Major Presenting Symptom Research Articles

Prevalence and presentation of uterine fibroid in a private hospital in Enugu: A 5-year retrospective study

Background: Fibroids are the commonest benign tumours of the uterus. They occur more commonly in the nulliparous women, and among the blacks. They are frequently found incidentally on ultrasonography but common presenting symptoms are abdominal swelling, heavy menstrual bleeding and sub-fertility. Surgery is the definitive treatment modality with most women having myomectomy to preserve fertility. Aim: The aim of this study was to determine the prevalence, presentation and treatment outcomes of fibroid cases treated in the centre. Result: From the study, 42 patients were diagnosed with uterine fibroids over the 5-year period out of a total of 338 gynaecological patients treated in the hospital. This gave a prevalence of 12.42% in the 5-year period. Majority of them, 20(47.6%) were aged 31-40 years, 13(31%) were between 21 and 30 years whereas only 9(21.4%) were aged 41 years and above. Almost all the patients 38(90.5%) were from the Igbo ethnic group; 21(50%) had secondary education while 19(45.2%) had tertiary education. Twenty of them (47.6%) were either civil servants or professionals, 19(42.5%) were traders and 3(7.1%) were unemployed. It also revealed that 22(52.4%) were nulliparous, 11(16.7%) were multiparous and only 2(4.8%) were grand multiparous. More than a quatre of the patients 17(40.5%) presented with abdominal swelling, 14(33.3%) with heavy menses, 8(19%) with infertility and the least 3(7.2%) with recurrent miscarriages. Almost all of them 38(90.5%) had myomectomy and only 4(9.5%) had hysterectomy. Only the age and occupation of the patients had a statistically significant influence on the prevalence of uterine fibroid among the women studied. Conclusion: Most of the women who had uterine fibroids were within the age bracket of 31-40 years with heavy menstrual bleeding as the major presenting symptom. Almost all of them had myomectomy as the definitive treatment.

Clinicopathologic Analysis of Malabsorption Syndrome in a Tertiary Care Center in South India

ABSTRACT Background: Malabsorption syndrome is an umbrella term for manifestations consisting of diarrhea, steatorrhea, malnutrition, unexplained weight loss, persistent or recurrent abdominal pain, and anemia. Celiac disease and Tropical sprue remain the two important causes among many more. Materials and Methods: The objectives of this study were to assess the spectrum of histological features of malabsorption at a tertiary care center and to correlate the clinical, endoscopic, and histological features between the various etiologies. Biopsy specimens of 547 subjects formed the sample for this institutional-based, retrospective research. All subjects who had a clinical diagnosis of malabsorption and underwent subsequent endoscopic evaluation along with biopsy were considered. The hematoxylin and eosin-stained sections were analyzed for villous architecture and intraepithelial lymphocytes (IELs). The histopathological findings were further correlated with the endoscopic findings. Data thus obtained were statistically analyzed using Microsoft Excel for Windows (2010). Results: The mean age of the subjects was 46.65 ± 17.31 years and with 330 males (60.33%) and 217 female (39.63%) subjects. Chronic diarrhea was the major presenting symptom in 95% of the subjects (n = 520). Normal villous architecture was noted in 68.19%, while the remaining cases showed varying degrees of atrophy ranging from mild in 27.61% (n = 151) to moderate in 2.56% (n = 14) to severe in 1.65% (n = 9). IELs were noted in 70.78% of cases. Conclusion: Histopathological findings, when analyzed, showed intraepithelial lymphocytosis as the major diagnosis in 34.19% of cases (n = 187), followed by tropical sprue in 19.56% (n = 107) cases. The pathology was nonspecific in about 13.89% (n = 76).

THU431 An Interesting Case Of Severe Osteoporosis In A Young Male

Abstract Disclosure: M. Bilbatua: None. M. Deshmukh: None. Background: Systemic Mastocytosis is a rare disorder in which Osteoporosis is seen in about 24% of cases. We describe a rare case of Secondary Osteoporosis in a young man caused by Systemic Mastocytosis. Case presentation: A 32-year-old male with no significant medical history was seen by Endocrinology for evaluation of Osteoporosis. Symptoms started after two episodes of falls which caused persistent pain. A CT scan of thoracic spine revealed chronic anterior wedge compression fracture of T5, T7 and T10 with approximately 5-10% loss of height. DEXA scan demonstrated T-score of -4.2 at L1-L4, T-score of -2.3 at left hip suggestive of severe Osteoporosis. The patient admitted to generalized flushing and itching after taking hot showers as well as intermittent episodes of palpitations. The patient was started on Calcitonin nasal spray daily for pain related to vertebral fracture. Testing for secondary causes of Osteoporosis showed a Total testosterone 410 ng/dL (250-1,100 ng/dL), PTH 16 pg/mL (16 - 77 pg/mL), TSH 1.88 mIU/L (0.40 - 4.50 mIU/L), Phosphorus 4.1 mg/dL (2.5 - 4.5 mg/dL), Magnesium 2 mg/dL (1.5 - 2.5 mg/dL), Alkaline phosphatase 66 U/L (36 - 130 U/L), Vitamin D 25 ng/mL (30 - 100 ng/mL), Calcium 9.3 mg/dL (8.6 - 10.3 mg/dL), Tryptase 64 mcg/L (<11.0 mcg/L), 5-HIAA 24H Ur mg/24H 3 (<=6.0 mg/24 h). Based on this, the patient was seen by Hematology/Oncology for evaluation on elevated tryptase levels. Bone marrow biopsy and aspirate was performed, demonstrating 20% Mast cells positive for CD 117, CD 25, patient was diagnosed with Mastocytosis and treatment with Midostaurin 100 mg PO twice daily and Zometa every 12 weeks was initiated. Improvement of Tryptase was noted within two months of treatment. Discussion: Systemic Mastocytosis is a rare disease often complicated by Osteoporosis of which around 37% of the patients will develop Osteoporotic fractures where Bisphosphonates are effective and have a role in the associated refractory bone pain. The pathophysiological mechanisms leading to osteoporosis in Systemic Mastocytosis are not well understood. Although rare, back pain secondary to osteoporotic vertebral fractures is often the major presenting symptom of Mastocytosis and it should be included in the differential diagnosis of idiopathic osteoporosis due to its significant morbidity. Presentation: Thursday, June 15, 2023

Pattern of fibroid presentation and management in ESUT Teaching Hospital, Enugu: A 5-year review

Background: Fibroids are usually under-reported. It is the most common benign pelvic tumors in women. Most women may have uterine fibroids before the age of 45 to 50 years yet, its actual prevalence is unknown. It is much commoner among women of black race and has become a major presenting pathology in many gynaecological clinics. Aim: The aim of this study was to audit the pattern of presentation and the management of uterine fibroids in ESUTH Methodology: This was a 5-year retrospective study conducted in ESUT Teaching Hospital, Enugu. A total of 9,588 folders were retrieved but only 596 had adequate information needed for the study and were used for the study. Data was collected from gynaecology clinics, theatre registers and patient’s case notes using a structured proforma. The data was analyzed using Statistical Products and Service Solutions version 25.0 Results: At the end of the data collection, 9,588 women were seen at the gynaecology clinic over the 5-year period. Out of these, 596 patients diagnosed with uterine fibroids and whose case files contained the requisite information needed for the study were recruited. From the figures above, the prevalence of uterine fibroid in ESUT Teaching Hospital, Enugu, over the period was 6.2%. According to socio-demographic distribution of the patients; majority of them were aged 31-35 years (37.8%), followed by those 36-40 years (34.2%). Very few of them were aged 25-30 years (9.2%). Most of the population studied were of the Igbo ethnic group (81.7%) and majority of them (81%) were nulliparous. The major presenting symptoms among the studied population were heavy menstrual bleeding, (55.4%), abdominal swelling, (54.5%), inability to conceive, (36.4%), abdominal pain, (18.6%), incidental findings (17.8%), and polyps, (9.4%). However, some had more than one presenting complaints. Regarding treatment options, majority (64.4%) had myomectomy, 27.3% had procoagulants like tranexamic acid, 18.8% had progestogens, 18% had NSAIDs for pain and bleeding, 9.4% had polypectomy, 8.6% had GNRH-analogue, while only 1% had hysterectomy. However, 19% did not receive any treatment, while many receive more than one treatment. There were varying degrees of influence by age and parity on the clinical presentations and treatment options accepted by the patients. Conclusion: The prevalence of uterine fibroid was found to be more among nulliparous women aged 24 to 30 years. A significant number presented with menorrhagia and inability to conceive. Majority of them chose myomectomy as an option of treatment.

Development and Validation of a Novel Risk Score for All-Cause Mortality Risk Stratification Prior to Permanent Pacemaker Implantation in Octogenarians or Older.

Background and Objectives: The demand for permanent pacemaker (PPM) implantation for extremely old patients is increasing. Prior to implanting PPMs, life expectancy evaluation is essential but difficult. We aimed to develop and validate a scoring system for all-cause mortality risk stratification prior to PPM implantation in patients aged ≥80. Materials and Methods: A total of 210 patients aged ≥80 who received PPM implantation were included. Multivariable analysis was performed to assess the effects of different variables on all-cause mortality in a derivation cohort (n = 100). We developed the MELODY score for stratifying all-cause mortality prior to PPM implantation and tested the scoring system in a validation cohort (n = 102). Results: After 4.0 ± 2.7 years of follow-up, 54 patients (54%) had died. The 0.5-, 1- and 2-year all-cause mortality rates were 7%, 10% and 24%, respectively. The MELODY score based on body mass index <21 kg/m2 (HR: 2.21, 95% CI: 1.06-4.61), estimated glomerular filtration rate <30 mL/min/1.73 m2 (3.35, 1.77-6.35), length of hospitalization before PPM implantation >7 days (1.87, 1.02-3.43) and dyspnea as the major presenting symptom (1.90, 1.03-3.50) successfully distinguished patients at high risk of mortality. Patients with MELODY scores ≥3 had a higher risk of mortality compared to those with MELODY scores <3 (8.49, 4.24-17.00). The areas under the receiver operating characteristic curves in predicting 0.5, 1 and 2 years mortality rates were 0.86, 0.81 and 0.74, respectively. The predictive value of the model was confirmed in a validation cohort. Conclusions: The novel scoring system is a simple and effective tool for all-cause mortality risk stratification prior to PPM implantation in patients aged ≥80.

A Clinical Study of Ventral Hernias in Tertiary Hospital, Goa Medical College

Background: Ventral hernias are commonly encountered problems in the field of general surgery. Less data is available as to its natural history and hence surgeons prefer surgical treatment. Incisional hernia is a common complication following abdominal surgery that requires reoperation. Aims and Objectives: To study the incidence of ventral hernias, its causes and modes of presentation with the changing trends, various treatment modalities and complications of surgeries and mortality and morbidity owing to ventral hernia. Materials and Methods: This prospective observational study was conducted in the Department of Surgery, Goa Medical College, on a total of 100 patients between May 2019 to March 2021. Detailed history was recorded in all cases. This includes age, sex, weight of the patients. Presence of predisposing factors like obesity and particulars regarding diseases like hypertension, diabetes and other complications were elicited and treatment for the same was undertaken. The data was analyzed using SPSS software. Results: Females were affected more than males. 49% patients complained of swelling, while 23% complained of swelling and pain and about 20% complained of only pain. Para umbilical and incisional hernias were the most common types of hernias diagnosed in the study majority (86 out of 100) had no complications. However, those who did have complications, the most common was infection which was seen among 14% of the participants. 8% had seroma and 5% each had ileus and dehiscence. The recurrence rate was only 3%. Conclusion: Ventral hernia tend to present mainly in the 40- to 60-year age with male to female ratio tends to be 2:1. Para umbilical with umbilical hernia were most common types followed by Incisional hernia. Swelling and pain were the major presenting symptoms. Mesh repair was being more frequently used, compared to primary suture repair.

A dangerous appetite

To describe an experience with laryngeal oncocytic cystadenomas and review the published literature regarding this uncommon diagnosis.A clinical review of patients presenting with cystic laryngeal masses in an urban academic medical center between January and December 2013 was performed. Three patients, two female and one male, with a mean age of 68 years, were diagnosed with oncocytic cystadenomata of the larynx. Major presenting symptoms included dysphonia, globus, and ipsilateral otalgia. Endoscopic examinations revealed a cystic structure arising from varied subsites of the larynx: laryngeal ventricle, aryepiglottic fold, and pre-epiglottic space. Cross-sectional radiographic imaging was obtained in each case. The patients were treated with transoral (CO2) laser microsurgery (TLM). In all three cases, pathological analysis revealed oncocytic cystadenoma with clear margins.Oncocytic cystadenoma is a rare entity of the larynx predominantly affecting elderly patients. Clinical presentation and imaging may suggest the diagnosis of an internal laryngocele. Complete excision is both diagnostic and therapeutic, and typically can be achieved using TLM. When clear margins are obtained, no adjuvant therapy is indicated. Although laryngoceles and malignancies are more commonly encountered, oncocytic cystadenomas should remain in the differential of cystic laryngeal masses.

Surgical management of acute intestinal obstruction study of 50 cases operated in emergency

Background: Intestinal obstruction is one the major cause that patients underwent emergency operations and which might lead to complications that could be turn fatal. Prompt evaluation and treatment prevents mortality and morbidity of post-operative patients. Methods: Prospective study conducted between 01 April 2020 to 31 March 2022 in 50 patients of intestinal obstruction operated in emergency according to inclusion criteria. Pre-operative, intraoperative, and post-operative assessment and recording of data done. Results: In 50 cases of intestinal obstruction, commonest age group is 41 to 60 years, pain and obstipation remains major presenting symptoms and tenderness, guarding and rigidity were most common signs. The commonest cause of intestinal obstruction in the adults in this study was postoperative adhesions (44%) followed by Koch’s abdomen (30%). Malignancy of the large bowel was seen in 6 cases constituting 12% of cases, obstructed hernia in 5 cases (10%), intussusception in 3 cases (6%) and gut malrotation in 1 case (2%). Comorbidity like hypertension and diabetes were main causes of post-operative complications. Conclusions: Maximum incidence of intestinal obstructions were reported in Age group 41-60 years with male predominance. Abdominal pain was the consistent symptoms followed by obstipation. Post-operative adhesion were the most common cause of the intestinal obstruction. Malignancy and multiple comorbidity remains the major risk factor for the post-operative complications and mortality.

Clinicopathologic features of early-onset (EO) esophageal and gastric cancers.

472 Background: The rates of gastric (GC) and esophageal adenocarcinoma (EA) among individuals younger than age 50 years have increased by 30% and 50%, respectively, over the past three decades in the US. There is limited information on incidence and demographics for EO esophageal and gastric cancer in Europe. Methods: We conducted a retrospective review of the prospectively maintained upper gastrointestinal (UGI) cancer database in St James’s Hospital (SJH), the National Centre for Oesophageal and Gastric Cancer in Ireland. We reviewed all cases diagnosed with esophageal cancer (EC) and gastric cancer (GC) less than or equal to 50 years of age from 2000 to 2021. Results: From 2000 to 2021, 374 EO EA &amp; GC cases were identified, 8% of the 4663 total EC &amp; GC cases. The results are presented in the table. Conclusions: The major presenting symptoms for EO-UGI cancer were dysphagia, weight loss and dyspepsia, further investigation is warranted in young patients presenting with these symptoms, even in the absence of elevated BMI or other known risk factors for malignancy. A high proportion have advanced disease at diagnosis despite good PS and clinical outcomes are poor. There is a critical need to understand the pathogenesis of EO-UGI cancers to determine optimal strategies for prevention and management.[Table: see text]

Neonatal classic galactosemia-diagnosis, clinical profile and molecular characteristics in unscreened Turkish population.

Classic galactosemia (CG) is a rare hereditary disease that can cause serious morbidity and death if it is not diagnosed and treated in early periods of life. Clinical findings usually occur in the neonatal period after the neonate is fed with milk that contains galactose. Most patients are presented with jaundice, hepatomegaly, hypoglycemia and cataracts. We aimed to document the clinical, molecular characteristics, regional estimated incidence and time of diagnosis in newborn with CG. The data of 63 newborn with CG who were diagnosed and followed up between January 2011 and January 2018 were analyzed retrospectively. During the study period, 63 (33 boys and 30 girls) newborns were diagnosed with CG. The median gestational age was 39 weeks (33-42). Major presenting symptoms were jaundice 90.5% and cataract 41.2%. The mean age at first symptom was 12 ± 7.4 days while the mean age at diagnosis was 18.9 ± 10.6 days. Nearly half of the patients (55.5%) were diagnosed later than the postnatal 15th day. Genetic analysis was performed on 56 patients and homozygous Q188R mutation was found in 92.8%. There were signs of sepsis in 33.3% of the cases. Six patients died due to sepsis. There was consanguinity in 84.1% of the parents and regional estimated incidence was calculated as 1 in 6103 live births. Q188R mutation was found in 92.8% of our cases. The regional estimated incidence was found as 1 in 6103 live births. Our study strongly supports that galactosemia should be included in the national newborn screening program.

PREGNANCY RHINITIS IN SOUTH INDIAN WOMEN

Background: Pregnancy rhinitis (PR) is a common condition which is misclassied and under-diagnosed. It is mainly attributed to changing levels of sex hormones during pregnancy which returns to normal once the pregnancy is over. Uncontrolled rhinitis during pregnancy may affect quality of life for mother and may have deleterious effect on fetus. Objectives of study: Objective of present study is to assess the prevalence, frequency of signs, symptoms and response to treatment in PR in South Indian women. Material and methods: In this prospective study, the pregnant patients with symptoms and signs of PR were enrolled. Anterior rhinoscopy was performed for signs of congestion, discharge and mucosal changes. Patients were followed during pregnancy upto two weeks post-partum. Results: Overall incidence of pregnancy rhinitis was 10% in pregnant women. Major presenting symptoms were nasal discharge, nasal obstruction, excessive sneezing and post-nasal drip. Quality of life was affected to variable extent in two thirds of patients. Response to the treatment was satisfactory to good in 79% of cases. Twenty one percent patients did not notice any subjective change in the symptoms. Conclusion: PR has signicant impact on quality of life. Safety of therapeutic measures, advice and conservative practice form the mainstay of treatment.

COVID-19 Prevalence and Survival Outcome in Pediatric Cancer Patients Undergoing Chemotherapy: A Study from Tertiary Cancer Center of North-East India

Background: Pediatric cancer patients are considered one of vulnerable group for Covid-19 infections and its associated complication. We assessed Covid-19 prevalence and implications in pediatric cancer patients of NorthEast India. Methods: Retrospective study was conducted between July 2020 to June 2021 at Dr B Borooah Cancer Institute (BBCI), Guwahati, Assam, India. Medical records of the childhood cancer patients were analyzed. All patients who were tested for SARS-CoV-2 were collected. All childhood cancer patients with age group between one to eighteen years were included. Results: Fifty two out of 701 (7%) cancer patients in children were found to be positive for SARS-CoV2 by RT-PCR testing. Among COVID-19 positive patients, the median age was six years. In COVID-19 positive group, thirty (57.6 %) were suffering from hematological malignancy and twenty two (42.4%) have solid malignancy. In COVID-19 positive group, Among the hematological malignancies; acute lymphoblastic leukemia (ALL) comprises 70% (21), acute myeloid leukemia (AML) 16.66% (5) and lymphoma accounting for 13.33%. Fever, cough and sore throat was presenting symptom in majority of patients. Survival outcome has shown statistically significant association (p=0.0001) between COVID-19 positive and negative pediatric cancer patients. Eight deaths occurred in COVID-19 positive patients but there was only one death in COVID-19 negative patients. Conclusion: Among COVID-19 positive childhood cancer patients risk of death was significantly higher compared to COVID-19 negative patients and majority of deaths occurred in hematological malignancies receiving intensive chemotherapy.

Clinical characteristics analysis of COVID-19 patients from the first significant community outbreak by SARS-CoV-2 variant B.1.1.7 in Taiwan as experienced from a single northern medical center.

Background/PurposeClinical characteristics of patients in the first community outbreak of coronavirus disease 2019 (COVID-19) by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant B.1.1.7 in Taiwan have not been characterized.MethodsSARS-CoV-2 positive specimens from inpatients between May 7 and June 15 in 2021were screen for SARS-CoV-2 B.1.1.7 lineage by VirSNiP assay. Clinical characteristics were reviewed and compared with those from Feb 1 to April 30, 2020 and from Jan 1 to March 31, 2022.ResultsOne hundred forty-one inpatients from May 7 to June 15, 2021 infected with SARS-CoV-2 B.1.1.7 lineage were included. The major presenting symptoms were fever (88.7%) and cough (59.6%). Incidence of relevant complications including pulmonary embolism, simultaneous infections with bacteria, virus, and fungi were 0.7%, 12.8%, 13.5%, and 2.1%, respectively. Old age, high Charlson comorbidity index, short of breath, and initial critical illness were independently associated with 28-day mortality (all p < 0.05). In comparison to COVID-19 inpatients from Feb 1 to April 30, 2020, patients from the outbreak by SARS-CoV-2 B.1.1.7 lineage were older, more severe in disease condition, higher mortality but less obvious initial presenting symptoms. After implementation of nationwide vaccination campaign in the next half year of 2021, COVID-19 inpatients from Jan 1 to March 31 in 2022 indicated less severe diseases than those infected with SARS-CoV-2 B.1.1.7 lineage.ConclusionCOVID-19 inpatients by SARS-CoV-2 variant B.1.1.7 with old age, multiple comorbidities, and more severe disease conditions were associated with increased mortality. Vaccination for this vulnerable populations may be helpful.

Acute Accidental Exposure to Chlorine Gas: Clinical Presentation, Pulmonary Functions and Outcomes

To study the clinical presentation, pulmonary functions and outcomes in subjects who were accidentally exposed to chlorine gas. Prospective observational study of 64 patients who sustained acute accidental exposure to chlorine gas during a leak in the chlorination system of the public bathing pool of a temple. The major presenting symptoms and signs included acute dyspnoea (100%), chest discomfort (100%), cough (97%), eye irritation (88%), giddiness (72%), vomiting (46%), and heaviness in the head (44%); tachycardia (100%), tachypnoea (96%) and polyphonic wheezing (28%). All patients were managed in the emergency room with humidified oxygen inhalation and beta-2 agonist nebulisation and 52 were discharged within six hours. Twelve patients were severely affected and required hospitalisation; three of them were admitted into the intensive care unit. Three patients developed pulmonary oedema six to eight hours following admission. Pulmonary function testing (n = 12) at presentation revealed obstructive defect in eight and mixed obstructive-cum-restrictive defect in four patients. The mean duration of hospital stay was 5.1 +/- 2.1 days. None of the patients died. Reactive airway dysfunction syndrome (RADS) was observed in three of the 12 hospitalised patients, who complained of manifested persistent cough that lasted for three months period following discharge. Serial pulmonary functions recovered to normal range by the end of the six months in all patients and remained so at one-year follow-up. Acute exposure to chlorine gas is an uncommon, but important public health hazard and can cause RADS, acute lung injury and pulmonary function abnormalities, which are reversible on prompt and appropriate management.

Zika a Vector Borne Disease Detected in Newer States of India Amidst the COVID-19 Pandemic.

BackgroundDuring the second wave of the COVID-19 pandemic, outbreaks of Zika were reported from Kerala, Uttar Pradesh, and Maharashtra, India in 2021. The Dengue and Chikungunya negative samples were retrospectively screened to determine the presence of the Zika virus from different geographical regions of India.MethodsDuring May to October 2021, the clinical samples of 1475 patients, across 13 states and a union territory of India were screened and re-tested for Dengue, Chikungunya and Zika by CDC Trioplex Real time RT-PCR. The Zika rRTPCR positive samples were further screened with anti-Zika IgM and Plaque Reduction Neutralization Test. Next generation sequencing was used for further molecular characterization.ResultsThe positivity was observed for Zika (67), Dengue (121), and Chikungunya (10) amongst screened cases. The co-infections of Dengue/Chikungunya, Dengue/Zika, and Dengue/Chikungunya/Zika were also observed. All Zika cases were symptomatic with fever (84%) and rash (78%) as major presenting symptoms. Of them, four patients had respiratory distress, one presented with seizures, and one with suspected microcephaly at birth. The Asian Lineage of Zika and all four serotypes of Dengue were found in circulation.ConclusionOur study indicates the spread of the Zika virus to several states of India and an urgent need to strengthen its surveillance.

Vaccination

Vaccination

Study of clinical profile of chronic kidney disease in non-diabetic patients

Background: Chronic kidney disease (CKD) encompasses a spectrum of different pathophysiological processes associated with abnormal kidney function and a progressive decline in glomerular filtration rate. Cardiovascular disease is one of the major cause of morbidity and mortality in patients at every stage of CKD. Diabetes mellitus and hypertension together being major cause for CKD. Hypertension is a common cause for CKD and an independent risk factor for cardiovascular disease. This study mainly focused on the causes of CKD other than diabetes mellitus. An early detection and appropriate intervention of these patients will possibly help prevent progression of renal disease.Methods:We assessed 55 non diabetic CKD patients who presented to the OPD/IPD in Victoria hospital, Bowring and Lady Curzon hospital and other hospitals affiliated to Bangalore medical college and research institute during period June 2018 to December 2019. A detailed history and clinical examination was performed and patients were subjected to necessary investigations.Results: The commonest etiology for CKD was found to be hypertensive nephropathy followed by glomerulonephritis. Common symptoms were generalized weakness, lower limb swelling. Commonest signs are pallor, pedal edema and hypertension.Conclusions:CKD is a major health problem. Diabetic nephropathy is the commonest cause for CKD followed by hypertensive nephropathy and glomerulonephritis. Anaemia, pedal oedema, oliguria and generalised weakness were the major presenting clinical signs and symptoms in CKD. This condition when detected in early stages and managed can slow down the progression of CKDs and delay the need of renal replacement therapy.

Frey procedure for chronic pancreatitis in adolescent with recurrent bleeding: a case report

Background: Chronic pancreatitis is rare in children and commonly unresponsive to medical therapy, associated with a higher complication and mortality rate. Abdominal pain is the major presenting symptom. Case presentation: A 13-year-old female presented with severe abdominal pain and massive hematemesis recurred several times during a period of 3 months, always crescendo-decrescendo followed by hemorrhage - starting once every 3-4 weeks and gradually became more frequent. Upper endoscopy found an active bleeding came out of the papilla Vater, with subacute bleeding intra-pseudocyst, suggestive of chronic arterial injury at the splenic artery (4 cm from the proximal part of coeliac trunk) and no dilatation of Intra- and extra-biliary was showed in MRCP. Results: Surgical exploration revealed a chronic pancreatitis with multiple pancreatic duct stone and pseudocyst. A pseudoaneurysm also found in the pseudocyt. Frey procedure was carried out. The post-operative course went uneventfully, and patient was discharged on post-operative day 14. Conclusions: Surgical failures in the management of chronic pancreatitis have been attributed to inadequate decompression of the head of the pancreas, The Frey procedure adds anterior resection of the head of the pancreas to the LPJ and was created to improve decompression of the head of the gland, with relatively lower morbidity compared to Beger procedure.

Renal Stones and Risk Factors in Jeddah and Riyadh.

Saudi Arabia has extremely hot climate for most of the year; this is associated with the risk of developing nephrolithiasis. This retrospective research aimed to investigate the current prevalence, manifestation, mode of treatment, and risk factors of renal stones in Jeddah and Riyadh, Saudi Arabia. A cross-sectional study was conducted from November 2018 to June 2019 at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. This study included 1031 participants aged ≥18 years from Jeddah (n=652, 63.3%) and Riyadh (n=379, 36.8%). Data were expressed as mean ± standard deviation (minimum-maximum) or number (%). Comparisons between patients with and without renal stones were made using the Chi-square test and unpaired Student's t-test as appropriate. The odds ratio (OR) with a 95% confidence interval (95% CI) was determined for the risk factors of renal stones. The prevalence of renal stones was 16.9% among the participants. A significantly high risk for renal stones was associated with male sex (2.96; 95% CI: 2.08-4.20, P = 0.0001) and age group of 34-40 years (OR: 1.44; 95% CI: 1.005-2.103, P = 0.047). Hypertension was more common in patients with renal stones than those without renal stones (9.5% vs.4.6%, P = 0.013). The percentage of patients who took diuretics was significantly higher among those with renal stones than among those without renal stones (11.2% vs. 3.5%, P = 0.001). Of the 169 patients with renal stones, 58.0% had a positive family history of renal stones, and 23.7% had a history of urinary tract infections (UTIs). The symptoms of renal stones were pain (86.4%), hematuria (11.2%), fever (2.4%), and others (0.6%). Of all the patients, 43.8% took medication. For most patients, the stones passed spontaneously (67.5%), while 23.7% underwent lithotripsy, and 1.5% received stents. In this study, we found a higher prevalence of renal stones two major cities in Saudi Arabia in Jeddah and Riyadh, at 16.4%. Risk factors included male sex and age group of 34-40 years. A significant number of patients with renal stones have a family history of renal stones and a history of UTI. Loin pain and hematuria were the two major clinical presenting symptoms for renal stones. In the majority of patients, the renal stones passed spontaneously without the need for lithotripsy or surgery.

Mutation Spectrum of Tuberous Sclerosis Complex Patients in Indian Population.

Tuberous sclerosis complex (TSC) is a multiorgan disorder characterized by formation of hamartomas and broad phenotypic spectrum including seizures, mental retardation, renal dysfunction, skin manifestations and brain tubers. It is inherited in an autosomal dominant pattern, caused due to mutation in either TSC1 or TSC2 genes. Seizures are one of the major presenting symptoms of TSC that helps in early diagnosis. The present study describes the mutation spectrum in TSC1 and TSC2 genes in TSC patients and their association with neurocognitive-behavioral phenotypes. Ninety-eight TSC patients were enrolled for TSC genetic testing after detailed clinical and neurobehavioral assessment. Large genomic rearrangement testing was performed by multiplex ligation-dependent probe amplification (MLPA) technique for all cases and Sanger sequencing was performed for MLPA negative cases. Large rearrangements were identified in approximately 1% in TSC1 and 14.3% in TSC2 genes. The present study observed the presence of duplications in two (2%) cases, both involving TSC2/PKD1 contiguous genes which to the best of our knowledge is reported for the first time. 8.1% of small variants were identified in the TSC1 gene and 85.7% in TSC2 gene, out of which 23 were novel variations and no variants were found in six (6.1%) cases. This study provides a representative picture of the distribution of variants in the TSC1 and TSC2 genes in Indian population along with the detailed assessment of neurological symptoms. This is the largest cohort study from India providing an overview of comprehensive clinical and molecular spectrum.