Pain In Abdomen Research Articles

Biliary tract infections caused by Enterococcus gallinarum and Escherichia coli: a rare case report.

Enterococcus gallinarum (E. gallinarum), an opportunistic pathogen with intrinsic resistance to vancomycin, has rarely been reported as a predominant pathogen responsible for biliary tract infections. Here, we report a case of biliary tract infections caused by E. gallinarum and Escherichia coli (E. coli) in a 57-year-old Chinese woman with symptoms of upper abdomen pain for 10days. The patient initially received empiric treatment with cefmetazole but failed to improve. Subsequently, bile cultures identified E. gallinarum and E. coli, and cefmetazole was switched to linezolid and meropenem based on drug susceptibility testing. After 10days of antibiotic therapy, the patient successfully recovered and was discharged from the hospital. The findings of this case remind us that E. gallinarum may be the causative factor of biliary tract infections, and timely identification of the causative organism and appropriate antibiotic treatment is important for optimal patient recovery.

Actinomycosis of the gallbladder: A rare case report and literature review

Actinomycosis of the gallbladder is rare, with only a few documented cases in the medical literature. Actinomyces is typically part of the normal flora of the cervicofacial region, gastrointestinal tract, and urogenital tract. Here, we report a case of a 31-year-old female who presented with pain abdomen. Radiological investigation revealed a contracted gallbladder with multiple calculi and a thickened wall. A provisional diagnosis of acute cholecystitis was considered preoperatively and hence planned for laparoscopic cholecystectomy. Histopathological examination showed moderate lymphocytic infiltrate within the muscular layer of the gallbladder along with colonies of filamentous bacteria suggestive of actinomycosis. The relevant stains, including Gram and Giemsa, highlighted the Gram-positive bacteria and confirmed the diagnosis. Post-cholecystectomy, the patient received prolonged antibiotic therapy to prevent recurrence.

Late Middle Age Woman With Nutcracker Syndrome With Abdominal Pain- A Case Report

Nutcracker syndrome (NCS) is caused by a compression of left renal vein between aorta and superior mesenteric artery. Typically, it presents with symptoms like abdominal pain, hematuria, and varicocele, but hypertension is rarely noted. This is a rare condition and often under-diagnosed, more prevalent in females and if not treated, can lead to severe problems. There are no clear guidelines regarding management. We present a case of a 45-year-old woman experiencing intense pain in the lower abdomen, with no signs of hematuria, who was diagnosed with nutcracker syndrome after undergoing a computed tomography scan

Gastrointestinal pathology in patients presenting with iron deficiency anaemia: A single-centre cross-sectional study

ABSTRACT Background: About a third of the world’s population is estimated to suffer from anaemia, and iron deficiency is expected to account for about half of all anaemia cases. This study was designed to get an estimate of the proportion of patients with iron deficiency anaemia (IDA) who have a significant gastrointestinal (GI) pathology, in particular a GI malignancy, and to identify any risk factors or predictors for the same. Methods: This cross-sectional study was conducted at a hospital in Eastern India. The study population comprised males above the age of 18 and postmenopausal females with IDA, excluding those haemodynamically unstable or with chronic diseases. Data collection included a detailed history, sociodemographic details, dietary habits, GI symptoms, and severity of anaemia. Faecal occult blood tests (OBTs) were conducted, and patients were referred for upper and lower GI endoscopy with biopsies. Results: Out of the 257 patients, 50.97% (n = 131) had a significant GI pathology, and 25.68% (n = 66) had a GI malignancy. Male gender (AOR: 5.203, 95% CI: 1.725–15.698) and a positive stool OBT (AOR: 6.516, 95% CI: 2.255–18.828) were found to be independent risk factors for any GI pathology. Age 40 years or above (AOR: 11.376, 95% CI: 1.199–107.946), loss of appetite (AOR: 15.548, 95% CI: 1.416–170.735), pain abdomen (AOR: 5.566, 95% CI: 1.149–26.953), dysphagia (AOR: 7.945, 95% CI: 1.036–60.915), family history of malignancy (AOR: 46.726, 95% CI: 4.076–535.645), and positive OBT (AOR: 22.430, 95% CI: 3.933–127.915) were found to be independent risk factors of GI malignancy. Conclusions: This study shows that a large proportion of adult males and postmenopausal females presenting with IDA in India have significant GI pathology. Furthermore, a significant proportion of them have GI malignancies. Thus, bidirectional endoscopy should be considered for these patients. Male patients, age >40, those with history of loss of appetite or weight, pain abdomen or dysphagia, positive family history, and positive OBT should be prioritised for the investigation.

A Rare Case Report Of Sigmoid Volvulus – An Important Differential To Consider In Acute Abdomen

Background: Sigmoid volvulus an uncommon source of bowel obstruction in middle-aged individuals.. This perilous condition pervades globally, with a pronounced predilection for elderly population burdened by concurrent health ailments. While both genders can fall victim, males (1) are more frequently affected. Case Report: A middle aged gentleman presented to emergency center reporting pain abdomen, vomiting , obstipation. On palpation generalized tenderness , guarding present, X – ray abdomen showed classic coffee bean (volvulus) immediately underwent emergency laparotomy - found sigmoid colon was distended and gangrenous. Sigmoidectomy with Hartmann’s performed. Conclusion: This case underscores the criticality of swift action in addressing this life-threatening ailment. Its evaluation should be of utmost importance among the potential diagnoses for individuals reporting with abdominal distention and pain, vomiting,obstipation. An abdominal X-ray (3) both erect and supine positions provides excellent diagnostic results

Epiploic Appendigitis – Presenting as Acute Abdomen: Diagnostic Pitfalls and Clinical Insights

Introduction: Epiploic appendigitis is a rare, benign, self-limiting inflammatory process of the epiploic appendices. The epiploic appendices are small pouches of the peritoneum filled with fat and situated along the colon, mainly the transverse and sigmoid parts, but are absent in the rectum and have an unknown function. These appendages can become acutely inflamed as a result of torsion or venous thrombosis. Case Report: A young patient came to emergency department of our hospital with complain of pain in abdomen at left lumber region since five days. On Physical examination revealed lump at left lumber region at the site of pain. Further investigated by radiological. Discussion: Epiploic appendigitis is an uncommon condition first described by Lynn et al in 1956 and is one of the rare causes of acute abdomen secondary to the inflammation and necrosis of small finger like projections along the colon. These appendages refer to adipose structures that rise in the surface of the colon and project into the abdominal cavity. Conclusion: Given the rarity of this condition, its elusive nature and tendency to mimic acute appendicitis, diverticulitis or cholecystitis, which all may require surgical intervention, it is increasingly apparent that we should educate medical professionals on this important differential diagnosis, as early and accurate diagnosis can prevent unnecessary invasive treatments and misdiagnosis.

Missing IUCD – A Case Report

Intra-uterine contraceptive devices are one of the long-acting reversible contraceptive methods which are highly acceptable by patients. These are well tolerated by patients and serious complications like perforation rarely occur, but if such complications remain undetected, they can cause major morbidity to the patient. We report one such case of missing IUCD, which was found to be in pelvis outside of uterus, that was detected on routine post-insertion follow-up. Patient was operated immediately and is now doing well. We through this case report, want to emphasize the importance of proper counseling of the warning signs of perforation like pain abdomen and missing threads along with post insertion follow -ups for early identification of perforated IUCD thus, minimizing the patient morbidity.

Pelvic pain from a chronic pain perspective

Chronic pelvic pain (CPP) refers to persistent pain in the lower abdomen or pelvis of a woman of at least 3 months in duration. It is common, affecting around one in six women. Chronic pelvic pain can be extremely debilitating, and has an impact on physical, psychological and social function. While CPP is often associated with various underlying pathologies (e.g. endometriosis, adenomyosis, pelvic inflammatory disease and polycystic ovaries), it can also exist without any identifiable underlying condition. Furthermore, pain is often poorly correlated to the extent, location and type of the underlying pathology. Therefore, CPP is complex, and can be extremely challenging to understand and effectively manage. In recognition of the complexity of this condition, guidelines suggest that management needs to reflect a biopsychosocial approach, i.e. one that considers and manages the physical, psychological and social factors that drive and influence CPP. This paper provides an overview of CPP, and draws from evidence and clinical practice to describe key considerations when applying a biopsychosocial approach to its management.

Endoscopic Findings of a Patient Having Cholelithasis in SOMCH, Sylhet, Bangladesh

Introduction: Cholelithiasis is one of the most frequently encountered disease and one of the major causes of abdominal morbidity throughout world [1]. Cholelithiasis is one of the most common and costly of all digestive diseases. Common causes of upper abdominal symptoms are peptic ulcer, acute and chronic gastritis and gallstones. Objective: To assess the endoscopic findings of a patient having cholelithasis in SOMCH. Methods: This was Retrospective Hospital based study conducted at Department of Surgery, Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh from January to December 2022 were (One hundred patients were included). All patients underwent OGD after being diagnosed as having cholelithiasis proved by Endoscopic. All patients above 18 years of age presenting with upper abdominal pain, dyspepsia with or without jaundice diagnosed ultrasonically as cholelithiasis and choledocholithiasis with cholelithiasis were included in the study and patients managed conservatively, patients with primary choledocholithiasis and with asymptomatic gallstones were excluded from the study. Results: Out of 100 subjects evaluated during the study period, 58 were females and 42 males. The most common age group affected was between 31-50 years (65%), followed by less than 30 years of age being 18% and more than 50 years being 17%. It should also be noted the higher rate of incidence (65%) in the age group of 31-50 years. Associated symptoms with cholelithiasis were pain in abdomen, which was observed in all the patients (100%). Of these, 74 patients (74%) presented with chronic upper abdominal pain and 26 patients (26%) presented with acute upper abdominal pain. Remaining 56% of the subjects had positive endoscopic findings. Endoscopic findings were positive in 56 had hiatus hernia, duodinitis, duodenal ulcer or other positive findings. Among patients with positive findings 14 had both oeophagitis as well as gastritis while 12 had both gastritis as well as gastric ulcer. All the 56 patients (100%) underwent surgery. Forty patients (71.4%) underwent laparoscopic cholecystectomy, 14 (25.0%) open cholecystectomy and 2 cholecystostomy for empyema gall bladder. Of the 56 patients 40 patients (71.4%) patient had chronic cholecystitis, 9 patients (16.07%) had acute cholecystitis, 4 patients (7.14%) had carcinoma gall bladder, 2 (3.57%) had xanthogranulomatous cholecystitis and 1(1.78%) had cholesterolosis of gallbladder. Of the 4 patients diagnosed of carcinoma gallbladder, 1 patient had carcinoma confined to muscularis mucosa with negative margins and no metastasis, hence no further surgical management was advised and the rest of the 3 patients had either metastasis or positive margins which were managed as per standard guidelines. Conclusion: Cholelithiasis is commonly seen in females in 4th and 5th decade mainly presenting with abdominal pain and dyspepsia. Endoscopy the most common finding was gastritis, oesophagitis and gastric ulcer in decreasing order. There was no hiatus hernia, duodinitis or duodenal ulcer in our study. Patients presenting with dyspepsia and gall-stones in rural setup should be directly treated surgically. Multiple gallstones are common and Laparoscopic cholecystectomy offers best surgical management with 6.57% of conversion rate to open cholecystectomy, with lesser complications.

Validation of an UPLC-PDA Method for the Simultaneous Quantification of Phenol and Iomeprol in a Sterile Parenteral Preparation Used for Coeliac Plexus Block, and Its Application to a Pharmaceutical Stability Study.

Objectives: A commonly applied analgesic therapy for patients with severe abdominal pain due to cancer-related pain in the upper abdomen, is coeliac plexus neurolysis (CPN). Herein, a combination product of phenol and an iodine contrast agent are injected simultaneously. The chemical stability of such a combination product is unknown, and no chromatographic method is yet available that describes the simultaneous quantification of phenol and iomeprol. The aim of this study was to develop and validate a stability-indicating UPLC method for the simultaneous quantification of both phenol and iomeprol and to determine the chemical stability of a sterile 100 mg/mL phenol in 350 mg I/mL iomeprol solution for injection during shelf life. Methods: The product was compounded and sterilized in a GMP certified facility. The pharmaceutical analysis was validated by determination of the accuracy, precision, specificity, selectivity, carry-over and linearity. Pharmaceutical product stability was determined before and after sterilization, and during shelf life of 36 months at 25°C ± 2°C. Results: The accuracy for phenol and iomeprol was 97.1% to 99.3% and 100.0% to 100.2%, respectively. The RSD for repeatability and reproducibility for phenol were 0.65% and 1.17%, and for iomeprol 0.61% and 1.49%, respectively. All other tested parameters met the predefined validation criteria. All concentrations at all tested time points remained within ±2% of the initial concentrations for phenol and ±4% for iomeprol. No additional peaks were visible on the chromatograms. Conclusion: A stability-indicating method for the simultaneous quantification of phenol and iomeprol in a parental pharmaceutical preparation was developed and validated. This method was used to demonstrate the chemical stability of a newly developed sterile solution of 100 mg/mL phenol and 350 mg I/mL iomeprol. Chemical product stability was demonstrated during shelf life of up to 36 months.

Clinico-Demographic Profile of Children Attending Pediatric Outpatient Department in Tertiary Care Center in Gandaki Province, Nepal: A Prospective, Descriptive Cross-Sectional Study

Introduction: Pediatric outpatient departments (OPDs) in tertiary care centers provide a vital connection for the early diagnosis and treatment of childhood illnesses. Understanding the clinico-demographic profile of pediatric patients attending these centers provides insight into the healthcare needs and challenges faced by children in specific regions. This study aimed to evaluate the clinico-demographic characteristics of children attending the pediatric OPD.  Methods: A prospective, descriptive cross-sectional study was conducted from April 12 to December 17, 2023 at pediatric OPD at GP Koirala National Centre for Respiratory Diseases and Hospital, Tanahun, Gandaki Province, Nepal. Data were collected from the pediatric OPD during clinical history taking and examination, including 7,020 children aged 0–14 years. Verbal consent was obtained from legal guardians for using clinical history and diagnostic data. Data on age, sex, socioeconomic status, parental education, and disease distribution were analyzed using SPSS version 23.  Results: Out of 7,020 children, 42.89% were aged 1–5 years, and 28.67% were aged 6–10 years. Males (50.7%) slightly outnumbered females (49.3%). Socioeconomic analysis showed that 57.3% of children were from low-income families. Regarding parental(either father or mother or any legal gurdian who brought child at hospital OPD) education, 31.19% had secondary education, and 28.3% had primary education. Respiratory infections (19.97%) were the most common diagnosis, followed by gastroenteritis (11%), pain abdomen (9%), and malnutrition, especially undernutrition (8%). Other notable conditions included enteric fever (7.4%) and acute conjunctivitis (7.3%).  Conclusion: The study highlights a high prevalence of respiratory and gastrointestinal conditions among children, particularly from low-income families. The findings emphasize the need for targeted healthcare interventions and improved parental education to reduce the burden of childhood illnesses in Gandaki Province.

Acute Onset Vision Loss and Acute Pain Abdomen.

Acute Onset Vision Loss and Acute Pain Abdomen.

Unraveling the complexities of ısolated cecal necrosis: a comprehensive presentation clinical symptoms, management strategies, and outcomes in a series of patients

Isolated cecal necrosis (ICN) represents a rare yet clinically significant variant of ischemic colitis, characterized by ischemic injury to the cecal region due to prolonged disruption of intestinal blood flow. While ICN can arise from various causes, including atherothrombotic occlusions in cecal arteries and non-occlusive factors such as shock or chronic diseases, its pathogenesis remains multifactorial. Clinical presentation often mirrors acute appendicitis, with patients typically presenting with sudden right lower quadrant abdominal pain. Prompt diagnosis and surgical intervention are paramount to mitigate the risk of cecal perforation and improve patient outcomes. However, preoperative diagnosis can be challenging due to non-specific radiological findings, necessitating urgent surgical resection of the affected intestine. Despite documented cases in the literature, knowledge regarding ICN remains limited, underscoring the importance of detailed case reporting to enhance disease understanding and refine diagnostic and therapeutic approaches. Here, we present a retrospective analysis of 7 ICN cases diagnosed in our hospital between 2019 and 2024, aiming to contribute insights into the clinical spectrum, management strategies, and outcomes associated with ICN. Our study revealed a diverse array of clinical presentations, radiological features, surgical interventions, and pathological findings among ICN patients. Hypertension and diabetes mellitus emerged as common comorbidities, with acute abdomen and abdominal pain being predominant symptoms. Radiologically, cecal wall thickening was frequently observed. Surgical management predominantly involved right hemicolectomy, with varying techniques employed. Pathological examination unveiled histological alterations indicative of ischemic necrosis, inflammation, and perforation. Our findings underscore the importance of considering ICN in the differential diagnosis of acute abdominal pain, particularly in elderly patients with predisposing risk factors. Further research efforts are warranted to elucidate its pathophysiological mechanisms and optimize therapeutic approaches.

12465 Unraveling The Enigma: A Multifaceted Presentation Of Hormonal Dysregulation In A 37-year-old Woman

Abstract Disclosure: S.Y. Rizvi: None. N. Ahmad: None. Title: Unraveling the Enigma: A Multifaceted Presentation of Hormonal Dysregulation in a 37-Year-Old Woman Background: Leydig cell tumors (LCTs) are rare gonadal tumors, arising from the interstitial cells of the testis or, less commonly, the ovary, 0.1%. These tumors are known for their potential to produce androgens, leading to virilization symptoms such as hirsutism. While LCTs are typically benign, they can occasionally exhibit malignant features. Accurate diagnosis and appropriate management are crucial to prevent complications and ensure favorable outcomes. Clinical Case: A 37-year-old, G3P3A0 woman, presented to our endocrinology clinic for a follow-up visit following the removal of a malignant thyroid nodule. During the visit, her endocrinologist noted elevated testosterone levels and worsening hirsutism. She reported mild abdominal pressure but denied other symptoms. She also complained of pain in the lower abdomen, although physical examination findings were limited due to type II obesity. Diagnostic investigations revealed a history of imaging studies, including CT scans and pelvic ultrasounds, demonstrating various findings such as a fibroid uterus, ovarian abnormalities, and a heterogeneous mass in the left adnexa. Laboratory evaluations over time showed fluctuations in androgen levels, with notable values including DHEA-sulfate (137.5 ug/dL), total testosterone (309.6 NG/dL), and free testosterone (12.85 NG/dL). Tumor markers, including CA 19-9= 16 U/mL, CA 125= 23.3 U/mL, CEA = 1.7 NG/mL, and HCG, were unremarkable. Gynae/Oncology was consulted, and she underwent surgical exploration with laparoscopic left oophorectomy. It revealed a Leydig cell tumor without overt malignant features, as confirmed by histopathological examination and immunohistochemical analysis. Her testosterone improved since oophorectomy. Patient undergoes frequent post-op follow up of her testosterone, free+total lc/MS to monitor for hyperandrogenism. Conclusion: This case highlights the importance of considering Leydig cell tumors in the differential diagnosis of hirsutism, particularly in the presence of elevated androgen levels. Multidisciplinary collaboration involving endocrinologists, gynecologists, oncologists, radiologists, and pathologists is essential for accurate diagnosis and optimal management. Surgical resection remains the cornerstone of treatment for Leydig cell tumors, with careful histopathological evaluation necessary to assess for potential malignancy. Long-term follow-up is warranted to monitor for recurrence or metastasis, although the prognosis for benign Leydig cell tumors is generally favorable. Patients with large body habitus may present challenges in physical examination, necessitating reliance on imaging and laboratory studies for diagnostic evaluation. Keywords: hirsutism, testosterone, ovary Presentation: 6/2/2024

8571 Co existence of aldosterone excess in adrenal myelolipomas

Abstract Disclosure: I. Mishra: None. A. Baliarsinha: None. Co existence of aldosterone excess in adrenal myelolipomas Abstract: Adrenal myelolipomas are benign, lipomatous tumours, most of which present as adrenal incidentalomas.Co existence of cortisol excess states and aldosterone producing carcinomas is reported with adrenal myelolipomas,however isolated aldosterone excess without imaging features of adrenal malignancy is rare.We describe 3 cases presenting for evaluation of hyperaldosteronism but with imaging features consistent with myelolipomas. Case 1;58 year female presented with hypertension and spontaneous hypokalemia.On evaluation BMI was 25.3kg/m2,Gr 2 hypertensive retinopathy with systemic examination within normal limits.Biochemical evaluation revealed; Pl.Aldo(ng/dl)32.5; PRA(ng/ml/hr)0.54; ARR 60.5; SIT Pl.Aldo(ng/ml)27.8; AVS- not done; IMAGING(CT) Left adrenal fat attenuating 16×13mm lesion baseline HU < - 20 ?adrenal myelolipoma; Mx Left adrenalectomy H/P Adrenocortical hyperplasia;post op-resolution of hypokalemia with persistence of hypertension controlled with decreased number of drugs. Case 2;38 year male presented with resistant hypertension ,cerebro vascular accident,right hemiparesis and diuretic induced hypokalemia.On evaluation BMI was 31 kg/m2,Gr 1 hypertensive retinopathy with right hemiparesis.Biochemical evaluation revealed; Pl.Aldo(ng/dl)12.3; PRA(ng/ml/hr) 0.82; ARR 15; SIT Pl.Aldo(ng/ml)7.79; AVS- not done; IMAGING(CT) Left adrenal fat attenuating 28×30mmlesion baseline HU < -20? adrenal myelolipoma; Mx Left adrenalectomy H/P adrenal myelolipoma;post op-resolution of hypokalemia ,recovery of weakness and normalization of hypertension without drugs. Case 3;49 year male presented with hypertension ,incidental detection of adrenal lesion on ultrasound for pain abdomen and normokalemia.On evaluation BMI was 27 kg/m2,no significant findings on general examination with systemic examination within normal limits. Biochemical evaluation revealed; Pl.Aldo(ng/dl)12.2; PRA(ng/ml/hr) 0.58; ARR 20.2; SIT Pl.Aldo(ng/ml)11; AVS- not done; IMAGING(CT) Left adrenal fat attenuating 22x 26 mm lesion baseline HU < -20? adrenal myelolipoma; Mx drug therapy for hypertension due to refusal for surgical therapy with monitoring of blood pressure. In surgically treated adrenal myelolipomas, adrenal hormone excess is reported in 5-6% of cases, with autonomous cortisol secretion being most common .Even on the background of CT findings consistent with myelolipomas, patients fulfilling the screening and confirmatory criterias of primary hyperaldosteronism must be subjected to apt therapeutic modality.The presence of aldosterone clusters with excessive aldosterone synthase activity in these lesions could be reason for occurrence of primary hyperaldosteronism in myelolipomas. Presentation: 6/3/2024

Herbs-Partitioned Moxibustion on the Navel in a Rat Model of Primary Dysmenorrhea with Cold Coagulation and Blood Stasis.

Primary dysmenorrhea (PDM) refers to the occurrence of spasmodic colicky pain in the lower abdomen without any obvious pelvic pathology, often accompanied by other systemic symptoms, which significantly reduces the quality of life of women with PDM, 45%-95% of menstrual women are affected by it. Despite the high incidence of PDM, it is often not well treated and is ignored by relevant researchers and women themselves. Herbs-partitioned moxibustion (HPM) is a characteristic external therapy in traditional Chinese medicine (TCM), which is widely used to treat diseases in China; it treats diseases by applying a Chinese herbal formula on the patient's acupoints and then igniting moxa sticks on the herbal formula for moxibustion therapy. The primary effectiveness of the herbs utilized in this study is meridian activation and warmth, which encourages qi circulation to relieve pain. Moxibustion's heat stimulation could hasten the infusion of the herbs into the human body. Consequently, HPM, which combines acupoint, herbal, and heat stimulations, is appropriate for treating gynecological disorders, particularly functional diseases such as PDM. This paper provides a detailed description of the procedures and precautions for HPM at the Shenque (CV8) acupoint in female experimental rats, which 0provides an experimental basis for better promoting the application and development of HPM on the navel in PDM.

A clinicoepidemiological study of serologically diagnosed acute febrile illness in a teaching hospital, Kolkata

ABSTRACT Introduction: Similar presenting manifestations in early phase and lack of awareness of aetiology of acute febrile illness (AFI) are major challenges in management of AFI. Material and Methods: This was a retrospective observational cross-sectional study conducted in the Department of Microbiology, NRS Medical College, from 1 July 2022 to 30 June 2023 in serologically diagnosed febrile patients attending the outpatient department or admitted. Clinical and epidemiological data and laboratory parameters were recorded in a pretested structured questionnaire study tool, and collected data were analysed on MS-Excel sheets with various charts and tables. Results: A total of 1711 serologically diagnosed febrile patients showed preponderance of dengue (38.3%), followed by leptospirosis (25%), scrub typhus (23.9%), malaria (12.6%), and enteric fever (1.92%). A majority of cases were male, less than 40 years of age, and from the rural population (73.2%), except in malaria (urban = 79.6%). The mean duration of fever was 9 days. Febrile cases were recorded maximum during the monsoon and postmonsoon periods (66.5%). The common manifestations are fever, headache (46.2%), pain abdomen (7.8%), nausea, and vomiting (9.4%). Thrombocytopenia with bleeding manifestation was higher in dengue (18%) cases. Mortality in dengue cases was recorded with multiorgan dysfunction syndrome (MODS). Scrub typhus cases showed seizure (8.3%) and altered sensorium (5%) due to fatal meningoencephalitis. Fatality in leptospirosis was mostly due to acute kidney injury (29.5%) and Weil’s disease (4.4%). Conclusion: Misdiagnosis or incorrect diagnosis and delay in initiation of appropriate treatment results in increased morbidity and mortality in AFI. Determination of epidemiological features and clinical manifestations of AFI along with timely correct diagnosis will benefit clinicians in proper treatment initiation, thereby reducing morbidity and mortality.

Mitochondrial DNA Copy Number Is Associated with the Severity of Irritable Bowel Syndrome

Background and Objectives: Irritable bowel syndrome (IBS), as a gastrointestinal disorder, presents with abdomen pain and alterations in the bowel habits. Its pathogenesis remains unclear. Here, we examined mitochondrial DNA copy number (mtCN) in IBS and its clinical value. Materials and Methods: mtCN was analyzed in 43 IBS patients using quantitative real-time polymerase chain reaction. Furthermore, data on the clinical characteristics of patients and symptom severity of IBS were collected, and their association with mtCN was analyzed. Results: mtCN was higher in patients with IBS (p = 0.008) and those with a drinking habit (p = 0.004). Smoking and the presence of a sleep partner showed a possible association with mtCN; however, it did not reach significance. The severity of IBS symptoms tended to positively correlate with mtCN (r = 0.279, p = 0.070). Conclusions: Overall, we demonstrated a potential association between mtCN and the clinicopathologic characteristics of patients with IBS. Further studies considering genetic and clinical factors are required.

Chronic granulomatous intestinal disease: case report

Chronic intestinal granulomatous disease is a disorder that directly compromises the entire immune system. The estimated incidence is one in a million inhabitants. Among the associated risk factors, the presence of chronic and recurrent infections stands out. In the present case, it is a 39-year-old female patient with a history of intestinal obstruction and endometriosis, who presents abdominal pain in the left abdomen and recurrent abdominal pain without an identifiable cause. Laboratory tests revealed leukocytosis and mild neutrophilia. The tomography showed intestinal dilation at the jejunoileal level without transition zones, and the serological tests were negative. Exploratory laparoscopy was performed and the presence of tumor implants was found in the omentum, extending to the abdominal, uterine, intestinal, and peritoneal regions, as well as sallow fluid at the abdominal level. Tumor markers are normal. Histopathology details fungal colonization with eosinophilic necrosis and presence of granulomas, negative immunohistochemistry for Aspergillus and negative Lowestein-jensen culture. Antifungal and antituberculous treatment was started, with a decrease in symptoms and improvement in the clinical picture.

The Subtle Signs Of Neonatal Grave’s Disease- ACase Report And Review

A newborn male is born via caesarean section at 37 weeks of gestation to a 25-year-old primigravida mother. Mother was a known case of Grave’s disease (TSH receptor antibody positive) on Carbimazole with gestational diabetes mellitus on Insulin, her antenatal course was otherwise uneventful, with normal fetal heart rate monitoring and appropriate fetal growth. She was admitted with complaints of pain abdomen and decreased fetal movement. She was planned for emergency section and a live, healthy male baby was born with a birth weight of 2.962 kg, appropriate for gestation age with APGAR 8/9. Postnatal examination was negative for congenital anomalies and no systemic involvement was noticed. The baby was discharged on close follow-up. On day 7th of life, the baby was re-admitted for phototherapy. In this admission, the baby was noticed to have a resting tachycardia heart rate of 170-180/min, no murmur or abnormal heart sound was noticed on examination. The baby had no significant weight loss or history of feeding difficulties. In consideration of maternal grave disease, a further workup for the baby was planned, which revealed a Cord TSH (0.007microIU/ml) range (2.30-13.20) and free T4 1.52 ng/dl (Range 1.10-2.00). Further, the workup revealed TSH receptor antibody positive 23.76 IU/L range (less than 1.22), free T4 7.77 ng/dl (1.120-2.00), TSH less than 0.005 microIU/ml. However, As per the paediatric Endocrinologist's opinion, the baby was started on propranolol and propylthiouracil. The resting tachycardia resolved upon starting the drug. On subsequent follow-up, the baby had an improving thyroid profile