blood sample volume and the number of needle punctures required for electrolytes assessment in neonates admitted to the NICU.
Background There is a growing enthusiasm for bodybuilding and fitness among young adults. Many gymgoers consume various nutritional supplements in pursuit of rapid results often without adequate awareness of their impact on metabolic processes in the body.Aim This cross-sectional study was conducted to investigate the effects of dietary supplements on routine laboratory parameters in gym-going young adult males.Methods A total of 50 participants were recruited and divided into two groups of 25 each based on their use or non-use of dietary supplements. Complete blood count and serum levels for fasting glucose renal function tests liver function tests and lipid profile were measured and statistically compared between the two groups.Results Differences were observed in several parameters between the two groups however statistical significance Pgt0.05 was found only for serum uric acid phosphorus total cholesterol and low density lipoprotein-cholesterol LDL-C. Serum levels of liver function tests and fasting glucose did not show any statistically significant differences between the groups.Conclusion Dietary supplements used by gym-goers may induce various metabolic changes. Understanding these effects may contribute to the development of more evidence-based guidelines for the use of dietary supplements and ultimately support better community health outcomes.nbsp
Background Pleural effusions are common manifestations of a variety of pathologies. The specific cause must be identified to initiate timely treatment. The primary step in establishing a diagnosis is to differentiate transudative and exudative effusions for which Lightrsquos criteria have been accepted as the gold standard. However recent studies investigating Lightrsquos criteria have revealed high sensitivity for exudates but low specificity. This prompted us to evaluate bedside hydrogen peroxide H2 O2 test as an alternative to Lightrsquos criteria.Methods A cross-sectional study involving 100 subjects was conducted to determine the diagnostic accuracy of the bedside H2nbspO2nbsptest in differentiating transudative and exudative pleural fluids using the Lightrsquos criteria as the reference standard. According to Lightrsquos criteria a pleural effusion is classified as an exudate when the pleural fluid proteinserum protein ratio gt0.5 or the pleural fluid lactate dehydrogenase LDHserum LDH gt0.6. A transudate is diagnosed when these criteria are not met. In the H2nbspO2nbsptest an exudate is identified by the appearance of profuse bubbling within one minute of adding H2nbspO2nbspto the pleural fluid whereas the absence of bubbling indicates a transudate.nbspResults A male preponderance was observed with a higher incidence of pleural effusion among urban dwellers. Among the study population 74 were chronic tobacco consumers and 62 were chronic alcoholics. The H2nbspO2nbsptest demonstrated a sensitivity of 88.52 specificity of 94.87 positive predictive value of 96.4 negative predictive value of 88.4 and an overall diagnostic accuracy of 91.0.Conclusion The simple bedside H2nbspO2nbsptest facilitates rapid categorization of pleural fluid as transudate or exudate thereby reducing diagnostic turn around time and allowing for earlier initiation of treatment. Additionally the H2 O2 test is cost-effective making it more viable option in resource-deficient laboratory settings. nbsp
Background Contraception is the deliberate use of artificial methods or techniques to prevent pregnancy resulting from sexual activity. Intrauterine contraceptive device IUCD is one of the contraception forms.Objectives The objectives of the present study were to identify the reasons for non-acceptance of intrauterine contraceptive devices IUCD and to analyze the demographic characteristics of the participants.Methods A total of 296 women visiting the PNC OPD were included. Women aged 20-40 years who had not undergone sterilization and eligible for contraception were counselled for IUCD insertion. Those who declined the method were asked to provide reasons for non-acceptance. Their socio-economic details were recorded and informed consent was obtained. Myths and misconceptions related to IUCDs were also documented.Results The acceptance rate was 36. Among the participants 27 of women belonged to the 20-25 and 35-40 years age group and 66 were multigravidas. A majority 74 were from lower socio-economic backgrounds and 57 were educated. Myths and misconceptions accounted for 73 of the reasons for nonacceptance. Other reasons included preference for alterative contraceptive methods 9 religious beliefs 7 refusal by husbands 6 opposition from family members 3 and fear of IUCD insertion pain 2. Among the myths the most commonly cited were belief that IUCD causes drastic weight loss 21 that it can migrate inside the body 15 that the male partner can feel the device during intercourse 11 and that it causes pain during sexual activity 10.Conclusion Intrauterine devices IUDs offer effective long-term protection against unintended pregnancies - a key factor in reducing abortion-related health risks. However misconceptions and limited awareness often hinder their acceptance highlighting the need for broader education to address myths and promote informed choices.nbsp
