International Journal of Advances in Medicine

Estimating maternal mortality and identifying causes of maternal deaths in Jammu and Kashmir: a two-year epidemiological study

2023-03-14T21:24:33+00:00

Background: An accurate estimate of the maternal mortality ratio and its underlying causes is crucial for the effective planning of maternal health services. The aim of the study was to estimate the maternal mortality ratio (MMR) and identify causes of maternal deaths in Jammu and Kashmir. A subnational geographical area in India.

Methods: The study included maternal deaths from April 2020 to March 2022 among residents of Jammu and Kashmir. We enumerated all maternal deaths and recorded their socio-clinical parameters from interviews with family members. The cause of death was inferred from the medical records and verbal autopsy. Live births data for the corresponding period was obtained from the routine health management information system. We calculated the maternal mortality ratio using a standard formula.

Results: A total of 185 maternal deaths and 3.97 lakh live births were recorded over the two-year study period. It translated into an MMR of 47 per lakh live births, exhibiting noteworthy variability between districts. Postpartum haemorrhage (PPH) and hypertensive disorders of pregnancy accounted for a substantial proportion of maternal deaths, representing 44.3% (82/185) of cases. Sepsis and other obstetric complications were identified as the cause of death in 15.7% (29/185) and 19.5% (36/185) of maternal deaths, respectively. Furthermore, the majority of maternal deaths occurred among women between 25-30 years of age. Approximately two-thirds of maternal deaths occurred during the post-partum period.

Conclusions: In summary, our study reveals that the maternal mortality rate (MMR) in Jammu and Kashmir falls below the sustainable development goal target, albeit with marked inter-district variability pointing to disparities in healthcare delivery. We recommend expanding the coverage of evidence-based interventions aimed at reducing the incidence of postpartum haemorrhage, eclampsia, and other obstetric complications to improve maternal health outcomes.

Clinical profile and treatment outcome in gastrointestinal cancer patients: a single-center experience in Kashmir valley, India

2023-03-03T04:42:56+00:00

Background: Gastrointestinal (GI) cancers are one of the common cancers and are associated with significant morbidity and mortality. The present study was conducted to evaluate the treatment outcome of GI cancer patients undergoing follow-up in the oncology OPD of a tertiary care hospital.

Methods: Cases previously treated for any GI cancer at one center and coming for follow-up to the hospital were enrolled. Treatment outcome was ascertained in these patients and its relationship with clinical and demographic characteristics of patients at diagnosis were analysed.

Results: A total of 68 cases of GI cancers were enrolled with a mean age of 57.44±8.3 years and of 39 (57.35%) were males. The most common site for cancers was oesophagus, stomach, Colo-rectal with 22,20 and 17 cases respectively. Stage II was the most common stage at presentation in 50% cases followed by Stage III in 32.35% of cases. There was significant association between stage at diagnosis with stage I disease at diagnosis significantly related to complete cure. Site of cancer, age and smoking history had no significant correlation with treatment outcome.

Conclusions: Diagnosis of GI cancers at early stage was associated with complete cure at follow up. This finding demonstrates the importance of early screening for GI cancers and the need to have robust screening guidelines and improving access to screening with highly valid tests particularly for individuals with high risk features.

Summarization of the literature published on biliary atresia: a comprehensive literature review

2023-03-13T11:22:54+00:00

The leading cause of pediatric liver failure and liver transplantation is biliary atresia. Early diagnosis of BA is challenging, and delayed diagnosis caused many complications. Most BA patients eventually went through liver transplantation even if received the initial treatment of the disease. The incidence of BA is rare hence limited literature has been published about diagnosis, treatment, risk factors and survival rate among BA patients. Therefore, this literature review aimed to provide an opportunity for physicians and researchers to know about different diagnostic and treatment tools as well as about the risk factors causing variation in the survival rate after liver transplantation. Therefore, knowledge about the advanced methods of diagnosis provides an early and accurate diagnosis and providing treatment with fewer risk factors help to increase favorable outcome and increase the survival rate among BA patients.

Sudden infant death syndrome

2023-03-04T20:59:36+00:00

The sudden death of infants younger than one year is known as SIDS. It is a major cause of mortality among infants less than one year of age. There is little focus in the literature on sudden infant death syndrome (SIDS). Thus, this review aims to provide new insights on the incidence, risk factors and prevention of SIDS in infants. Following preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines, this review explored eligible articles from PubMed, Google Scholar, and research gate databases. Several keywords were used for the search to obtain all possible related articles. The inclusion criteria were reviews and original articles focused on the current subject and written in English. The eligible articles used to compile this review were published between 2007 and 2021. Three main titles were discussed in this review: incidence, risk factors, and prevention. SIDS is the most common reason for death among infants aged less than one year. There is great variation in the global incidence of SIDS. Factors related to the sleeping environment are the major risk factors for SIDS and should be the focus. Hence, following the recommendations of the American academy of pediatrics can reduce incidence of SIDS.

10-year-old case report of pediculosis with severe anaemia

2023-03-14T19:25:56+00:00

Excessive consumption of cow milk and menorrhagia are the two most common causes of iron deficiency anaemia (IDA) in children. However, there have been reported cases of parasitic infestation causing IDA. Pediculus humanus survives on human blood, and prolonged blood loss causes anaemic symptoms. In the current case report, a 10-year-old girl complained of pallor and dizziness. During her physical examination, a head lice infestation was discovered. The patient had no history of chronic illness and used to eat a normal diet that was high in iron. Her haemoglobin level was measured to be 4 g/dl. Doctors determined that the severe iron deficiency was caused due to the head lice infestation. To reach the required haemoglobin level, she was admitted to the hospital and given a blood transfusion. Her head was washed with permethrin 1% shampoo, which removed over 60% of the lice in a single wash. She was instructed to wash her hair with the shampoo again after seven days.

Spontaneous haemorrhagic stroke associated with expanded dengue syndrome: a case report

2023-02-13T13:44:56+00:00

The term "expanded dengue syndrome" was introduced to describe the severe clinical manifestations that result from dengue fever (DF), namely severe multi-organ involvement including disorders of the nervous system. Neurological complications occur in 1-5% of dengue patients, including haemorrhagic stroke. A 68-year-old man presented with complaints of full-body convulsions for 1 minute. Four days earlier the patient complained of headache, fever, and nausea. Non-contrast CT scan of the head showed abnormal hyperdense lesions with focal intraparenchymal oedema in the frontoparietoocipital region, cortical sulci and gyri appeared dilated, ventricular system and sisterna were dilated. Anti-dengue IgG and IgM were positive. Neuropathogenesis that may play an important role in dengue-related neurological syndromes include direct CNS invasion by the virus, autoimmune reactions, and metabolic changes. The diagnosis of neurological complications related to dengue haemorrhagic fever (DHF) requires special attention, especially for areas where DF is still endemic.

Deep vein thrombosis as a rare complication of scrub typhus

2023-02-28T11:32:59+00:00

Scrub typhus is a common re-emerging, acute febrile infectious disease, caused by orientia tsutsugamushi, transmitted by bite of chiggers of trombiculid mite. The clinical presentation of infection can vary from mild symptoms to severe multi organ failure, shock, encephalopathy, meningoencephalitis, DIC and various thromboembolic complications. We describe a rare hematological complication of deep vein thrombosis (DVT) caused by scrub typhus in a 61-year-old female. Vasculitis and perivasculitis with endothelial dysfunction could be considered as the main pathologic mechanism causing this complication.

Recurrence hospitalization due to SARS-CoV-2 infection on human immunodeficiency virus patients

2023-02-24T07:14:17+00:00

COVID-19 is a global health concern with varying severity. Moderate to severe cases require isolation for 10-20 days, and those with weakened immune systems (like HIV) should isolate for 20 days. Indonesia has a rising number of HIV cases. HIV-positive individuals have a higher risk of COVID-19 and may have lower antibody levels after vaccination. Two case studies of HIV-positive patients who contracted SARS-CoV-2 are presented. In case 1, a 29-year-old patient who received the COVID-19 vaccine and was on antiretroviral therapy was hospitalized three times with worsening symptoms, and unfortunately did not survive. In case 2, a 46-year-old patient with a history of tuberculosis and also on antiretroviral therapy was hospitalized twice, reporting mild symptoms, and did not experience any further symptoms related to COVID-19 after being discharged. Both patients tested positive for COVID-19 using rapid antigen tests and PCR tests and did not report any history of contact with COVID-positive individuals. These case studies highlight the challenges faced by HIV-positive individuals in managing COVID-19, and the need for continued research in this area. Immunocompromised COVID-19 patients need special isolation, even with mild symptoms. Longer isolation periods may be necessary, as studies show positive tests can still mean infectiousness. Viral culture tests can help identify contagious individuals who test positive on PCR tests. People with HIV may need a COVID-19 booster vaccine due to lower antibody levels after the initial vaccine. Further research is needed to develop antiviral treatments for COVID-19 infection in individuals with immunocompromised.

A rare presentation of amyloid goiter with renal amyloidosis in a young female

2023-01-31T06:45:31+00:00

Amyloidosis is a rare systemic disorder caused by abnormal folding of normal soluble proteins leading to fibril formation in one or more body organs, systems or soft tissues. Amyloid goiter is characterized by deposits of amyloid protein in the thyroid tissue. Amyloid infiltration of thyroid gland with development of secondary goiter is rare. Here we report a case of 36-year-old female presented with progressive painless swelling over neck. Thyroid profile was normal. Ultrasound neck showed enlarged bilateral thyroid gland and isthmus. Fine needle aspiration cytology suggestive of subacute thyroiditis (granulomatous thyroiditis). Total thyroidectomy was done and biopsy sample revealed amyloid goiter.

Ultrasound-guided treatment of meralgia paresthetica: case report

2023-02-03T01:28:42+00:00

Meralgia paresthetica (MP) or so-called as lateral femoral cutaneous nerve (LFCN) entrapment is a mononeuropathy characterized by a localized area of paresthesia, dysesthesia, tingling, burning, and numbness on the anterolateral aspect of the thigh, between the inguinal ligament and the knee without associated loss of reflexes and motor weakness. The incidence of MP increases with obesity and diabetes. Ultrasound-guided has been demonstrated useful for visualization of peripheral nerves, in particular very small nerves such as the LFCN. Hereby, we reported a case of 63-year-old man diagnosed with MP. The patient complained of numbness, and no pain when pinched in his anterolateral aspect of the left thigh since 3 weeks ago. On physical examination, his body mass index (BMI) was 27 (overweight) with normal vital signs. Neurological examination revealed normal motoric function and refleks; but decreased sensation to pinprick in the left anterolateral thigh in the LFCN distribution. No abnormal findings on plain radiographs of the pelvis and lumbar spine. Ultrasound-guided injection was performed in this patient.

An interesting case of thyrotoxic periodic paralysis

2023-02-26T16:50:07+00:00

Hyperthyroidism rarely cause paralysis by redistributive hypokalemia, with periodic attacks of paralysis termed as thyrotoxic periodic paralysis (TPP). It is more commonly seen in the Asian or Hispanic populations, genetic variation in Kir2.6, a muscle specific thyroid hormone responsive potassium channel cause predisposition of TPP. It typically presents in the early morning with limb weakness. Hyperthyroidism signs and symptoms are need not to be present in all patients. TPP attacks can be triggered by factors such a high-carbohydrate diet, sternous activity, mental stress, and steroids. TPP should be suspected in young patients presenting with acute muscle weakness and severe hypokalemia. Arrhythmias can be noted but most of these will resolve with normalization of potassium.

Primary antiphospholipid syndrome with celiac and splenic artery thrombosis

2023-02-28T12:02:23+00:00

Antiphospholipid syndrome (APS) is an autoantibody mediated acquired thrombophilia characterized by recurrent arterial or venous thrombosis and or pregnancy morbidity. We describe a case of 32-year-old female who had a medical history of APLA presented with complaints of abdominal pain for 20 days. On evaluation, CT abdomen contrast revealed celiac and splenic artery thrombosis. She was successfully treated with IV unfractionated heparin, warfarin and antiplatelets.

An interesting case of ascites

2023-02-11T12:50:16+00:00

The Krukenberg tumor is a rare tumor of the ovary which is malignant. It is usually a bilateral involvement of ovaries from the metastatic deposit from adenocarcinoma of the stomach. It is characterized by the stiffening and thickening of the gastric wall. The most common malignancy to manifest as the Krukenberg tumor is the stomach. Here, we discuss a case of diffuse adenocarcinoma of the stomach presenting as linitis plastica with ascites.

A rare case of autoimmune pancreatitis with pancreatic divisum

2023-02-12T11:43:24+00:00

Chronic pancreatitis has a fibro-inflammatory subtype called autoimmune pancreatitis. A combination of imaging tests, including a CT scan and pancreatography, lab tests that check for IgG4 and/or autoantibodies, histological analysis, and a favourable response to corticosteroid treatment are used for diagnosis. Hereby we present a case of a young boy who presented to our hospital with recurrent abdominal pain and on further investigation was found to have elevated levels of IgG4 as well as a developmental abnormality of pancreatic duct known as pancreatic divisum.

Young male with cardio-vascular complication: culprit Takayasu arteritis

2023-02-11T22:14:44+00:00

Takayasu arteritis (TA), a rare type of granulomatous vasculitis characterized by inflammatory changes and stenosis in large and medium sized arteries with a strong predilection for the aortic arch and its branches, usually presented in young female. We are reporting a rare case of TA in 23-year-old male with cardiovascular complication in form of heart failure and hypertension with involvement of right supraclavicular artery and abdominal aorta in form of aneurysm and stenosis, respectively.

A rare case presentation of top of basilar artery syndrome

2023-02-01T18:18:21+00:00

Top of basilar syndrome occurs due to the thrombotic occlusion of basilar artery. It is very rare in occurrence and constitutes about 1% of all strokes. Clinical manifestations commonly may have the hallmarks of basilar artery occlusion that include dysarthria, visual, oculomotor and behavioural abnormalities with or without significant motor dysfunction and non-specific symptoms like vertigo and headache. Here we report a case of 60year old male who presented with decreased responsiveness and slurring of speech since 2 days and history of vomiting since one day. Neurological examination revealed normal higher mental functions with MMSE score of 28/30, horizontal nystagmus was present, other cranial nerve examination was normal, tone was increased in all the four limbs, Power was 4/5 in all the 4 limbs and Plantar was mute bilaterally. Patient condition deteriorated later and on further evaluation patient was found to have Basilar Artery Occlusion.

Gangrene as a rare manifestation of systemic lupus erythematosus

2023-02-28T12:37:41+00:00

Systemic lupus erythematosus (SLE) is a chronic, multifaceted autoimmune inflammatory disease that can affect any part of the body. Peripheral gangrene is a rare manifestation of SLE. We describe a case of 26-year-old female who presented with complaints of bilateral lower limb rash, blackish discoloration of skin over right little finger and right third toe for past 2 months. On evaluation her anti RNP, anti SM and anti dsDNA antibodies were strongly positive. She was treated with IV unfractionated heparin, IV corticosteroids, IV antibiotics and other supportive measures.