Advances in internal medicine最新文献_第8页

Wellens’ Syndrome, a case report of an electrocardiographic warning sign 韦伦斯综合征一例心电图警告信号

Advances in internal medicine Pub Date : 2017-03-30 DOI: 10.3126/JAIM.V5I1.17067

Y. Sedhai, A. Pawar, Priyanka T. Bhattacharya, S. Basnyat

{"title":"Wellens’ Syndrome, a case report of an electrocardiographic warning sign","authors":"Y. Sedhai, A. Pawar, Priyanka T. Bhattacharya, S. Basnyat","doi":"10.3126/JAIM.V5I1.17067","DOIUrl":"https://doi.org/10.3126/JAIM.V5I1.17067","url":null,"abstract":"Introduction Wellens’ syndrome is described as a characteristic biphasic or symmetrical electrocardiographic T-wave inversions in precordial leads seen in a subset of patients with unstable angina. It is associated with critical stenosis of left anterior descending coronary artery. These patients have a high likelihood of progressing to acute myocardial infarction within a few days to weeks of onset of symptoms, thus it warrants an early invasive approach. Case Presentation: We present a 33-year-old otherwise healthy Indo-Jamaican male who presented with chest pain and characteristic electrocardiographic changes. Wellens’ syndrome was recognized. Emergent coronary angiography revealed 99% stenosis of proximal left anterior descending coronary artery. It was treated with a drug eluting stent. Conclusion: Electrocardiographic changes in Wellens’ syndrome are subtle and characteristically appear during chest pain free interval. It can be easily overlooked as non-specific ST, T wave change. Clinicians should be well aware of this subtle yet alarming electrocardiographic sign. This case report underlines the importance of recognizing the ominous electrocardiographic sign and its association with critical stenosis of the left anterior descending coronary artery. Journal of Advances in Internal Medicine 2016;05(01):19-23","PeriodicalId":75443,"journal":{"name":"Advances in internal medicine","volume":"5 1","pages":"19-23"},"PeriodicalIF":0.0,"publicationDate":"2017-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3126/JAIM.V5I1.17067","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46905342","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}

引用次数: 2

Unani Treatment Improved Fibrosis in Decompensated Cirrhosis of Liver: A Case Series Unani治疗改善失代偿性肝硬化的纤维化:一个病例系列

Advances in internal medicine Pub Date : 2017-03-05 DOI: 10.3126/JAIM.V4I2.16898

M. Siddiqui, S. Ansari

{"title":"Unani Treatment Improved Fibrosis in Decompensated Cirrhosis of Liver: A Case Series","authors":"M. Siddiqui, S. Ansari","doi":"10.3126/JAIM.V4I2.16898","DOIUrl":"https://doi.org/10.3126/JAIM.V4I2.16898","url":null,"abstract":"Introduction At present, liver transplantation remains the only curative option for the patients with cirrhosis and end-stage liver diseases. The survival rate and recurrent diseases remains the major issue in the patient post-transplantation. Unani medicine is one of the oldest traditional system of medicine, has been treating chronic liver diseases and cirrhosis [ Talayyaful-Kabid ] since centuries. The purpose of our study was to assess the impact of Unani treatment in decompensated cirrhosis and collect data to warrant further clinical trials. Case presentation We have conducted a case series with three patients of decompensated cirrhosis and portal hypertension. Cases were confirmed by fibroscan and ultrasound and treated with Unani treatment orally for 3 months. Results were evaluated based on fibroscan, liver function test, EQ5D and TTO-TIME [tradeoff question]. Conclusions Significant improvement in liver function test, fibrosis and quality of life were achieved in the patients. We reviewed the literature related to the herbal constituents of chief medicines used for the treatment in this case. The herbs have been proved for its potential anti-oxidative, anti-inflammatory, hepatoprotective, immuno-modulator and antiviral activities, suggesting plausible mechanisms of action in these cases. The preliminary findings indicate the potential therapeutic role of Unani treatment in decompensated cirrhosis. Clinical trials should be conducted to explore the further therapeutic potential of Unani treatment in decompensated cirrhosis.","PeriodicalId":75443,"journal":{"name":"Advances in internal medicine","volume":"4 1","pages":"61-66"},"PeriodicalIF":0.0,"publicationDate":"2017-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47055848","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}

引用次数: 0

Clinical profile of 103 patients with abdominal tuberculosis in Nepal 尼泊尔103例腹部结核患者的临床资料

Advances in internal medicine Pub Date : 2017-03-05 DOI: 10.3126/JAIM.V4I2.16896

U. Shrestha, D. Shrestha, R. Shrestha, Arnab Ghosh

{"title":"Clinical profile of 103 patients with abdominal tuberculosis in Nepal","authors":"U. Shrestha, D. Shrestha, R. Shrestha, Arnab Ghosh","doi":"10.3126/JAIM.V4I2.16896","DOIUrl":"https://doi.org/10.3126/JAIM.V4I2.16896","url":null,"abstract":"Background and aims: The nonspecific clinical features of abdominal tuberculosis (TB) have made its diagnosis difficult, which can lead to the poor outcome in patients who are not able to receive early treatment. Hence, the aim of our study was to determine the clinical profile of abdominal TB in the patients of Nepal. Methods: This is a prospective observational study in which 103 patients with abdominal TB were analyzed for clinical profiles from May 2010 to April 2015. All diagnosed patients received anti-tubercular treatment (ATT) and were followed up at 1 and 6 months of ATT. Results: Among 103 patients of abdominal TB [males 48 (46.6%), females 55 (53.4%); mean age 33.1 years (±12.9)], 47.6% had histopathological examination (HPE) confirmation, 27.2% had high ascitic adenosine deaminase (ADA) value and another 25.2% had suggestive imaging findings. The common symptoms were abdominal pain (84.5%), weight loss (75.7%), anorexia (63.1%), chronic diarrhea (56.3%) and fever (52.4%). The mean weight was 40 mm/first hour. The sites involved were ileo-cecal (35.9%), peritoneal (27.2%), ileal (15.5%), colonic (15.5%), lymph nodal (3.9%) and gastroduodenal (1.9%). The sensitivity of HPE for diagnosis of abdominal TB was 47.6% (95% confidence interval 37.6% to 57.6%). All patients of abdominal TB had a good clinical response after ATT. Conclusion: The common symptoms of abdominal TB were abdominal pain, weight loss, anorexia, chronic diarrhea and fever. Since the diagnosis of abdominal TB by HPE may not always be positive, other parameters such as ascitic ADA value, imaging findings and associated supportive clinical features have to be considered, and a therapeutic trial of ATT may be indicated so that all patients of abdominal TB can be treated early in the course of disease.","PeriodicalId":75443,"journal":{"name":"Advances in internal medicine","volume":"4 1","pages":"51-56"},"PeriodicalIF":0.0,"publicationDate":"2017-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3126/JAIM.V4I2.16896","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49399845","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}

引用次数: 2

Sedation Free Colonoscopy: Patients’ Characteristics and satisfaction in a hospital based Endoscopy Unit 无镇静结肠镜检查:医院内窥镜检查组患者的特点和满意度

Advances in internal medicine Pub Date : 2017-03-05 DOI: 10.3126/JAIM.V4I2.16895

Amit Kumar, R. Pathak

{"title":"Sedation Free Colonoscopy: Patients’ Characteristics and satisfaction in a hospital based Endoscopy Unit","authors":"Amit Kumar, R. Pathak","doi":"10.3126/JAIM.V4I2.16895","DOIUrl":"https://doi.org/10.3126/JAIM.V4I2.16895","url":null,"abstract":"Background and aims: Colonoscopy without sedation costs less and is more convenient than sedated colonoscopy and is the main mode of examination in our settings. The aims of the present study is to determine the percentage of patients who can successfully undergo unsedated colonoscopy and the factors contributing to patient satisfaction following the examination. Material and Methods: Demographic, clinical, and colonoscopy related data were prospectively evaluated in 113 patients undergoing unsedated colonoscopy by an experienced endoscopist during the period of October 2015 to January 2016 at a single hospital based endoscopy setup. All colonoscopies routinely began without sedation and was curtailed if the patient or physician desired. Age, sex, prior abdominal operation, pain during examination and the time required to complete the colonoscopy were recorded. The patients were asked to rate their pain on scale of 0 to 10, their satisfaction and willingness to undergo colonoscopy without sedation in future if required. Results: In a total of 113 patients (mean age of 54.01 years) undergoing sedation free colonoscopy, 108 (95.5%) required no sedation. Complete colonoscopy was done in 106 of the 108 and 110 of the 113 patients. The mean pain score was 2.58 in an average time taken of 11.9 minutes. Average time for intubation taken in post-operative patients (n=20) was 12.24 minutes. 96(84.9%) of the patients were completely or well satisfied with the examination and 7(6.2%) were not satisfied with the procedure. There was not much difference in pain perception or satisfaction based on gender. Conclusion: Colonoscopy without sedation can be completed successfully in a vast majority of patients with proper technique by experienced endoscopist. The practice saves time and money and patients are willing to return for future examinations if required. The facility of sedation should be present if required for any reason.","PeriodicalId":75443,"journal":{"name":"Advances in internal medicine","volume":"4 1","pages":"45-50"},"PeriodicalIF":0.0,"publicationDate":"2017-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42818683","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}

引用次数: 0

Serial Ascitic Fluid Analysis – Prognostic Marker for Adverse Outcome in Spontaneous Bacterial Peritonitis in Liver Cirrhosis? 连续腹水分析-肝硬化自发性细菌性腹膜炎不良结局的预后标志?

Advances in internal medicine Pub Date : 2015-12-18 DOI: 10.3126/JAIM.V4I1.14174

R. Pathak, A. V. Thun, K. Singh, P. Khadga, Shashi S. Sharma

{"title":"Serial Ascitic Fluid Analysis – Prognostic Marker for Adverse Outcome in Spontaneous Bacterial Peritonitis in Liver Cirrhosis?","authors":"R. Pathak, A. V. Thun, K. Singh, P. Khadga, Shashi S. Sharma","doi":"10.3126/JAIM.V4I1.14174","DOIUrl":"https://doi.org/10.3126/JAIM.V4I1.14174","url":null,"abstract":"Background: Cirrhosis is a frequent cause of hospital admissions in Nepal with spontaneous bacterial peritonitis (SBP) being a major determinant of mortality. Limited diagnostic options preclude early risk stratification to improve patient outcomes. We assessed the predictive value of polymorphonuclear leukocyte counts (PMNs) and its association with mortality in hospitalized SBP patients. Methods: We examined 51 cirrhotic patients diagnosed with SBP in a prospective case-control study admitted to a Nepali tertiary care facility from February 2010 to November 2012. Serial paracentesis and ascitic fluid analysis were performed at admission, 24, and 48 hours. Receiver operating characteristic (ROC) curves, repeated measures analysis of variance, and logistic regression evaluated ascitic PMNs as predictors of mortality. Results: Deceased patients demonstrated significantly elevated mean circulating and ascitic PMNs. Ascitic PMNs in the non-survivors were significantly elevated upon admission and at 24 and 48 hours. These differences were significant based on absolute counts, relative differences and trends across time. ROC curves provided diagnostic thresholds (1600, 860, 500 cells/mm3) distinguishing the two groups upon presentation, at 24 and 48 hours respectively, with high sensitivities (100%), specificities (82.5-97.5%), and positive predictive values (52.4-84.6%). After adjusting for age and case severity, there was a 9.1-fold greater odds of mortality upon admission, for every increase of 500 ascitic PMNs. Conclusion: In this study of cirrhotic patients with SBP, in-hospital mortality was associated with persistently elevated ascitic PMNs. Ascites PMN thresholds offer a quick, low-tech option to risk stratify patients, prognosticate mortality, and guide patient care in low resourced settings. Journal of Advances in Internal Medicine 2015;04(01):6-12","PeriodicalId":75443,"journal":{"name":"Advances in internal medicine","volume":"4 1","pages":"6-12"},"PeriodicalIF":0.0,"publicationDate":"2015-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69272266","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}

引用次数: 0

Nailfold capillaroscopic findings in patients with Raynaud’s phenomenon: Preliminary report 雷诺现象患者的甲襞毛细血管镜检查结果:初步报告

Advances in internal medicine Pub Date : 2015-12-18 DOI: 10.3126/JAIM.V4I1.14175

B. Vaidya, Manisha Bhochhibhoya

{"title":"Nailfold capillaroscopic findings in patients with Raynaud’s phenomenon: Preliminary report","authors":"B. Vaidya, Manisha Bhochhibhoya","doi":"10.3126/JAIM.V4I1.14175","DOIUrl":"https://doi.org/10.3126/JAIM.V4I1.14175","url":null,"abstract":"Back grounds and Aims: Microvascular involvement of nailfold often occurs in systemic rheumatic diseases, especially scleroderma and related conditions. Nailfold capillaroscopy is easily performed non-invasive, simple, repeatable, sensitive, safe and inexpensive method to examine nailfold architecture by microscope.The normal capillaries are thin, symmetrical and have hair-pin appearance. Anomalies include dilated capillary loops, dropouts, tortuosity, avascular area, arborifications, megacapillaries, infracts,thrombsis and haemorrhages. This study aims to see the morphological changes in microcirculation in nailfolds of patients with Raynaud’s, which can be helpful in predicting the presence of connective tissue disorder. Methods: It is an observational study conducted at National Center for Rheumatic Diseases, Kathmandu from 26th March 2014 to 30th March 2015. Nailfolds of 8 fingers of both hands in 105 patients were examined using a hand held microscope. Results: Of 105 patients, 91 patients (86.6%) had abnormal morphological changes while 14 (13.4%) had no significant changes in microvessels. Normal patients had no underlying connective tissue disease(CTD) but those with abnormal findings had proven underlying CTD which included Lupus 6.5%, Scleroderma 17.5%, Rheumatoid Arthritis 14.2%, Mixed CTD7.6%, Undifferentiated CTD1.0%, Undifferentiated inflammatory arthritis 14.2%, Psorasis 1.0%, Rheumatoid Arthritis with scleroderma overlap 4.3%. No primary diagnosis was found in 32.9% of patients. Conclusion: Nailfold capillaroscopy allows direct examination of microvascular structure of a patient. Abnormal findings in a patient with Raynaud’s phenomenon might help to identify the presence of or future evolution into systemic connective tissue disorder. Journal of Advances in Internal Medicine 2015;04(01):13-15","PeriodicalId":75443,"journal":{"name":"Advances in internal medicine","volume":"4 1","pages":"13-15"},"PeriodicalIF":0.0,"publicationDate":"2015-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3126/JAIM.V4I1.14175","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69272327","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}

引用次数: 0

Concurrent multiple intracranial and intramedullary tuberculoma: a rare form of neurotuberculosis 并发多发性颅内及髓内结核瘤:一种罕见的神经结核

Advances in internal medicine Pub Date : 2015-12-18 DOI: 10.3126/JAIM.V4I1.14177

V. Tanwar, Harpreet Singh, N. Govil, S. Arora, Ruchi Jagota

引用次数: 6

Immunology of the gut and oral tolerance 肠道免疫学与口腔耐受

Advances in internal medicine Pub Date : 2015-12-18 DOI: 10.3126/JAIM.V4I1.14176

U. Shrestha

{"title":"Immunology of the gut and oral tolerance","authors":"U. Shrestha","doi":"10.3126/JAIM.V4I1.14176","DOIUrl":"https://doi.org/10.3126/JAIM.V4I1.14176","url":null,"abstract":"The pathogens and harmless antigens from the bacterial flora and food constantly expose the mucosal surface of the gastrointestinal tract. The mucosal epithelial cells act not only as a physical barrier, but also as a local immune system, which plays a vital role in defense and self-tolerance. The gut mucosal immune system comprises several compartments: Peyer’s patches and lymphoid follicles in the colonic mucosa, and lymphocytes in the lamina propria and intraepithelial lymphocytes. Peyer’s patches mediate antigen uptake via specialized epithelial cells (M cells) and are rich in B cells for class switching into IgA-secreting cells. IgA secretion is one of the primary defenses against pathogens at mucosal surfaces. The lamina propria contains a high proportion of activated and memory T cells that allows rapid immune response against pathogens. In the physiological situation, mucosally encountered antigens induce tolerance of lamina propria and intraepithelial lymphocytes by modified antigen presentation, antigen-induced anergy, or deletion of T cells, or regulation of effector T cells by regulatory or suppressor T cells. Costimulatory molecules mediate cellular interaction and induce regulatory cytokines. While the absence of gut immune privilege to food results in food allergy, the consequences of immune privilege collapse to commensal gut flora is Inflammatory Bowel Disease (IBD). Hence, the knowledge of the homeostatic regulation of the intestinal immune system paves the way for the development of the new immunomodulatory drugs in the therapy of IBD. Moreover, the generation of immune mediated cells through orally fed antigens could be the area of research in the treatment of certain autoimmune diseases. Journal of Advances in Internal Medicine 2015;04(01):16-24","PeriodicalId":75443,"journal":{"name":"Advances in internal medicine","volume":"4 1","pages":"16-24"},"PeriodicalIF":0.0,"publicationDate":"2015-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69272401","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}

引用次数: 1

Ulcerative Colitis complicated by lower limbs thromboemboilism- an unusual case scenario 溃疡性结肠炎合并下肢血栓栓塞-一个不寻常的情况

Advances in internal medicine Pub Date : 2015-12-18 DOI: 10.3126/JAIM.V4I1.14178

Harpreet Singh, Rekha Mathur, Parminder Kaur, V. Tanwar

引用次数: 0

Metastatic nodular pneumonia due to septic embolism: a Staphylococcal infection 脓毒性栓塞引起的转移性结节性肺炎:葡萄球菌感染

Advances in internal medicine Pub Date : 2015-12-09 DOI: 10.3126/JAIM.V3I2.14068

S. Shrestha, B. Srivastava, R. Khunjeli, Ushab Rana Mousin

{"title":"Metastatic nodular pneumonia due to septic embolism: a Staphylococcal infection","authors":"S. Shrestha, B. Srivastava, R. Khunjeli, Ushab Rana Mousin","doi":"10.3126/JAIM.V3I2.14068","DOIUrl":"https://doi.org/10.3126/JAIM.V3I2.14068","url":null,"abstract":"Ill-defined lung nodules mimicking secondary metastasis caused by Staphylococcus aureus though defined, is uncommon. We report a 58 years male with chest pain, dry cough, fever and abscess over the nape of neck. Bilateral nodules in the chest x-ray resembled metastasis. Workup for malignancy was negative. Induced sputum grew Staphylococcus aureus resistant to penicillin group. The lesions cavitated and produced air-fluid levels. Computed tomography confirmed the peripheral location, right sided hydropneumothorax and loculated fissural collection. Recovery was favourable but delayed with injectable ceftriaxone and levofloxacin initially followed by oral levofloxacin. Review chest radiograph showed residual cavities with small pneumothorax. Follow-up after three months showed resolution of all cavities and pneumothorax. Literature review revealed both Methicillin sensitive and resistant staphylococcus aureus can cause metastatic nodular pneumonia. Rapidly necrosis occurs if the organisms are capable of producing the toxin: Panton-Valentine Leukocidin. But this tendency is more common with community-acquired methicillin resistant strains. Journal of Advances in Internal Medicine 2014;3(2):68-71","PeriodicalId":75443,"journal":{"name":"Advances in internal medicine","volume":"3 1","pages":"68-71"},"PeriodicalIF":0.0,"publicationDate":"2015-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3126/JAIM.V3I2.14068","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69271980","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}

引用次数: 0