Indian Journal of Medical Specialities最新文献

{"title":"Prevalence and antibiotic resistance of ESKAPE pathogens isolated from patients with bacteremia in Tehran, Iran","authors":"M. Ghorbani, A. Emamie, Pouria Zolfaghari, Atefeh Zarei","doi":"10.4103/injms.injms_12_23","DOIUrl":"https://doi.org/10.4103/injms.injms_12_23","url":null,"abstract":"Introduction: The ESKAPE acronym refers to a group of deadly hospital-acquired pathogens, including Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp. These organisms can evade antibacterial drugs and pose a significant threat to public health. This study investigated the prevalence and antimicrobial resistance of ESKAPE pathogens in patients with bacteremia. Methods: We collected 412 blood samples from patients diagnosed with bacteremia. The ESKAPE isolates were subjected to multidrug-resistant (MDR), extensively drug-resistant (XDR), extended-spectrum beta-lactamase (ESBL), metallo-β-lactamase (MBL), methicillin-resistant S. aureus (MRSA), and vancomycin-resistant Enterococcus (VRE) by the disk diffusion and E-test methods. In the case of VRE, molecular detection was done for vanA and vanB genes. Results: A total of 270 ESKAPE isolates were identified. The frequency of S. aureus was 30%, A. baumannii 22%, P. aeruginosa 17%, K. pneumoniae 13%, E. aerogenes 10.3%, and E. faecium 7.7%. MRSA was 71% and VRE was 19%. ESBL- and MBL-producing strains of A. baumannii were found to account for 39%, P. aeruginosa for 35.7% and 28.2%, and K. pneumoniae for 25.7% and 17.1%. In total, MDR and XDR were present in 52.2% and 15.5% of isolates and were most prevalent in E. aerogenes, A. baumannii, and P. aeruginosa. The vanA gene was detected in all 19% of E. faecium isolates that were VRE. Conclusions: Antibiotic resistance is widespread among ESKAPE pathogens, particularly in patients with bacteremia. Health-care professionals must consider the increasing rates of antibiotic resistance among ESKAPE pathogens and implement new measures to control infections.","PeriodicalId":43811,"journal":{"name":"Indian Journal of Medical Specialities","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70771903","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":"Lower gastrointestinal bleeding in children: Clinical profile and outcome","authors":"M. Narang, Narender Kumar, A. Aggarwal, Nitasha Sharma","doi":"10.4103/injms.injms_144_22","DOIUrl":"https://doi.org/10.4103/injms.injms_144_22","url":null,"abstract":"Background: Bleeding per rectum is a fairly common clinical problem in children. Gastrointestinal infections, anal fissures, and polyps are the most common causes. However, many cases remain undiagnosed due to the nonavailability of diagnostic modalities. This prospective hospital-based study was designed to study clinical profiles and outcomes in children with lower gastrointestinal bleeding. Materials and Methods: Fifty-six children (1–12 years) presenting with bleeding per rectum were enrolled in the study. History and detailed examination were recorded. Investigations were done on basis of the clinical scenario. Children with bleeding per rectum were analyzed for demographic profile, clinical presentation, etiology, diagnostic investigations, and outcome in bleeding per rectum. Results and Observations: Anal fissure (67.3%) was the most common cause followed by colorectal polyp (16.4%), nonspecific colitis (7.3%), invasive amoebiasis (1.8%), intussusception (1.8%), and rectal mucosal prolapse (1.8%). Colonoscopy was diagnostic in 73% of children. Conclusion: Anal fissures and colorectal polyps are the most common noninfective cause of bleeding per rectum. Undiagnosed chronic cases of bleeding per rectum can result in complications such as anemia and malnutrition. The availability of diagnostic modalities can help in early diagnosis and treatment for better outcomes.","PeriodicalId":43811,"journal":{"name":"Indian Journal of Medical Specialities","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45845832","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":"Gingival hypertrophy in acute promyelocytic leukemia – A rare clinical encounter","authors":"Arpit Shastri, A. Rohatgi, S. Shukla, Roopali Dahiya, Aman Panchal, Divita Rohatgi","doi":"10.4103/injms.injms_26_23","DOIUrl":"https://doi.org/10.4103/injms.injms_26_23","url":null,"abstract":"Acute promyelocytic leukemia (APL) is a subtype of acute myeloid leukemia (AML), a cancer of the white blood cells. Its common manifestations are fatigue, fever, coagulopathy, anorexia, and pancytopenia. Oral manifestations are identified in huge majority of patients with AML of which gingival hypertrophy is more specific to acute monocytic (M5) and acute myelomonocytic (M4) subtypes of AML. Very rarely, gingival hypertrophy may be encountered in patients with APL. Herein, we present a case of a young male who presented with gingival hypertrophy and was subsequently diagnosed with APL (M3).","PeriodicalId":43811,"journal":{"name":"Indian Journal of Medical Specialities","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47820519","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":"Awake fiberoptic intubation: The first mandatory choice of difficult airway – A report of two cases","authors":"T. Prasad, C. Kumar, Abinaya Devi, SVijay Narayanan","doi":"10.4103/injms.injms_6_23","DOIUrl":"https://doi.org/10.4103/injms.injms_6_23","url":null,"abstract":"We may have many devices in this 21st century, which can be used to secure the airway in patients who have been predicted to have a difficult airway. There are many studies about difficult airways and suggested various devices such as flexible fiberoptic scope, video laryngoscope, and the specialized intubating laryngeal mask airway and they ended up concluding one device better than another. Furthermore, ET intubation requires continued practice and carries with it its own set of complications. Technical problems with the placement of endotracheal tubes have been the most frequent cause of anesthetic deaths in published analyses from all over the world. The basic responsibility of an anesthesiologist is to maintain adequate gas exchange in patients by securing a patent airway through a proper device. Fiberoptic bronchoscopy and intubation have the advantage of being easier, with shorter intubation time and continuous oxygenation and ventilation throughout the procedure, especially in the case of children. We report two such cases, where “Awake flexible fiberoptic-guided intubation” was considered the only desirable choice.","PeriodicalId":43811,"journal":{"name":"Indian Journal of Medical Specialities","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46761155","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 medication adherence in chronic kidney disease patients with and without hemodialysis","authors":"Amra Ahsan, Shaurya Kaul, NarinderPal Singh, Dinesh Khullar, AnishKumar Gupta","doi":"10.4103/injms.injms_46_23","DOIUrl":"https://doi.org/10.4103/injms.injms_46_23","url":null,"abstract":"Background: Poor long-term adherence and persistence to pharmacological therapy is widely acknowledged as one of the primary clinical difficulties in the management of chronic diseases such as chronic kidney disease (CKD). The present study was aimed to measure treatment adherence using the Morisky Medication Adherence Scale (MMAS)-8 questionnaire in CKD patients with or without hemodialysis. Methodology: It was a cross-sectional study conducted in 120 clinically stable CKD patients with Stage 3 onward with or without hemodialysis. The sociodemographic and clinical characteristics of participants were collected in a predesigned format. Individual participants were scheduled for interviews and asked to complete inventory questionnaires. Medication adherence was assessed using a validated diagnostic tool MMAS-8 questionnaire. Results: Out of 120 individuals, the average number of medicines prescribed per prescription was 5.63 ± 2.22 and 4.65 ± 1.72 in the dialysis and nondialysis groups, respectively. Patients on dialysis had a higher pill burden than nondialysis patients, with more than three-fourths (78.3%) of them taking more than five medications every prescription. Low, moderate, and good adherence were reported in 61.7% (n = 37) versus 26.7% (n = 16), 33.3% (n = 20) versus 71.7% (n = 43), and 5% (n = 3) versus 1.6% (n = 1) of patients with and without dialysis, respectively, in MMAS-8. The most often reported nonadherence behaviors were forgetting to take medications, forgetting to pack medications while traveling, and feeling pressured to follow a treatment plan. There was an association between the dialysis and nondialysis groups in education level, employment, and pill load among patients with low adherence. Conclusion: Majority of the respondents (more than 90%) reported low-to-moderate adherence in both dialysis and nondialysis populations. Physicians and all other health-care professionals should work together to reduce the obstacles to good adherence by enhancing communication, reducing the burden of taking a lot of pills, and, if possible, by occasionally checking on patient adherence when there is suspicion of poor adherence.","PeriodicalId":43811,"journal":{"name":"Indian Journal of Medical Specialities","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135844887","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":"Neglected locally advanced breast cancer: Ignorance is a curse","authors":"Mayank Tripathi, AvadheshKumar Yadav, RajendraKumar Sahu, GJ Pavithira","doi":"10.4103/injms.injms_31_23","DOIUrl":"https://doi.org/10.4103/injms.injms_31_23","url":null,"abstract":"Breast cancer is the most common cancer worldwide. As per GLOBOCAN 2020, female breast cancer is the most commonly diagnosed cancer (11.7% of total cases). In India, like any other cancer, breast cancer patients present late to the clinic with more than 60% presenting in Stage 3rd and 4th, of these 25% of locally advanced breast cancers develop a fungating breast lesion causing significant distress for the patient, physically, mentally, as well as socially. The subset of patients with locally advanced fungating mass poses a big challenge to the treating surgeon. In this case report, a locally advanced fungating breast cancer weighing 7.5 kg was removed by surgery.","PeriodicalId":43811,"journal":{"name":"Indian Journal of Medical Specialities","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135844888","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":"Understanding the challenges of providing holistic nursing care for persons with diabetes: A Nigerian perspective","authors":"Olaolorunpo Olorunfemi","doi":"10.4103/injms.injms_15_23","DOIUrl":"https://doi.org/10.4103/injms.injms_15_23","url":null,"abstract":"The aim of this research is to explain the current level of nursing care for people with diabetes in Nigeria, as well as the numerous challenges involved in providing appropriate nursing care. The main issue discovered was a lack of specialized diabetes nursing education, which should serve as the foundation for nurses working in endocrinology settings. Other issues include insufficient diabetes nursing care facilities and a lack of dedicated diabetes centers, which forces diabetes patients to be, managed in general wards. It is therefore recommended that a strong framework be put in place, such as the establishment of diabetes training schools and the development and strengthening of the nursing curriculum, which has a high potential for improving nurses’ knowledge and abilities to care for people with diabetes in Nigeria.","PeriodicalId":43811,"journal":{"name":"Indian Journal of Medical Specialities","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135845189","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 serum zinc levels in type 2 diabetes mellitus patients and its correlation with glycosylated hemoglobin and overt diabetic complications","authors":"RahulDilip Bhiwgade, ShobhanaAmol Bitey, Amol Bitey, SurajRamesh Hiwarkar","doi":"10.4103/injms.injms_22_23","DOIUrl":"https://doi.org/10.4103/injms.injms_22_23","url":null,"abstract":"Background: Diabetes mellitus is the most prevalent disease in worldwide. It is characterized by hyperglycemia, insulin resistance, and relative insulin deficiency. The goal of this study is to estimate serum zinc levels in type 2 diabetes mellitus patients and correlation between serum zinc levels, glycosylated hemoglobin (HbA1c) levels, and complications in type 2 diabetes patients. Aims and Objectives: To estimate serum zinc levels in patients with type 2 diabetes mellitus, study correlation between serum zinc levels and HbA1c levels, and compare serum zinc levels, HbA1c, and overt diabetic complications. Materials and Methods: This prospective observational study was conducted in a tertiary center. Diagnosed 100 cases of type 2 diabetes mellitus were taken and detailed examination was done. Serum zinc levels were estimated by absorption spectrophotometry, and HbA1c levels were estimated using high-performance liquid chromatography method. Statistical software STATA version 14.0 was used for data analysis. Results: The mean age of the patients was 49.6 ± 11.18 years with a male: female ratio of 2.1:1. Mean serum zinc levels in males with macrovascular complications were 43.65 ± 14.55 μg/dl, significantly lower than the mean serum zinc levels in females 67.31 ± 18.84 μg/dl, P < 0.0001. Serum zinc levels were low in patients with microvascular complications and macrovascular complications, which were statistically significant P < 0.0001 and an inverse correlation was observed between HbA1c levels and serum zinc levels (r = −0.4456, P < 0.0001). Conclusion: Low serum zinc levels associated with micro- and macrovascular complications of diabetes mellitus. This study revealed an inverse relationship between HbA1c and serum zinc concentration in type 2 diabetes mellitus patients.","PeriodicalId":43811,"journal":{"name":"Indian Journal of Medical Specialities","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135845191","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":"The dark areas of esophagus: Esophageal melanocytosis","authors":"T. Afroz, S. Radha, B. Reddy, Mohammed Amaan","doi":"10.4103/injms.injms_120_22","DOIUrl":"https://doi.org/10.4103/injms.injms_120_22","url":null,"abstract":"Esophageal melanocytosis characterized by melanocytic proliferation in the epithelium of esophagus is extremely rare disease. Aberrant migration of melanocytes during embryogenesis occurs in a small number of cases. Hence, the occurrence of benign and malignant melanocytic lesions is now known entities in esophagus. Melanocytosis is a benign entity and is very rare with an incidence of 0.07%–2.1%. The etiology of these lesions is not known. Endoscopic, histologic, and staining characteristics of two lesions are described. These cases were diagnosed from 450 endoscopic biopsies studied over a period of 10 months.","PeriodicalId":43811,"journal":{"name":"Indian Journal of Medical Specialities","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46619678","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":"Dolichoectasia of the left internal carotid artery with unilateral agenesis of the right internal carotid artery","authors":"MansoorC Abdulla","doi":"10.4103/injms.injms_97_23","DOIUrl":"https://doi.org/10.4103/injms.injms_97_23","url":null,"abstract":"Dear Editor, Intracranial dolichoectasia (DE) is a rare arteriopathy characterized by dilation and tortuosity of the intracranial arteries. DE could be detected incidentally or can be associated with neurological complications. Unilateral agenesis of the internal carotid artery (ICA) with intercavernous anastomosis is a rare congenital anomaly. We present a patient with DE of the left ICA with agenesis of the right ICA, which was not reported previously. A 53-year-old female presented to us with a holocranial headache for 1 month. The headache was insidious in onset, moderately severe and was not associated with other neurological symptoms. She had hypertension and diabetes for the past 6 years. She was also receiving thyroxine supplementation for hypothyroidism. She had no addictions. Examination was normal except for high blood pressure. Biochemical parameters were normal. Electrocardiogram showed left ventricular hypertrophy. Computed tomography of the brain showed absent bony carotid canal on the right side. Magnetic resonance imaging of the brain with contrast showed scattered nonenhancing hyperintensities in bilateral frontoparietal white matter (small-vessel ischemic changes), DE of the left ICA and left vertebral arteries and absent flow voids of right ICA [Figures 1a and b].Figure 1: Magnetic resonance imaging of the brain with contrast showing dolichoectasia of the left internal carotid artery and left vertebral arteries (1 a marked with arrow) and absent flow voids of right ICA (1 b marked with arrow)DE is common in the vertebrobasilar system but can affect the vertebrobasilar system and anterior circulation simultaneously.[1] The prevalence of vertebrobasilar DE ranges from 7.6% to 18.8% in patients with stroke, and 1.3% to 4.4% in the general population.[2] DE is commonly seen in patients with advanced cerebral atherosclerosis and arterial hypertension. Besides atherosclerosis and hypertension, multiple pathophysiological processes, including inherited, inflammatory, and infectious, might contribute to its development.[2] Histological studies support the hypothesis of underlying degeneration of the internal elastic lamina and thinning of the media secondary to smooth muscle atrophy. Most cases are asymptomatic, but symptoms can occur as a result of compression on cranial nerves or brain stem, obstructive hydrocephalus, and ischemia. Emboli from the thrombi or fragments of plaques in the walls of the enlarged arterial segment causes ischemia. Rarely intracranial hemorrhages due to dissection of the ectatic artery, rupture of associated aneurysm, or rupture of stretched perforating arteries can be seen. However, this arteriopathy is frequently found in the absence of an apparent cause. Most patients with DE are asymptomatic but may have clinical manifestations secondary to compression, rupture, or ischemia. Agenesis of ICA is a rare anomaly with male predominance.[3] Absent ICA flow void on MRI and absence of bony carotid canal on rout","PeriodicalId":43811,"journal":{"name":"Indian Journal of Medical Specialities","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135844877","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}