Asian Journal of Medical Research

A Rare Case Report of ‘Fetus in Fetu’ in a One Year Eight Month Old Child

2020-10-10T09:53:17+00:00

Fetus in fetu is a very unusual pathology in which a deformed underdeveloped fetus is found inside the body of another child. It is an uncommon abnormality and thought to be a result of abnormal embryogenesis in the case of diamniotic monochorionic pregnancy. Most commonly presents as a palpable mass in the abdomen. Imaging modalities can reveal the presence of bony elements within the mass cavity like vertebral bodies, long bones, and even underdeveloped organ systems. It should be differentiated from mature or well-organized teratoma & other causes of infantile abdominal masses like Nephroblastoma, Neuroblastoma, Hydronephrosis & malignant germ cell tumors in undescended testis. Surgery is the mainstay of treatment. To date around two hundred cases have been reported worldwide.

Versatility of Limberg and Its Modiﬁed Flaps in Post Firearm Wounds - A Case Series

2020-10-10T10:12:31+00:00

Background: The aim is to present our experience of Limberg and it’s modified flaps in post firearm injuries (FAI). Subjects and Methods: A series of patients with FAI underwent Limberg and its modified flaps under general anaesthesia over a period of one year from June 2018 to May 2019. Results: All patients were young male aged between twenty-one and twenty-five years and in all patients, Limberg and it’s modified local flap proved to be better than skin grafts with early return of patient functionality and did not require frequent dressing change. Conclusion: Our series indicates that Limberg and its modified flaps can be safely used to reconstruct post firearm moderate to large wounds.

Correlation of Hepatic Steatosis with Hepatic Fibrosis in NAFLD Patients by Fibroscan

2020-10-06T11:19:33+00:00

Introduction: Nonalcoholic fatty liver disease (NAFLD) is a significant cause of liver injury in the world. Transient elastography with controlled attenuation parameter (CAP) is now days commonly used as a non-invasive modality to quantify liver steatosis and stage of Fibrosis in the Liver. This study was done to the correlation of hepatic Steatosis with hepatic Fibrosis in NAFLD Patients by fibroscan. Subjects and Methods: All NAFLD patients coming to DMCH from 1/1/18 to 30/11/18 were retrospectively analysed for the presence of any correlation between Steatosis and Fibrosis using a controlled attenuation parameter (CAP) and liver stiffness measurement (kPa), respectively by Fibroscan. Patients with a history of significant alcohol intake, viral infection, severe weight loss, on TPN, on drugs like amiodarone, diltiazem, steroids were excluded. Along with this history of hypertension, diabetes and smoking were noted from the available data. Results: The mean CAP of all 446 patients was 310.58 53.55 and the mean kPa was 7.14 4.75. Overall there was a significant correlation between CAP and kPa in all NAFLD patients (p <0.000). This was also true in patients who were more than 20 years of age, who have increased levels of triglycerides and were obese. Patients with S0 steatosis had a mean kPa value of 5.33 and as the steatosis stage worsened to S3 mean kPa value also increased to a maximum of 7.63. Conclusion: Quantification of Steatosis by CAP has a significant correlation with the stage of Fibrosis, especially in patients with increasing age, obese and who have high triglyceride levels.

Clinical Proﬁle and Outcome of Patients with Severe Acute Pancreatitis

2020-10-06T11:26:39+00:00

Background: Acute pancreatitis (AP) is an acute inflammatory condition of the pancreas leading to pancreatic autodigestion. The present study was conducted to study the clinical profile and outcome of patients with severe acute pancreatitis. Subjects & Methods: The study was conducted on 40 patients of acute pancreatitis. Clinical profile including history, examination findings, etiology of pancreatitis, clinical severity (according to Modified Marshall Score, BISAP score, APACHE II, HAPS score, SOFA score) was recorded. Results: Severe Acute Pancreatitis (SAP) among patients. Majority of the patients i.e. 22 (55%) had alcohol consumption as etiological factor causing SAP followed by biliary 10 (25%) & idiopathic 5 (12.5%). Hypertriglyceridemia and drug-induced (herbal medication) pancreatitis was present in 1 (2.5%) patient each. Out of all 1 (2.5%), patients had a history of both alcohol consumption and the presence of gallstone as an etiological factor. 22 patients (55%) out of 40 patients only conservative management was used while 18(45%) patients underwent USG guided percutaneous drainage was done. Out of these 18 patients, 3(7.5%) patients required Laparoscopic Necrosectomy & 2(5%) patients required open necrosectomy in addition to ultrasound-guided PCD. Patients who improved had a mean BISAP SCORE of 2.15 0.54, Modified Marshall score of 3.65 1.44, APACHE II score of 9.77 4.45, SOFA score 5.54 2.49, RANSON’s score 3.85 1.80 and HAP score of 0.65 0.63. Conclusion: Most common etiology of severe acute pancreatitis is alcohol followed by biliary etiology. Out of severity scores (BISAP, APACHE-II, SOFA, HAPS), only BISAP score ≥3 is predictive of poor outcome in patients with severe acute pancreatitis.

Clinical Charecterstics and Out Come of Patients with Symptomatic Corona Virus Disease 2019 in Small District of Himachal Pradesh in India

2020-10-10T10:40:39+00:00

Background: In India Covid 19 cases started rising after the Lockdown and from January 30 to August 02 there have been 18,07,222 confirmed cases of Covid 19 with 38176 deaths. Now Covid 19 cases are present in small towns and villages as people from major cities has been migrates to their native places. This study describes the demographic, baseline comorbidity, presenting clinical complaints and outcome of the first sequentially patients with COVID -19 in a small district from Himachal Pradesh, In India. Subjects and Methods: This retrospective observational study was conducted in Dr. Radha Krishnan Government medical college, Hamirpur, Himachal Pradesh, India. The inclusion criteria for the study was All symptomatic patients with laboratory-confirmed COVID-19 by Real time polymerase chain reaction (RT-PCR) in Distt. Hamirpur in Himachal Pradesh from March 2020 to 31 July 2020. Oral consent was obtained for the study. The medical records of patients were analysed by the research team of the department of medicine, Dr. Radha Krishnan Government Medical College Hamirpur. Results: Maximum number of patients (92%) migrated from outside the state and majority from the cities of high number of Covid cases. During hospital periods 36% patients had peripheral capillary spo2 less than 95% and required oxygen support. 2(4%) patients died in the hospital and 5(10%) was referred to higher centre. 43(86%) patents recovered and discharged in stable condition. Fever (64%) was the most common symptom followed by cough (60%), fatigue (40), rhinorrhoea (28%), headache (26%) and hypogeusia (16%). Conclusion : The clinical presentation was milder and complications were seen in very few. Special attention is required to the geriatric population and with severe comorbid condition, as they are more likely to have a poor outcome.

Predictors Associated with COVID-19 deaths in Ethiopia

2020-10-08T08:50:11+00:00

Background: Coronavirus disease is an infectious disease that causes a newly discovered coronavirus. Ethiopia is one of the most impacted countries relative to the proportion of COVID-19 case growth and infection. The purpose of this investigation was to identify the determinants of COVID-19 disease in Ethiopia. Subjects & Methods: The source of the data for this study was the 2020 Ethiopia health ministry from March up to July using multiple linear regression models. Results: Among 468,814 total tests, 9,027 recovered, 20,900 confirmed cases, and 365 deaths from Coronavirus diseases in Ethiopia. Critical cases (β= 0.570, p= 0.006) and average temperature (β= -35.061, p= 0.003) variables were statistically significant. Conclusion: Critical or serious cases significantly and positively affect the deaths of this pandemic disease, while average temperature significantly and negatively affects the deaths of COVID-19 diseases in Ethiopia.

Management of Occult Hypoperfusion Syndrome in Trauma Patients: A Narrative Review

2020-10-10T07:28:56+00:00

Occult hypoperfusion (OH) is connected with higher levels of morbidity and mortality after trauma. Occult hypoperfusion, defined as serum lactate concentration of more than 2.5 mmol / L persisting in the intensive care unit for more than 12 hours after admission. This refers to the reversible risk factor for negative results after traumatic injury. Occult hypoperfusion can be observed and patients at risk of complications should be classified other than frequently regulated metrics (blood pressure and heart rate), central venous oxygen saturation, and blood lactate levels. An elevated hospital duration of stay (LOS) and a greater incidence of postoperative difficulties are linked with OH. The focus of this review article is to assess the different approaches and methods involved in the management of OH syndrome in trauma patients. Identification of OH treatment methods can be helpful in reducing morbidity in patients with various injuries. The outcomes from this review article may prove beneficial to patients by rapid resuscitation and aggressive monitoring of OH. These management practices will severely reduce OH-associated morbidity and mortality. LOS, ICU readmission incidence and post-operative complications per patient was decreased by early treatment of OH.