Patients Got Research Articles

CTIM-35. PD-1 BLOCKADE WITH CAMRELIZUMAB IN RELAPSED/REFRACTORY PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA

Abstract Primary central nervous system lymphoma (PCNSL) are rare extranodal large B-cell lymphomas. There are no standard-of-care treatment options for patients with relapsed and refractory PCNSL and the overall prognosis is poor. We conducted a phase 2 clinical trial to evaluate the efficacy and adverse events of PD-1 antibody camrelizumab in relapsed/refractory PCNSL. Enrolled patients received camrelizumab 200mg intravenously every 2 weeks. The primary endpoint was overall response rate (ORR). Here we present results of 20 relapsed PCNSL patients who treated with camrelizumab. Among them,12 were male and 8 were female. The median age was 57 years (range 25-67 years). Fourteen patients were available to evaluate efficacy. After camrelizumab treatment, 4 got complete response (CR), 3 got partial response (PR), 1 got stable disease, and 6 got progressed disease (PD). The ORR was 50%. The median progression-free survival (PFS) was 19.3 weeks (95% CI, 3.1-35.5). 24 week PFS rate was 40%. For the 7 patients who got CR/PR, got a long sustained response, with a median PFS of 93.6 weeks (range 17-211.6+ weeks). One patient developed pseudoprogression 2 months after initiation of treatment. By the last follow-up, 18 patients discontinued treatment (10 PD, 4 complete treatment, 3 withdrawal of informed consent, 1 lost follow-up). Eleven patient got PD. Nine patients received chemotherapy and 5 received radiotherapy after PD. PD-L1 expression, microsatellite stability and mutation burden of the tumors were detected in 9 patients, and all the three factors were not correlated with efficacy. The main drug-related adverse reaction was cutaneous capillary hyperplasia. None of the patients dropped out of the study due to adverse reactions. Our data suggest that camrelizumab is active in relapsed/refractory PCNSL and support further investigation of PD-1 blockade in PCNSL.

Postpartum Pubic Diastasis with Significant Widening: A Rare Case Series.

Postpartum pubic symphysis diastasis is a relatively rare entity. It is usually associated with cephalopelvic disproportion, macrosomia, multiparity, precipitate labor, difficult labor, difficult forceps delivery, any other pelvic bone pathologies, and underlying connective tissue disorders. Management is typically conservative in most cases, but surgical intervention is sometimes required in cases where pubic symphysis is >4 cm and not responding to conservative management. Case with more than 4 cm of pubic diastasis is usually associated with disruption of the symphyseal ligament, sacroiliac joint capsule, and ligaments. Surgical management promotes early ambulation with good functional recovery and decreases the chances of symphyseal sclerosis, functional disability, and chronic pain. Four female patients with postpartum pubic diastasis of more than 7 cm with an age ranging from 20 to 30 years underwent open reduction and internal fixation using plates and screws.In all four cases, the patient got early ambulation and full functional recovery without any pain, discomfort, and disability at 3 months of follow up. Although conservative management has been advocated for postpartum pubic diastasis typically, surgical intervention should be sought for significant pubic diastasis (more than 4 cm) to promote early full functional recovery and avoid chronic pain, functional disability, and symphyseal sclerosis.

Siddha Management of Geriatric Urolithiasis (Kallataippu- XA) - A Single Case Report

Introduction: Kallataippu (NSMC-XA, Urolithiasis or Nephrolithiasis) is one of the most common emerging urological disorders worldwide with an increasing frequency in geriatric patients (>65 years). Siddha system provides oral medications for the management of urolithiasis which is non-invasive and cost effective. Method: A 68-year-old patient approached the OPD with complaints of episodic flank pain radiating from the loin to the groin region, pain, and an urge to urinate. On interrogation, the patient gave a history of poor water intake. Ultrasound scan of the abdomen revealed the renal calculi measuring 3 mm noted in the mid-pole calyx of the right kidney, 4 mm in the upper pole calyx of the left kidney and the Urinary bladder is partially distended with a 4.0 mm thickened wall. It was diagnosed as Kallataippu (XA- Urolithiasis) based on signs and symptoms and investigational reports. The patient was administered a combination of medicines based on the Siddha line of treatment. Result: In the first follow-up, the patient informed that he experienced moderate pain and disturbance in the urine flow and the first stone was expelled out through urine on the second follow-up. The patient got moderate relief from pain in the abdomen and did not experience dysuria, and the second stone was expelled through urine on the third follow-up. The patient was asked to take CT-KUB on the fourth follow-up. The reported case has a prospective follow-up for 6 months and was found to be free of renal stone-related complaints. Conclusion: The present work suggests that the combination of Siddha drugs markedly worked well on the disintegration and expulsion of the calculi in the geriatric age.

Clinical effects of percutaneous elastic intramedullary nail assisted by arthrography for the treatment of radial neck fractures in children

To explore clinical effect of closed reduction percutaneous elastic intramedullary nail assisted by arthrography in the treatment of radial neck fracture in children. A retrospective analysis was performed on 23 children with radial neck fracture treated with arthrography assisted closed reduction and percutaneous elastic intramedullary nail internal fixation (arthrography with elastic nail group) from January 2019 to December 2022, including 12 males and 11 females, aged from 2 to 12 years old with an average of (7.36±1.89) years old;According to Judet fracture types, 14 children were type Ⅲ and 9 children were type Ⅳ. In addition, 23 children with radial neck fracture were selected from January 2015 to December 2018 who were treated with closed reduction and percutaneous elastic intramedullary nail fixation (elastic nail group), including 11 males and 12 females, aged from 2 to 14 years old with an average of (7.50±1.91) years old;Judet classification included 15 children were type Ⅲ and 8 children were type Ⅳ. Operative time and intraoperative fluoroscopy times were compared between two groups. Metaizeau evaluation criteria was used to evaluate fracture reduction, and Tibone-Stoltz evaluation criteria was used to evaluate functional recovery of elbow between two groups. Both groups were followed up for 12 to 24 months with an average of (16.56±6.34) months. Operative time and intraoperative fluoroscopy times of elastic nail group were (56.64±19.27) min and (21.13±7.87) times, while those of joint angiography with elastic nail group were (40.33±11.50) min and (12.10±3.52) times;there were difference between two groups (P<0.05). According to Metaizeau evaluation, 11 patients got excellent result, 9 good and 3 fair in joint angiography with elastic nail group, while in elastic nail group, 5 excellent, 13 good, 4 acceptable, and 1 poor;the difference between two groups was statistically significant (P<0.05). According to Tibone-Stoltz criteria, 14 patients got excellent result, 8 good, and 1 fair in joint arthrography with elastic nail group;while in elastic nail group, 12 patients got excellent result, 9 good, 1 fair and 1 poor;there was no significant difference between two groups (P>0.05). Compared to percutaneous elastic intramedullary nail fixation, closed reduction assisted by arthrography has advantages of reduced operation time, decreased intraoperative fluoroscopy frequency, and improved fracture reduction. Arthrography enables clear visualization of the anatomical structures of radius, head, neck, bone, and cartilage in children, facilitating comprehensive display of fracture reduction and brachioradial joint alignment. This technique more precisely guides the depth of elastic intramedullary nail implantation in radius neck, thereby enhancing surgical efficiency and success rate.

Long-term effect of supporting immunotherapy in a patient with metastatic small cell lung cancer

About 15 % of lung tumors are small cell lung cancer. Because of its extremely poor prognosis with a median overall survival of 10 months, and the long absence of new treatment options beyond the combination of platinum and etoposide (EP), the introduction of immunotherapy has been a significant development in the treatment of this disease. IMpower133 was the first phase III trial demonstrated a statistically significant increase in median overall survival in the atezolizumab group from 10.3 to 12.3 months. Our clinical case demonstrates the efficacy of an EP with atezolizumab. The patient got 6 courses of EP with atezolizumab and 29 courses of atezolizumab maintenance immunotherapy, indicating the efficacy and tolerability of this combination.

A CASE REPORT ON PARKINSON’S DISEASE (KAMPAVATA) – AN AYURVEDIC APPROACH

Parkinson's disease is a progressive neurodegenerative disease. It holds the second place among the most common diseases. The patient, in this case, report has presented with complaints of slowness of walking, difficulty in speech, tremors during activities, difficulty standing, initiating walking and getting up from a chair without support, and uncontrollable movements while walking. Through careful history taking, examination and assessment using the UPDRS scale, the patient was diagnosed with Parkinson's disease (Kampavata). She was given oral medications at OPD and then Panchakarma therapies like Rookshana, Snehanam and Brimhanam, along with oral medications for 22 days at IPD. The patient got marked improvement in her signs and symptoms. So, by this case study, it can be concluded that ayurvedic management effectively improves the quality of life of patients with Parkinson's disease.

Clinical, oncological, and prognostic differences of patients with subsequent skeletal-related events in bone metastases.

Advances in treatment have extended the life expectancy of patients with metastatic bone disease (MBD). Patients could experience more skeletal-related events (SREs) as a result of this progress. Those who have already experienced a SRE could encounter another local management for a subsequent SRE, which is not part of the treatment for the initial SRE. However, there is a noted gap in research on the rate and characteristics of subsequent SREs requiring further localized treatment, obligating clinicians to extrapolate from experiences with initial SREs when confronting subsequent ones. This study aimed to investigate the proportion of MBD patients developing subsequent SREs requiring local treatment, examine if there are prognostic differences at the initial treatment between those with single versus subsequent SREs, and determine if clinical, oncological, and prognostic features differ between initial and subsequent SRE treatments. This retrospective study included 3,814 adult patients who received local treatment - surgery and/or radiotherapy - for bone metastasis between 1 January 2010 and 31 December 2019. All included patients had at least one SRE requiring local treatment. A subsequent SRE was defined as a second SRE requiring local treatment. Clinical, oncological, and prognostic features were compared between single SREs and subsequent SREs using Mann-Whitney U test, Fisher's exact test, and Kaplan-Meier curve. Of the 3,814 patients with SREs, 3,159 (83%) patients had a single SRE and 655 (17%) patients developed a subsequent SRE. Patients who developed subsequent SREs generally had characteristics that favoured longer survival, such as higher BMI, higher albumin levels, fewer comorbidities, or lower neutrophil count. Once the patient got to the point of subsequent SRE, their clinical and oncological characteristics and one-year survival (28%) were not as good as those with only a single SRE (35%; p < 0.001), indicating that clinicians' experiences when treating the initial SRE are not similar when treating a subsequent SRE. This study found that 17% of patients required treatments for a second, subsequent SRE, and the current clinical guideline did not provide a specific approach to this clinical condition. We observed that referencing the initial treatment, patients in the subsequent SRE group had longer six-week, 90-day, and one-year median survival than patients in the single SRE group. Once patients develop a subsequent SRE, they have a worse one-year survival rate than those who receive treatment for a single SRE. Future research should identify prognostic factors and assess the applicability of existing survival prediction models for better management of subsequent SREs.

Tracheal gas insufflation for refractory hypercapnia

A 65 year male patient got admitted to ICU after alleged intake of ~ 250 ml of Chlorpyrifos (Organophosphate insecticides which cause cholinergic toxidrome) and cypermethrin (Synthetic pyrethroid) and presented with cholinergic toxidrome with severe hypercapnia (supercarbia). All conventional and advanced modes of ventilation failed to ventilate the patient because of severe bronchospasm and a prolonged expiratory time constant with high airway pressures and high auto-peep. As a last resort, we resorted to unconventional modes, as the patient could not afford ECMO. Tracheal gas insufflation was done using a coaxial flow of humidified oxygen at 8 lpm with a suction catheter and ventilator parameter were adjusted to match the added gas flows. Tracheal gas insufflation can be delivered by a thin catheter placed through the endotracheal tube (terminating within 1 to 2 cm of the main carina) or via a modified endotracheal tube with channels embedded in the walls of the tube. Tracheal gas insufflation flow can be forward (toward the alveoli) or reversed in direction toward the proximal end of the endotracheal tube. Keywords: TGI, Hypercapnia, organophosphate toxicity

Trends in the use of granulocyte colony stimulating factors for older patients with cancer, 2010 to 2019

IntroductionOlder patients with cancer receiving myelosuppressive treatment are at an increased risk for developing febrile neutropenia (FN) or having chemotherapy dose-reductions or delays, resulting in suboptimal health outcomes. Granulocyte colony stimulating factors (G-CSF) are effective medications to reduce these adverse events and are recommended for patients ≥65 years receiving chemotherapy with >10 % FN risk. We sought to characterize the trends and predictors of G-CSF use between the youngest-old (66–74 years), middle-old (75–84 years), and oldest-old (≥85 years) patients with cancer. Materials and MethodsWe used registry data from SEER-Medicare for breast, lung, ovarian, colorectal, esophageal, gastric, uterine, prostate, pancreatic cancer, and non-Hodgkin lymphoma (NHL) diagnoses from 2010 to 2019. Cox proportional hazard analysis was used. ResultsOverall, 41.4 % of patients received G-CSF from chemotherapy initiation to three days after completion of the first chemotherapy course. The use rate remained relatively stable for all cancers, except for an increase in use for those with pancreatic cancer. G-CSF use decreased as patients got older. The oldest-old were 43.0 % (95 % confidence interval: 40.7–45.2 %) less likely to receive G-CSF compared to the youngest-old. Patients with breast cancer or NHL were more likely to receive G-CSF than those with other cancers. Patients who were female, married, White or Hispanic, and had fewer comorbidities were more likely to receive G-CSF. DiscussionG-CSF is used less often in populations at higher risk of developing FN and related complications. Improving adherence to recommendations can improve health outcomes, especially in the oldest adults, older males, and Black patients.

Use of antihypertensive agents and its present perspective: an observational retrospective study

Objectives: To evaluate the utilization of antihypertensive agents for the patients of Hypertension and subsequently their health outcome at a Tertiary Care Level Hospital and to observe the relationship among demographic profile of the patients. Materials and Methods: An observational retrospective study was undertaken collecting total 680 patients’ data from patient admission ticket of a Tertiary Care Level Hospital. Mainly drugs used and outcome of the patients were recorded. Of all patients 306 were found to be treated with calcium channel blockers (CCBs), 77 with angiotensin receptor blockers (ARBs), 229 with CCBs plus ARBs, 46 with CCBs plus ARBs and beta blockers and only 22 patients got CCBs, ARBs and diuretics. Data were statistically analysed in respect of demographic profile, drugs used and clinical features of the patients. Results: Best outcome was observed in patients treated with solely CCBs where in 289 out of 306 patients, hypertension was controlled. 194 out of 229 patients with CCBs and ARBs showed desired outcomes. 41 out of 77 with only ARBs, 29 out of 46 with CCBs, ARBs and beta blockers and 16 out of 22 with CCBs, ARBs and diuretics ended with positive results. Conclusion: Calcium channel blockers alone and in few cases in combination with angiotensin receptor blocking agents are very effective in controlling hypertension. Keywords: Hypertension, calcium channel blockers and angiotensin receptor blockers

A study of knowledge, attitude and behavior of patients towards their illness and their relation to sociodemographic factors

Background: This study was conducted to assess basic knowledge, attitudes, and practices of patients to their illness and find its correlation with various socio-demographic factors. Method: This was a cross-sectional questionnaire-based analytical study. All patients over 18 years of age who attended the OPD or were admitted to the medical ward and who agreed to participate in the study were included. A questionnaire regarding the demographic characteristics of the study participants as well as the patient’s knowledge, attitudes, and practices regarding their disease was administered regularly by experienced physicians dealing with OPD and IPD both type of patients. Results: Out of total 100, only 38% patients came for regular follow up and only 57% brought old records. 36% were not taking medications regularly for various reasons (trying alternative medicine (22.2%), advice from others (11.1%), found medicines ineffective and stopped without reconsulting (8.3%), fear of adverse effects (8.3%), couldn’t afford (8.3%), worsening of symptoms (5.6%) etc. 19.4% had no reasons. 67% patients got medicines prescribed from a qualified clinician while other sources were pharmacist (9%), relatives/friends (5%) and self-medication (6%). Significantly more females, educated and employed were aware about their medical condition and medications. Significantly more educated and employed brought old records and came for regular follow up (p-0.0187), Significantly more educated seeked qualified doctor’s advice as compared to uneducated. (p=0.0002). Conclusion: There is a need to educate patients about the importance of medication awareness, adherence, regular follow up, disadvantages of unscientific and unreliable information to improve compliance to treatment.

A phase I/II study of nanoliposomal irinotecan and carboplatin in patients with advanced or metastatic, poorly differentiated gastroenteropancreatic neuroendocrine carcinoma characterized by tissue and liquid next-generation sequencing.

52 Background: For locally advanced or metastatic gastroenteropancreatic neuroendocrine carcinomas (GEP-NECs), standard chemotherapy typically incorporates etoposide or irinotecan plus platinum agents. Herein, we initiate a phase I/II trial to apply Nal-IRI in combination with carboplatin as the 1st line treatment in patients with GEP-NECs to define the dose-limiting toxicity (DLT) and recommended phase II dose (RP2D). Methods: In the phase I part, traditional 3+3 design was applied. Enrolled patients would receive escalating dose of 60 (level -1), 80 (starting dose, level 0) or 100 (level 1) mg/m2 salt-form nal-IRI plus carboplatin AUC=4 with maximum total dose of 600 mg on D1, every 21 days as a cycle. DLTs were evaluated during the first one cycle of treatment with tumor assessment every 6 weeks. Prophylaxis G-CSF was not allowed in the first cycle Paired testing of tissue (TBx) and liquid biopsy (LBx) was done by Illumina TSO500 platform before treatment. The second LBx would be repeated for confirmed partial responders when progression. Results: Totally 6 GEP-NEC patients with primary sites of colon in three, and each one in esophagus, ampulla of Vater and pancreas were enrolled to level 0. One patient had DLT of grade 4 neutropenia lasting for 3 days even under salvage G-CSF. Treatment-related adverse events showed grade 3/4 neutropenia (33.4%), grade 2 anemia (16.7%), grade 3 fatigue (16.7%), and grade 2 skin rash (16.7%). Four patients achieved confirmed partial response and 2 patients got stable disease, with the objective response rate of 66.7% (95% confidence interval: 22%-96%). After the data and safety monitoring board meeting, level 0 was decided as RP2D but not escalation to level 1 because of acceptable toxicity profiles and promising efficacies. Comprehensive genomic profiling showed that driver mutations were identified in three cases including two harboring BRAFV600E mutation and one with KRASG12D mutation. The other three cases lacking driver mutation showed frequent copy number alteration including 1 with MDM2 amplification (copy number 27) and a wild-type TP53. Homologous recombination deficiency (HRD), as determined by GIS score, was identified in a colon GEP-NEC who remained to be HRD-positive at progression but a higher TMB (from 4.7 to 10.2 Muts/Mb) and a higher BRAFV600E mutation allele frequency (from 24.1% to 43.6%) in tumor tissue, compared to the baseline profiling. Conclusions: Based on current data, the RP2D is 80 mg/m2 of nal-IRI (salt-form) and carboplatin of AUC=4, every 3 weeks. The extension phase II study in GEP-NEC is ongoing. Clinical trial information: NCT05385861 .

Reproductive and transcriptome characteristics of endometrium at the window of im-plantation in patients after fertility-sparing treatment of endometrial intraepithelial neoplasm or cancer

BackgroundProgestin therapy is an option for patients with endometrial carcinoma (EC) or endometrial intraepithelial neoplasm (EIN) who fit specific criteria of fertility-sparing treatment. However, the implantation rate remains low among females receiving in vitro fertilization (IVF) even after the complete reversal of endometrial lesions. MethodsHere, ten patients with EC/EIN achieved complete regression (CR) in histology. Their relevant metabolic and IVF parameters were collected. An endometrial sampling at the window of implantation (WOI) and transcriptome analysis were conducted among them, and four healthy controls were analyzed to analyze endometrial receptivity. ResultsOn average, it took ten patients five months to achieve CR after four curettage procedures. The interquartile range of endometrium thickness on trigger day was between 8.8 and 10.0 mm, while the range was 15.2–18.5 mm for controls. Five patients got pregnant after a frozen-embryo transfer. According to ERA analysis, the endometrial sampling at WOI showed pre-receptive status in four cases. In total, 1458 differential expression genes were identified, and 70 belonged to the ERA genes. ImmuneScore indicated decreased NK cells in the endometrium, affecting endometrial receptivity. ConclusionsEven after EC/EIN reversal in histology, endometrial receptivity has already been compromised regarding altered WOI and immune microenvironment, leading to a low pregnancy rate.

An Ayurvedic Management for Artava Kshaya – A Case report

A female patient aged 27 years, came to OPD of Vaidya Ratnam Hubballi Ayurveda, on 20th March 2024, with chief complaint of menstruation flow occurs only on intake of hormonal tablets, in the last one year, and also having over weight of 103kg and also undergone salpingectomy. Methodology: Detailed history with all necessary clinical, physical examination and laboratory investigations were carried out. No gross physical and chemical abnormality was found. All the laboratory investigations were found to be normal. So, the treatment was planned according to the symptoms. Diagnosis was made on the basis of presenting complaints as Artava Kshaya. Patient was treated with Virechana karma with Manibhadra leha, followed with shamanoshadhi’s with Tila kwatha granules, Menvos Tablets, Ashokarishta, for one month. Result: Patient got her menstruation regular with normal duration after taking medicine also the amount of flow was also good for five days.

Management of Parkinson’s Disease (Kampavata) Through Panchakarma

Parkinson's disease is a progressive degenerative neurological disorder mainly affecting geriatric population. The most crucial signs and symptoms of Parkinson’s disease arise while the nerve cells in basal ganglia, an area of mind that controls the movement grow to be impaired or die. When these neurons die or get impaired, they generally tend to produce much less amount of vital chemical in the brain known as Dopamine which causes numerous signs and symptoms like tremors, rigidity in muscular tissues, akinesia and postural disability related to numerous cognitive, behavioural and other mental signs. In Ayurveda due to similar disease presentation, Parkinson's disease can be compared with Kampavata. Kampavata has been described under Vataja Nanatmaja Vyadhi. Various Panchakarma therapies have been mentioned in classics for the treatment of Kampavata like Abhyanga, Swedana, Niruha Basti, Anuvasana Basti, Shirobasti and Virechana. In this case study, a 68 years old male patient came to ITRA Hospital having complaints of tremors in both upper limbs, difficulty in speech and slowness of movements since last 10 years. He was already diagnosed with Pankinson's disease and is receiving allopathy treatment for the same since last 10 years. Here he was given treatment like Abhyanga, Swedana, Matra Basti and Nasya for 21 days. The patient got moderate improvement in his signs and symptoms. It was concluded with the study that Panchakarma therapies has been found beneficial in improving quality of life of patient.

Matra Basti in the Management of Katigraha

Katigraha is one of the most common encountered diseases in present era. In this condition Shoola (pain) and Stabhdhata (stiffness) is seen in the Katipradesh (low back). In this condition Shuddha vata or Samavata gets lodged at Katipradesh and produces symptoms. Katigraha which is correlated with lumbar spondylosis, it is a degenerative condition that effects the disc, vertebral bodies and joints associated with lumbar spine. The current case study was carried out at the department of Panchakarma Shri Shivayogeeshwar Rural Ayurvedic Medical College, Hospital and Post Graduate Research Centre, Inchal. A 38 year old female patient with Katigraha was treated with the Samanya chikitsa of Vata vyadhi that is Abhyanga, Swedana, Basti, and Katibasti. Treatment was given for a period of 7 days. Patient got relief in pain and stiffness and also improvement in walking was seen. Clinically cardinal symptoms were significantly reduced. Radiologically spine showed improvement.

Ayurvedic Management of Kampavata

Kampavata is one among Vataja nanatmaja vyadhis. Acharya Charaka, Susrutha, Vagbhata, Madhavakara, Kashyapa mentioned Kampavata as Vepathu. It can be correlated with “Tremors” in modern science which is the most common movement disorder. The total number of people suffering from ET worldwide was 24.91 million in 2020 and incidence increases with age. Kampa is the prominent feature in Kampavata which is categorized as Sarvanga-kampa and Shiro-kampa. Kampa occurs due to Prakopa of Chalaguna which is the inherent quality of Vata dosha. The management of essential tremors in the conventional system of medicine is decreasing quality of life of patient with certain side effects like fatigue, impotence, bradycardia, reduced blood pressure, drowsiness, nausea, dizziness, ataxia, confusion, vertigo, paresthesia etc. By Ayurvedic intervention patient quality of life can be preserved. In the present clinical study patient was treated with Snehana and Brmhana line of management in the form of Shirodhara, Nasya and Samana oushadies like Sarvamayantakaghrta etc. The outcome of the study revealed good therapeutic efficacy and patient got remarkable relief in symptoms, that are assessed by TRG Essential tremor rating assessment scale (TETRAS©) V 3.1.

Ventricular Tachycardia and Fibrillation: Amiodarone as a Safety and Prophylactic

Background: The best antiarrhythmic drug on the market right now for treating both atrial and ventricular arrhythmias is amiodarone. This is a derivative of iodinated benzofuran that has shown promise in treating a variety of cardiac arrhythmias, such as life-threatening ventricular arrhythmias, paroxysmal supraventricular tachycardias, and atrial fibrillation. Objective: To assess the status of amiodarone with therapeutic doses in the Bangladeshi population. Materials and Method: The quasi experimental study was conducted in the Department of Cardiology, Northeast Medical College, Sylhet during April, 2022 to March, 2023 patients got admitted in the Department of Cardiology, NMCH, Sylhet, consecutive patients who had been treated with amiodarone for arrhythmia were included in this study. Patients without an amiodarone prescription were assumed and patients who will not give informed written consent were excluded in this study. Result: In multivariable logistic regression, bradycardia or conduction disturbance, amiodarone daily dose (≥300 mg), and duration of amiodarone (&gt;4 month) were substantially (p&lt;0.05) linked with deleterious effects of amiodarone. Conclusion: The most common adverse event was bradycardia or conduction disturbance followed by thyroid toxicity, hepatic toxicity, eye toxicity and pulmonary toxicity. Bradycardia or conduction disturbance, amiodarone daily dose (≥300 mg) and duration of amiodarone (&gt;4 month) was found to be significantly associated with adverse effects of amiodarone.

Therapeutic effect of calcaneal beak-like fracture secondary to calcaneal osteomyelitis caused by diabetic foot

To explore clinical effect of vancomycin calcium sulfate combined with internal fixation on calcaneal beak-like fracture secondary to calcaneal osteomyelitis caused by diabetic foot. From April 2018 to October 2021, a retrospective analysis was performed on 5 patients with calcaneal bone osteomyelitis secondary to diabetic foot, including 2 males and 3 females, aged from 48 to 60 years old;diabetes course ranged from 5 to 13 years;the courses of diabetic foot disease ranged from 18 to 52 days;5 patients were grade Ⅲ according to Wagner classification. All patients were treated with debridement, vancomycin bone cement implantation, negative pressure aspiration at stageⅠ, vancomycin calcium sulfate and internal fixation at stageⅡfor calcaneal beak-like fracture. Surgical incision and fracture healing time were recorded, and the recurrence of osteomyelitis was observed. American Orthopedic Foot Andankle Society (AOFAS) score and exudation at 12 months after operation were evaluated. Five patients were successfully completed operation without lower extremity vascular occlusion, and were followed up for 16 to 36 months. The wound healing time after internal fixation ranged from 16 to 26 days, and healing time of fractures ranged from 16 to 27 weeks. AOFAS score ranged from 65 to 91 at 12 months after operation, and 2 patients got excellent result, 2 good and 1 fair. Among them, 1 patient with skin ulcer on the back of foot caused by scalding at 5 months after operation (non-complication), was recovered after treatment;the wound leakage complication occurred in 2 patients, and were recovered after dressing change. No osteomyelitis or fracture occurred in all patients. Vancomycin calcium sulfate with internal fixation in treating calcaneal osteomyelitis secondary to calcaneal osteomyelitis caused by diabetic foot could not only control infection, but also promote fracture healing, and obtain good clinical results.

Ayurvedic management of IBS - A Case Study

Irritable bowel syndrome (IBS) is characterized by recurrent abdominal discomfort in association with alternate episodes of diarrhea and constipation. Physiological, luminal, behavioral and psychosocial factors are responsible for IBS. They are caused by two entirely different mechanisms. Bowels habit is disturbed by diarrhea or constipation occurring alone or alternating. A 30 years old male patient having symptoms of Muhurbaddha Muhurshithil (episode of constipated and loose stools), Apakwa Malapravritti (stool with mucus), Udarshool (abdominal pain). Patient treated with various Panchakarma (five bio-cleaning Ayurvedic therapies) procedures like Basti (herbal medicated enema), Herbal and oral medications. At the end of 50 days of treatment, patient got significant improvement.