Apollo Medicine最新文献

{"title":"Multimorbidity and pattern of diseases in elderly patients attending the geriatric outdoor department: A cross-sectional study from Western India","authors":"K. Mehta, Varsha Y. Godbole, Meenakshi Shah, Irfan Nagori, Rikin Raj, Tejas Patel","doi":"10.4103/am.am_47_23","DOIUrl":"https://doi.org/10.4103/am.am_47_23","url":null,"abstract":"Background: The geriatric population has been increasing in developing countries like India. There are fewer studies on multimorbidity in geriatric populations from low- and middle-income countries including India. Objectives: This study was conducted to assess the multimorbidity and pattern of diseases in patients attending a geriatric clinic. Materials and Methods: This cross-sectional study was conducted in a tertiary care hospital in western India among 300 geriatric patients (age ≥65 years) attending geriatric clinics in 2018. The presence of multimorbidity was defined as the coexistence of two or more chronic conditions. The 10-year survival was estimated using Charlson's Comorbidity Index. Data were entered in a Microsoft Excel worksheet and analyzed using EpiData Software version 2.8.3. Results: Out of the total 300 patients, 102 (34%) had single morbidity, whereas 198 (66%) suffered from multimorbidity. The most frequent chronic diseases in all patients were hypertension (63.33%), mental diseases (35.66%), diabetes mellitus (25.66%), chronic obstructive pulmonary disease (COPD) (18.66%), and coronary artery disease (CAD) (18.33%). The common prevalent chronic disease pairs were mental and neurological diseases in 107 (35.6%) patients, hypertension and diabetes mellitus in 57 (19%), hypertension and CAD in 38 (12.6%), and hypertension and COPD in 15 (5%) patients. Most of the patients had a Charlson's Comorbidity Index of 3 with a predicted 10-year survival rate of 77%. Conclusion: Sixty-six percent of our cohort was multimorbid. Hypertension was the most common chronic disease while CAD had the highest relative risk for multimorbidity. The most common comorbid pair was mental and neurological disorders.","PeriodicalId":34670,"journal":{"name":"Apollo Medicine","volume":"1 1","pages":"314 - 319"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70667599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Wolf in Sheep’s Clothing – A Rare Case of an Angiosarcoma Arising from a Schwannoma in the Posterior Mediastinum: A Case Report","authors":"Sheba S. K. Jacob, Dillip Mishra","doi":"10.4103/am.am_168_23","DOIUrl":"https://doi.org/10.4103/am.am_168_23","url":null,"abstract":"Introduction: Schwannoma is one of the benign tumors occurring in the posterior mediastinum. However, angiosarcoma is a malignant tumor of vascular origin and presents as an infiltrating mass. Primary angiosarcoma of the mediastinum is very rare. Few cases have been reported in the atrium, pulmonary vein, and lung and present with chest pain. Angiosarcoma arising from a benign tumor like a schwannoma is very rare; only a handful of cases have been reported in the literature. This case is presented for its rarity and awareness that even a schwannoma presenting as well-circumscribed mediastinal mass can harbor a life-threatening malignancy. Case Report: A 51-year-old male presented with chest pain, and on investigation, there was an extrapulmonary and posterior mediastinal mass in the left paravertebral region with a benign appearance and his serum tumor markers were normal. However, a needle biopsy showed evidence of an angiosarcoma. Hence, with these contradicting results, a surgical exploration was done and since it was well delineated was excised completely. Grossly, it was a well-circumscribed mass measuring 12.5 cm × 9.5 cm × 6.5 cm with a variegated appearance with pale–yellow and hemorrhagic areas. A diagnosis of an epithelioid angiosarcoma arising from a schwannoma was made by light microscopic and immunohistochemical findings. Conclusion: Epithelioid angiosarcoma is a rare malignant transformation occurring in a schwannoma. It can also have a deceptively benign appearance as in our case, and in any symptomatic long-standing posterior mediastinal schwannoma, this differential should be kept in mind when planning surgery and further treatment.","PeriodicalId":34670,"journal":{"name":"Apollo Medicine","volume":"110 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135706122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of cognitive function in patients with type 2 diabetes mellitus: Comparison with age-matched controls: A prospective study","authors":"S. Sood, Dhruv R Patel, RichaM Patel, V. Arya, RushinS Shah","doi":"10.4103/am.am_52_23","DOIUrl":"https://doi.org/10.4103/am.am_52_23","url":null,"abstract":"Introduction: A relative deficiency in insulin production, chronic hyperglycemia, abnormalities in carbohydrate and lipid metabolism, and insulin resistance are all the symptoms of type 2 diabetes mellitus (T2DM). The brain is one of many organ systems that is negatively impacted, increasing the likelihood of cognitive decline. Aim: Evaluation of cognitive functions in patients with T2DM and comparison with aged-matched controls. Methodology: Fifty T2DM patients as well as 50 age-matched controls were subjected to Adden Brooke's Cognitive Examination (ACE-III). The examination assesses attention, orientation, memory, language, fluency, visual perception, and visuospatial skills. It comprises tests of memory (7-item analysis), letter fluency, clock drawing, and memory recall. The optimal ACE-III cutoff scores to detect mild cognitive impairment and dementia are 88/89 (sensitivity 0.77 and specificity 0.92) and 75/76 (sensitivity 0.82 and specificity 0.90), respectively. The comparison of scores of patients and controls was done using the appropriate statistical tests (SPSS version 25). Statistical Analysis Used: Unpaired t-test, Chi-square test, and Pearson correlation coefficient test. Results: The mean ± standard deviation ACE-III scores of T2DM patients and controls were 81.48 ± 12.426 and 86.2 ± 10.447, respectively; the difference between them was not statistically significant. There was a decrease in attention, memory, fluency, and visuospatial ability in cases as compared to controls, but the difference was not statistically significant. Dementia was observed in 30% of cases and 20% of controls. Mild cognitive impairment was similar in both groups. Weak association was seen between the number of drugs prescribed and duration of disease with ACE-III scores. Conclusion: We find a negative association of cognitive function and T2DM.","PeriodicalId":34670,"journal":{"name":"Apollo Medicine","volume":"17 1","pages":"329 - 335"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70667697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum amylase as a prognostic factor in diabetic ketoacidosis","authors":"U. Singh, D. Malviya, Keshav Singh, DhirajKumar Soni, DheerendraKumar Mishra","doi":"10.4103/am.am_54_23","DOIUrl":"https://doi.org/10.4103/am.am_54_23","url":null,"abstract":"Objective: The study's objectives were to learn about the impact of serum amylase levels on morbidity and mortality of diabetic ketoacidosis (DKA) patients. Methodology: This is a single-center cross-sectional study of 100 patients admitted to the Medicine Intensive Care Unit at Shyam Shah Medical College and SGM Hospital Rewa between January 2021 and June 2022. Results: Mean duration of hospital stay in DKA patients with serum amylase level <140 U/L was 10.56± 5.04 days while DKA patients with serum amylase level ≥140 U/L was 23.75 + 1.66 Days. The mean amylase level in death cases of DKA was 198.32 IU/L and in recovered cases of DKA was 87.22 IU/L. Conclusion: In our study, we discovered that as serum amylase levels rise so does the length of hospital stay. Amylase levels were extremely high in death cases.","PeriodicalId":34670,"journal":{"name":"Apollo Medicine","volume":"1 1","pages":"326 - 328"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70667880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dorsal dermal sinus with intramedullary epidermoid cyst in a toddler: A tiny clue to underlying major neurological condition","authors":"ThirunavukkarasuArun Babu, P. Balakrishnan","doi":"10.4103/am.am_74_23","DOIUrl":"https://doi.org/10.4103/am.am_74_23","url":null,"abstract":"Background: Skin dimples at specific sites of the body at birth are a clue to underlying congenital malformation and intimate the need for extensive evaluation. A midline dimple in the spinal region may be a sign of occult spinal dysraphism in a neonate. Methods: A toddler presented with clinical symptoms and signs of acute paraparesis. The child also had thoracic dermal sinus on clinical examination. The child was evaluated with hematological and radiological investigations to diagnose the cause of acute paraparesis. Results: Hematological investigations were normal. Magnetic resonance imaging of the spine showed an intramedullary epidermoid cyst at the D1 vertebral level to D4 vertebral level with dorsal dermal sinus at the D3 vertebral level. Conclusion: We are reporting this case to insist on clinical examination of all neonates for skin dimples and detailed evaluation of neonates with suspicious skin dimples to prevent future neurological disability. A clinically significant skin dimple implies impending neurological problems in a patient.","PeriodicalId":34670,"journal":{"name":"Apollo Medicine","volume":"1 1","pages":"55 - 57"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70668751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surging Mupirocin Resistance in Staphylococci – Does It Warrant Routine Testing?","authors":"Poongodi Santhana Kumarasamy, Nagalakshmi Ranjan, Aparnna Vaikundam Subramanian","doi":"10.4103/am.am_176_23","DOIUrl":"https://doi.org/10.4103/am.am_176_23","url":null,"abstract":"Sir, The nose and extranasal sites are mostly colonized by Staphylococcus aureus. It has been proposed that about 30% of colonizers eventually develop infection.[1] Decolonization with mupirocin is recommended for colonized individuals and is being treated with nasal topical application 4 times daily for 5 days.[2] Pharmacological concentration of the drug used for the treatment leads to persistence of low-level drug being concentrated in pharynx and may initiate emergence of resistance.[3] Mupirocin resistance appears to be increasing worldwide, which ranges from 1% to 45%. This study was done to analyze the rates of mupirocin resistance among Staphylococcus isolates. In this study, a total of 100 nonduplicate staphylococcal isolates from different clinical samples collected from inpatients (84 pus, 8 sputum, 7 urine, and 1 tissue) were identified by standard microbiological techniques. Antibiotic susceptibility testing was done by Kirby–Bauer’s disk diffusion method as per the CLSI guidelines. Quality control strain used was S. arueus ATCC 25923. Low-level (MuL) and high-level resistance (MuH) were detected, respectively, by 5 μg and 200 μg mupirocin disks. Sensitivity and specificity with 5 μg was 100% and 98.1%, and for 200 μg, it was 100% and 92.3%, respectively.[4] Currently, there are no CLSI guidelines for outlining interpretive criteria for mupirocin. Studies defined the interpretative criteria are the following:[5] A zone diameter of >14 mm for both 5 μg and 200 μg disks was considered to be susceptible for mupirocin A zone diameter of <14 mm in the 5 μg disk but >14 mm in the 200 μg disk was considered to be MuL strains A zone diameter of <14 mm for both 5 μg and 200 μg was considered to be MuH strains. Among these 100 isolates, MuL was detected in 14% and MuH in 5%. Mupirocin resistance was noted as 38% and 5% among methicillin-sensitive S. aureus (MSSA) and methicillin-resistant S. aureus (MRSA) isolates, respectively [Table 1 and Figures 1, 2]. All staphylococcal isolates were sensitive to netilmicin and linezolid. Erythromycin-induced clindamycin resistance was noted in 16% of staphylococcal isolates. Multidrug resistance was observed in 65% of isolates and 19% showed mupirocin resistance.Table 1: Distribution of mupirocin resistance among StaphylococciFigure 1: Antibiogram showing sensitive zone for Mup 200 µg and resistance for Mup 5 µgFigure 2: Antibiogram showing resistance for Mup 200 µg and 5 µgOommen et al. noted MuH among 7% of staphylococcal isolates, which correlates with our study.[6] MuH is mediated through plasmid, whereas MuL is mediated through chromosomes rather than plasmid. Mupirocin resistance may also aid in the spread of multidrug resistance through coselection with other resistance genes. Mupirocin susceptibility is not being tested routinely in clinical care practice because MuH has been reported to be relatively rare, ranging from 1% to 5% of MRSA isolates.[7] A study by Rudresh et al. reported 26% of the MS","PeriodicalId":34670,"journal":{"name":"Apollo Medicine","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135705978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antiplatelets in acute management and prevention of transient ischemic attack and stroke","authors":"Vinit Suri, K. Suri, Kunal Suri","doi":"10.4103/am.am_124_22","DOIUrl":"https://doi.org/10.4103/am.am_124_22","url":null,"abstract":"Introduction: Antiplatelet drugs (AD) reversibly or irreversibly inhibit activation and platelet aggregation and hence inhibit genesis of thrombus. Methods: In this article, we review the administration of AD in acute stroke management as well as in the primary and secondary prevention of stroke and transient ischemic attack (TIA). Conclusions: For primary stroke prevention of the first ever stroke, aspirin is advised only when a 10-year vascular risk is more than 10%, patient has a likely survival of >10 years and has a low risk for hemorrhage. For patients with acute ischemic stroke (AIS) or TIA administration of aspirin is strongly recommended within 24–48 h of symptom onset. For patients managed with IV thrombolysis, aspirin administration should be deferred for 24 h. For patients with recent minor non cardioembolic AIS and a National Institutes of Health Stroke Scale (NIHSS) score ≤3 or patients with a high-risk TIA with ABCD2 score ≥4, dual Antiplatelet therapy with aspirin and clopidogrel should be started within 12–24 h of stroke or TIA onset and definitely within a week of onset and then should be continued for a period of 21–90 days, followed by switching to a single antiplatelet therapy. The US Food and Drug Administration has given approval for Ticagrelor usage to prevent the risk of for stroke recurrence in patients with AIS with a NIHSS score of ≤5 or high-risk TIA where ticagrelor – Aspirin combination maybe prescribed for 30 days. For patients who are carriers of CYP2C19 a 90-day ticagrelor – Aspirin offers better stroke prevention. ADs in dual combination for short term and single agent in the long term remain the dominant therapy for prevention of non-cardioembolic ischemic stroke.","PeriodicalId":34670,"journal":{"name":"Apollo Medicine","volume":"1 1","pages":"365 - 370"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70664007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sociodemographic profile of animal bite cases attending at a tertiary care center, Rewa (M.P.)","authors":"UmeshPratap Singh, D. Malviya, DheerendraKumar Mishra, Meghnath Pawar, A. Gupta","doi":"10.4103/am.am_34_23","DOIUrl":"https://doi.org/10.4103/am.am_34_23","url":null,"abstract":"Objective: The study's objectives were to learn about the sociodemographic profile of animal bite cases in Madhya Pradesh's Vindhya region while attending the Medicine Outpatient Department (OPD) at Shyam Shah Medical College in Rewa (M. P.). Materials and Methods: Between January 1, 2018, and December 31, 2018, this study was conducted in the Medicine OPD, Department of Medicine, at Shyam Shah Medical College in Rewa, Madhya Pradesh, India. A cross-sectional study was conducted. A total of 1440 cases of animal bites were included in the sample, and for each patient, a sociodemographic profile was obtained along with a comprehensive history of the animal's category and type, bite type and site, duration of exposure, and category of exposure. Results: The majority of the 1440 animal bite cases were bitten by dogs 1198 (76.94%). There are 763 (52.98%) Category II bites, 605 (42.01%) Category III bites, and 72 (5%) Category I bite. Lower limbs were bitten 914 (63.47%), upper limbs 389 (27.01%), head and neck 67 (4.65%), and trunk 70 (4.86%). Conclusion: This study found that rural areas have a high number of dog bite cases, and adult males have a higher incidence of animal bites than adult females. The most common biting animal is the dog, and the most common site of bite in adults is the lower limbs.","PeriodicalId":34670,"journal":{"name":"Apollo Medicine","volume":"1 1","pages":"351 - 353"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70666373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Follow-up of 29 years of renal transplant – A case report","authors":"Himleena Gautam, Tonmoy Das, A. Das, S. Choudhury","doi":"10.4103/am.am_33_23","DOIUrl":"https://doi.org/10.4103/am.am_33_23","url":null,"abstract":"Introduction: With the increasing longevity of renal transplant patients, the long-term morbidities of these patients have also increased. Thus, a multidisciplinary team is needed to follow-up on these cases and adequately detect and manage the complications. Furthermore, pregnancy rates have increased in this set of patients. Case Report: In this report, we discuss briefly the posttransplant period of a female patient who had spontaneous conception with two live births and had complications such as recurrent tuberculosis, skin cancers, and chronic diarrhea. However, the patient is leading an active life even after 29 years posttransplant. Conclusion: Pregnancy is less reported in renal transplant patients, but it needs a multidisciplinary approach to the management. Furthermore, early detection and management of posttransplant complications are of utmost importance and needs extreme vigilance and care.","PeriodicalId":34670,"journal":{"name":"Apollo Medicine","volume":"1 1","pages":"52 - 54"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70666481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clear Cell Hidradenoma with Extensive Mucinous Change in the Axillary Tail of Breast as Mimicker: A Rare Case Report","authors":"Ramya Yethadka, Ranjitha Vodigenahalli Nagaraj","doi":"10.4103/am.am_173_23","DOIUrl":"https://doi.org/10.4103/am.am_173_23","url":null,"abstract":"Introduction: Clear cell hidradenoma (CCH) is a rare benign tumor of sweat gland. It can mimic other diseases clinically, radiologically and histologically when found in axilla. Methods: A 62-year-old female presented with a solitary lump in the axillary tail of her breast. Differentials in clinical examination and imaging were breast neoplasm and lymph nodal mass. Results: The patient underwent preoperative diagnostic workup, and the lesion was suspicious of hidradenoma. She underwent wide excision of the lesion. The final histopathological examination was suggestive of CCH with extensive mucinous change. Conclusion: Even though rare, hidradenoma should always be kept as a differential when presented as a solitary painless swelling. The present case represents diagnostic challenges involved during the course of her management and accurate use of preoperative tools, which helped in the diagnosis of the case before the definitive treatment.","PeriodicalId":34670,"journal":{"name":"Apollo Medicine","volume":"148 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135706319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}