bluuebunny/crossref_metadata_2025 huggingface dataset:
Angiographic profile of young patients (≤ 40 years) in a tertiary care center of Nepal
Authors: Binay Kumar Rauniyar  , Arun Kadel  , Kiran Prasad Acharya  , Kartikesh Kumar Thakur  , Rakesh Bahadur Adhikari  , Deepak Limbu  , Sujeeb Rajbhandari  , Subodh Kansakar  , Chandra Mani Adhikari  , Arun Maskey  , Rajib Rajbhandari  , Rabi Malla
Published: January 2025

Background: With rise in prevalence of conventional risk factors like diabetes, hypertension, smoking, dyslipidemia and obesity the incidence of coronary artery disease in young patients have increased in the recent decades even in developing world. There have been multiple studies done in Nepal studying the angiographic profile of coronary disease in general population. However, only few studies has been done till date on the angiographic profile in the young population in our country.
Aims and Objectives: In this study, we aim to determine the angiographic profile of young patient ≤ 40 years in a tertiary care centre of Nepal.
Materials and Methods: A retrospective analytic study was done in Shahid Gangalal National Heart Centre from January 2019 to December 2019. Individuals of both genders with age ≤ 40 years who underwent coronary angiography were included.
Results: Total 109 patients were included. Out of 109, 89 were male and 20 were female. The mean age for male was 35.55 ± 4.31 and for female was 38.55 ± 1.90 (P = 0.003). Among 61 (55.96%) patients who had significant coronary artery disease, 33 patients (30.27%) with single vessel disease, 15 patients (13.76%) had double vessel disease, and 13 patients (11.92%) had triple vessel disease. Left anterior descending (LAD) artery was found to be most frequently involved in all patterns of Coronary artery disease (CAD). Smoking was the most common coronary risk factor present in 29.3% of patients followed by hypertension, family history of premature CAD and diabetes in 14.6%, 7.5% and 5.5% of patients respectively. Overall, the prevalence of smoking was more in males (31.4%) than in females (20%).
Conclusion: Single vessel disease (SVD) was most prevalent in young patients with significant CAD. LAD is the most commonly involved coronary artery followed by Right coronary artery (RCA) and Left Circumflex (LCX).
Bilateral abducens palsy in closed head injury: A comprehensive review of literature based on a case report
Authors: Sandeep B V  , Rekha K R  , Banga Manpreet Singh , Anantha Kishan  , Vittal I Nayak  , Sneha Priya Prabhakar
Published: January 2025

Isolated bilateral sixth nerve palsies are rare, particularly in the setting of trauma. Most post-head injury cases with bilateral abducens palsy involve either basal skull fractures, particularly clival fractures. We present a case of bilateral abducens palsy after closed head injury in a young male who presented to the emergency department and a comprehensive literature review based on our clinical case. A Medline search for bilateral abducens palsy in closed head injury showed 89 results. Articles were excluded if crush head injury, non-traumatic bilateral abducens nerve palsy, associated vascular malformations were reported. After thorough search and filtering of those articles, fifty-one publications were found which reported and discussed about traumatic bilateral abducens palsy with closed head injury. In these 51 articles, a total of 139 cases were recorded. Several theories have been postulated to explain mechanisms of abducens nerve injury in trauma both in immediate and delayed settings. In our case, patient presented with immediate onset of bilateral abducens palsy. On imaging, clival fracture was seen in CT brain, which can be attributed for the nerve injury. Cases with retroclival extradural haematoma had higher chances of multiple cranial nerve injuries. Cases with multiple basal skull fracture involving petrous temporal bone fracture had higher chances of facial nerve injury. Along with bilateral involvement, the poorer outcome for recovery can be related with the severity of the adduction deficit. Our case showed no improvement in bilateral abduction during follow-up at 6 months. Clinical presentation of traumatic bilateral abducens nerve palsy is rare following closed head trauma and is usually associated with other injuries which are incompatible with life. It can be associated with other nerve injuries depending on basal skull fractures.
Effect of intermittent normobaric hypoxia exposure on acclimatization to high altitude by air induction
Authors: Gopinath Bhaumik  , Deepak Dass  , Dishari Ghosh  , Kishan Singh  , Maram Prasanna Kumar Reddy
Published: January 2025

Background: In emergency like condition, defence personnel are deployed to high altitude without proper acclimatization. Maladaption at high altitude leads to high altitude illness like acute mountain sickness (AMS), high altitude pulmonary edema (HAPE) and high-altitude cerebral edema (HACE) which hampers the operational capabilities.
Aims and Objectives: The aim of the present study was to assess the effect of intermittent normobaric hypoxia exposure (IHE) at sea level on different physiological responses during initial days of acclimatization at 3500m and 4000m altitudes in acute induction.
Materials and Methods: The IHE subjects were exposed to 12% FIO2 (equivalent altitude 14500 ft) for 4 hrs/day for 4 consecutive days at sea level and 5th day they were inducted by air to 3500m altitude. Baseline recording of different physiological parameters like cardiovascular, respiratory, oxygen saturation and AMS score were measured at sea level as well as 3500m altitude on daily basis for 6 days to assess acclimatization status. To confirm acclimatization status at 3500m, on fifth day the IHE group subjects were transported by road to 4000m and again measured different basal physiological parameters (like cardiovascular, oxygen saturation and AMS score) for four consecutive days.
Results: Different physiological parameters of IHE treated group were stabilized by day 4 of air induction at 3500m altitude. Whereas, at 4000m altitude, these parameters were stabilized by day 2 of induction.
Conclusion: Acclimatization schedules of four days at 3500m and two days at 4000m are essential to avoid malacclimatization/or high-altitude illness.
Clustering analysis of coronavirus disease 2019 pandemic
Authors: Al-Imam Ahmed , Usama Khalid Enjaz  , Hend Al-Doori
Published: January 2025

This is Letter to the Editor
Study on demographic variables of controlled ovarian Hyperstimulation and Intrauterine Insemination (husband) in a tertiary medical college and hospital in Kolkata
Authors: Agniv Sarkar  , Rajib Roy  , Joydeb Roy Chowdhury  , Bibhas Saha Dalal
Published: January 2025

Background: Intrauterine Insemination (IUI) is anage old reliable and safe procedure for couples having infertility. Success rate of IUI with ovulation induction ranges from 8-20% depending on many factors.
Aims and Objectives: The current study was to assess the factors which are responsible for favourable outcome of IUI after ovulation induction.
Materials and Methods: Total 67 couples were included fulfilling inclusion and exclusion criteria. They underwent 90 cycles of IUI with each couple having maximum of 3 cycles. Ovulation induction was done byeitherclomiphene citrate or letrozole or gonadotrophins. Semen preparation was done by density gradient method. The participant’s demographic parameters were analyzed.
Results: Out of 90 IUI, 8 were successful resulting in a success rate of 8.8% per cycle and 11.9% per couple. Factors which had positive impact were age less than 35 years, less than 10 years of infertility, normal and overweight BMI. Anovulation and unexplained infertility had better outcome. Type of infertility did not have any impact on the outcome.
Conclusion: The study concluded that IUI after ovulation induction is more useful in cases like unexplained infertility and anovulation in a patient aged less than 35 years with less than 10 years of infertility and normal or overweight BMI.
Predictive Epidemiology for SARS-CoV-2 Pandemic in Iraq
Authors: Al-Imam Ahmed , Usama Khalid Enjaz  , Hend Al-Doori
Published: January 2025

This is a Letter to Editor
Spontaneous regression of lumbosacral disc- A case report
Authors: Sibaji Dasgupta  , Sushmita Mukherji
Published: January 2025

Spontaneous regression of lumbar disc is a rare phenomenon. There is no exact described mechanism behind such event. Follow up of such cases in adequate numbers are also lacking. Here we present a case of spontaneous regression of lumbosacral disc prolapse along with resolution of symptoms. A 36 year old lady came to the Out Patient Department (OPD) with sudden onset severe low back pain along with radiation to left lower limb. Magnetic Resonance Imaging (MRI) scan of lumbosacral spine showed a left posterolaterally extruded and inferiorly migrated L5-S1 disc with compression over respective nerve root. She was counseled and possible treatment options were explained. She refused surgery and continued conservative management even knowing all the merits and demerits. Her symptoms improved over time and she had a pain free life for almost two and a half years. Then she experienced mild low back pain again and reviewed at the OPD. Further MRI scan showed significant regression of previously prolapsed L5-S1 disc. Hence, spontaneous regression of prolapsed discs may occur and should be included during counseling of patients with prolapsed disc. But the serious complications of prolapsed discs like muscle weakness and cauda equina syndrome should also be explained along with.
Comparative study between WIDAL and DOT ELISA in the diagnosis of Typhoid fever
Authors: Sarah Hassan  , Vineeta Khare  , Shadma Yaqool  , Syed Abid Asghar  , Mastan Singh  , Zeba Siddiqi
Published: January 2025

Background: Typhoid fever, also known as enteric fever, is a communicable disease, found only in man and occurs due to systemic infection mainly by Salmonella typhi organisms. Blood culture is regarded as the gold standard for diagnosis and carry 70-75% diagnostic yield in the first week of illness.
Aims and Objective: To compare the sensitivity and specificity of Widal test and dot ELISA with blood culture in the early diagnosis of Typhoid fever.
Materials and Methods: A Cross-Sectional study was carried out in the Department of Microbiology, Era’s Lucknow Medical College and Hospital for a period of 18 months. Patients presenting with acute febrile illness suspicious of typhoid fever accompanied by clinical signs and symptoms of typhoid fever in the absence of any other known febrile illnesses, were included in the study. Widal and Dot ELISA was performed using serum samples and for blood culture aseptically collected blood was used.
Results: Sensitivity, Specificity, PPV, NPV of DOT ELISA as compared to Blood culture for typhoid positivity was found to be 92.6%, 83.7%, 55.6% and 98.1% respectively. Diagnostic accuracy of DOT ELISA as compared to Blood culture was found to be 85.3%. Conclusion: For both early and late diagnosis of typhoid fever with high sensitivity as well as accuracy for identification of typhoid fever, the rapid diagnostic test (Dot Elisa) is better than the Widal test. However, it may be an increased burden to healthcare owing to a low positive predictive value in a low prevalence scenario.
Cardio-respiratory and biochemical responses of military training event at Jungle environment
Authors: Angad Yadav  , Tirthankar Chatterjee  , Debojyoti Bhattacharyya  , Somnath Singh  , Madhusudan Pal
Published: January 2025

Background: In military environment, soldiers regularly practice or undergo different types of extreme training activities. However, globally the literatures available on the physiological and biochemical demand of different extreme military training activities are very scanty and less reported.
Aims and Objective: The present study was undertaken to quantify the cardio-respiratory and biochemical responses of military training event in jungle environment.
Materials and Methods: Mathew’s Mad Mile (MMM) activity is a type of specialized run of 1.5 mile in jungle environment. This training activity was conducted on rugged jungle terrain comprised of undulated uphill, downhill, muddy surface. Twenty-five SHAPE-1 healthy soldiers were volunteered into training event. Cardiorespiratory data was recorded continuously throughout the event and venous blood sample was drawn before and immediately after completion of the event. Statistical significance was considered at p<0.05.
Results: There was no significant difference observed in heart rate and breathing rate while core body temperature was significantly (p = 0.02) higher in slow finisher as compared to fast finisher. In fast finisher, post exercise level of BDNF, BNP, SDH, cortisol and UCP1 increased significantly (p<0.05), whereas, BHB (p<0.01) decreased significantly in comparison to pre-exercise. In slow finishers, post exercise level of cortisol, KYNA and UCP1 increased significantly (p<0.05), whereas, BDNF, BNP and SDH decreased significantly (p<0.05), in comparison to pre-exercise.
Conclusion: The outcome of this study indicated that the slow finishers were more susceptible to risk of injury due to higher exercise induced thermogenesis and mental stress in comparison to fast finisher.
Hemihyperplasia with Multiple intestinal Lipomatosis presenting with intestinal obstruction due to intussusception, challenges in treatment- A Rare case
Authors: Pushpendra Malik  , Mahinder K Garg
Published: January 2025

Hemihyperplasia is a syndrome with overgrowth of limbs and associated with various genomic syndromes. Rarely patient presents with intestinal obstruction when it is associated with sub mucosal lipomas. Submucosal lipomas are common in colon. But whole of small and large bowel studded with them is very rare as in our case. It presents dilemma not only in diagnosis but in treatment also. Here we present a case of forty two years females with hemihyperplasia syndrome came to causality with recurrent intestinal obstruction. On CECT Abdomen diagnosis of intestinal obstruction due to intussusception was made. Whole of bowel is studded with submucosal lipomas. Patient was tried to manage conservatively but patient does not respond and Right Hemicolectomy was done of intussusception segment. Anastomosis leaked and on re-exploration end ileostomy was done. Obstruction due to Multiple Intestinal Lipomatosis (as a part of Genetic Syndrome) should be managed conservatively and if operative intervention is required avoid primary anastomosis.
Helicobacter pylori Infection: Diagnosis and Therapy
Authors: Darius Hartanto
Published: January 2025

Helicobacter pylori (H. pylori) is a spiral shape gram-negative bacillus and have flagella for motility in mucus environment. H. pylori is microaerophilic organism, slow growing and requires complex growth media in vitro. H. pylori infecting more than 50% populations in worldwide. Prevalence of H. pylori infection is higher in developing countries compared to developed one, and indicates that socioeconomic and living standard may play a major role in the distribution. This study aims to provide an overview of how to diagnose and manage Helicobacter pylori infection. This study reviewed various sources then reviewed as a literature review. The most successful regimens are triple and quadruple combinations, which consist of a PPI and two or three antibiotics for 7 – 14 days. Patient’s compliance and the use of drug to which strain of H. pylori has not acquired resistance are the most important factors in successful H. pylori treatment.
High-Dose amoxicillin supported with clavulanic acid as empirical therapy in acute otitis media
Authors: Sandeep Lahiry  , Krunal Dalal  , Ashwini Pawar  , Bhavesh Kotak
Published: January 2025

An increase in the daily dose of amoxicillin from 45 mg/kg to 90 mg/kg was introduced in late 2000 to respond to increasing presence of penicillin-resistant Streptococcus pneumoniae (PRSP) in Acute Otitis Media (AOM) and in other respiratory infections. The basis for this recommendation is a well understood mechanism of resistance among PRSP as well as established safety profile of amoxicillin with known tolerance to high doses. The addition of a standard dose of clavulanic acid provides protection against resistance present in other pathogens involved in AOM and other respiratory infections. A formulation of high dose of amoxicillin with standard dose of clavulanic acid has been developed to meet the increasing needs for efficacy against bacteria with growing antibiotic resistance. While, on the one hand, there is continued empirical use of standard/lower dose of amoxicillin (45 mg/kg/day) or a second- or third-generation cephalosporin in AOM, on the other hand, there is evidence of a rise in intractable cases (relapses or first-line therapy failures). In addition to this, an evolving disease bacteriology and regional variation in antibiotic susceptibility are determinants of clinical outcome in AOM. The current paper discusses the unmet areas and explains rationale behind guideline-directed empirical high-dose amoxicillin supported with clavulanic acid in AOM.
Spectrum of AIDS-defining Opportunistic Infections among Anti-retroviral treatment-naïve HIV-seropositive Cases in Northeast India
Authors: Singh Ranjan Kumar
Published: January 2025

This is Letter to the Editor
Port site infection by Mycobacterium fortuitum after laparoscopic hysterectomy and its management– A case report
Authors: Abdulrazack Farook  , Iyanar Kannan  , N Gunasekaran  , E Premalatha  , R Dineshraj
Published: January 2025

In the department of gynaecology vaginal hysterectomy and laparoscopic hysterectomy are popular methods of surgery. They involve less amount of blood loss, with short hospital stay. In recent times, laparoscopic hysterectomy is done commonly. Forty-two-year female was admitted in surgery ward, Tagore Medical College and Hospital, with pain in abdomen at the laparoscopic site and lower abdomen. Pus discharge through the port site, left loin for the last 3 months. The microbiological examination of the pus showed the presence of Mycobacterium fortuitum. After identification of atypical mycobacterium, the patient was administrated with amikacin injection for 3 months and clarithromycin and ofloxacin tablet for one year. Patient was discharged and was advised to come for periodical review.
Posterior reversible encephalopathy syndrome (PRES) presenting as Status Epilepticus in a case of Autoimmune Hemolytic Anemia (AIHA): A Case report
Authors: Sameera Dronamraju  , Shilpa Gaidhane  , Aayush Somani  , Sourya Acharya
Published: January 2025

Posterior reversible encephalopathy syndrome (PRES) is a neurotoxic state, caused by imbalance in autoregulation of posterior cerebral circulation. We report a case of young female, presented at emergency department with complains of nausea, vomiting and generalized tonic clonic seizures prior to admission. During the course of hospital stay patient landed in status epilepticus which was treated appropriately. Patient’s magnetic resonance imaging (MRI) was done which had classical features of vasogenic edema in occipital and parietal region, suggestive of PRES. She was a known case of autoimmune hemolytic anemia thatwas treated with multiple blood transfusions and low dose oral steroids. She was discharged after complete resolution of symptoms with the advice to follow up in medicine outpatient department. Our case describes about autoimmune hemolytic anemia in which occurrence of PRES is uncommon. Early diagnosis and robust treatment can prevent permanent damage to the brain, and is often associated with complete recovery.
IgM and IgG antibody response to SARS-CoV-2 Infection and Viral RNA Persistence in hospitalized chronic kidney disease patients under Hemodialysis (HD)
Authors: Ioannis Griveas
Published: January 2025

Letter to Editor
Mucormycosis in RT-PCR negative Covid 19 patient with newly diagnosed Diabetes Mellitus: A Case Report
Authors: Vankadari Venkata Sesha Satya Sagar  , Pallavi Yelne  , Swapneel Mathurkar  , Shilpa Gaidhane
Published: January 2025

Corona Virus Disease 2019 (COVID 19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), first identified in Wuhan city of China in December 2019. Since then, the disease has spread very rapidly which has led to the current pandemic. Secondary infections are reported now a days during the illness in Covid-19 patients of any age and patients recovered from COVID 19. The high-risk conditions prone for opportunistic infections are uncontrolled blood sugar levels, prolonged steroid usage and oxygen therapy. Mucormycosis is highly invasive secondary infection. Early diagnosis along with surgical and medical intervention and control of all risk factors plays a crucial role. Delay in presentation of patient to medical care is really challenging to the physicians and ENT surgeons.
The curious case of COVID-19: Its murky origin, negligence and a botched international attempt for a cover-up
Authors: Ruby Dhar  , Karthikeyan Pethusamy  , Joyeeta Talukdar  , Abhibrato Karmakar  , Arun Kumar  , Subhradip Karmakar
Published: January 2025

COVD-19 caused due to SARS-CoV2, family of Coronaviridae, the order Nidovirales, and the genus Coronavirus. A zoonotic spillover infection from bats to humans through some intermediate host was proposed to be responsible for its origin. This theory gained traction and raised no concern because our experience with other pathogenic viruses with humans in the past followed a similar trajectory. However, what caught the attention are few missing pieces of the jigsaw puzzle that seems to defy logic. A detailed investigation revealed a trail of deception, negligence, and blotched attempt of cover-up.
What is the effect of advanced diagnostic methods on sensitivity and survival in the multiple breast cancers? A systematic analysis and comparison
Authors: Hasan Zafer Acar  , Nazmi - Ozer
Published: January 2025

The sensitivities of the advanced diagnostic methods appear to be higher than the conventional methods and do have the potential to prolong survival, in multiple (multifocal and multicenter) breast cancers. Thus, the aim of this study is to compare the sensitivities of advanced and conventional diagnostic methods and to reveal their effects on survival. The studies published about diagnosis and treatment methods in multiple breast cancer in literature were searched, analyzed, and the sensitivities obtained with advanced and conventional diagnostic methods were compared, and the results were evaluated statistically. The sensitivity obtained with the advanced diagnostic methods in multiple breast cancers was found to be significantly higher than the conventional methods (p <0.05). The high sensitivities obtained with advanced diagnostic methods were found to have a high potential for survivial prolongation in multiple breast cancers. The use of advanced diagnostic methods in breast cancer screening programs, the investigation of tumor foci with molecular methods, increases the rate of diagnosis in multiple breast cancers. In the treatment of multiple breast cancers, a personalized treatment plan is made with the diagnosis of the molecular structure of the tumor foci. Thus, the recurrence rates are reduced, the survival is prolonged.
Bardet-biedl syndrome: A case report from Nepal
Authors: Rajesh Kumar Mandal  , Rajan Pande  , Rajani Shah KC  , Bibek Acharya
Published: January 2025

The Bardet–Biedl syndrome (BBS) is a rare ciliopathic autosomal-recessive disorder, with multiple organ systems involvement. It is usually seen in family with consanguinous marriage.   It is characterized by truncal obesity, polydactyly, retinal dystrophy, mental retardation, renal dysfunction and hypogonadism in males. It affects both males and females. Very few cases are reported in Nepal. Here we report a 30 year obese lady who presented to our center with history of excessive weight gain and blindness with polydactyly. She visited many local medical centers before landing to our hospital.
Helicobacter pylori seropositivity in psoriasis
Authors: Pratima Poudel  , Bhaskar M M Kayastha  , Anupama Karki
Published: January 2025

Background: Psoriasis is a common inflammatory disease characterized by erythematous papules and plaques with silvery white scales. Recently, the role of H. pylori has been studied as a possible etiological factor. Various published studies conducted to see the association of psoriasis with H. pylori show conflicting results.
Aims and Objective: The aim of this study was to find out the association of H. pylori infection in patients with psoriasis.
Materials and Methods: Cross sectional comparative study was conducted in Outpatient Department (OPD) of Dermatology, Bir Hospital. Any patient presenting at dermatology OPD above 16yrs of age with psoriasis were taken as cases. Age and gender matched patients with skin disease other than psoriasis were taken as controls. The test was done by collecting 2ml of venous blood from each patient. The serum was separated by centrifuging the sample. All the patients were screened for Helicobacter pylori infection by using a commercially available immunochromatographic kit for the detection of immunoglobulin G antibody against H. pylori in the serum.
Results: Chronic plaque psoriasis was the most common variant (72.2%) and there was no significant association between psoriasis type and gender. Male to female ratio was 1.61:1. The mean age of onset in male patients was 42.41years and mean onset of disease in females was 40.61years. Our study showed 21.3% of the psoriasis patients had the history of psoriasis in the family. Nail changes were noted in 40.42% of patients. Psoriatic arthritis was present in 3% of cases. In our study H. pylori infection was found in 25(53.19%) of psoriasis patients and 15(31.91%) of the controls. This showed that H. pylori infection was found higher in psoriasis patients than the controls and the difference was statistically significant (p=0.037).
Conclusion: This study showed the higher prevalence of H. pylori infection in patients with psoriasis and the differences is statistically significant. It also showed that there is increased prevalence of H. pylori seropositivity with the severity of the disease and with increased duration of illness though it is not statistically significant.
Histopathological Study of Endometrium in Patients of Perimenopausal Age Group in a tertiary care Hospital in West Bengal
Authors: Nabanita Chakraborty  , Rajasri Chunder  , Barnali Mukherjee  , Soham Chakraborty
Published: January 2025

Background: Menopause is an important event in women’s life and it marks the end of a woman`s reproductive life. Perimenopause is the interval in which a woman`s body makes a natural shift from regular cycles of ovulation & menstruation to irregular cycles and various forms of abnormal uterine bleeding. Dysfunctional uterine bleeding (DUB) is a very frequent complaint from women in the perimenopausal age group. The histological diagnosis of DUB and its proper management is very essential in this age group.
Aims and Objective: Primary aim of our study was to identify the spectrum of histological changes that occur in the endometrium in perimenopausal age group and to identify the demographic pattern of each histological change.
Materials and Methods: Fifty-two specimens of endometrial biopsy obtained from the patients in the perimenopausal age group of 40-50 years attending the Gynaecology and Obstetrics department were studied.
Results: 71.15% cases of DUB was diagnosed amongst the 52 endometrial biopsy specimens in perimenopausal age group and Secretory endometrium is most common histological pattern.
Conclusion: This study reflects a spectrum of endometrial histology present during perimenopausal age. This study has  also highlighted the correlation of endometrial histology with final diagnoses of the patients, and this may help in diagnosis and treatment of gynaecological diseases of this specific age group in future.
Role of LDH levels in differentiating anemias
Authors: Zaidi Noorin , Rasha Zia Usmani  , Kshama Tiwari  , Sumaiya Irfan  , Syed Riaz Mehdi
Published: January 2025

Background: There is a need to differentiate megaloblastic anemia from mixed deficiency anemia as both require different management protocols. With the acquisition of more information about them, tests such as serum vitamin estimation and Schilling test, were found to have their limitations. Hence there is a need to search newer diagnostic candidates to differentiate between megaloblastic anemia and mixed deficiency anemia.
Aims and Objective: The current study was undertaken to find usefulness of serum Lactate Dehydrogenase (LDH) in differentiating megaloblastic anemia from mixed deficiency anemia.
Materials and Methods: 100 patients were included in the study. Blood smears were stained and analysed. Complete blood counts were performed. Bone marrow examination was done, where needed. Biochemical tests were performed for estimation of vitamin B12, Folate and for LDH.
Results: Out of the 100 cases 51 were diagnosed as megaloblastic anemia and 49 were diagnosed as mixed deficiency anemia. The LDH levels were significantly higher in cases of megaloblastic anemia as compared to mixed deficiency anemia.
Conclusion: Serum LDH levels can be used in differentiating megaloblastic anemia from mixed deficiency anemia.
Budd Chiari syndrome in a patient with Celiac disease: A rare entity
Authors: Hina Ismail  , Zain Majid  , Zahid Shah  , Ghazi Abrar  , Raja Taha Yaseen Khan  , Farina Hanif  , Nasir Hassan Luck
Published: January 2025

Celiac disease is an immune mediated enteropathy that causes malabsorption. It is associated with a number of autoimmune diseases, however is rarely associated with Budd chiari syndrome. We present a case of a young girl who was a diagnosed case of celiac disease and had presented with abdominal distension along with pedal edema. Her initial workup was all negative while ultrasound abdomen along with CT scan abdomen had given the impression of Budd chiari syndrome. She was managed with gluten free diet, diuretics along with anticoagulants.
Multifocal Tuberculosis
Authors: Singh Ranjan Kumar
Published: January 2025

This is Letter to the Editor
Variable presentations of systemic lupus erythematosus based on presence or absence of antidouble stranded DNA antibodies: A case series
Authors: Somnath Maitra  , Swapan Sarkar  , Biswaroop Mukherjee  , Suprotim Ghosh
Published: January 2025

Systemic lupus erythematosus (SLE) presents with diverse clinical features causing diagnostic challenges. Apart from the clinical features, autoantibodies are important for diagnosis along with certain laboratory parameters. Diagnosis is made with the European League against Rheumatism/American College of Rheumatology 2019 Criteria. The case series presented here signifies the correlation between anti ds DNA positivity and its association with poor prognosis and renal disease, whereas antidouble stranded DNA (anti-dsDNA) negativity may lead to lack of renal involvement and may be associated with polyserositis. The importance lies in the fact that these patients with anti-dsDNA negativity should be followed up for assessing conversion to positivity of anti-dsDNA, thus altering the prognosis and leading to renal involvement. Moreover, anti-SSA positive SLE patients must be followed up for possible development of sicca symptoms.
Case series of maternal mortality and maternal near miss due to severe acute respiratory syndrome coronavirus 2
Authors: Vanremmawii  , Lalrinfela Associate  , Lalduhchhungi  , Harvey Vanlalpeka  , Lalramhluna PC
Published: January 2025

The severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) that causes the COVID-19 pandemic has affected every household of the remotest part of North East India, Mizoram. The pregnant women do not have a higher chance of getting infected, yet the infection seems to be more severe. We are reporting five cases of maternal death and two cases of maternal near miss in ZMC of Mizoram. Case 1 to 5 were maternal death due to COVID-19. All of them were multigravida within the age group of 27–41 years with a period of gestation 24–37 weeks. The presenting complaints were fever and cough more than 3 days with an investigation report revealing raised C-reactive protein (CRP) and severe pneumonia. Case 6 (Near miss) was 20 years, primigravida at term pregnancy in labor with a history of fever for 2 days with an investigation report revealing raised CRP and severe pneumonia, the baby was delivered asphyxiated and died. Case 7 (Near miss) was 17 years old primigravida at term pregnancy admitted as asymptomatic COVID-19 positive, elective caesarean section was done for Obstetrics indication, the patient later developed fever and moderate pneumonia on 5 days of hospitalization, she also developed eclampsia on 7th hospital day, she survived after intensive care in the intensive care unit.
Correlation of biofilm production with antibiotic susceptibility pattern of Pseudomonas aeruginosa from various clinical specimens
Authors: M Swapna  , G Sumathi  , M Anitha
Published: January 2025

Background: Pseudomonas aeruginosa is one of the most prevalent nosocomial pathogens that cause a life-threatening infection. One of the important characteristics of P. aeruginosa is biofilm formation which leads to antibiotic resistance.
Aims and Objectives: The aim of the study was to study the antibiotic resistance pattern of P. aeruginosa isolates and correlation with their biofilm-production.
Materials and Methods: A total of 87 P. aeruginosa isolates from different clinical specimens were processed and confirmed by conventional microbiological methods as per standard methodology. Antibiotic sensitivity testing was done for all isolates. Biofilm producing isolates were identified by the microtiter plate method (MTPM).
Results: Of 87 P. aeruginosa isolates, majority were from pus 33 (38%), followed by urine 26 (30%), sputum 19 (22%), body fluids 7 (8%), and blood 2 (2%). Biofilm producing isolates showed more resistance in comparison to non-biofilm producers. The observed difference between biofilm formation for multidrug resistant and susceptible isolates was found to be statistically significant.
Conclusion: MTPM method was an effective test for detection of biofilm formation and was also able to verify biofilm production by P. aeruginosa. This indicated a higher propensity among the clinical isolates of P. aeruginosa to form biofilm and revealed a positive correlation between biofilm formation and antibiotic resistance. This indicates the need for testing of even susceptible isolates for virulence factors such as biofilm production.
Histomorphological spectrum of ovarian tumors - A tertiary care center experience
Authors: K Sampurna  , B Jyothi
Published: January 2025

Background: Ovarian tumors are a heterogeneous group of neoplasms with variable clinical, morphological, and histological features. Ovarian cancer is the leading cause of death in females.
Aims and Objectives: (1) To study and characterize the ovarian tumors based on gross and histopathological features. (2) To study prevalence and age distribution of various ovarian tumors. (3) To study the clinical features in patients with ovarian tumors. (4)To compare the frequency of benign and malignant neoplasms of the ovary with other studies.
Materials and Methods: This is a prospective study conducted in Upgraded Department of Pathology, Modern Government maternity hospital, and Osmania General Hospital, Hyderabad, Telangana from March 2018 to February 2021. A total of 200 ovarian tumors were studied.
Results: Out of 200 ovarian tumors, 132 were benign, seven were borderline and 61 were malignant. The surface epithelial tumors were the most common tumors accounting for 159cases (79.5%), germ cell tumors were seen in 27 cases (13.5%), sex-cord stromal tumors formed 10 cases (5%), and metastasis in 4 cases (2%).
Conclusion: Ovary is a common site of tumors in the female genital tract and usually presents with a variety of clinocomorphological and histological features. Benign are the most common, of these surface epithelial tumors are the commonest, affects mainly reproductive age group.
Ara C face: Cytarabine related dermatological toxicity
Authors: Manideepa Maji  , Nita Radhakrishnan
Published: January 2025

Cutaneous complications due to cytarabine are often seen in patients with hematological malignancy. The usual toxic drug eruptions are acral erythema which occurs as a result of accumulation of drug and its metabolites in the sweat glands. This manifests as not only redness, but pain, swelling, itching, and peeling of skin of hands and feet and at times the trunk. We describe drug induced erythema that developed predominantly on the face of a child with acute myeloid leukemia. An 8-year-old girl of acute myeloid leukemia with FMS-like tyrosine kinase 3 internal tandem duplication positive status on induction chemotherapy with cytarabine at ad dose of 100 mg/m2/dose twice a day developed erythematous, maculopapular, and itchy rashes on 4th day of treatment involving face, bilateral upper limb and anterior chest. There were no blisters, conjunctival, or mucosal involvement. The rash was well tolerated after symptomatic treatment and improved after 28th day of treatment. Although the rash looks aggressive, there were no associated symptoms and disappear without subsequent sequelae. Due to benign nature of this rashes, cytarabine therapy should not be stopped.
Clinical profile of patients with hypertensive crisis in a tertiary care hospital in Haryana, India – A retrospective cross-sectional study
Authors: Navtej Singh  , Tarun  , Ravinder Pal  , Ankit Chamoli
Published: January 2025

Background: A hypertensive crisis may manifest as hypertensive emergency or urgency. Hypertensive emergency is characterized by target organ damage and poses immediate threat to life, a situation not seen in urgency.
Aims and Objectives: The aims of the study were as follows: (1) To determine the prevalence of hypertensive crisis classified as emergency, urgency, and pseudocrisis. (2) To assess the various systems (neurological, cardiovascular, and renal) affected in relation to a particular type of hypertensive crisis.
Materials and Methods: The retrospective study comprised analysis of medical records of 100 patients of hypertensive crisis admitted to emergency unit of BPS Government Medical College and Hospital for Women, Sonepat, Haryana, India, in the 2 years period from January 2018 to December 2019 and study their prevalence among hospital emergencies and clinical presentation.
Results: Total number of clinical emergencies analyzed during this time interval was 6666. The prevalence of hypertensive crisis accounted to 1.5% of all the clinical emergencies received. About 66% presented as hypertensive emergencies, 32% as hypertensive urgency, and 2% presented as hypertensive pseudocrisis. Males of the fifth decade of life while females of the sixth decade of life were most affected by hypertensive crisis. Headache (58%) followed by giddiness (44%) was the most common clinical presentation in the emergency. About 34% of patients had associated neurological deficit. Only 16% of patients had cardiovascular system involvement.
Conclusion: Symptoms provided by patients in the emergency department are of paramount importance for the outcome of hypertensive crisis. Severe complication of hypertensive crisis can be prevented if hypertension is timely diagnosed and appropriately managed.
A clinical registry of multisystemic presentation of hypovitaminosis D in hospital attendees in Kolkata
Authors: Jayati Roy Choudhury  , Debasmita Bandyopadhyay  , Kheya Mukherjee  , Debojyoti Bhattacharjee
Published: January 2025

Background: Vitamin D (Vit D) is a steroid hormone essential for maintaining functional homeostasis in the body. Hypovitaminosis D has been a recognized worldwide problem affecting all age groups and sex. Its prevalence is very high in South Asia.
Aims and Objectives: Therefore, this study was aimed to determine the spectrum of presentation of biochemical levels of hypovitaminosis D in Indian population in terms of age, sex, and multisystemic disorders.
Materials and Methods: A cross-sectional study carried out on selective study population attending a tertiary care hospital from July 2019 to December 2020 with clinical presentations suspected to arise due to Vit D deficiency. Serum 25OH Vit D level was estimated by chemiluminescence method. Data were analyzed using GraphPad Prism 8.
Results: Of the study population (n = 685), average serum 25(OH)D level in females and males was 24.13 ng/ml and 28.59 ng/ml, respectively. Significant difference in mean value of Vit D existed in males and females in the 21–40 years age group (p = 0.0048). Females in the Vit D deficient group (Vit D level<20) mostly presented with mastalgia (20.45%), low back pain (17.61%), and joint pain (11.36%). Common clinical presentation in males with Vit D levels less than 20 ng/ml was diabetes mellitus without CKD (18.34%), non-diabetic CKD (19.27%), and low back pain (16.51%).
Conclusion: Low Vit D levels manifest itself as signs and symptoms involving various multisystemic disorders involving different age groups in both sexes. Early recognition and replacement can prevent the progress of complications which Vit D deficiency makes us prone to develop.
Knowledge, attitude, and practice of medical students regarding immunization and National Maternal and Child Health program in India
Authors: Singh Lily , Pranjali Saxena  , Faridi MMA
Published: January 2025

Background: There are gaps in knowledge, attitude, and practice (KAP) regarding immunization and National Maternal and Child Health program among health care workers.
Aims and Objectives: This study aims to study the KAP gaps related with immunization among medical students at a teaching institute.
Materials and Methods: A total of 321 medical students were evaluated using a 54-item pre-validated inventory containing 36 items on knowledge, 8 on attitude, and 10 on practice with total possible scores of 55, 8, and 17, respectively. Details regarding type of student (undergraduates, intern, and postgraduates), sex, age, and marital status were noted. For illustrative purposes, the domain scores were transformed to percentages. Data were analyzed using SPSS 21.0 Software. Kruskal–Wallis, Mann–Whitney U tests, and Pearson correlation coefficient were employed for statistical analysis.
Results: Maximum were final year MBBS (n=146) followed by interns (n=106) and 1st year postgraduate students (n=69). Majority were female (55.8%), aged 22–25 years (74.8%), and unmarried (91.9%). Mean percentage scores for knowledge and attitude were 51.44±13.35% and 65.54±31.05%. For immunization subdomain of knowledge, attitude, and practice, these were 58.45±16.15%, 72.20±32.59%, and 36.74±13.10%, respectively. Knowledge and practice scores showed a significant association with type of student. Attitude scores did not show a significant association with demographic profile of student. Maximum scores for all the domains were observed among postgraduates. Overall practice scores were much lower than knowledge and attitude. A significant correlationwas observed between knowledge, attitude, and practice scores.
Conclusion: The study identifies wide gaps in KAP of medical students that indicate need for strategic interventions.
The superiority of midazolam-pethidine combination in three different anesthetic methods applied in conscious sedation during transesophageal echocardiography procedure
Authors: Hulya Yilmaz AK  , Yasemin Ozsahin  , Mehmet Ali Yesiltas  , Sukru Arslan  , Cem Bostan  , İsmail Haberal  , Mustafa Yildiz
Published: January 2025

Background: During the transesophageal echocardiography (TEE) procedure, as in many other diagnostic semi-invasive applications, moderate sedation is preferred over deep sedation. Rarely, patients who cannot tolerate moderate sedation may require deep sedation when difficulties are encountered during TEE probe insertion. Although many different methods have been tried for the TEE procedure in clinical practice, the most appropriate sedation method is still controversial.
Aims and Objectives: We aimed to evaluate the clinical effects of three different sedoanalgesia methods consisting of midazolam, propofol, and midazolam-pethidine combination protocols applied for conscious sedation in the patients undergoing a TEE procedure, and to evaluate the patient and doctor satisfaction during the procedure.
Materials and Methods: One-hundred twenty five patients who underwent TEE for diagnostic purposes in our hospital were included consecutively in our prospective randomized trial. The patients were divided into three groups as those who were administered midazolam (group M), propofol (group Pr), and midazolam-pethidine (group MPe) during the TEE procedure.
Results: In the MPe group, both patient and doctor satisfaction were significantly higher than the two groups. The rate of difficulty in probe placement was lower in the Pr and MPe groups compared to the M group (P<0.05).
Conclusion: In this study, it has been observed that conscious sedation with the combination of midazolam-pethidine was significantly advantageous in terms of patient and physician satisfaction compared to the use of only midazolam and only propofol.
Environmental surface sampling for SARS-CoV-2 around hospitalized patients with COVID-19 in a tertiary care hospital
Authors: Varun Goel  , Savita Gupta  , Vivek Gupta  , Ajay Kumar Sahni
Published: January 2025

Background: The contamination of patients’ surroundings by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains understudied. Discordant findings of SARS-CoV-2 RNA in environmental samples were noted in many reports.
Aims and Objectives: The study assessed the extent and persistence of environmental surface contamination in real-world surfaces around COVID-19 patients.
Materials and Methods: We sampled the surroundings of two intensive care unit (ICU) and one ward that were occupied by laboratory-confirmed coronavirus disease 2019 (COVID-19) patients. Frequently touched environmental surfaces near patients were swabbed before and after daily environmental disinfection.
Results: Of 355 environmental samples, 6 (1.69%) were positive by real-time reverse-transcription polymerase chain reaction assay. Among those, 5 of 75 ICU samples (6.67%) and 1 of 75 ward environmental samples (1.33%) in the pre-fumigation areas occupied by COVID-19 positive patients were positive. No samples obtained within the first 2 h of fumigation and surface disinfection was found to be positive.
Conclusion: Surrounding environment of symptomatic COVID-19 patients can get contaminated and in cases of asymptomatic COVID-19 patients, contamination of their surroundings was an uncommon phenomenon. Strict contact barrier precaution, routine cleaning with disinfectants are mandatory hospital infection control practices in the management of patients infected with SARS-CoV-2.
Veno-arterial extracorporeal membrane oxygenation as a bridge to recovery in acute aluminium phosphide poisoning: A case report
Authors: Arvind Kumar  , Jai Prakash  , Gaurav Arya  , Anand Kumar Yadav  , Aman Dhankar
Published: January 2025

Aluminium phosphide (AlP) is a common fumigant used for controlling rodents and pests in grain storage facilities. Its consumption is reported in accidental or suicidal cases carrying high mortality. In the present case, a young male was reported with ingestion of AlP with severe lactic acidosis and systolic dysfunction. The patient was managed with extracorporeal membrane oxygenation. In reserved cases, ECMO can be instituted taking in view of risk and complications.
A cat scratch disease case presenting with underarm painful lymphadenopathy
Authors: Yardimci Bulent
Published: January 2025

Cat Scratch Disease is an infectious disease that typically begins as a cutaneous lesion and causes proximal regional lymph nodes enlargement. In general, it is infected as a result of cat saliva and scratches. It rarely causes systemic manifestations. Since it may be observed worldwide, the differential diagnosis should be strictly introduced in case of local lymphadenopathies.