Clinical Profile Of Patients Research Articles

Trends in Clinico-radiological and Laboratory Characteristics of All-Cause Meningoencephalitis in Western Rajasthan.

Meningoencephalitis encompasses the coexistence of meningitis and encephalitis in different proportions. This study aimed to delineate the clinical profile, laboratory parameters, radiological features, and outcome predictors of patients with meningoencephalitis. This prospective, observational, and descriptive study was conducted from July 2021 to March 2023. Patients satisfying the case definition of "meningitis" and "encephalitis" were enrolled. Mortality and morbidity (by modified Rankin Score [mRS]) were noted at discharge and at 1 and 3 months post-discharge. Of 102 patients recruited, among infectious meningoencephalitis cases, 28 (27.5%) were viral, 11 (10.8%) were pyogenic, 32 (31.4%) were tubercular, four (3.9%) each were rickettsial, atypical bacterial, and fungal, and three (2.9%) were parasitic. Among noninfectious etiologies, 12 (11.8%) were antineuronal antibody mediated, three (2.9%) had systemic inflammatory etiology, and one (1%) had carcinomatous meningitis. Cerebrospinal fluid (CSF) analysis showed the highest protein content (336.82 ± 251.26 mg/dL) and cell count (476.73 ± 999.16/mm3) in pyogenic followed by tubercular (200.29 ± 174.28/mm3) meningoencephalitis. CSF glucose was lowest in tubercular group (38.30 ± 20.29 mg/dL). Imaging showed leptomeningeal enhancement predominantly in tubercular group (89.7%) and limbic involvement in viral etiology (38.5%). Overall mortality was highest in fungal and rickettsial groups (three out of four patients died at 1 month in each group). Pyogenic, atypical bacterial, and systemic inflammatory meningoencephalitis had maximum temporal improvement in mRS at 1 month, while tubercular, viral, and antineuronal antibody-mediated meningoencephalitis had decrease of at least 1 mRS at 3 months. Fever, altered sensorium, speech disturbances, neck stiffness, albumin, total leukocyte count, erythrocyte sedimentation rate, C-reactive protein, kidney and liver function tests showed significant association with mortality. Tubercular, followed by viral meningoencephalitis, was the most common cause in our center in western India. Pyogenic, atypical bacterial, and systemic inflammatory groups had the best recovery at discharge, while fungal and rickettsial meningoencephalitis groups had worst mRS at 3 months.

Clinical Profile of Patients Diagnosed with Liver Abscess – a Retrospective Study at a Teaching Hospital

Background: Liver abscesses continue to present a significant diagnostic and therapeutic challenge to the medical community. Early clinical distinction between an amoebic and a pyogenic liver abscess is challenging due to their overlapping clinical presentations. Aim: The present study was undertaken to evaluate the clinical characteristics, lab parameters as well as management in patients suspected of liver abscess. Methods: A retrospective study was carried out in 60 consecutive patients presenting with liver abscess, admitted at tertiary care hospital. Lab investigations were carried out. All patients underwent ultrasound-guided aspiration of a liver abscess either by percutaneous needle or by a pigtail catheter. Patients were monitored during the period of hospital stay to note their outcome. The data variables collected were compiled by using an excel spreadsheet and later analysed using Medcalc (version 20.118). Results: The commonly observed clinical presentation was abdominal pain (95%) followed by fever (57%) and jaundice (7%). On examination, 60% of the liver abscess cases had right hypochondrial tenderness while Hepatomegaly was observed in about 17% of the subjects. Leucocytosis was observed in 67% of the cases in view of underlying infectious etiology. The size of the majority (60%) of the liver abscess were in the range of 5.1 to 9.9 cms and right lobe was the most affected region (75.2%). Conclusion: Early recognition of symptoms, institution of antibiotic and amoebicidal therapy and drainage of abscess via appropriate modality improves the prognosis of liver abscess.

Clinical and microbiological profile of patients with urinary tract infection visiting general outpatient department, National Referral Hospital

Background: Urinary Tract Infection (UTI) is one of the most common infections encountered in outpatient settings. The random use of antibiotics, particularly in resource-limited settings, has contributed to the emergence of antibiotic resistance. This study aimed to identify common uropathogens and assess their antibiotic sensitivity patterns among patients with symptoms of UTI attending the General Outpatient Department (GOPD) at Jigme Dorji Wangchuck National Referral Hospital in Thimphu. Method: A cross-sectional study was conducted from September 2021 to August 2022, involving patients over the age of 13 years with symptoms of UTI. Midstream urine collected via proper technique was analyzed by the laboratory. Once there was growth on the urine culture media, antibiotic sensitivity testing was performed against the commonly used antibiotics in the GOPD. Result: Amongst 351 participants, 77.8% were female, and the most common symptoms reported were dysuria (93.4%) and increased urinary frequency of micturition (92.3%). Patient’s age, sex and previous episodes of UTI were significantly associated with the occurrence of UTI (p < 0.05). The overall urine culture positivity rate was 50.53%, with Escherichia coli (84.7%) identified as the predominant uropathogen, followed by Klebsiella pneumoniae (7.3%). Among the antibiotics tested, gentamicin and nitrofurantoin exhibited the highest sensitivity, while amoxicillin and ampicillin were the least effective antibiotics against Escherichia coli. Conclusion: UTI predominantly affected females. Escherichia coli was the commonest causative agent and nitrofurantoin could be the potential drug of choice for UTI treatment. The irrational use of antibiotics, as a contributing factor to resistance should be addressed.

Clinical Profile and Outcome of Burn Injuries amongst Children in a Tertiary Care Center of North India

Objectives: The study aims to describe the clinical characteristics and outcome of pediatric burn patients admitted to a tertiary care hospital. Patients and methods: This was a cross-sectional, retrospective study that reviewed the records of all burn victims aged 0 to 12 who were admitted in a tertiary care hospital in North India over one year. Collected data included patient demographics such as age, gender, burn causal agents, discharge time, Total body surface area (TBSA) burnt by using Lund and Brauder’s Rule, the duration of stay, the season and month of admission that burn occurred, and burn characteristics, such as region of body involved, percentage of area burnt, complications and outcome. Results: 129 paediatric burn patients under 12 were included with median age of 4 years. Scald caused the majority of burns (81.4%), followed by dry burns (14.7%) and electric injuries (3.9%). The Median burn percentage was 20 and most burn patients were encountered during the winter season. The face and neck (56.6%) were involved in majority of cases, with a 4.6% overall mortality rate. Conclusion: This retrospective study provides valuable insights into the clinical profile of burn patients admitted to a tertiary care center in North India. The study's findings can help guide the development of targeted interventions and resource allocation to improve burn care in this region, ultimately reducing morbidity and mortality among burn patients.

Presentation and management outcome of foot drop with tibialis posterior tendon transfer.

Foot drop causes considerable disability. The ankle-dorsiflexion is either weak or lost completely. Additionally, the ankle eversion and toe extensions are also impaired. This results in a high steppage gait while walking. Overall, the gait is awkward; there is greater energy consumption; increased proneness to sustain injury of the forefoot; and more frequent falling during walking. To document the clinical and epidemiological profile of foot drop patients in our population and evaluate the outcome of tibialis posterior (TP) tendon transfer for restoring the lost dorsiflexion in foot drop. The study was carried out at the National Institute of Rehabilitation Medicine in Islamabad over a period of 7 years. It included patients of all sexes and ages who presented with foot drop and had no contraindications for the procedure of TP tendon transfer. Exclusion criteria were patients who had contraindications for the operation. For instance, paralyzed posterior leg compartment muscles, Achilles tendon contracture, stiff ankle or toes, unstable ankle joint, weak gastrocnemius and scarred skin spanning over the route of planned tendon transfer. Also, patients who had the foot drop as a result of disc prolapses or brain diseases were excluded. Convenience sampling technique was used. The circum-tibial route of TP tendon transfer was employed. Out of 37 patients, 26 (70.27%) were males whereas 11 (29.72%) were females. The mean age was 22.59 ± 8.19 years. Among the underlying causes of foot drop, road traffic accidents constituted the most common cause, found among 20 (54.05%) patients. The share of complications included wound infections in 3 (8.10%) patients and hypertrophic scars in 2 (5.40%) patients. At 1-year postoperative follow-up visits, the outcome was excellent in 8 (21.62%), good in 20 (54.05%) and moderate in 9 (24.31%). The majority of cases of foot drop resulted from road traffic accidents that directly involved the common peroneal nerve. TP tendon transfer through the circumtibial route was found to be an easily executed effective operation which restored good dorsiflexion of the ankle among the majority of patients.

The evaluation of myocarditis in patients with Still's disease; clinical findings from the multicentre international AIDA Network Still's Disease Registry.

To evaluate the cardiac involvement in patients with Still's disease with a focus on myocarditis included in the multicenter AIDA (AutoInflammatory Disease Alliance) network Still's disease registry. To exploit the predictive factors for myocarditis in deriving a clinical risk patient profile for this severe manifestation. A multicenter observational study was built up assessing consecutive patients with Still's disease characterized by the cardiac involvement among those included in the AIDA Network Still's Disease Registry. The cardiac involvement was defined according to the presence of pericarditis, tamponade, myocarditis, and/or aseptic endocarditis. In total, 73 patients with Still's disease and cardiac involvement were assessed (mean age 36.3±19.9 years, 42.5% male sex); out of them, 21.9% were children. The most common cardiac manifestation was the pericarditis in 90.4% of patients, 26.0% presented with myocarditis, and less frequently endocarditis (2.7%) and tamponade (1.4%). Comparing clinical features of patients with myocarditis than others, significantly increased frequencies of skin rash, and pleuritis as well as higher values of systemic score were recognised. Furthermore, an enhanced mortality rate was registered in patients with myocarditis. In regression models, the skin rash and the systemic score independently predicted the myocarditis. The characteristics of patients with Still's disease and cardiac involvement were assessed in the AIDA network. The most common feature was the pericarditis but also a more severe clinical picture was reported in patients with myocarditis. The latter was associated with increased mortality rate and with higher systemic score, identifying patients to be carefully managed.

Abstract 4120131: Absence of standard modifiable risk factors (SMuRF-less) among 5002 Middle Eastern patients with atherosclerotic cardiovascular disease: (Interim analysis from the Jo-SMuRF Study)

Introduction: A growing number of patients develop atherosclerotic cardiovascular disease (ASCVD) despite the absence of standard modifiable risk factors i.e. hypertension (HTN), type 2 diabetes (T2D), dyslipidemia (DSL), and cigarette smoking (SMuRF-less). There is scarcity of studies on prevalence and clinical profiles of SMuRF-less patients in the Middle Ease (ME). Aim: To study the prevalence and clinical features of ME patients with ASCVD who are SMuRF-less vs. those with ≥ 1 SMuRFs, presence of other risk factors and utilization of secondary preventive medications in the 2 groups, and one year survival. Methods: Clinical details of adult patients with ASCVD who participated in 5 previous registries were analyzed according to the absence or presence of ≥ 1 SMuRFs. Results: Of the 5002 patients included in the analysis, 676 (13.5%) were SMuRF-less and 4326 (86.5%) had ≥ 1 SMuRFs. Prevalence of the 4 SMuRFs in the whole cohort was 53.5% HTN, 47.8% T2D, 40.2% smoking, and 37.5% DSL, and the SMuRF group was 61.9%, 55.2%, 46.5%, and 43.4%, respectively. Compared with the SMuRFs group, patients in the SMuRFless group were younger (mean age 52±11.4 years vs. 56.3±11.5 years, respectively, p<0.001) and more likely to be women than men (38.6% vs. 27.9%, p<0.0001). Furthermore, SMuRF-less patients had lower mean body mass index, and less prevalence of metabolic syndrome, heart failure, and family history of ASCVD. Utilization of secondary cardiovascular prevention medications was significantly less in the SMuRF -less group than those with SMuRFs; dual antiplatelet therapy (36.4% vs. 69.5%), statins (66.3% vs. 87.4%), B blockers (57.5% vs. 70.5%), and renin-angiotensin inhibitors (35.2% vs. 55.3%, respectively, all p<0.001. Of the subgroup with one year follow up after percutaneous coronary intervention (N=2641), mortality rate was not different in the 2 groups; 1.4% vs. 1.8%, p=0.98. Conclusions: In this first study of SMuRFs in ASCVD patients in the Middle East, SMuRF-less patients account for nearly 14% of the studied cohort. These patients were younger, had less comorbid disease, received less guidelines-recommended prevention medication, and had same one year event rate compared with patients who have SMuRFs.

A Prospective Observational Study on the Clinical Profile Assessment of Myocardial Infarction Patients in a Tertiary Care Teaching Hospital

Background: Cardiovascular Diseases (CVDs) are the single largest contributor to the global burden of disease and are recognized as the leading cause of death globally. CHD has various clinical manifestations ranging from asymptomatic to acute conditions, namely acute coronary syndrome. Cardiovascular risk factors for acute coronary syndrome (ACS) are on the rise in people of Indian origin. Myocardial Infarction (MI) also called as heart attack, infarction means the death of an area of tissue because of interrupted blood supply. Myocardial Infarction has become a growing concern among the cardiovascular diseases, hence the study is conducted in order to assess the clinical profile of patients suffering from MI. Aim: To assess the clinical presentations, risk factors, short-term complications and management of patients with MI. Methodology: A prospective observational study was conducted in a tertiary care teaching hospital over six months. A total of 121 patients were selected based on inclusion and exclusion criteria. Results: Among the 121 patients included, the predominant were males (63.63%). Most of the patients fell under the age group of 51-60 (n=46). The common presenting symptoms were chest pain (42.32%), followed by breathlessness (26.04%) and sweating (15.34%). Most patients had NSTEMI (62.80%) and STEMI (37.19%). Alcohol (23.44%) was major risk factor followed by smoking (22.48%) and diabetes (14.35%). The elevated biomarkers noted were Troponin I (42.14%), Troponin T (37.19%) and CK-MB (6.61%) respectively. The majority of infarctions occurred on inferior wall (30.57%). The most prevalent complication observed was heart failure (14.8%) followed by sinus tachycardia (6.61%), and sinus bradycardia (5.78%). The majority of patients received key medications like anti-platelet agents, statins and anti-coagulants during hospital stay. Conclusion: The risk of men developing myocardial infarction is more compared to women due to various reasons. It is more likely that the diagnosis of myocardial infarction is neglected due to certain presenting symptoms like epigastric pain, syncope, vomiting, sweating etc., hence this study was conducted with an overview of creating awareness regarding the severity of myocardial infarction along with the advantages of early diagnosis.

NCOG-16. A PROSPECTIVE OBSERVATIONAL STUDY OF CLINICAL PROFILE, COURSE AND OUTCOME OF PRIMARY BRAIN TUMOR AT A TERTIARY CARE CENTER

Abstract Primary brain tumors include tumor arising from neuro-epithelial cells, cranial nerves, meninges, germ cells, pituitary gland, and blood-forming organs. These tumors can present with either generalized or focal signs and symptoms.General symptoms are due to raised intracranial pressure (headache, vomiting). Focal symptoms are due to the compression of a structure or destruction (focal neurological deficits). The aim of this study is to analyze the clinical profiles of pediatric and adult brain tumor patients. Data of primary brain tumor patients who were diagnosed from 1st December 2019 to December 2021 were prospectively collected and analysed. In our study of 61 patients, the majority of patients had GBM (32.8%) and astrocytoma (31.1%) and medulloblastoma (11.5%). Less common histologies ependymomas (9.8%), meningioma (6.6%), brain stem glioma (3.3%), oligodendrogliomas (3.3%) and germinoma (1.6%). Out of 19 astrocytomas, 10 were of low grade (1 or 2), while 9 were of high grade (3 or 4).The majority (61.7%) of gliomas were of high grade, while the remaining 38.3% were of low grade. The majority (57.5%) of patients received multimodal treatment,26.2%received dual modality (surgery and RT), while the remaining 16.3% received single modality, either surgery or RT. Most (86.9%) of the patients treated with radiotherapy as a part of a single or multimodal treatment. A significant percentage of patients (77.1%) received concurrent and adjuvant temozolamide-based chemotherapy. Primary brain tumors have a different profile in pediatric patients. Among pediatric patients, the median age was 11.8 years, with male predominance. This study concludes that primary brain tumors have a different profile among adults and pediatric patients, with the majority of patients achieving a response to the first line therapy with an overall good tolerance for therapy.

Clinical Profile, Etiology, and Outcomes of Patients With Eosinophilia: A Prospective Study From Western India

Clinical Profile, Etiology, and Outcomes of Patients With Eosinophilia: A Prospective Study From Western India

Demographic and clinical profile of patients with acute biliary pancreatitis: an experience in Patan academy of health sciences

Background: Acute pancreatitis is one of the most common causes of acute abdomen encountered in emergency department with wide range of severity from mild self-limiting disease to severe and rapidly progressive illness leading to multi organ failure and even death. Gall stones are leading cause of acute pancreatitis. This study has been carried out to find out demographic pattern and clinical profile of patients with acute biliary pancreatitis. Methods: This is a prospective cross-sectional study carried out in the department of surgery in Patan academy of health sciences (PAHS) in the time period between May 1, 2021 and April 30, 2022. The process of data collection was started after obtaining ethical approval from institutional review committee (IRC) of PAHS, and written informed consent was obtained from patients. Total sampling was done and 66 patients were enrolled into the study, who were diagnosed as acute biliary pancreatitis. Data was analyzed with SPSS ver 25 and Microsoft excel 2016. Results: Out of total 66 patients in the study 25 (37.9%) were male and 41 (62.1%) were female with male: female ratio of 1:1.64. Mean age was 48.42±16.62 years. ranging from 16-88 years. Epigastric abdominal pain was predominant presenting symptoms accounting for 57 (86.4%) cases. Pleural effusion was most common complication seen in 17 (25.8%) cases. Mortality occurs in 2 (3%) cases, both of cases had severe pancreatitis. Only 21 (31.8%) patients underwent cholecystectomy among which 13 (19.7%) interval and 8 (12.1%) index cholecystectomy. Conclusions: Female gender with age group of 40-60 years. predominates acute biliary pancreatitis. Though most of the cases are mild and have benign course, severe cases and patients with advanced age are associated with high mortality. Acceptance of index cholecystectomy is very low.

Clinical and biologic profiles of patients with acute respiratory distress syndrome by prevalence of chronic obstructive pulmonary disease or emphysema; a cohort study

IntroductionAcute respiratory distress syndrome (ARDS) is characterized by diffuse lung injury. The impact of pre-existing chronic obstructive pulmonary disease (COPD) or emphysema on ARDS pathogenesis is not well characterized.MethodsSecondary analysis of ARDS patients enrolled in the Acute Lung Injury Registry and Biospecimen Repository at the University of Pittsburgh between June 2012 and September 2021. Patients were categorized into two mutually exclusive groups by the prevalence of COPD or emphysema at the time of ARDS diagnosis. The COPD/emphysema group comprised ARDS patients with radiological evidence of emphysema, chart diagnosis of COPD, or both. Demographics, lung mechanics, and clinical outcomes were obtained from the electronic medical record. Host-response biomarkers known to have validated associations with ARDS were previously measured in plasma and lower respiratory tract samples using a customized Luminex assay. Continuous and categorical variables were compared between groups with and without COPD/emphysema.Results217 patients with ARDS were included in the study, 57 (27%) had COPD/emphysema. Patients with COPD/emphysema were older (median 62 [interquartile range 55–69] versus 53 [41–64] years, p < 0.01), more likely to be male (62% vs. 44%, p = 0.02) and had a higher prevalence of congestive heart failure (25% vs. 4%, p < 0.01) compared to patients without COPD/emphysema. Baseline demographics, laboratory parameters, and mechanical ventilatory characteristics were otherwise similar between the two groups. No difference in 90-day mortality was observed between groups; however, patients with COPD/emphysema had shorter duration of intensive care unit (ICU) stay (median 10 [7–18] versus 16 [9–28] days, p = 0.04) and shorter duration of mechanical ventilation (median 7 [4–16] vs. 12 [6–20] days, p = 0.01). Host response biomarkers in serum and lower respiratory tract samples did not significantly differ between groups.ConclusionARDS patients with COPD or emphysema had similar respiratory mechanics, host response biomarker profiles, and mortality compared to those without COPD or emphysema but with a shorter median duration of mechanical ventilation and ICU length of stay. Future studies should address differences in clinical and biological responses by disease severity, and should investigate the impact of severity of COPD and emphysema on mechanical ventilation and targeted therapeutic strategies in ARDS.Clinical trial numberNot applicable

Real-world characteristics and treatment of cardiac transthyretin amyloidosis: A multicentre, observational study.

Data on the clinical profiles of patients with transthyretin amyloidosis cardiomyopathy (ATTR-CM) in the post-approval era of tafamidis 61mg are lacking. Study aims were characterization of contemporary ATTR-CM patients, analysis of potential eligibility for the 'Transthyretin Amyloidosis Cardiomyopathy Clinical Trial' (ATTR-ACT) and identification of factors associated with the decision on tafamidis 61mg treatment. This retrospective study analysed ATTR-CM patients seen at eight University Hospitals in the first year after approval of tafamidis 61mg for ATTR-CM in Germany (April 2020 to March 2021). The cohort comprised 366 patients (median age 79 [74; 82] years, 84% male), with 47% and 45% of the cohort being in National Amyloidosis Centre ATTR stage≥II and NYHA class≥III, respectively. Sixty-four per cent of patients met key eligibility criteria of the pivotal ATTR-ACT. In recently diagnosed patients (58% with diagnosis ≤6months), the rate of variant ATTR was significantly lower than in patients diagnosed more than 6months ago (9.3% vs. 19.7%). Of the 293 patients without prior ATTR specific treatment, tafamidis 61mg was newly initiated in 77%. Patients with tafamidis 61mg treatment were significantly younger, were more often eligible for ATTR-ACT, had lower NYHA class and higher serum albumin levels. These variables explained 16% of the variance of treatment decision. Unadjusted survival was higher in patients with than those without treatment (1-year survival 98.6% vs. 87.3%, P<0.001). Wild-type ATTR was the primary aetiology amongst contemporary ATTR-CM patients and almost two-thirds of patients were in an advanced disease stage. Clinical profiles of 64% of patients in routine care matched those of the ATTR-ACT. Further effort is needed to detect patients at an earlier disease stage and to validate criteria justifying treatment initiation.

Clinical profile of neonatal jaundice patients admitted in a tertiary care hospital in Khulna, Bangladesh

Background: A significant proportion of term and preterm infants develop neonatal jaundice. Jaundice in an otherwise healthy term infant is the most common reason for readmission to the hospital. Therefore, it is necessary to evaluate different aspects of neonatal jaundice in our clinical setup. Objective: The objective of this research was to find out different associated causes, clinical features, and treatment options for neonatal jaundice. Methods: A cross-sectional study was conducted in Gazi Medical College Hospital (GMCH), Khulna, Bangladesh with a total number of 140 neonates with jaundice from January 2018 to January 2021. All data were collected and analyzed prospectively. Convenient purposive sampling was the sampling method. Results: In this study, 79.2% of neonates were full-term and 20.8% were preterm neonates. Physiological jaundice (33.5%) was found as the commonest type. Jaundice with infection was associated with 32.8% of cases. Jaundice with umbilical redness, discharge, and/or foul-smelling (17.9%), and reluctance to feed were commonly associated symptoms. Hepatomegaly and splenomegaly were detected in 7.1% and 3.6% neonates respectively. Phototherapy was given in 61% of cases and 17.8% (25) cases exchange therapy was required. In neonates with physiological jaundice, phototherapy was recommended for most of the cases. In the case of ABO and Rh incompatibility, exchange therapy was required most often along with phototherapy. Conclusion: Physiological jaundice is the most common pattern of neonatal jaundice. Most often, neonatal jaundice may co-exist with neonatal infections. In most cases, phototherapy is required along with or without exchange therapy, depending upon the associated causes and conditions. Mediscope 2024;11(2): 58-61

Clinical Profile, Management and Outcomes in Patients with Acute Coronary Syndrome: An Observational Study from a Tertiary Care Hospital in Central India

Clinical Profile, Management and Outcomes in Patients with Acute Coronary Syndrome: An Observational Study from a Tertiary Care Hospital in Central India

Clinical profile and etiological spectrum of patients presenting with corneal hydrops over a 12-year period.

To describe the demographics, clinical characteristics, and management of corneal hydrops in patients presenting to a multi-tier ophthalmology hospital network in India. Cross-sectional hospital-based study. Of the total of 3,140,941 new patients presenting between October 2010 and March 2022, patients with a clinical diagnosis of corneal hydrops in at least one eye were included in the study. All the data was collected using an electronic medical record system. 1291 eyes of 1110 patients were diagnosed with corneal hydrops and included in the study and 961 patients (83.69%) had a unilateral affliction. Corneal hydrops was noted to be significantly more common in males (62.43%) and adults (62.7%). The most common age group at presentation was during the second decade of life with 472 (42.52%) patients. They were more commonly from the higher socio-economic status (77.3%) and from the urban geography (44.23%). In the 1291 eyes, 567 (43.92%) eyes had a visual impairment of blindness (> 20/400-20/1200) followed by moderate visual impairment (> 20/70-20/200) in 166 (12.86%) eyes. Overall, the most common etiology was keratoconus in 1,082 (83.81%) eyes followed by primary congenital glaucoma (PCG) in 91 (7.05%) eyes. Surgical intervention to hasten the recovery of hydrops was performed in 7.82% of eyes with ectasia and as a definite management in 7.05% eyes with PCG. Visual rehabilitation was with contact lenses in 29.1% eyes and keratoplasty in 13.94% eyes. Corneal hydrops is predominantly unilateral and is more common in males. Keratoconus was the commonest etiological condition; however, the risk of hydrops was highest in keratoglobus, followed by PMD. Most affected age was the second decade of life and visual impairment was severe in majority (60%). A surgical intervention was performed in a third of the cases.

Clinical and Demographic Profile of Patients with Crohn's Disease in Specialized Hospital for Gastrointestinal and Liver Diseases and Surgery in Al-Najaf Province

Background: Crohn’s disease (CD) It is a chronic inflammation that occurs in the digestive system. This disease is widespread in developing countries. Aim of study: To estimation the ratio of clinical and demographic data of CD patients at Specialized Hospital for Gastrointestinal and Liver Diseases and Surgery in AL- Najaf Province. Patients and Methods : Demographic and clinical data were obtained by medical analysis data to patients attended into Specialized Hospital for Gastrointestinal and Liver Diseases and Surgery in AL- Najaf Province from October 2022 to March 2024. Results: Sixty-four patients diagnosed with Crohn's disease participated in this study. The findings indicated that the majority of individuals infected with this disease were women, with the age group of 30 to 39 years being the most prevalent among the infected population. The findings indicate that freelancers and housewives are the most impacted by this disease. The results indicated that the majority of patients visiting the hospital are from Najaf Governorate. The disease was diagnosed through biopsy samples collected from different regions of the digestive system, and the treatment for the majority of patients involved immunosuppressant medications. Conclusions: Despite the increasing incidence, we highlight the Education and a extra intestinal manifestation in this study, and reflecting a high need for hospitalization and immune-modulatory, and uses biological treatment, , and surgery.

A study of clinical profile and outcome of patients with snake bite-induced acute kidney injury

ABSTRACT Background: Snake bite is a well-known occupational hazard amongst farmers, plantation workers, and other outdoor workers and results in much morbidity and mortality throughout the world. The complications related to kidneys are observed in most patients with snake bites admitted to a hospital. The current study aimed to study the renal involvement in patients with snake bites with reference to clinical features and the time of onset of acute renal failure. Methods: A prospective clinical study of 68 patients of snake bite was done to know the clinical profile and outcome in Gandhi Hospital Secunderabad and cases were particularly looked for development of acute kidney injury. Later each case was studied and investigated with respect to onset, clinical features, course in the hospital, need for renal replacement therapy including dialysis, and mortality due to AKI. Patients were followed up till discharge or death. They were treated as per protocol. Results: The incidence of AKI was 29.1%. Common signs and symptoms were fang mark (100%), swelling (91.2%), tenderness (91.2%), bleeding manifestations (79.4%) oliguria (26.47%), anuria (5.8%), and haematuria (8.8%). Hypotension was present in 73%, which may be the cause of AKI. All the AKI patients showed coagulation abnormalities in the form of prolonged BT, CT, PT, and aPTT. Thrombocytopenia was seen in 29.4%. All the AKI patients were given ASV for 2 to 3 days. The mean ASV vials used in the present study is 15 ± 5. Hemodialysis was done in 29.4% of patients. Conclusion: The cause of AKI in snakebite was multifactorial in origin. Bleeding and hypotension were among the important causes. Thrombocytopenia was significantly related to clinical bleeding. The type of snakebite is an important factor in the development of AKI and Russell’s viper bite is more commonly associated with it. AKI is usually associated with oliguria and generally occurs within 48 hours.

Paraneoplastic Neurologic Syndromes Associated With Merkel Cell Carcinoma.

To define the clinical and immunologic profile of patients with paraneoplastic neurologic syndromes (PNSs) associated with Merkel cell carcinoma (MCC). Retrospective analysis was conducted on patients with suspected MCC-related PNS assessed at the French Reference Center, and cases were identified by a systematic review of the literature (MEDLINE, Embase) following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 17 patients were identified in our center and 30 in the systematic review, resulting in an overall cohort of 47 patients. The median age was 65 years (range 41-90), and 30 of 46 (65%) were men. Lambert-Eaton myasthenic syndrome (LEMS) (14/47, 29%), rapidly progressive cerebellar syndrome (11/47, 23%), and encephalomyelitis (EM) (8/47, 17%) were the most common associated clinical phenotypes. The most frequently associated neural antibodies (Abs) were voltage-gated calcium channel (VGCC)-Abs (14/45, 31%), followed by Hu-Abs (8/45, 17%) and neurofilament (NF)-Abs (8/45, 17%). Patients with NF-Abs only exhibited CNS disorders (8/8, 100%) and often had antibodies against >1 NF subunit (6/8, 75%). At onset, 26 of 43 patients (60%) had no identifiable primary skin tumor but had lymph node metastasis; these patients were more frequently men (21/26, 80%, vs 7/17, 41%; p = 0.007), had more frequently VGCC-Abs (12/26, 46%, vs 2/17, 11%, p = 0.02) predominantly among those with LEMS, and presented reduced mortality than patients with a known primary tumor (5/25, 20%, vs 8/15, 53%; p = 0.02). MCC-related PNSs present as a heterogeneous clinical spectrum including central and/or peripheral nervous system disorders such as LEMS, RCPS, and EM, mainly associated with VGCC-Abs, NF-Abs, and Hu-Abs. NF-Abs were only seen among patients with CNS disorders. At onset, the absence of a primary skin tumor but presence of lymph node metastasis is frequently observed, and this particular clinical presentation is linked to reduced mortality, highlighting distinctive clinical and immunologic features of MCC-related PNS.

Vascular complications in TAVI procedures: assessment, management, and outcomes-a retrospective study

ObjectiveTranscatheter Aortic Valve Implantation (TAVI) has emerged as a pivotal therapeutic modality for aortic stenosis, predominantly in the elderly population. Despite its clinical success, the incidence and implications of vascular complications during TAVI remain a subject of critical concern. MethodsA retrospective analysis was conducted on 140 patients who experienced vascular complications during TAVI procedures from a total cohort of 1343 cases. Patient demographics, clinical profiles, and procedural characteristics were scrupulously examined. Vascular complications, both intraoperative and postoperative, were identified through various diagnostic modalities. Statistical analyses were employed to discern associations and significance levels. Comparative assessments with international literature were performed to gain broader insights. ResultsThe study unveiled an overall incidence of vascular complications at approximately 10.44%. Coronary Artery Disease (CAD)-p-value (0.013), choice of valve type-p-value (0.016), and access point-p-value (0.027) demonstrated significant correlations with these complications. Complication incidences in TAVI procedures included pseudoaneurysms (4.76%), arteriovenous fistulas (1.49%), hematomas (0.37%), dissections (2.24%), arterial perforations (0.15%), stenosis/occlusion (0.37%), and closure device failures (1.94%). Over 70% of complications at the valve entry point result from dissections and closure device failures, while the pigtail entry point is predominantly linked to over 70% of pseudoaneurysms. Extended hospitalization (7.84 ± SD 3.14) was observed for patients experiencing vascular complications, underlining the importance of vigilant postprocedural care. ConclusionThis study provides comprehensive insights into vascular complications during TAVI procedures, shedding light on their incidence, risk factors, clinical presentations, diagnostic methodologies, and management strategies.