Department Of Medicine Research Articles

PREVALENCE OF DIDANOSINE-RELATED RETINAL TOXICITY AT AN URBAN ACADEMIC CENTER AS DIAGNOSED WITH ULTRA-WIDEFIELD IMAGING.

Antiretroviral therapy has revolutionized HIV treatment with didanosine (DDI) as a pioneering drug. However, DDI has been associated with retinal toxicity, characterized by peripheral chorioretinal degeneration with macular sparing. Despite its clinical recognition, the prevalence and risk factors for didanosine-induced retinopathy are not well described. This retrospective case series analyzed 127 DDI-treated patients at Weill Cornell Medicine Department of Ophthalmology. Inclusion criteria included at least 6 months of DDI use and available ultra-widefield imaging. Patients were categorized as affected or unaffected based on retinal imaging assessed by two reviewers. The affected group was further divided into "probable" or "possible" retinopathy. Patient demographics, DDI usage characteristics, and imaging findings were analyzed with statistical comparisons drawn between affected and unaffected cohorts. Of the 127 patients, 9 (7%) showed signs of didanosine-induced retinal toxicity. On average, the affected group was older compared with the unaffected group (65.1 vs. 56.5 years, P = 0.025), with lower BMI (23.2 vs. 27.4, P = 0.04), and older at the start of the treatment (51.6 vs. 40.8 years, P = 0.026). Mild phenotypes with peripheral pigmentary changes were also identified using ultra-widefield imaging. This pioneering academic study highlighted a notable prevalence of DDI-induced retinal toxicity. Statistical analysis demonstrated age, BMI, and age at treatment initiation as potential risk factors. Ultra-widefield autofluorescence emerged as a valuable tool in detecting and delineating findings. Follow-up studies are needed to determine the necessity of regular screening for individuals on or with a history of didanosine use.

Evaluation of Recovery Rate in Poison Patients with or Without Standard Antidote Treatment

Aim: To evaluate the recovery rate of poisoning with regards to the availability and administration of standard antidote. Introduction: Poison consumption is one of the most common causes of death across the world. The reason is its easy availability and impulsive behaviour associated with suicidal thoughts. Antidotes are the agents which counteract the harmful effects of poison. Poisoning can be treated with antidotes but not all poisons have antidotes, this study helps to analyze the effectiveness of antidotes in early recovery from poisoning accompanied by stabilization techniques implemented. Methodology: A prospective observational study was conducted in the inpatient department of General Medicine, Gandhi Hospital, Secunderabad from October 2021 to March 2022. Results: Poison consumption was more predominant among males, and young adults are the most affected age group. Suicide was identified as the primary reason for poison intake, while accidental poison ingestion was mostly seen in children. Pesticides were the most commonly consumed poisons. The antidote was administered in approximately 33% of cases, while it was not provided in 15%. For the remaining cases, an antidote was not available. The overall recovery rate was 77%, with females showing higher recovery rates than males. Adolescents had the highest recovery rate, followed by middle-aged adults. Conclusion: Our study concludes that the recovery was rapid in cases where a standard antidote was available and administered. Performing decontamination techniques within a few hours of poison consumption was also efficient.

Platelet indices as a predictor in patients with aplastic anemia and immune thrombocytopenic purpura: a retrospective case–control study

Background and objectivesPlatelet indices are widely available and relatively cheap platelet parameters. The critical objective of this study is to assess the reliability of platelet indices as biomarkers for diagnosis and prognosis in adult thrombocytopenic patients.MethodsA retrospective case–control study, including 81 immune thrombocytopenia (ITP) cases, 50 aplastic anemia (AA) cases, and 150 participants as a control group. This study included patients admitted from 2016 to 2021 to the Clinical Hematology Unit, Department of Internal Medicine, University Hospital. The collected data included sociodemographic information, clinical data, laboratory data, and an assessment of the therapeutic response in the studied groups.ResultsFor the diagnosis of adult thrombocytopenic patients, platelet distribution width (PDW) showed the best diagnostic accuracy (85% for ITP and 91.9% for AA) at cutoff points of 14.9% and 17.2%, respectively. This was followed by mean platelet volume (MPV) with diagnostic accuracies of 77% for ITP and 89.3% for AA at a cutoff point of 9.4 fl. Platelet large cell ratio (PLCR) demonstrated insignificant accuracy in diagnosing either ITP or AA.ConclusionPlatelet indices can play a crucial influence in the diagnosis, not the prognosis, of adult thrombocytopenia.Trial registrationNCT05116033. https://classic.clinicaltrials.gov/ct2/show/NCT05116033

The LUSBI Protocol (Lung Ultrasound/BREST Score/Inferior Vena Cava)—Its Role in a Differential Diagnostic Approach to Dyspnea of Cardiogenic and Non-Cardiogenic Origin

Background and Objectives: PoCUS ultrasound applications are widely used in everyday work, especially in the field of emergency medicine. The main goal of this research was to create a diagnostic and therapeutic protocol that will integrate ultrasound examination of the lungs, ultrasound measurements of the inferior vena cava (assessment of central venous pressure) and BREST scores (risk stratification for heart failure), with the aim of establishing a more effective differential diagnostic approach for dyspneic patients. Materials and Methods: A cross-sectional study was conducted in the emergency medicine department with the educational center of the community health center of Banja Luka. Eighty patients of both sexes were included and divided into experimental and control groups based on the presence or absence of dyspnea as a dominant subjective complaint. Based on the abovementioned variables, the LUSBI protocol (lung ultrasound/BREST score/inferior vena cava) was created, including profiles to determine the nature of the origin of complaints. The biochemical marker of heart failure NT pro-BNP served as a laboratory confirmation of the cardiac origin of the complaints. Results: The distribution of NT pro BNP values in the experimental group showed statistically significant differences between individual profiles of the LUSBI protocol (p < 0.001). Patients assigned to group B PLAPS 2 had significantly higher average values of NT pro-BNP (20159.00 ± 3114.02 pg/mL) compared to other LUSBI profiles. Patients from the experimental group who had a high risk of heart failure according to their BREST scores also had a significantly higher average maximum expiratory diameter compared to those without heart failure (p = 0.004). A statistically significant difference (p = 0.001) in LUSBI profiles was observed between the groups of patients divided according to CVP categories. Conclusion: The integration of the LUSBI protocol into the differential diagnosis of dyspnea has been shown to be very effective in confirming or excluding a cardiac cause of the disease in patients.

Characterization of the Elderly Patients Admitted with Infection to a Tertiary Hospital in Bangladesh

Background: The proportion of hospitalizations attributable to infectious diseases is high, and likely to increase further in the future as a result of the expected aging of the population and the increasing prevalence of comorbid conditions among the elderly. The present study aimed to investigate the clinical characteristics and outcomes of elderly patients admitted due to infection in a tertiary-level hospital in Chattogram, Bangladesh. Materials and methods: This prospective observational study was conducted in Chittagong Medical College Hospital (CMCH) Chattogram. Two hundred and six patients aged ≥60 admitted with a diagnosis of infectious aetiology in the medicine department were enrolled according to set inclusion criteria. Patients were followed up for in-hospital outcomes after admission. Results: Age ranges from 60-90 years with a mean age of 65.82 (±5.56) years) and 51.5% were male. Pre-hospital antibiotic was received by 108 (52.4%) patients and 7.4% had antibiotic prescribed by registered physicians The most frequent infections were respiratory tract infections (47.6%) and urinary tract infections (43.2%). Sixty-four (31.1%) patients developed sepsis and 17 (8.3%) required ICU support. Eleven patients expired in-hospital, indicating a mortality rate of 5.3%. Length of hospitalization ranged from 2 to 17 days, with a median of 6 days. Conclusion: This study result suggests that infection-related hospitalization and outcomes of elderly individuals were high and their health seeking behaviour was poor. IAHS Medical Journal Vol 6(2), December 2023; 31-34

Comparison of Causes of Mortality Between Hospitalized Unsheltered Homeless Patients and Non-Homeless Sex and Age-Matched Controls: A Retrospective Case-Control Study

ObjectivesRoofless individuals represent the most severe category of homelessness. Their clinical characteristics and mortality patterns in Central and Eastern Europe are little known.MethodsA single-center retrospective case-control study at the internal medicine department in Bratislava, Slovakia was conducted. 5694 mortality records from 2010 to 2023 were screened, and 141 (118 men, 23 women) roofless individuals were identified. Patients were sex- and age-matched, with 141 patients from the cohort of non-homeless deceased patients.ResultsCompared to controls, roofless people had a higher incidence of immobility (p = 0.02) and hypothermia (p < 0.0001) at admission. 83% of the roofless people were men, and 59% of the roofless people died before reaching old age (60+). Homeless men died more often from infectious disease (p = 0.02), pneumonia being the most common one (60%). Men from the control group died more often from liver diseases (p = 0.03). There were no significant differences in the causes of mortality between women.ConclusionThese findings could help to reduce the invisibility of the issue of massive premature mortality amongst homeless populations and roofless individuals, in particular.

Ocular Sarcoidosis as Initial Presentation of the Disease: Clinical Characteristics and Risk Factors Associated with Disease Recurrence

ABSTRACT Purpose To review the clinical presentation and diagnostic workup of patients presenting with ocular sarcoidosis as initial manifestation of the disease and identify risk factors for disease recurrence. Methods All cases of sarcoidosis followed in our departments of Ophthalmology and Internal Medicine were retrospectively reviewed. Among 177 patients, 50 had ocular sarcoidosis as initial presentation of the disease. Clinical, biological, radiological, and treatment data were collected. Logistic regression analysis was conducted to identify risk factors for recurrence. Results Mean age of patients was 51 years, with an equal M/F ratio. Bilateral ocular involvement was present in 86% of cases, with granulomatous panuveitis being the most common manifestation (48%). Two-thirds of patients had extraocular symptoms related to the disease, mostly fatigue. The most frequently involved extraocular site was the supradiaphragmatic lymph nodes, identified in 84% of cases. CRP was normal in 68% of patients, while ACE and lysozyme were elevated in 19% and 64% of cases, respectively. Histopathological confirmation was obtained in 68% of patients. Female sex (odds ratio [OR] 6.66, 95% confidence interval [CI] 1.50–40.40, p = 0.021) and granulomatous panuveitis (OR 7.23, 95% CI 1.70–40.99, p = 0.013) were identified as significant risk factors for disease recurrence. Conclusion Ocular sarcoidosis is a common initial presentation of systemic sarcoidosis. Diagnosis should be suspected in the presence of bilateral granulomatous panuveitis. Chest CT scan or 18F-FDG PET/CT is mandatory for systemic workup and biopsy is necessary for definite diagnosis. Female sex and a panuveitis presentation are significantly associated with disease recurrence.

Hypothyroidism in Metabolic Syndrome.

Metabolic syndrome (MetS) and hypothyroidism are well-established forerunners of atherogenic cardiovascular disease (CVD). It is possible that patients suffering from both these disease entities may have a compounded risk. This study aimed at determining the prevalence of hypothyroidism in MetS. This cross-sectional study was conducted from September 2017 to August 2018 in the department of medicine at a tertiary care hospital in Northern India. Ethical approval was obtained from the institutional ethical committee. The study subjects consisted of 157 patients with MetS, the diagnosis of which was based on the International Diabetes Federation criteria. After a detailed history and physical examination, relevant investigations including complete thyroid profile were done. The data were analyzed using appropriate statistical tests (P < 0.05). In our study, the age of subjects ranged between 14 and 92 years, with a mean ± standard deviation of 48.1 ± 17.01 years. There were more females than males with a male-to-female ratio of 1:1.3. The prevalence of hypothyroidism was 46.5%. Hypothyroidism was more common in females (58.9%) as compared to males (41.1%). Patients with hypothyroidism had significantly higher body weight and body mass index (BMI) in comparison to euthyroid patients. The rest of the anthropometric parameters were comparable. Waist circumference and BMI of overt hypothyroid patients were found to be higher as compared to subclinical hypothyroid patients. Total cholesterol and triglyceride were significantly higher (P = 0.001 and P < 0.001, respectively), while high-density lipoprotein levels were significantly lower in patients with hypothyroidism than the euthyroid group (P < 0.001). Hypothyroidism, especially subclinical hypothyroidism, is a common endocrine disorder in patients with MetS. As MetS and hypothyroidism are independent risk factors for CVD, hence there is a need for screening for hypothyroidism and the treatment of the same can be beneficial in reducing the cardiovascular morbidity and mortality in patients with MetS.

Evaluation of Risk Factors, Clinical Spectrum and Management of New Onset Seizure

A seizure is a brief deviation from the brain's regular electrical activity that alters awareness and behavior. Seizures are brief burst so fun controllable movement that can affect either a piece of the body (partial) or the full body (generalized) and are frequently followed by a loss of awareness and control over bowel or bladder function. Epilepsy is distinguished by recurring seizures. Epilepsy is a neurological disorder marked by sudden recurrent episodes of sensory disturbance, loss of consciousness, associated with abnormal electrical activity in the brain. The goal of the study is to find out risk factors and prescribing pattern of antiseizure drugs in different types of seizure disorder. An educational observational study was carried out among 42 samples in the In-patient Department of General Medicine, ESI MC- PGIMSR, and Rajajinagar. The data was collected using self-designed data collection form. All information’s were processed and analyzed by using Microsoft excel. It was observed that a majority of the subjects involved in the study was prescribed with Levetiracetam (69.81%). A high prevalence of New onset seizure with risk factor of CVS causes (36.92%) and Alcohol withdrawal (20%) was observed. In CVS cause, stroke was prominent. From this study, generalized tonic clonic seizure was most commonly observed type of seizure and Levetiracetam was most frequently prescribed drug to them. Majority of patients were given mono therapy to achieve seizure control.

Sex differences in Helicobacter pylori infection and recurrence rate among 81,754 Chinese adults: a cross-sectional study

ObjectiveTo compare the sex differences of Helicobacter pylori (HP) infection rate and 1-year recurrence rate.MethodsA cross-sectional study was conducted on the prevalence of HP infection in 81,754 people who underwent physical examination in physical examination centers and outpatient clinics of the Affiliated Hospital of Gansu University of Traditional Chinese Medicine, the Second People’s Hospital of Zhangye City, Tianshui City Hospital of Integrated Chinese and Western Medicine, the First and Second Department of The First Hospital of Lanzhou University Physical Examination Center, from March 2010 to December 2019. Among them, 53,771 (65.77%) were males (18–91 years old) and 27,983 (34.23%) were females (18–94 years old). According to age, they were divided into young group, middle-aged group and old group. 1448 asymptomatic infected patients were selected and treated with bismuth-containing quadruple drug eradication therapy for 2 weeks. The eradication rate and recurrence rate after 1 year were compared between males and females.ResultsThe overall infection rate was 49.59%, including 49.74% in males and 49.3% in females. The risk of infection in young women was lower than that in men (OR = 0.908, 95%CI: 0.868–0.95, P < 0.01), the risk of infection in older women was higher than that in men (OR = 1.137, 95%CI: 1.041–1.243, P < 0.01). The female infection rate was positively correlated with age from 18 to 60, and Spearman’s correlation coefficient was 0.825 (P < 0.01). The overall eradication rate was 84.67% in intention-to-treat analysis (ITT) and 88.46% in protocol analysis (PP). The eradication rates of ITT and PP in the older group were 78.38% and 82.27%, respectively, which were lower than 87.25% and 89.39% in the male group (P < 0.05). The 1-year overall recurrence rate was 3.86%, including 2.82% in males and 5.44% in females (P < 0.05), female was a risk factor for recurrence after eradication after controlling for age (OR = 2.177, 95%CI 1.166–4.066, P < 0.05). There were no obvious adverse reactions during the treatment.ConclusionThere is a positive linear correlation between HP infection rate and age increase in women. Older women have the characteristics of high HP infection rate, low eradication rate and high recurrence rate.

A SIMPLE FRAILTY INDEX PREDICTS IN-HOSPITAL MORTALITY.

Comparing frailty models in different settings that predict in-hospital mortality might modify patient disposition and treatment, but models are often complex. In the following study we selected all acutely admitted adult patients in 2020- 2021 to the three internal medicine departments at a regional 400-bed hospital. We attempt to determine (a) if a new scale (Laniado-4 scale) that includes only three yes/no questions derived from the Norton scale and the presence of a urinary catheter performs as well as the graded Norton scale (including all five domains), in predicting in-hospital mortality and (b) to determine the predictive value of a simple frailty index that includes the new scale as well as categories of age, serum albumin, and creatinine values. We calculated odds ratios with 95% confidence intervals and c-statistics for the various models predicting in-hospital mortality. The mean patient age was 73±19 years, and 49.1% (5665/11542) were males. A Laniado-4 scale performed better than the Norton scale for predicting in-hospital mortality. A simple frailty index ranging from 0 to ≥8 points was associated with rates of in-hospital mortality that increased from 0 to 37.7%, with an odds ratio of 2.13(2.03-2.25) per 1 index point. The c-statistic was 0.887 (0.881-0.893). We conclude the Laniado-4 scale performed better than the Norton scale in predicting in-hospital mortality and that a simple frailty index that included the 4-question scale and categories of age, serum creatinine, and serum albumin performed as well or better than more complicated models.

Genetic analysis of a child with Dias-Logan syndrome due to variant of BCL11A gene

To analyze the clinical and genetic characteristics of a child featuring Dias-Logan syndrome. A child with speech disorders and delayed psychomotor development from childhood who was admitted to the Rehabilitation Medicine Department of Children's Hospital Affiliated to Zhengzhou University in July 2022 was selected as the research subject. Clinical data of the child was collected. Genomic DNA was extracted from peripheral blood samples of the child and his parents. Potential variant was screened by whole exome sequencing, and candidate variant was verified by Sanger sequencing. The child has presented with global developmental delay, microcephaly, special facial features and behavioral problems. Genetic testing revealed a de novo variant of the BCL11A gene, namely c.561_567delACACGCA (p.Q187fs*7), which was classified as pathogenic (PVS1+PS2+PM2_Supporting). The heterozygous variant of BCL11A gene probably underlay the Dias-Logan syndrome in this child. Above finding has enriched the phenotypic and mutational spectrum of the BCL11A gene and provides a basis for genetic counseling and clinical decision-making.

Clinical Phenotyping for Prognosis and Immunotherapy Guidance in Bacterial Sepsis and COVID-19.

It is suggested that sepsis may be classified into four clinical phenotypes, using an algorithm employing 29 admission parameters. We applied a simplified phenotyping algorithm among patients with bacterial sepsis and severe COVID-19 and assessed characteristics and outcomes of the derived phenotypes. Retrospective analysis of data from prospective clinical studies. Greek ICUs and Internal Medicine departments. We analyzed 1498 patients, 620 with bacterial sepsis and 878 with severe COVID-19. We implemented a six-parameter algorithm (creatinine, lactate, aspartate transaminase, bilirubin, C-reactive protein, and international normalized ratio) to classify patients with bacterial sepsis intro previously defined phenotypes. Patients with severe COVID-19, included in two open-label immunotherapy trials were subsequently classified. Heterogeneity of treatment effect of anakinra was assessed. The primary outcome was 28-day mortality. The algorithm validated the presence of the four phenotypes across the cohort of bacterial sepsis and the individual studies included in this cohort. Phenotype α represented younger patients with low risk of death, β was associated with high comorbidity burden, and δ with the highest mortality. Phenotype assignment was independently associated with outcome, even after adjustment for Charlson Comorbidity Index. Phenotype distribution and outcomes in severe COVID-19 followed a similar pattern. A simplified algorithm successfully identified previously derived phenotypes of bacterial sepsis, which were predictive of outcome. This classification may apply to patients with severe COVID-19 with prognostic implications.

Anthropometric and Nutritional status of Chronic Obstructive Pulmonary Disease presenting in Acute Exacerbation in Tertiary care Hospital in Eastern Nepal

Background: There is scarcity of data regarding the nutritional status of COPD patients presenting in exacerbation in our setup, thus this observational study was conducted. Methods: We performed an observational study of patients with acute exacerbation of COPD, who were admitted in the Department of Pulmonary, Critical care and Sleep Medicine in tertiary hospital in eastern Nepal from April 2023 to June 2023. Results: During the study period, a total of 154 patients of COPD with exacerbations were admitted in our department. The baseline anthropometric parameters, lab parameters as well as the malnutrition scores were determined. The mean BMI was 21.82 ± 3.92 kg/m2 and only 29% had BMI &lt; 18.5 kg/m2.The mean hemoglobin, mean cell volume, serum protein, serum albumin, serum calcium, phosphorus and vitamin D level were 12.43 ± 2.32 g/dL, 84.4 ± 9.41 fL, 6.42 ± 1.74 g/ dL, 3.32 ± 0.34 g/dL, 8.98 ± 0.63 mg/dL, 3.02 ± 0.42 mg/dL, 18.48 ± 8.22 pg/mL and 40%, 12%, 28%, 41%, 31%, 42% and 49% of these values were below the lower normal limit respectively. The nutritional status tool used NRS-2002, MUST and MNAS-F screened malnutrition in about 68%, 51% and 54% respectively. There shows a discrepancy between the evaluation of the malnutrition assessed by BMI with that of nutritional assessment score. Conclusion: COPD who present in exacerbations are malnourished, but use of sole BMI to rule out malnutrition in such group of patients can cause false negative result.

ThP7.16 - Multidisciplinary management of elderly patients undergoing emergency laparotomy: an audit at a small district general hospital

Abstract Aims The National Emergency Laparotomy Audit (NELA) suggests early involvement of the multidisciplinary geriatrician team for preoperative care of elderly patients aged over 80, or 65 and frail. Methods we audited our unit against the NELA guidelines for elderly patients. We looked at all emergency laparotomies carried out at our hospital over a 6 month period against the audit standards as set out by NELA. Results A total of 55 laparotomies were carried out in 6 months. 17 patients fit the criteria of patients needing early geriatrician involvement. Of the 34 patients aged 65 and above, 22 patients had their frailty score recorded in the notes (64%). Less than 10% of patients had early geriatrician input. Overall, six patients (11%) died within 30 days of their initial operation, and all were aged over 65. Conclusions we must take the perioperative care of elderly patients seriously and work with the Geriatric Medicine teams for early perioperative review, including accurate clinical frailty score assessments. We will initiate a project with the Geriatric Medicine department to implement an Elderly Laparotomy Perioperative Pathway for these patients.

A comprehensive approach to continuous quality improvement of massive transfusion by developing key performance indicators.

To develop key performance indicators (KPI) for use in quality assessment of our institutional goal-directed massive transfusion (GDMT). A team comprising our transfusion and emergency medicine departments carried out a cross-sectional data analysis of GDMT in adult patients from January 2021 to December 2022. The study was rooted in the Define, Measure, Analyse, Improve, Control (DMAIC) approach. Features of KPIs were (a) importance, (b) scientific soundness and (c) feasibility. Study parameters were defined and analysed using measures of central tendencies and benchmark comparison. Ninety-two massive transfusion events occurred and 1405 blood components were used. Trauma was the leading cause, followed by postpartum haemorrhage and upper gastrointestinal bleeding. Appropriate GDMT activation was observed only in 43.47% of events. The turnaround time (TAT) was within the benchmark in 85.8% of events with an average of 16 ± 10 min. The average utilization of blood components was 20.5 (interquartile range [IQR] = 11.3) in the appropriate group and 5.5 (IQR = 4.25) in the inappropriate group with a wastage rate of 3.5%. Duration of activation was 6.19 ± 4.59 h, and the adherence to thromboelastography was 66.3%. Overall mortality was 45.65%, and the average duration of hospital stay was 6.1 ± 5.9 days. The KPIs developed were easy to capture, and the analysis provided a comprehensive approach to the quality improvement of the GDMT protocol.

Performance and Interpretation of Lung Scintigraphy: An Evaluation of Current Practices in Australia, Canada, France, Germany, and United States.

Although ventilation/perfusion (V/Q) scintigraphy is a widely used imaging test, different options are possible for the acquisition and interpretation of the scan. The aim of this study was to assess current practices regarding the use and interpretation of lung scintigraphy in various clinical indications. An online survey comprising 25 questions was sent to nuclear medicine departments in Australia, Canada, France, Germany, and United States between 2022 and 2023. A single response per department was consolidated. Four hundred nineteen responses were collected (Australia: 32, Canada: 58, France: 149, Germany: 92, and United States: 88). For acute pulmonary embolism (PE) diagnosis, 82.8% of centers reported using SPECT acquisitions (Australia: 93.3%, Canada: 91.8%, France: 99.2%, Germany: 96.2%, and United States: 32.1%). Among them, SPECT images were combined with a CT scan in 70.5% of centers. A total of 10.6% of centers reported not using ventilation for acute PE diagnosis. SPECT acquisition was used in 97.8% of centers using 99m Tc carbon particles, 97.1% 81m Kr gas, 58.7% 99m Tc-DTPA, and 19.4% 133 Xe gas, respectively. For V/Q SPECT interpretation, the EANM criteria were used in 65.0% of departments. A very wide variety of practices were observed in pregnant women and in COVID-19 patients. SPECT acquisition was widely used in the follow-up of PE and for the screening of chronic thromboembolic pulmonary hypertension (>90% of centers), with inconsistency regarding the interpretation of matched perfusion defects in this setting. This survey shows the strong adoption of SPECT in the various clinical indications of lung scintigraphy, except in the United States, where planar imaging is still mostly used. The survey also shows variability in interpretation criteria both for PE diagnosis and screening for chronic thromboembolic pulmonary hypertension, highlighting the need for further standardizations of practices.

The burden of tuberculosis among patients with non-small cell lung carcinoma in a tertiary care center

BackgroundLung cancer and tuberculosis share similar risk factors, clinical spectrum, radiological features and it is difficult to differentiate but it is important to diagnose both conditions for targeted therapy and better outcome. AimsOur primary objective was to estimate the proportion of TB in primary biopsy proven non-small cell lung carcinoma (NSCLC) cases. Material & methodsThis prospective observational study was conducted in the Departments of Medicine/Pulmonary Medicine/Medical Oncology and Microbiology at the All India Institute of Medical Sciences, New Delhi for a period of 2 years (January 2020–December 2021). Patients with biopsy proven, primary non-small cell lung cancer were recruited and sputum samples were subjected to microbiological investigations to confirm tuberculosis. Comparison was done in two groups of lung cancer patients with confirmed TB (Group A) and without confirmed tuberculosis (Group B). ResultsTotal 75 patients with biopsy proven, primary NSCLC were recruited and 16 % (12/75) were diagnosed with confirmed TB. Adenocarcinoma (36.48 %) and Squamous cell carcinoma (33.44 %) were the two predominant histopathological subtypes of NSCLC. About 57 (76 %) of them were found to be in stage IV of Lung cancer at initial presentation itself (75 % in group A & 74.6 % in group B; p value < 0.80). A majority of patients (11/12 cases; 91 %) of group A were males with a mean age of 59 ± 7.5 years. The upper lobes of the lung were involved in 65 % (49/75) of the cases and showing a mass lesion on imaging (75 % in group A & 65 % in group B; p value < 0.52). Kaplan Meier survival revealed a median survival time of 11 months in subjects with only NSCLC and a median survival time of 4 months in the group with concomitant TB and NSCLC (p value < 0.44).

DESCRIPTION OF DIABETES, RISK FACTORS, ADVANCEMENTS IN DIABETES TREATMENT, AND THE EFFECT OF DIET ON QUALITY OF LIFE

Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia due to abnormalities in insulin production, activity, or both. This condition leads to long-term complications, including dysfunction and damage to the kidneys, heart, nerves, eyes, and blood vessels. Insulin resistance, particularly in skeletal muscles, adipose tissue, and the liver, plays a key role in the metabolic defects associated with diabetes. A prospective study was conducted at KIMS Hospital's General Medicine Department to assess the development of diabetic medications. Sixty patients were included, and the study summarized the development of insulin, oral drugs, and injectable non-insulin drugs for treating hypoglycemia. The pharmacological properties and side effects were briefly reviewed SGLT2 inhibitors, DPP-4 inhibitors, and GPR40 agonists are promising treatments. Future research should focus on understanding the mechanisms of diabetes, preventative measures, early diagnosis, and developing new drugs with fewer side effects.

Lessons in clinical reasoning- pitfalls, myths, and pearls: a case of persistent dysphagia and patient partnership.

Diagnostic excellence underscores the patient-centered diagnosis and patient engagement in the diagnostic process. In contrast to a patient-centered diagnosis, adoctor-centered diagnosis with a lack of patient engagement may inhibit the diagnostic process due to the lack ofresponsibility, disrupted information, and increased effect of cognitive biases, particularly in a situation where multiple physicians are involved. In this paper, we suggest a promising idea to enhance patient engagement in the diagnostic process by using written information by a patient about their perspective and experience, which canfill the gaps needed for diagnosis that doctors cannot find alone. A 38-year-old woman developed chest pain, which gradually worsened during the following two years. For two years, she was evaluated in multiple departments; however, no definitive diagnosis was made, and her condition did not improve. During this evaluation, she searched her symptoms and image findings online. Shereached a possible diagnosis of 'esophageal achalasia.' Still, she could not tell her concerns to any physicians because she felt that her concerns were not correctly recognized, although she showed her notes that her symptoms were recorded. She finally consulted the department of internal medicine, where her notes and previous test results were thoroughly reviewed. The final diagnosis of esophageal achalasia was confirmed. Doctors must organize an environment where patients can freely express their thoughts, emotions, and ideas regarding their diagnosis. Cogenerating visit notes using patient input through written communication can be apromising idea to facilitate patient engagement in the diagnostic process.