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   Table of Contents - Current issue
Coverpage
July-September 2020
Volume 8 | Issue 3
Page Nos. 103-154

Online since Wednesday, July 15, 2020

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EDITORIAL  

Editorial Highly accessed article p. 103
Manjunath Premanath
DOI:10.4103/AJIM.AJIM_43_20  
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GUEST EDITORIAL Top

Uncertainty in the time of Covid-19 Highly accessed article p. 104
BV Murali Mohan, George K Varghese
DOI:10.4103/AJIM.AJIM_42_20  
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REVIEW ARTICLES Top

Management of ankylosing spondylitis; present concepts and guidelines Highly accessed article p. 107
Ramaswamy Subramanian, Shiva Prasad
DOI:10.4103/AJIM.AJIM_69_19  
Ankylosing spondylitis (AS) belongs to spondyloarthritis (SpA) group of inflammatory arthritis, which has common genetic, clinical, and radiological features. The management aims at improving the quality of life, long-term control of inflammation so as to prevent structural damage, preserve functional abilities, and maintain the social life of patients. Treatment strategies and modalities in inflammatory arthritis have tremendously improved in recent times. With the discovery of molecular mechanisms, a new series of targets involving the cytokines, cells, and intracellular signaling pathways have been explored. The introduction of tumor necrosis factor inhibitor drugs heralded a new era of therapeutics for SpA, especially AS. Recently, the licensing of secukinumab, an interleukin 17A inhibitor for the treatment of AS, has given a new pathway to look at. These new targets give us an opportunity to achieve disease remission in both AS and nonradiologic axial SpA. They have also opened up new horizon to look for different research strategies in achieving disease remission using biological drugs in early disease and in stratified manner. International societies have been regularly providing and updating the guidelines for the management of AS. In this review, we discuss the treatment of AS and future trends in the management.
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COVID 19-Fighting an unseen enemy p. 114
Vasantha Kamath, Shreyashi Ganguly, B Nivea
DOI:10.4103/AJIM.AJIM_29_20  
In December 2019, a previously unknown coronavirus, named SARS-CoV-2, was discovered in Wuhan, Hubei province of China. It was sequenced and isolated by January 2020. SARS-CoV-2 is associated with an ongoing outbreak of atypical pneumonia (Covid-2019) that has affected over 2,118,700 people and killed more than 141,900 of those affected in >210 countries as of April 16, 2020. Community-acquired coronaviruses are ubiquitous. COVID-19 is predominantly seen in older population with chronic medical conditions. There is a male preponderance. Median age was 55-59 years. SARS-CoV-2 is also more likely to infect people with chronic comorbidities such as cardiovascular and cerebrovascular diseases and diabetes. Coronavirus has an R0 of 3.28. Unlike European countries and USA, majority of the cases in India were affecting people of age group between 31 and 40 years. Mortality rate is around 3.34%. WHO, described three main transmission routes for the COVID-19: 1) droplets transmission, 2) contact transmission, and 3) aerosol transmission. COVID presents with fever, dry cough, dyspnoea, chest pain, fatigue and myalgia. Less common symptoms include headache, dizziness, abdominal pain, diarrhoea, nausea, and vomiting. Characteristic cutaneous, haematological, gastrointestinal, neurological manifestations are also seen. Testing with RT-PCR, antibody testing, and quarantine, social distancing, contact tracing are the only arsenals to reduce the burden. Every case is different; beyond standard antipyretics, anti-tussives, the role of ventilation, anticoagulation, antivirals, steroids, hydroxychloroquine, retroviral agents are still being dynamically assessed. In the absence of dedicated cures, vaccines, the novel coronavirus, is a challenge and exercise of public health measures and effective governance like no other phenomenon in the 21st century.
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ORIGINAL ARTICLES Top

A study of clinical and laboratory evaluation and outcome of patients with acute febrile illness with thrombocytopenia p. 121
S Sumangala, Sangram Biradar, Mohd Zeeshan Ali, Mushtaq Saudagar
DOI:10.4103/AJIM.AJIM_44_19  
Introduction: Fever with thrombocytopenia has become a common presenting problem. Infection is the main cause of thrombocytopenia. Fever with thrombocytopenia is frequently associated with an increased risk of morbidity and mortality. Infections such as malaria, dengue, enteric fever, and septicemia are some of the major causes of fever with thrombocytopenia in India. Aims and Objectives: To evaluate clinical profile of febrile thrombocytopenia, to identify different causes and the most common cause of febrile thrombocytopenia, and to assess the outcome and complications associated with febrile thrombocytopenia. Materials and Methods: A cross-sectional study of 160 patients was carried out at Basaveshwar Teaching and General Hospital. Patients with thrombocytopenia who were ≥18 years of age at admission between November 2016 and May 2018 were observed and followed up during their stay in hospital, diagnoses were made, and bleeding manifestations and requirement of platelet transfusion were also recorded. Results: Febrile thrombocytopenia affected all age groups ranging from 18 to 75 years of age but was common in 21–30 years of age group (40.60%), with a male-to-female ratio 57:43. Infection (88.12%) was the most common cause of thrombocytopenia, while dengue (53.13%) was the most common of the infections followed by malaria (15.63%) and septicemia (8.75%). Bleeding manifestations were seen in 33.13% of patients. 81% of the patients with bleeding tendencies had petechiae/purpura as the most common bleeding manifestation, followed by spontaneous bleeding in 54.70%. Melena (34.48%) was the most common among spontaneous bleeding. Bleeding manifestations were more common when the platelet counts were <20,000 cells/cumm. Good recovery was noted in 92.50%, while 5% had mortality and 2.50% cases were referred. Septicemia was the major cause of mortality. Conclusion: In our setup, infection such as dengue fever was the common cause of fever with thrombocytopenia followed by malaria and septicemia. In majority of patients, thrombocytopenia was transient and asymptomatic, but in significant number of cases, there were bleeding manifestations. On treating the specific cause, drastic improvement in the platelet count was noted. Mortality in febrile thrombocytopenia is not directly associated with degree of thrombocytopenia but with concomitant involvement of other organs, leading to multiorgan dysfunction.
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Occurence of gallbladder stones and its association with hba1c among participants with type 2 diabetes mellitus: One-year cross-sectional study p. 128
Vivek Veereshkumar Shirol, Pooja S Motimath
DOI:10.4103/AJIM.AJIM_35_19  
Aims: The aim was to study the occurrence of gallbladder stones and its association with HbA1c among participants with Type 2 diabetes mellitus. Settings and Design: This was a 1-year cross-sectional study. Subjects and Methods: The study was done on 200 participants of Type 2 diabetes mellitus admitted in the Department of General Medicine over a period of 1 year from January 2018 to December 2018. A thorough medical history was obtained, and clinical examination and investigations were performed on the study participants. Ultrasonography of the abdomen was done with special reference to gallbladder and gallstones. Statistical Analysis: The data were entered into Excel 2010 and analyzed by SPSS version 20.0 software. The data were analyzed by descriptive statistics including frequency, percentage, mean, and standard deviation. The Chi-square test was used to assess the association between the two attributes. Results: The occurrence of gallbladder stones was 33.50%, with 67 Type 2 diabetes mellitus participants having asymptomatic gallstones out of the total 200 study participants. The association of higher occurrence of gallstones was found to be statistically significant with higher HbA1c values. In the participants with gallstones, the mean HbA1c was 9.67 ± 2.16%. The maximum number of participants belonged to the group of study participants having HbA1c range of 08%–9.9%, which consists of 44.5% of the total study participants. Conclusions: The occurrence of gallbladder stones was 33.50% among Type 2 diabetes participants. A higher HbA1c level was found to be significantly associated with gallstone formation. This knowledge may provide an early interventional opportunity to implement adequate measures for a strict glycemic control and prevent further morbidity and mortality.
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Correlation of high-sensitivity C-reactive protein with severity and spirometric values of asthma p. 132
Suaad Muhammed Hassan Rasheed, Iman Jabbar Kadhim Al-Ghizzi, Falah Abdulhasan Deli, Tagreed Aljazaaeri
DOI:10.4103/AJIM.AJIM_5_20  
Background: Asthma is an important community problem that increased in incidence worldwide, with a considerable acute and chronic sequale and being an inflammatory process, following and interrupting this process is extremely important. High-sensitivity C-reactive protein (hs-CRP) is proposed to be a good indicator for the degree of inflammation; we aimed to utilize hs-CRP as an inflammatory biomarker to assess the severity and stability of asthma. Patients and Methods: Forty-one asthmatics (19 males and 24 females) with a mean age of 41 ± 14 and 22 years and gender- and body mass index-matched controls were assessed by questionnaire, spirometry, and level of hs-CRP in Al-Sader Teaching Hospital in Al-Najaf at 2018. Results: The mean values of hs-CRP were significantly higher in asthma than the control group, and this was marked in asthmatics during acute exacerbation than those with stable clinical status, hs-CRP was recorded significantly higher in adult asthmatic patients as compared to adolescents and middle aged, smoking history and allergic history did not show any significant difference, and the elevation of hs-CRP was markedly more in acute exacerbation as compared to stable state; on the other hand, the level of hs-CRP was correlated significantly more with the drop in forced expiratory volume1 and peak expiratory flow rate, indicating the relation with the severity of the illness. Conclusions: Hs-CRP can be considered as a good biomarker for assessing the severity and stability of asthma.
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CASE REPORTS Top

A case report of pulmonary mucormycosis p. 136
Surajsingh Ravindra Taur, Suresh Harsoor, Channamma Goudagaon
DOI:10.4103/AJIM.AJIM_26_19  
Pulmonary mucormycosis is a relatively rare pulmonary fungal disease which is difficult to diagnose and lacks effective treatment. The present study reports that the case of a 57-year-old patient who was treated successfully for pulmonary mucormycosis in Basaveshwar Hospital. The patient presented with low-grade fever and a productive cough that persisted for 2 months with no evident cause, and change of voice with weight loss and also suffered from diabetes mellitus. Prior antibiotic treatment with levofloxacin had been ineffective. The culture of mucus obtained by bronchoscopy resulted in a diagnosis of pulmonary mucormycosis. The patient was started on liposomal amphotericin, received a cumulative dose of 1250 mg amphotericin over 2 months, and presented a full recovery.
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Fractures: The opening batsmen of an autoimmune disease p. 139
K Ravi, KR Chaitra
DOI:10.4103/AJIM.AJIM_49_19  
Renal involvement is a well-known extraglandular manifestation of primary Sjögren's syndrome (pSS). Most of the manifestations are related to tubular dysfunction. Metabolic bone disease rarely occurs as the first manifestation of a renal tubule disorder due to pSS. Here, we present a 28-year-old female patient whose first presentation of pSS was with multiple skeletal fractures caused by renal tubular dysfunction. Clinicians should always search for the evidence for Sjögren's syndrome in adult patients with unexplained osteomalacia and renal tubular acidosis, even in the absence of sicca syndrome.
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Plummer–Vinson syndrome: A case series p. 142
ST Kavya, HR Sanjay Kumar, T Sridevi, Devapriya Rejeev
DOI:10.4103/AJIM.AJIM_51_19  
Plummer–Vinson syndrome (PVS), also known as Paterson–Brown–Kelly syndrome, is characterized by a triad of dysphagia, upper esophageal web, and iron deficiency anemia. It predominantly affects middle-aged females. The postcricoid webs are associated with a higher risk of squamous cell carcinoma; therefore, timely diagnosis and treatment is important. Herein, we report three cases of PVS.
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ECG DIAGNOSIS Top

ECG diagnosis p. 145
Raghavendra Bhat
DOI:10.4103/AJIM.AJIM_75_19  
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PICTORIAL CME Top

Congenital tortuous retinal vessels with blurred disc margins and a pale disc p. 147
Anubhav Chauhan, Anchit Wapa, Deepak Sharma, Pankaj Thakur
DOI:10.4103/AJIM.AJIM_11_20  
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SCIENTIST REVIEW Top

Scientist Review p. 149
Swetha Amaresh
DOI:10.4103/AJIM.AJIM_28_20  
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LETTERS TO THE EDITOR Top

India's response to air pollution from cooking fuel p. 150
Manas Pratim Roy
DOI:10.4103/AJIM.AJIM_16_20  
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Dapsone old drug can be useful in management of COVID-19 p. 150
Naguib El Farnawany
DOI:10.4103/AJIM.AJIM_23_20  
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Intradermal purified protein-derivative injection in the prevention of COVID-19 in highly risk individuals p. 152
Ahmed Farouk, Naguib El Farnawany
DOI:10.4103/AJIM.AJIM_24_20  
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OBITUARY Top

Obituary p. 154
Manjunath Premanath
DOI:10.4103/AJIM.AJIM_50_20  
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