Application of the International Society on Thrombosis and Haemostasis Scoring System in Evaluation of Disseminated Intravascular Coagulation in Patients with Acute Leukemias

Background Coagulation abnormalities are common in acute leukemia (AL) and disseminated intravascular coagulation (DIC) frequently complicates the onset of AL. Aim To determine the prevalence of overt DIC in AL using the International Society on Thrombosis and Haemostasis (ISTH) scoring system. Materials and Methods This prospective observational study was performed on 57 newly diagnosed or relapsed cases of AL. Detailed clinical history and coagulation profile of the patients were evaluated. Diagnosis of overt and nonovert DIC was established using the ISTH scoring system and results tabulated. Observations A total of 57 patients with AL participated in the study, including 31 (54.39%) patients with acute lymphoblastic leukemia (ALL) and 26 (45.61%) with acute myeloid leukemia (AML). In total, 18 of 57 patients (31.58%) with AL fulfilled the criteria of overt DIC according to the ISTH scoring system, including 10 (32.25%) patients with ALL and 8 (30.76%) patients with AML. The highest prevalence of DIC was seen in the M3 subtype among AML and the L1 subtype among ALL, respectively. The mean ISTH score in patients of overt DIC in ALL and AML patients was 5.1 and 5, respectively. Abnormalities in platelet count and D-dimer levels were the most useful parameters in diagnosing overt DIC and the difference between overt DIC and nonovert DIC groups was highly significant. Conclusions Overt DIC was observed in approximately one-third of patients with AL. Prevalence of overt DIC was found to be comparable in patients with ALL and AML. Mean platelet count and D-dimer levels were the most useful parameters in detecting overt DIC.

Dilemma in diagnosing Metabolic Disorder: A case of Galactokinase Deficiency with an unusual presentation

An infant with metabolic disorder can have vague presentations like repeated chest infections, feeding intolerance and failure to thrive. This may lead to a diagnostic dilemma. Detailed clinical history together with biochemical investigations are must to reach a diagnosis. Galactokinase Deficiency (GKD) has a varied presentation with some features like microcephaly, juvenile cataracts and failure to thrive. We encountered a case of GKD in an infant in which there was an absence of cataracts. Raised Immunoreactive Trypsinogen (IRT) in Newborn Screening was strongly suggestive of Cystic Fibrosis (CF), however Genetic Analysis revealed a heterozygous missense variation in EXON4 of the GALK1 GENE, confirming the diagnosis of GKD. Hence, this case highlights the importance of considering different metabolic disorders as differential diagnoses of one another even in absence of a typical feature of a particular disorder.

Precipitating Factors of Psoriasis in North Indian Population

Aim: This study aims to study precipitating factors of psoriasis in the north Indian population.Material & Method:Two hundred twenty-eight psoriasis patients regardless of age, sex, religion,occupation, attending the skin, and V.D. outpatients Department, B.R.D. Medical College, Gorakhpurfor were taken because of the subject of this study. The bulk of patients belonged to the Eastern U.P.and adjoining areas of Bihar and Nepal. The clinical criteria for diagnosis of psoriasis were thepresence of Erythematous and papulosquamous lesions with loosely adherent silvery-white scales.The auspitz's sign was demonstrated all told the cases. The detailed clinical history and examinationwere recorded. Each patient was categorized into mild to severe psoriasis. Result: The maximumpercentage of cases was aggravated by weather (winter), 55.26%, next to that was trauma 27.19%, and least after infections 4.35%. The summer and spring seasons showed an improved effecton the condition of psoriasis. Alcohol, smoking, and mental stress found no relation with psoriasis.In most cases, where the infection was associated with the disease, it had been aggravated only inchildren, and young adults and lesions were of guttate type. Pregnancy had no effect in 25.43% ofcases, while the disease was improved in 3.50% of patients and worsen in 4.35% of cases.Conclusion: Psoriasis is positively correlated with the winter season and negatively associated withSummer and Spring.

Right frontal meningioma presenting as delusional parasitosis

Central nervous system tumours can occasionally present with psychiatric symptoms as the only manifestation and can often pose diagnostic challenges. A man in his early 60s presented to the psychiatry outpatient department with delusional parasitosis. His old age and an episode of urinary and faecal incontinence made the clinician consider neuroimaging at the very first visit itself. He was detected to have a right frontal meningioma with features of intracranial hypertension with midline shift, and he underwent emergency surgery. His delusional symptoms completely resolved after surgery and did not recur during the follow-up period of 2.5 years. A right frontal meningioma presenting as delusional parasitosis has probably not been reported in the literature before, and the case is being reported to highlight the rarity of its presentation, the importance of eliciting a detailed clinical history and the need for early neuroimaging in these cases.

EVALUATION OF PANCYTOPENIA IN ADULTS PATIENTS OF BIHAR

INTRODUCTION– Pancytopenia usually indicates presence of serious underlying disease. Determining the etiology of pancytopenia is important for appropriate management of the patients. AIMS AND OBJECTIVES- This study was undertaken to identify the etiological factors leading to pancytopenia in a tertiary care hospital of Bihar. MATERIAL AND METHODS– This was a prospective study conducted over 12 months in the department of pathology, Nalanda medical college, Patna. The study included adult patients (>18yrs) who had pancytopenia in complete blood count. Relevant blood tests and bone marrow aspiration (BMA) and bone marrow biopsy (BMB) were done to delineate the etiology of pancytopenia. RESULTS– The commonest cause of pancytopenia in our study was aplastic anemia (46.67%) followed by megaloblastic anemia (23.33%) and hematological malignancies (acute leukemia and lymphoma- 15%). Other causes include infective diseases (kala-azar, malaria and tuberculosis), hypersplenism and hemophagocytosis. CONCLUSION- Determination of etiology of pancytopenia needs detailed clinical history and physical examination, and appropriate hematological tests and bone marrow examination.

Spectrum of neurological disorders in pregnancy in a neurology clinic in eastern Uttar Pradesh

Background: Pregnancy-induced endocrinal and physiological changes increase the risk of neuropathy and musculoskeletal problems in pregnancy. The purpose of this study is to provide a comprehensive look at the neurological and musculoskeletal disorders occurring during pregnancy.Methods: A total of 202 antenatal women with neurological and musculoskeletal problems were enrolled for study. Their demographic characteristics were noted. Detailed clinical history and neurological examination was done. Radiological investigations including x-ray, CT head, MRI brain, MRA, MR Venography with electrophysiological NCS studies were performed accordingly.Results: Among musculoskeletal symptoms most prevalent was LBA (50%), cramps (15.7 %) followed by pelvic girdle pain (10%) and wrist pain (8,5). Among peripheral neurological disorders most common was CTS (12.37%) followed by bells palsy. Among Central neurological disorders most common was headache (26.23%), seizures (12.37%), eclampsia (2.47%), followed by Cortical venous thrombosis CVT, BIH, PRES.Conclusions: Among musculoskeletal complaints the most frequent symptoms during pregnancy were low back pain, hip joint pain, cramps and wrist pain. Among neuropathies CTS prevalence was relatively higher in pregnant women especially in third trimester and was mostly bilateral. Among central neurological symptoms headache especially migraine without aura and seizures were common while eclampsia, CVT, BIH, PRES were less common.

Diagnosis and Management of Antibiotic Allergies

Drug allergies encompass a spectrum of immune-mediated hypersensitivity reactions with various mechanisms and clinical presentations. β-lactam drugs are common causes of drug allergies. A detailed clinical history as well as skin and drug provocation tests, are essential to diagnose drug allergies. The key to successful treatment is avoidance or discontinuation of the offending drug, and replacing it with a safe alternative. Cross-reactivities among β-lactam antibiotics should be considered when choosing alternative medications. Proper management of β-lactam allergies is important at the individual and population levels, to reduce the likelihood of drug allergies and prevent antibiotic-related adverse outcomes.

A PROSPECTIVE STUDY ON CLINICAL PROFILE OF DEVIATED NASAL SEPTUM AND EFFICACY OF SEPTOPLASTY

Deviated nasal septum is one of the most common ENTnding . we did this study to nd out the clinical prole of deviated nasal septum Materials and methods: This study is a prospective, observational,single-center study .The study was conducted in Government sivagangai medical college hospital , sivagangai , tamil, India. A detailed clinical history was taken and clinical examination of the patient was carried out. Sixty symptomatic patients were taken up. Patient scored their symptom-related severity using a Likert scale preoperatively. All patients underwent conventional septoplasty. Postoperatively,their symptoms were scored on 30th, 45th, and 90th day. Results: Preoperative and Postoperative values were analyzed.Statistically signicant improvement was observed in the entire population: Nasal obstruction (p<0.001), headache(p<0.001), nasal discharge (p<0.001), facial pain (p<0.001),and hyposmia (p<0.001). Patient satisfaction was high and they used fewer nasal medications. Conclusion:After surgical correction of the septum and analysis of the subjective scale showed improvement in all symptoms.

Clinical features & outcome of dengue cases at a tertiary care centre

Background: Dengue is a very common seasonal public health problem causing significant mortality every year. In 2019 an outbreak occurred in Bangladesh. Few new manifestations and multi organ involvement were found. Objective: The objective of the study was to see the clinical and laboratory manifestations and outcome of dengue fever in a medical college hospital. Methods: It was an observational study in a medical college hospital in Bangladesh. Study period was one year. The patients were confirmed cases of dengue. Apart from detailed clinical history, examination of patient, relevant investigations and follow up was done until discharge. Result: Total number of cases was 98. Out of them 62 (63.2%) were male and 36 (36.73%) were female. Fever was most common (100%) manifestation and duration of fever ranged from 5 to 8 days with a mean duration of 6.3 (± 1.0) days. Among other symptoms generalized body ache was most common (63, 64.3%). Generalized weakness was present in 60 cases (61.2% cases) Bleeding manifestations was present in 41 cases; abdominal manifestations were found in 11 cases. Blood for NSI was positive in 94 (95.9%) cases; most cases (71, 72.4%) became positive between 2nd to 4th day. Ninety (91.9%) cases developed thrombocylopcnia and it started at 5th day in 45 (45.9%) cases. Blood transfusion was given in 12 (12.2%) cases & Platelet transfusion was given in 3 (3.1%) cases. Complete recovery was in 96 (98%) cases and Death occurred in 2 (2.0%) cases. Conclusion: Bleeding was a dominant presentation. Some atypical manifestations like gastro intestinal features were also observed. These findings will help physicians in early diagnosis of dengue. Bang Med J Khulna 2020: 53 : 3-7

CLINICAL STUDY TO EVALUATE EFFECT OF MUSTADI KWATH IN MADHUMEHA

The dissertation is entitled “Clinical study to evaluate the effect of Mustadi kwath in Madhumeha. Diabetes mellitus has become a dreadful disease in the era. It is also described in Ayurvedic text in terms of Madhumeha. Diabetes Mellitus is a group of metabolic disease in which there are high blood sugar levels over a prolonged period, this high blood sugar produces the symptoms of frequent urination, increased thirst, and increased hunger. Untreated, diabetes can cause many complications. Sedentary lifestyle, lack of exercise, improper medication and urbanization precipitates the disease. In the present study, Mustadi kwath (mentioned in Bhaisjya Ratnawali) was selected for clinical trial. The study comprises of 40 patients of Madhumeha. These patients were randomly selected on the basis of inclusion and exclusion criteria with detailed clinical history, physical examination and other desired investigation. The duration of study is of 90 days with 15 days follow up. After evaluating therapy it was observed that the ‘Mustadi kwath’ provided better relief to the patients of Madhumeha.