bluuebunny/crossref_metadata_2025 huggingface dataset:
Anterior Wall Myocardial Infarction; Challenges in Recognition and Management in an IntellectuallyDisabled Patient in the Emergency Department
Authors:   Resident, Department of Emergency Medicine, Max Super Speciality Hospital, Vaishali, Ghaziabad, Uttar Pradesh 201012, India., Jha Tanmay Kumar , Sabharwal Ritu ,   Attending cunsoltant, Department of Emergency Medicine, Max Super Speciality Hospital, Vaishali, Ghaziabad, Uttar Pradesh 201012, India., Chiranjeevi Chintala Venkata Sai ,   Senior resident, Department of Emergency Medicine, Max Super Speciality Hospital, Vaishali, Ghaziabad, Uttar Pradesh 201012, India., Naidu Sarat Kumar ,   Attending cunsoltant, Department of Emergency Medicine, Max Super Speciality Hospital, Vaishali, Ghaziabad, Uttar Pradesh 201012, India., Nair Dheeraj Bhaskaran ,   Head of Department, Department of Emergency Medicine, Max Super Speciality Hospital, Vaishali, Ghaziabad, Uttar Pradesh 201012, India.
Published: January 2024

Acute MI would rarely be a first differential diagnosis in a young boy of 19 years old withintellectual disabilitywith non-specific complaints. We present a case of a 19-year old boywithhistory of seizure disorder, who presented to the Emergency Department with complaint ofnon-specific chest discomfort since1 day.While being examined, he had one episode of seizure after which he suddenly developed cardiac arrest;he was immediately given high quality CPR along with DC shock (initial rhythm = VF) as per ACLS protocol. Post ROSC2D Echo revealed LV dysfunction with LVEF~ 40%. Post ROSC ECG revealed AWMI. Patient was loaded with antiplatelets, statins and anticoagulants. Patient underwent CAG which revealed single vessel disease. Subsequently, he underwent primary PTCA+ Stent (DES) to LAD with good end result. He was discharged in a stable condition after 6 days.
A Case of Aortic Dissection Presenting as CVA with Pulmonary Embolism
Authors:   Attending cunsoltant, Department of Emergency Medicine, Max Hospital, Dehradun, Uttarakhand 248001, India., Gupta Arunil , Haque Wasiul ,   PGY2,  Department of Emergency Medicine, Max Hospital, Dehradun, Uttarakhand 248001, India., Luthra Neha ,   PGY1, Department of Emergency Medicine, Max Hospital, Dehradun, Uttarakhand 248001, India., Jhaldiyal Pankaj ,   HOD & Senior Consultant, Department of Emergency Medicine, Max Hospital, Dehradun, Uttarakhand 248001, India.
Published: January 2024

Aortic dissection is a life threatening condition of the aorta. Early diagnosis and management can reduce the patient’s morbidity and mortality; hence one should have a high index of suspicion for this condition. This case reports a 53 yrs old male presenting with headache, slurring of speech, Rt leg weakness with dyspnoea and sweating. A patient of aortic dissection can present in many ways depending on the site involved and may mimic other disorders like ACS, PE or CVA. Therefore, clinicians must always be aware of aortic dissection and its different clinical manifestations.
A Case of Rheumatoid Cerebral Vasculitis Presenting to the ED
Authors:   PGY2, Department of Emergency Medicine, Max Hospital, Dehradun, Uttarakhand 248001, India., Kumar Mayank , Jhaldiyal Pankaj ,   HOD & Senior Consultant, Department of Emergency Medicine, Max Hospital, Dehradun, Uttarakhand 248001, India., Das Indranil ,   Attending Consultant, Department of Emergency Medicine, Max Hospital, Dehradun, Uttarakhand 248001, India.
Published: January 2024

Central nervous system involvement in rheumatoid arthritis is infrequent. The most frequent neurological manifestations of rheumatoid arthritis are peripheral neuropathy and cervical spinal cord compression due to subluxation of the cervical vertebrae. Cerebral rheumatoid vasculitis is an uncommon and serious complication which can be life-threatening Neurological involvement in RA is rare, present in only 1% of patients. Disorders of the central nervous system (CNS) include cervical myelopathy, vasculitis, RNs located within the CNS, or meningitis. Stroke also occurs with increased frequency. CNS vasculitis is extremely rare. The diagnosis is supported by magnetic resonance imaging (MRI), alone or with magnetic resonance angiography (MRA), showing the segmental vascular stenosis characteristic of vasculitis. Peripheral neuropathy is usually manifested as sensorimotor neuropathy or mononeuritis multiplex. The underlying mechanism is small vessel vasculitis of the vasa vasorum of the nerves with ischaemic neuropathy and demyelinisation as part of the rheumatoid vasculitis (RV) syndrome. Rheumatoid vasculitis typically affects small and medium-size blood vessels. It is associated with high rates of premature mortality with up to 40% of patients dying by 5 years as well as significant morbidity due to both organ damage from vasculitis and consequences of the treatment. High levels of circulating immune complexes have been observed in atients with rheumatoid vasculitis, and in particular high serum levels of rheumatoid factor are often detected at the time of onset of vasculitis.Deposition of immune complexes most likely contributes to small vessel inflammation and organ damage. Anti CCP levels also tend to be higher in patients with RA who have systemic vasculitis than in those who do not. Histologically, rheumatoid vasculitis involves blood vessels of the small arteries, and all layers of the vessel wall are infiltrated by neutrophils, lymphocytes, and plasma cells.
Right MCA Lacunar Infarct with Concomitant Right Ventricular Myocardial Infarction
Authors:   Attending Consultant, Department of Emergency Medicine, Max Hospital, Dehradun, Uttarakhand 248001, India., Gupta Arunil , Sharma Vaibhav ,   PGY2,  Department of Emergency Medicine, Max Hospital, Dehradun, Uttarakhand 248001, India., Sotie Neha ,   PGY2,  Department of Emergency Medicine, Max Hospital, Dehradun, Uttarakhand 248001, India., Jhaldiyal Pankaj ,   HOD & Senior Consultant, Department of Emergency Medicine, Max Hospital, Dehradun, Uttarakhand 248001, India.
Published: January 2024

Concomitant acute myocardial infarction and ischemic cerebrovascular accidents has been rarely reported in the literature. In this report, we are describing a 74 year old male patient previous diabetic and hypertensive who presented to ER with a H/O sudden fall at home after which he had weakness of left leg, slurring of speech and left sided hemianopia after which a screening MRI revealed a Rt sided thalamic lacunar infarct. On further probing he revealed a vague epigastric pain and ECG revealed ST elevation in Lead II,III and AVF with atrial fibrillation & CVR. After that pt was urgently shifted to cath lab for percutaneous coronary intervention. This association can best be described as “cardio-cerebral infarction”. Early recognition of such cases is important and determines the patient’s further management and prognosis.
An Unusual Presentation of Pituitary Macro Adenoma as Altered Sensorium
Authors:   PGY1, Department of Emergency Medicine, Max Hospital, Dehradun, Uttarakhand 248001, India., Sonali Saklani , Indranil Das ,   Attending Consultant, Department of Emergency Medicine, Max Hospital, Dehradun, Uttarakhand 248001, India., Pankaj Jhaldiyal ,   HOD & Senior Consultant, Department of Emergency Medicine, Max Hospital, Dehradun, Uttarakhand 248001, India.
Published: January 2024

Pitutary macroadenoma and microadenoma has their own clinical presentations. These conditions are not very common and they may present with varied symptoms to the ED. There are instances when these conditions are incidentally detected by emergency radiological investigations. However in most of the instances the patient may present with vague complaints like dizziness and headache and in some rare instances the patient may resent with poor GCS. The cause may be attributed to the raised ICP due to growing adenoma or sometimes due to other effects.
Complicated Femur Fracture with Acute Respiratory Distress Syndrome Secondary to Fat Embolism Syndrome
Authors:   Resident, Department of Emergency Medicine, Max Super Speciality Hospital, Vaishali, Ghaziabad, Uttar Pradesh 201012, India., Devi Kangjam Lakshmi , Naidu Sarat Kumar ,   Attending cunsoltant, Department of Emergency Medicine, Max Super Speciality Hospital, Vaishali, Ghaziabad, Uttar Pradesh 201012, India., Nair Dheeraj Bhaskaran ,   Associate Consultant and Coordinator, Department of Emergency Medicine, Max Super Speciality Hospital, Vaishali, Ghaziabad, Uttar Pradesh 201012, India.
Published: January 2024

Fat embolism (FE) is defined as a blockage of vasculature by fat globules that originate either from bone marrow or adipose tissue. It mainly affects the lungs, but can also affect the skin, retina, and central nervous system. FE is very common after long bone fractures, but this may lead to a rare clinical entity called fat embolism syndrome (FES), a systemic inflammatory cascade affecting multiple organ systems which has a high mortality and morbidity. We report a case of a 22 year old male presented with left femur fracture after a mechanical fall. Orthopedic repair was done, but he developed FES and ARDS on 2nd day of the injury following which he was aggressively anaged for these complications of his long bone fracture and was discharged in a stable condition after 16 days.
Prognostic Significance of Creatine Phospokinase (CPK) Levels in Assessing the Severity of Organophosphorus Poisoning Compound Poisoning
Authors:   Professor and head, Department of General Medicine, Shimoga Institute of Medical Sciences, Karnataka 577201 India., V. Virupakshappa , I. Girish ,   Assistant Professor, Department of General Medicine, Shimoga Institute of Medical Sciences, Karnataka 577201 India.
Published: January 2024

Organophosphorus poisoning (OP poisoning) is common poisoning specially in developing countries like India. This compound is easily available, cheap and is used in agricultural field as pesticides. Both accidental and suicidal poisoning has been reported. Laboratory parameters like erythrocyte cholinesterase activity has been used to support clinical diagnosis and to predict prognosis and it is costly. Pseudocholinesterase is cheaper alternative but it is less reliable. There are few other biochemical markers including CPK which is usually raised in cases of acute OP poisoning and it is a cheaper investigation and is easily performed in all laboratories. Hence this study was done to evaluate role of creatine phosphokinase levels to support clinical diagnosis as well as predicting prognosis in acute OP compound poisoning. Materials and Methods: It was a prospective observational study which included 50 patients who presented within 6 hours of consumption of OP compound afterconsidering inclusion and exclusion criteria. Patients were categorized into mild, moderate and severe poisoning according to POP score and initial CPK levels were noted. Data expressed in percentages and chi-square test was used to know statistical significance. Results: Out of 50 patients, 28 (56%)had mild, 16 (32%) had moderate and 6 (12%) had severe poisoning. Initial CPK levels were positively correlated with POP score. Four deaths occurred in our studyout of which one had moderate poisoning and threehad severe poisoning. Conclusion: Initial CPK levels correlated with severity of OP compound poisoning and mortality.
Clinical Profile of Patients with Heart Failure at Tertiary Care Hospital
Authors:   Senior Resident, Department of General Medicine, Raichur Institute of Medical Sciences, Raichur, Karnataka 584102, India., .. Bhaskara , K Abhilash ,   Senior Resident, Department of General Medicine, Raichur Institute of Medical Sciences, Raichur, Karnataka 584102, India., .. Shashdhar ,   Senior Resident, Department of General Medicine, Shimoga Institute of Medical Sciences, Shivamogga, Karnataka 577201, India.
Published: January 2024

Heart failure is third most common cardiovascular disease in the US affecting 2 per cent of the U.S. population, or almost 5 million people. The prevalence of heart failure increases with the age from less than 1 per cent in the 20 - 39-year-old age group to over 20 per cent in the people age 80 year or older. The life time risk of developing heart failure is estimated at about 20 per cent both in men and women. Methodology: The target population consisted of patients of either sex diagnosed as Congestive Heart Failure according to the Framingham Criteria for Congestive Heart Failure, either admitted to the In-Patient Department (IPD) or visiting the out-patient department. They were contacted, explained about the purpose of study and requested for enrolment. They were provided with a patient information sheet either in Kannada, Hindi or English. Results: The mean arterial blood pressure was subsequently measured and patients were divided into two categories – Normal (70-105 mg/dl) and Hypertensives(>105 mg/dl). Conclusion: The mean value of MABP in the study group was 96.43 ± 12.38 mmHg with a median value of 95 mmHg. In the study group, 78.67% patients had normal MABP (70-105 mg/dl) while 21.33% patients had high MABP (> 105 mmHg). Keywords: Heart failure; MABP; Hypertensive.
Mean Platelet Volume as A Diagnostic Predictor in Myocardial Infarction
Authors:   Professor, Department of General Medicine, Shri Dharmasthala Manjunatheshwara College of Medical Sciences and Hospital, Dharwad, Karnataka, India., Parakh Rajendra Kumar , Nukavarapu Madhusudana Rao ,   Junior Resident, Department of General Medicine, Shri Dharmasthala Manjunatheshwara College of Medical Sciences and Hospital, Dharwad, Karnataka, India.
Published: January 2024

Platelets play a pivotal role in both hemostasis and thrombosis. Mean platelet volume (MPV) is a measure of the average size of your platelets. Mean platelet volume (MPV) has been found to be an independent risk factor in western populations and also from Indian Data. Aims: To investigate whether there is association between Mean Platelet Volume (MPV) and Cardiac Troponins (C Tn I ) in patients admitted with suspected case of Myocardial infarction. To Assess the potential efficiency of MPV in the diagnostic workup of Myocardial infarction. Methodology: 100 patients admitted in SDM Medical College and Hospital casualty and CCU of Narayana Hrudayala were included in this study after taking informed consent. Results: In our study, we found that only 5 % of patients has MPV Value more than 11.5 out of 100 patients, 20 % of patients has MPV value more than 10. It is observed that it MPV is higher in males with mean value of 9.27 compared to females which is 8.946.where as Troponin-I is higher in females with mean value 5.089 in comparison with females which is 5.303. Conclusion: Mean platelet volume (MPV) has been found to be an independent risk factor in western populations and also from Indian Data. Hence we thought it appropriate to look at this parameter in Indian patients with history of MI or CAD.
Did Emergency Admissions Reduce During Covid Lockdown in India?
Authors:   Joint Vice President, Star Health Insurance, 1, New Tank Street, Valluvar Kottam High Road, Chennai 600034, India., Ramakrishnan Madhumathi , Subbarayan Prakash ,   Managing Director, Star Health Insurance, 1, New Tank Street, Valluvar Kottam High Road, Chennai 600034, India.
Published: January 2024

Corona Virus disease 2019 (COVID-19) related lockdown has affected the health sector in many ways. In this study we have analysed the impact of lockdown on emergency admissions. Aim: To compare the trend and number of claims for medical and surgical emergencies during the lockdown period 1.0 and 2.0 from 25th March to 3rd May 2020 with the same period in 2019. Methods: All the claims for medical and surgical emergencies from 25th March 2020 to 3rd May 2020 were compared with the similar data for the same period in 2019. This study was performed sourcing the data from the database of Star Health Insurance medical claims platform. ICD-10 codes (59 medical and 57 surgical) were chosen for common medical and surgical emergencies. The results were expressed as percentage of total claims and statistical analysis was performed with Chi square test (Graphpad Prism version 7). Results: Number of medical emergency claims dropped significantly by 61% during lockdown period 2020 (1899) compared to the same period in 2019 (4900). Cardiac emergencies dropped by 58%; strokes by 58% and gastrointestinal emergencies by 50%. Surgical emergencies dropped significantly by 78% (Non-traumatic emergencies by 67%; Traumatic emergencies by 89%). In 2019 proportion of (medical+surgical) emergencies/ total claims was 10413/68480 (15.2 %) and this dropped significantly to 3138/28767 (10.9%) in 2020 (p=0.0001). Conclusions: Both non traumatic surgical and medical emergencies dropped significantly during lockdown. The reasons for such drop in emergencies are worth analysing further.
Profile of Patients with Diabetes Mellitus at Tertiary Care Hospital, Clinical Study
Authors:   Senior Resident, Department of General Medicine, Vijayanagar Institute of Medical Sciences, Ballari, Karnataka 583104, India., Reddy G Ramakrishna , ... Bhaskara ,   Senior Resident, Department of General Medicine, Raichur Institute of Medical Sciences, Raichur, Karnataka 584102, India., K Abhilash ,   Senior Resident, Department of General Medicine, Raichur Institute of Medical Sciences, Raichur, Karnataka 584102, India.
Published: January 2024

In Diabetes mellitus, it is observed that there will be an increase in plasma glucose levels because of the failure in inhibition of hepatic glucose production in combination with reduction in uptake by tissues especially muscles. These occur due to combination of insulin resistance and inadequate insulin secretion by both liver and muscle failure to suppress plasma glucose. Methodology: Data was entered using MS Excel (2010) and statistical analysis was done using SPSS software version 16. Statistical analysis was done by using percentages, mean values and standard deviation. All statistical analysis was carried out at 5% level of significance and p value <0.05 was considered as significant. Results: The mean haemoglobin value was 11.11±1.94 g%. The fasting blood sugar and the post prandial blood sugar mean values were 157.52 ± 47.52 mg/dl and 226.34±56.93 mg/dl respectively. The HbA1c mean value was 7.94±0.54%. The serum creatinine and blood urea levels were 0.98 ±0.26 mg/dl and 31.28±12.56 mg/dl respectively. Conclusion: Out of 90 patients, 47(52.2%) of patients were on OHA treatment and 43(47.8%) patients were on insulin. Keywords: Diabetes mellitus; HbA1c; OHA.
The Effect of Glycemic Control on Spirometric Variables in Patients of Type 2 Diabetes Mellitus
Authors:   Assistant Professor, Department of General Medicine, The Oxford Medical College, Hospital and Research Centre, Bangalore, Karnataka 562107, India., Kumar Prasanna , Hussain Mohd Asif ,   Assistant Professor, Department of General Medicine, Employees State Insurance Corporation Medical College, Kalaburagi, Karnataka 585106, India.
Published: January 2024

Introduction: Pulmonary function tests (PFTs) is a generic term used to indicate a battery of studies or manoeuvres that may be performed using standardized equipment to measure lung function. PFTs can include simple screening spirometry, formal lung volume measurement, diffusing capacity for carbon monoxide, and arterial blood gases. These studies may collectively be referred to as a complete pulmonary function survey. Methodology: Information was collected through a pre tested and structured proforma for each patient Qualifying patients will be undergoing detailed history, clinical examination, routine investigations like FBS, PPBS, HBA1c, fundus evaluation and spirometric evaluation using a easy one flow spirometer. Glycemic control is taken as HBA1C below 7.5 and HBA1C more than 7.5 is considered as uncontrolled sugars Diabetic patients of different durations are selected Using criteria laid down. Results: In our study, 2(10%)patients with HBA1C < 7.5 had restrictive pattern and out of 26 patients with HBA1C >7.5, restrictive pattern was seen in 21 patients in group 2. Conclusion: Spirometry is the most commonly used lung function screening study. It generally should be the clinicians first option.
A Rare Case of a Traditional Indian Medicine Therapy (Desi Massage) Leading to Acute Osteomyelitis of Right Calcaneum in a Child
Authors:   Emergency Medicine Resident,Department of Emergency Medicine, Max Hospital, Shalimar Bagh, New Delhi 110088, India., Ansari Zeeshan Ali , Govil Priya ,   Consultant, Department of Emergency Medicine, Max Hospital, Shalimar Bagh, New Delhi 110088, India., Datta Kishalay ,   Associate Director and HOD, Department of Emergency Medicine, Max Hospital, Shalimar Bagh, New Delhi 110088, India.
Published: January 2024

A 10-year old child presented to ED with pain and swelling over the right ankle for 2 days H/O right ankle twist 3 days back and the patient had undergone traditional Indian medicine treatment (desi massage) No H/O Juvenile arthritis or vasculitis Outside X-ray suggestive of – no obvious bony abnormality MRI Right ankle joint done in ED which showed diffusely altered calcaneal signal, osteomyelitis large associated collections in the adjacent tissue Partial tear of the plantar fascia at its calcaneal attachment laterally.
Profile of Diabetic Patients Subjected for Spirometry
Authors:   Assistant Professor, Department of General Medicine, Employees' State Insurance Corporation Medical College, Gulbarga, Karnataka 585106, India., Hussain Mohd Asif , Kumar Prasanna ,   Assistant Professor, Department of General Medicine, The Oxford Medical College, Hospital and Research Centre, Bangalore, Karnataka 562107, India.
Published: January 2024

Introduction: When the air passes through the nasal cavity and pharynx, it gets warmed and takes up water vapour. And it passes down the trachea and through bronchioles, respiratory bronchioles and alveolar ducts to the alveoli. Between the trachea and the alveolar sacs, the airway divides 23 times forming 23 generations. The first 16 generations form the conducting zone of the airways made up of bronchi, bronchioles and terminal bronchioles. The remaining 7 generations from the transitional and respiratory zones where gas exchange occur and are made up of respiratory bronchioles, alveolar ducts and alveoli. Methodology: Information will be collected through a pre tested and structured proforma for each patient Qualifying patients will be undergoing detailed history, clinical examination, routine investigations like FBS, PPBS, HBA1c, fundus evaluation and spirometric evaluation using a easy one flow spirometer Glycemic control is taken as HBA1C below 7.5 and HBA1C more than 7.5 is considered as uncontrolled sugars. Results: Group 1 had 15 patients with uncontrolled sugars i.e HbA1c of more than 7.5 Group 2 had 26 patients with HbA1c of more than 7.5, out of 70 patients of type 2 DM, 41 (58.6%) patients had HBA1C of more than 7.5. Conclusion: Diabetes mellitus leads to increased hepatic glucose output. First, liver glycogen stores are mobilised then hepatic gluconeogenesis is used to produce glucose. Insulin deficiency also impairs non-hepatic tissue utilization of glucose, particularly in adipose tissue and skeletal muscle, insulin stimulates glucose uptake.
A Retrospective Study of Injury Pattern & Analysis of Its Outcome In Patients presenting to Emergency Department after Near hanging
Authors:   Professor & Head of Department, Kempegowda Institute of Medical Sciences Hospital ,V V puram, Bangalore, Karnataka 560004, India., B Brinda , K Bharat ,   Assistant Professor,Kempegowda Institute of Medical Sciences Hospital ,V V puram, Bangalore, Karnataka 560004, India., B R Sanjay ,   Resident, Kempegowda Institute of Medical Sciences Hospital ,V V puram, Bangalore, Karnataka 560004, India.
Published: January 2024

Near hanging is one of the common modes of suicidal methods presenting to the A&E department. Despite hanging having high fatality rate, survival is possible with early prompt intervention & resuscitation of the victim. To study the injury pattern & analysis of its outcome innear hanging victims presenting to emergency department. Medical records of 30 patients aged between 15&50 years was reviewed retrospectively. Information regarding age, gender, marital status & material used was noted. Outcome of those patients were analyzed maintaining strict confidentiality. Female gender accounted for 16 patients & 14 were males. 54% of patients presented to ED with complete hanging & 46% with partial hanging. 80% (24) patients had a coma scale of (GCS) <8 & all of them required mechanical ventilator support. 60% (18) required <2days of ventilation, 4 patients for 3- 6 days & 2 patients had >7days of ventilator support. Co-morbidities associated were alcohol abuse, seizure disorder, drug abuse, & opioid dependence with uncomplicated withdrawal. Outcome in 66% of patients was good were discharged with minimal or no neurological deficits, 10% died & 24% got discharged against medical advice. Probable cause of death was post near hanging cardiac arrest, hypoxic ischemic injury, seizures, severe metabolic acidosis & brain death. Longer hanging time with severe injury pattern had bad prognosis with increase in morbidity & mortality. However, in spite of low GCS active intervention, resuscitation & aggressive management improved the outcome.
Thrombosis of Aberrant Right Subclavian Artery Presenting As Myocardial Infarction
Authors:   Resident, Department of Emergency Medicine Max Hospital, Shalimar Bagh, New Delhi 110088, India., Ansari Zeeshan Ali , Datta Kishalay ,   Head of Department, Department of Emergency Medicine Max Hospital, Shalimar Bagh, New Delhi 110088, India.
Published: January 2024

Aberrant right subclavian artery (ARSA) is a rare anomaly, in which the right subclavian artery arises directly from the aortic arch instead of originating from the brachiocephalic artery. This anomaly should be taken into consideration during surgical procedures around the esophagus, such as esophagectomy. Any unintentional injury of this artery during surgical procedures could be extremely life-threatening. The patient was an 88-year-old male, known case of hypertension, CAD, COPD, presented with the chief complaint of chest pain for 2 days associated with the history of right-hand weakness and numbness for 1 week. ECG has done suggestive of Sinus Rhythm with LBBB Trop I – 6.1 ng/ml Coronary Angiography LMCA- Normal LAD- Mid LAD 80% stenosis LCX- Proximal 99-100% occluded RCA- normal CT ANGIO right upper limb done findings revealed anomalous retro esophageal course of right subclavian artery with narrowing at its origin and a small thrombus in juxta osteal segment. Thrombus of 6.7 cm long segment of the distal third of right brachial artery with the reformation of brachial artery at the level of elbow joint along with thrombosis of right ulnar artery at a short distance from its origin. Keywords: Aberrant right subclavian artery; Thrombosis; Myocardial infarction.
Lateral Medullary Syndrome in a patient with Covid 19 disease
Authors:   Emergency Medicine Resident, Department of Emergency Medicine Max Hospital, Shalimar Bagh, New Delhi - 110088, India., Ansari Zeeshan Ali , Govil Priya ,   Consultant, Department of Emergency Medicine Max Hospital, Shalimar Bagh, New Delhi - 110088, India., Datta Kishalay ,   Head of Department, Department of Emergency Medicine Max Hospital, Shalimar Bagh, New Delhi - 110088, India.
Published: January 2024

A 68 years old male diabetic patient presented to the Emergency Departmentwith chief complaints of slurring of speech and weakness in the left lower limb for 1 day. The patient was also experiencing respiratory symptoms from the last 4-5 days, cough, and dyspnea. On arrival in the emergency department, the patient was pyrexial. Covid-19 rapid antigen test was done was comes to positive. The patient was shifted to covid ICU, a Covid RT PCR sample was sent, and an MRI stroke protocol was planned. MRI BRAIN was suggestive of right-sided lateral medullary infarcts. Right vertebral artery flow void absent. MR ANGIO BRAIN- Eccentric short segment plaque involving the proximal segment of the left subclavian. Eccentric plaques involving the posterior aspect of left proximal ICA left petrous ICA and both cavernous ICA. Lack of flow-related enhancement in right vertebral artery! occluded. Nonvisualized inferior division of right MCA. Keywords: Lateral Medullary Syndrome; Covid 19 disease.
Oxidant and Antioxidant Imbalance in Urolithiasis Patients
Authors:   Assistant Professor, Department of General Medicine,Basaveshwara Medical College Hospital & Research Centre, Chitradurga 577501, Karnataka, India., N S Soumya , Kadli Suresh U ,   Associate Professor, Department of General Surgery,Basaveshwara Medical College Hospital & Research Centre, Chitradurga 577501, Karnataka, India., C M Gopal Das ,   Associate Professor, Department of Psychiatry,Basaveshwara Medical College Hospital & Research Centre, Chitradurga 577501, Karnataka, India., S V Manjunath Rao ,   Professor & Head, Department of ENT,Basaveshwara Medical College Hospital & Research Centre, Chitradurga 577501, Karnataka, India., B V Sharath ,   Professor & Head, Department of General Surgery, Basaveshwara Medical College Hospital & Research Centre, Chitradurga 577501, Karnataka, India.
Published: January 2024

Disturbances in mineral metabolism are commonly seen in patients with chronic renal failure. But there are very few studies on their prevalence in Indian dialysis population. Aim: To know the prevalence of secondary hyperparathyroidism in patients with stage 5 chronic kidney disease on maintenance hemodialysis. Settings and Design: Hospital based cross sectional study. Methods and Material: This study was done on 85 patients undergoing maintenance hemodialysis for > six months. and data was collected between January 2018 and December 2018, for a period of one year.Patients were examined for clinical features of secondary hyperparathyroidism and serum calcium, phosphorus, alkaline phosphatase, 25 hydroxy vitamin D and intact parathyroid hormone levels were measured. Statistical analysis used: The data was analysed with SPSS using Descriptive statistics, Chi-square testand significance by p value. Results : Various mineral, bone abnormalities in our study population were as follows- hypercalcemia (5.88%), hypocalcemia (36.47%), hyperphosphatemia (30.59%), hypophosphatemia (28.24%), hyperparathyroidism (36.48%), hypoparathyroidism (10.59%), deficiency of vitamin D(52.94%) and insufficiency of vitamin D (20%). Conclusions: Prevalence rate of secondary hyperparathyroidism was 36% in our study and 40% had over suppresion of iPTH levels. One third of our patients had a risk of adynamic bone disease.
Acute Onset Quadriplegia as a Complication of Hepatitis a Infection: A Case Report
Authors:   Senior resident, Department of Emergency Medicines Nizam’s Institute of Medical Sciences Hyderabad, Mayana Noorulla Khan , Nizami Mohammed Ismail ,   Assistant professor, Department of Emergency Medicines Nizam’s Institute of Medical Sciences Hyderabad, Ramineni Kiran Kumar ,   Consultant Neurophysician,Department of Emergency Medicines Yashoda Super Speciality Hospital, Malakpet Hyderabad 500024, India., Verma Kiran Kumar ,   Consultant Emergency Physician and HOD, Department of Emergency Medicines Yashoda Super Speciality Hospital, Malakpet Hyderabad 500024, India.
Published: January 2024

Acute onset quadriplegia is a potentially treatable neurological emergency. Common etiologies include radiculoneuropathies, compressive and non-compressive myelopathies. Spontaneous non traumatic spinal epidural hematoma is a relatively uncommon phenomenon. Here we report an interesting patient who developed coagulopathy related spinal epidural hematoma resulting in acute painful quadriplegia as a complication of hepatitis A infection.
Superior Mesentric Arteryocclusion Presenting as Pain AB Domen
Authors:   Resident, Department of Emergency Medicine, Max Hospital, Shalimar Bagh, New Delhi 110088, India., Acharya Surjeet , Datta Kishalay ,   Director and HOD, Department of Emergency Medicine, Max Hospital, Shalimar Bagh, New Delhi 110088, India., Rawat Anita ,   Senior Consultant, Emergency Medicine,Department of Emergency Medicine, Max Hospital, Shalimar Bagh, New Delhi 110088, India., Verma Pallavi ,   Resident, Department of Emergency Medicine, Max Hospital, Shalimar Bagh, New Delhi 110088, India.
Published: January 2024

Superior mesenteric artery thrombosis (SMA) is a rare but potentially fatal disease. With the rapid increase in imaging modalities for patients with abdominal pain like biphasic CT scan1 and multidetector biphasic CT angiography2. There are two main intervention strategies for treatment of acute superior mesenteric artery occlusion namely endovascular revascularization of superior mesenteric artery and open surgery where the favourable outcome was more with endovascular revascularization therapy when compared to open surgery.
Unusual Presentation of a Covid Patient with MI with Survival after Cardiac Arrest
Authors:   MEM Resident,Max Hospital, Shalimar Bagh, Delhi 110088, India., Verma Pallavi , Datta Kishalay ,   Director & HOD of Emergency Medicine,  Max Hospital, Shalimar Bagh, Delhi 110088, India., Rawat Anita ,   Senior Consultant,Max Hospital, Shalimar Bagh, Delhi 110088, India., Khan Ashar ,   Resident, Emergency Medicine, Max Hospital, Shalimar Bagh, Delhi 110088, India.
Published: January 2024

The novel coronavirus disease (COVID-19) has been declared as a pandemic. With the increasing number of COVID-19 patients, it is necessary to rangeover the factors related to the disease to aid patient management until a definitive vaccine is prepared, As the disease is not limited to the respiratory system alone. COVID-19 has been associated with various cardiac, vascular complications including acute myocardial injury, arrhythmias, myocarditis and venous thromboembolism. It can expand thrombotic complications that ultimately lead to myocardial infarction even in patients without having a history of underlying heart disease.
An Unusual Emergency Department Case: Ruptured Ectopic Pregnancy Presenting as Diarrhoea
Authors:   Senior Specialist,Emergency Medicine, Department of Emergency, Aster RV Hospital, J.P.Nagar, Bengaluru, Karnataka 560078, India., Kasyap K Harish , Soherwardi Mohammed Imran ,   HOD and Consultant, Emergency Medicine, Department of Emergency, Aster RV Hospital, J.P.Nagar, Bengaluru, Karnataka 560078, India.
Published: January 2024

Introduction: Gynecological emergencies often present as acute abdominal pain, however diarrhoea owing to gynecological pathology is rather unusual. Objective: We would like to report a case of diarrhoea developed secondary to ruptured tubal ectopic. Study Design: Case report. Place and time of study: Emergency department Aster RV hospital Banagalore on 13th June 2021. Methodology: The patient presented with diarrhoea as a major symptom and on carrying out relevant investigations, including CT abdomen and pelvis lead to our final diagnosis. Conclusion: Our case report depicts that a typical presentations of ectopic pregnancies are important to recognize as they can gastrointestinal disease. Its recommended that women of reproductive age who present with diarrhoea, vomiting or collapse, be investigated for possible ectopic pregnancy.
Pneumomediastinum: An Early Predictor of Mortality in Paraquat Poisoning: A Rare Case Presentation
Authors:   Emergency Consultant, Ramakrishna Care Hospital, Raipur 492001, Chhattisgarh, India., Dhillon Sonika , Nandy Aishwarya ,   Post Graduate 2nd Year Student, Ramakrishna Care Hospital, Raipur 492001, Chhattisgarh, India., Singh Santosh Kumar ,   Head of the Department, Ramakrishna Care Hospital, Raipur 492001, Chhattisgarh, India., Sofi Rayees Ahmad ,   Specialty Registrar, Department of Emergency Medicine, King Hamad University Hospital Bahrain.
Published: January 2024

Paraquat is a broad spectrum liquid herbicide (1,1'- dimethyl-4,4'- dipyridylium) associated with both accidental and intentional ingestion. It has a very high case fatality rate assuming to be due to inherent toxicity and lack of effective treatments. Poisoning by Paraquat herbicide has been a major medical problem in parts of Asia. Despite widespread availability, reports of Paraquat poisoning is not common due to very high case fatality rate might be due to not reaching to tertiary care centres and non specific clinical features with absence of proper history. Case Presentation: We report a case of previously healthy 19 years old male who was brought to the emergency department 3 days after intentional ingestion of approximately 100ml of 24% Paraquat herbicide with complaints of retrosternal chest pain while breathing & dysphagia followed by several episodes of vomiting followed by the development of pneumomediastinum and death from respiratory failure. Paraquat poisoning should always be considered in the differential diagnosis in patients presenting with spontaneous pneumothorax or pneumomediastinum in places with high paraquat poisoning prevalence. Conclusion: Though Pneumomediastinum being an early predictor of 100% mortality in Paraquat poisoning but an emergency physician should establish the diagnosis early and to pursue aggressive decontamination and prevention of further absorption. Increased awareness of the clinician and availability of the laboratory diagnostic methods will definitely help in successful management of paraquat poisoning and to decrease the case fatality rate. What we already know? There are quite a few case reports that already mentioned about possibilities of occurrence of spontaneous pneumomediastinum, pneumothorax or lung fibrosis along with acute renal failure, liver toxicity and mucosal injury. What this paper adds? This is rare case report of spontaneous pneumomediastinum in Paraquat poisoning presenting to our tertiary care centre. A chest radiograph or a CT chest should be performed which may be useful in early detection of pneumomediastinum, pneumothorax or lung fibrosis for assessing long term damage in survivors. We specifically point towards the fact that no obvious clinical guideline can decrease the case fatality rates in these kind of cases.
An Atypical Presentation of Acute Coronary Syndrome
Authors:   Consultant and Head of the Department, Department of Emergency Medicine, B P Poddar Hospital and Medical Research Pvt. Ltd., New Alipore 700053, Kolkata West Bengal, India, Chakraborty Sudip , Mukherjee Debanjana ,   Postgraduate 1st Year Student,  Department of Emergency Medicine, B P Poddar Hospital and Medical Research Pvt. Ltd., New Alipore 700053, Kolkata West Bengal, India, Goswami Souvik ,   RMO, ICU, Department of Emergency Medicine, B P Poddar Hospital and Medical Research Pvt. Ltd., New Alipore 700053, Kolkata West Bengal, India
Published: January 2024

A 62 year old male patient was presented in ER due to the sudden onset of a precordial chest pain for an hour which aggravated in the last 30 minutes along with vomiting. The patient had no medical co-morbidities as such but had a known case of haemorrhoids and was a chronic smoker. On admission, he was conscious about the time and place and his vitals were HR: 50, BP: 110/70 mm of hg, RR: 20/min, SPO2: 99% (RA), CBG: 163 mg/dl. We could not find any evidence of MI in ECG, or any wall motion abnormality in ECHO but the patient was still complaining of chest pain and diaphoresis even post getting treated with isosorbide dinitrate and ranolazine. So, we took the patient to the Cath lab for a coronary angiography, which revealed LCX proximal 95-99% disease and RCA minor plaque in mid-part and diffuse disease in distal RCA. Primary PCI to LCX was done and treated conservatively. From this particular case, we learnt the significance of coronary angiography in ACS even if there was no significant finding on ECG, ECHO or cardiac enzymes.
A Rare Case of Leech Therapy Induced Right Foot and Leg Cellulitis with Septic Shock
Authors:   Resident, Department of Emergency Medicine, Max Hospital, Shalimar Bagh, New Delhi-110088, India, Srivastava Ritul , Kapoor Aisvarya ,   Attending consultant, Department of Emergency Medicine, Max Hospital, Shalimar Bagh, New Delhi-110088, India, Datta Kishalay ,   Associate Director, Department of Emergency Medicine, Max Hospital, Shalimar Bagh, New Delhi-110088, India
Published: January 2024

A 57 year old female came to emergency department with complaint ofpain and swelling over right foot and leg distally. On local examination there was multiple scar marks with redness and blisters formation. Patient was also giving complaint of discharge from the site since night yesterday. On further examination the patient was conscious and little drowsy but in arousable state. On further evaluation, the patient was hypotensive with tachycardia andtachypnoea. Patient was known case of Arthritis and Hypothyroidism. On further assessment attendants gave history of Leech therapy over right foot and leg distally since 20 days prior coming to emergency department. The leech therapy was started at an Ayurvedic hospital for detoxification from steroid. Patient was on steroids since long time for arthritis and she was told in ayurvedic hospital that leech therapy will detoxify her blood and remove excess steroids from her body. Patient was immediately taken on to symptomatic supportive treatment with intravenous antibiotics, intravenous fluids and ionotropic support. All relevant investigations sent from emergency department and patient was admitted in Intensive Care Unit for observation. Patient was discharged after 5 days in haemodynamically stable condition.
A Rare case of Miller Fisher Syndrome with Ophthalmoplegia with Bulbar Palsy with Bifacial Weakness with Progressive Quadriparesi
Authors:   Resident, Department of Emergency Medicine, Max Hospital, Shalimar Bagh, New Delhi 110088, India, Srivastava Ritul , Govil Priya ,   Senior consultant, Department of Emergency Medicine, Max Hospital, Shalimar Bagh, New Delhi 110088, India, Datta Kishalay ,   Associate Director, Department of Emergency Medicine, Max Hospital, Shalimar Bagh, New Delhi 110088, India.
Published: January 2024

A 20 years old female came to ED with c/o giddiness since 4 days, headache since 3 days with diplopia with slurring of speech, lower limb weakness, difficulty in swallowing, and dropping of left eyelid since 1 day. Patient had no any pre-existing comorbidity and not on any regular medication. Last menstrual period was on 5 days back. On examination Patient was vitally and haemodynamically stable. Diplopia on right sided distant vision present. Venous blood gas samples showed Hyponatremia. On CNS examination the Glasgow coma scale was 15/15 with power in upper and lower limb 5/5 bilaterally. There was no neck stiffness. Gag reflex present. Patient was taken immediately on symptomatic supportive treatment and admitted in Intensive care unit. Patient was planned for contrast enhanced MRI brain, lumbar puncture for CSF study, chest x-ray, ultrasound whole abdomen. Blood samples for complete haemogram and other relevant blood investigations with serum electrolytes sent for further study.
Gravid Uterus in an Anterior Abdominal Wall Hernia and Successful Repair at the Time of Cesarean Section
Authors:   Associate Professor, Department of obstetrics and Gynecology, Vinayaka Missions Medical College (Vinyaka Mission’s Research Foundation-DU, Salem), Keezhakasakudy, Karaikal, Pondicherry 609609, India., K Geetha
Published: January 2024

This is a case report of a pregnant woman with previous 1 cesarean and 1 ectopic exploration whose uterus herniated in an incisional hernia of the anterior abdominal wall at 33 weeks + 6 days of pregnancy. Incarceration of the pregnant uterus in an incisional hernia is a rare but serious obstetric situation1. Treatment is conservative until term followed by delivery and repair of incisional hernia thus resulting in a successful outcome.
Association of Preeclampsia and Thyroid Dysfunction in Pregnant Women and Perinatal Outcome
Authors:   Assistant Professor, Department of Obstetrics and Gynecology/Biostatistics, GSL Medical College and Hospital, Rajahmundry, Andhra Pradesh 533296, India., Yalla Annapoorna , Y Jhansi ,   Senior Resident, Department of Obstetrics and Gynecology/Biostatistics, GSL Medical College and Hospital, Rajahmundry, Andhra Pradesh 533296, India., A Sahithi ,   Senior Resident, Department of Obstetrics and Gynecology/Biostatistics, GSL Medical College and Hospital, Rajahmundry, Andhra Pradesh 533296, India., Swamy C Ganapathi ,   Assistant professor, Department of Obstetrics and Gynecology/Biostatistics, GSL Medical College and Hospital, Rajahmundry, Andhra Pradesh 533296, India.
Published: January 2024

Introduction: In preeclampsia, there is failure of estrogen production due to placental dysfunction resulting in lowering of TBG, TT3, TT4 along with growth retardation of the foetus. It has been shown that individuals with subclinical hypothyroidism have impaired endothelium derived vasodilatation from diminished nitric oxide secretion that is restored after thyroxine (T4) replacement. The present study is proposed to evaluate the association of preeclampsia and thyroid dysfunction in pregnant women and perinatal outcome. Methods: The present study was carried out on pregnant women with preeclampsia admitted to or attending the Outpatient Department of Obstetrics and Gynecology GSL medical college and hospital, between June 1st 2018 to May 31st 2019. Similar number of age & parity-matched normotensive pregnant women served as controls. Battery of investigations focusing on thyroid hormones were performed and both groups were compared in terms of thyroid status, perinatal outcome and complications. Results: Incidence of hypothyroidism is high but mostly subclinical.Women with preeclampsia had higher TT3, TT4 levels as compared to non pregnant women. TSH levels were higher significantly higher in preeclamptic women than normotensive pregnant women. A significant negative correlation was observed between birth weight and TSH levels serum albumin and TSH levels in preeclamptic women. Conclusion: These findings indicate that there is state of hypothyroxinemia in normal pregnancy and in preeclampsia. Identification of changes in thyroid hormones in preeclampsia might be of help in preventing the occurrence of preeclampsia.
Vasa Previa: Review Article
Authors:   Professor and HOD, Department of Obstetrics and Gynecology, Annasaheb Chudaman Patil Memorial Medical College, Dhule, Maharashtra 424002, India., Patil Alka , Badade Bhagyashree ,   Junior Resident, Department of Obstetrics and Gynecology, Annasaheb Chudaman Patil Memorial Medical College, Dhule, Maharashtra 424002, India., Suhas Thavare Sayli ,   Junior Resident, Department of Obstetrics and Gynecology, Annasaheb Chudaman Patil Memorial Medical College, Dhule, Maharashtra 424002, India.
Published: January 2024

The umbilical cord is the fetal lifeline and is the vital link between the fetus and placenta. Various abnormalities are observed in morphology and pathology of placenta. Variations in umbilical morphometry leads to neonatal morbidity and mortality. Vasa previa is one of the insertion anomaly of umbilical cord. Antenatal diagnosis is possible using ultrasonography. Diagnosis of vasa previa should be confirmed with colour or power doppler demonstrating pulsatile flow with fetal vascular waveform pattern. Vasa previa is one of the rare cause of antepartum haemorrhage. What differentiates vasa previa from other etiological factors of antepartum haemorrhage is that bleeding is of fetal origin. Although a rare anomaly, Vasa previa has significant mortality rates and therefore should always be looked for with great precision in antenatal ultrasonography.