Assessing the Utility of the Aspartate Aminotransferase to Platelet Ratio Index (APRI) as a Noninvasive Indicator for Liver Cirrhosis.

Background Of liver-related disorders, cirrhosis is currently the leading cause of death and has become a significant global public health concern. Aspartate aminotransferase to platelet ratio index (APRI), a newer prognostic modality, is a very effective noninvasive diagnostic for identifying advanced liver fibrosis. Methods A prospective observational study was conducted among individuals with liver disease, 100 cases and 100 controls for two years. All the sociodemographic details, clinical features of the patients, and clinical findings such as prothrombin time (PT), liver function tests, kidney function tests, and total blood count were recorded using a pretested semi-structured questionnaire. Results According to our survey results, 48% of the participants were between the ages of 40 and 60. Regarding aPTT (activated partial thromboplastin time) and liver function test characteristics (serum glutamic-oxaloacetic transaminase(SGOT), serum glutamic pyruvic transaminase (SGPT)), we showed a substantial difference between the patients and controls. Regarding the APRI distribution, we also found a statistically significant variation between the research groups. When we compared the validity of APRI scores in diagnosing cirrhosis, we discovered that the ideal cutoff value of APRI was determined to be 3.99, with sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 33%, 86%, 70%, and 56%, respectively. The area under the receiver operating characteristic (ROC) curve for APRI in detecting cirrhosis was also 0.693. Conclusion Thus, our study results conclude that APRI is a crucial noninvasive prognostic tool that can be utilized to prognostize liver cirrhosis.

A Comprehensive Review on Serum Ferritin as a Prognostic Marker in Intensive Care Units: Insights Into Ischemic Heart Disease.

Serum ferritin has garnered considerable attention as a prognostic marker in intensive care units (ICUs), offering valuable insights into patient outcomes and clinical management strategies. This comprehensive review examines the role of serum ferritin in predicting outcomes among critically ill patients, with a particular focus on its implications for ischemic heart disease (IHD). Elevated serum ferritin levels have consistently been associated with adverse outcomes in ICU settings, including increased mortality, prolonged hospital stays, and higher morbidity rates. Furthermore, the relationship between serum ferritin levels and IHD underscores its potential as a biomarker for cardiovascular risk assessment in critically ill populations. The review synthesizes existing literature to highlight the predictive value of serum ferritin in assessing illness severity and guiding clinical decision-making in the ICUs. It also explores potential mechanisms linking serum ferritin to adverse outcomes and discusses implications for clinical practice. Integrating serum ferritin measurements into routine assessments could enhance prognostication and risk stratification in ICU patients, while further research is needed to elucidate optimal management strategies and therapeutic targets. Collaborative efforts between clinicians and researchers are essential to advance our understanding of serum ferritin's prognostic value in the ICUs and translate this knowledge into improved patient care and outcomes.

Advancements in Wearable Digital Health Technology: A Review of Epilepsy Management.

This review explores recent advancements in wearable digital health technology specifically designed to manage epilepsy. Epilepsy presents unique challenges in monitoring and management due to the unpredictable nature of seizures. Wearable devices offer continuous monitoring and real-time data collection, providing insights into seizure patterns and trends. Wearable technology is important in epilepsy management because it enables early detection, prediction, and personalized intervention, empowering patients and healthcare providers. Key findings highlight the potential of wearable devices to improve seizure detection accuracy, enhance patient empowerment through real-time monitoring, and facilitate data-driven decision-making in clinical practice. However, further research is needed to validate the accuracy and reliability of these devices across diverse patient populations and clinical settings. Collaborative efforts between researchers, clinicians, technology developers, and patients are essential to drive innovation and advancements in wearable digital health technology for epilepsy management, ultimately improving outcomes and quality of life for individuals with this neurological condition.

Enteric Fever Presenting With Complete Heart Block (CHB): A Rare Case of Reversible Arrhythmia.

Salmonella enterica serovar Typhi is the causative agent of enteric fever, commonly called "typhoid". This fever can be mistaken for a variety of other febrile disorders. It is an endemic sickness, especially in developing nations. Enteric fever typically manifests with fever, abdominal pain, and constitutional symptoms, making it a diagnostic challenge due to its broad clinical spectrum. Enteric fever also affects various other systems, causing complications, amongst which the cardiovascular system is no exception. Complications in the cardiovascular system may range from myocarditis to cardiomyopathy and various arrhythmias. This case report describes a case of a 28-year-old male who presented to us with fever and giddiness. Examination revealed profound bradycardia and electrocardiography (ECG) revealed features of a complete heart block (CHB). Investigations for fever confirmed enteric fever. This case report highlights one of the rarest complications of enteric fever.

A Comprehensive Review of the Immunomodulatory Effects of Vitamin D in Sepsis.

Sepsis remains a critical global health challenge characterised by a dysregulated immune response to infection, leading to systemic inflammation and organ dysfunction. This review examines the immunomodulatory effects of Vitamin D in sepsis, focusing on its regulation of immune cell function, modulation of cytokine production, and enhancement of antimicrobial responses. While the potential of Vitamin D as an adjunctive therapy in sepsis management is evident, challenges such as variability in Vitamin D status, uncertainties regarding optimal dosages and patient heterogeneity, and potential adverse effects require careful consideration. The review highlights the implications for future research and clinical practice, emphasising the need for standardised measurement protocols, elucidation of optimal supplementation strategies, and integration of Vitamin D assessments into routine care. Despite the complexities, Vitamin D emerges as a promising avenue for personalised interventions in sepsis, necessitating ongoing research collaboration and evidence-based guidelines to harness its full therapeutic potential and improve clinical outcomes.

Utility of Platelet Indices as Prognostic Markers of Sepsis: A Medical Intensive Care Unit-Based Cross-Sectional Study at a Rural Setup.

Introduction Even after the breakthrough advancements in the management and prognostic scoring of sepsis, it remains an important cause of morbidity and mortality encountered in intensive care units (ICUs) throughout the globe. This study highlights the utility of platelet indices as prognostic markers of sepsis. Methods In the present prospective cross-sectional study, a total of 177 patients with sepsis were enrolled using the Sepsis-3 criteria. The platelet indices were then linked to severity using the Acute Physiology and Chronic Health Evaluation (APACHE) II score. The correlation of platelet indices to morbidity in terms of the length of ICU stay, need for a mechanical ventilator, types of infection, and mortality was also assessed. Results The results showed that mean platelet volume (p = 0.004) and platelet distribution width (PDW; p = 0.009) were positively correlated with the severity of sepsis. Among all the parameters, plateletcrit (%) was the best predictor of the need for an invasive mechanical ventilator at a cutoff point of ≤0.22 with a 60.90% chance of correctly predicting the need for an invasive mechanical ventilator, as was mortality at a cutoff point of ≤0.22 with a 67.30% chance of correct prediction. Among the platelet indices, only PDW showed a significant association with growth in culture because patients with growth had significantly higher PDW as compared to those who did not have growth (22.4 ± 4.47 vs 20.81 ± 4.29, p = 0.011). Conclusion The difference between the survivors and non-survivor groups was statistically significant for platelet indices, making them easily available, cost-effective, and useful prognostic markers for patients in septic shock. This will help in easy understanding and preventing its morbid complications, even at the primary care physician level.

The Leukemoid Reaction in Severe Alcoholic Hepatitis: A Case Report.

Alcoholic hepatitis (AH) is a clinicopathologic illness caused by excessive alcohol abuse and is a precursor of cirrhosis. The leukemoid reaction (LR) is characterized by a strikingly raised granulocyte count of 40,000-50,000 cells/mm3. The LR usually suggests an acute inflammatory reaction. It is usually mistaken for chronic myeloid leukemia. The initial phase of leukocytosis occurs due to the releasing of cells from the bone marrow with more immature cells, causing a left upper shift in the ratio of immature to mature neutrophils and macrophages. The LR is usually seen in cases of leukemia but is rare to present in alcohol hepatitis. Excessive alcohol use causes AH in persons with or without underlying chronic liver disease. In severe AH, leukemoid responses have been associated with very poor prognosis and short-term mortality. We describe a case of a 35-year-old male with severe AH with an LR.

Unraveling Neurological Shades: Vitamin D Toxication and Central Pontine Myelinolysis Exposed.

This case report is about a middle-aged female who presented with complaints of pain in the abdomen with intractable vomiting for three months, pain and weakness in bilateral lower limbs for two months, and irritability for three days. She was previously treated for lumbar disc bulge and severe narrowing of the spinal cord whose treatment also included vitamin D supplements. After taking high doses of a vitamin D supplement daily for approximately four months, it resulted in vitamin D toxicity. The sodium level of the patient was in the normal range throughout the treatment. Her magnetic resonance imaging brain revealed features of central pontine myelinolysis. The development of central pontine myelinolysis due to vitamin D toxicity, with normal sodium levels, makes this a rare case for discussion.

Amaurosis Fugax in Posterior Reversible Encephalopathy Syndrome: A Vexed Hurdle in a Postpartum Primigravida Patient.

In this case report, we highlight a case of a 24-year-old primigravida who suffered a sudden and painless loss of vision and headache in the immediate postpartum period. Vision loss was transient and remarkable. Her brain magnetic resonance imaging revealed vasogenic edema in parieto-occipital white matter, suggestive of posterior reversible encephalopathy syndrome. Posterior reversible encephalopathy syndrome is a clinical-radiological entity, having hemodynamic catastrophe also known as reversible posterior cerebral edema syndrome. It tends to occur during pregnancy complicated by eclampsia. Hypertension and a hypercoagulable tendency tend to engulf the entire homeostasis into its deadly clutches sending the autoregulation into a frizzy. It presents with a gamut of red flags like headache, seizures, encephalopathy, amaurosis fugax, cortical visual disturbances, and even blindness. Clinical improvement was seen with supportive treatment in this patient. Thus, timely diagnosis and intervention help reverse the dire consequences.

Thyroid Dysfunction at Different Stages of Chronic Kidney Disease: A Cross-Sectional Study at a Rural Teaching College in Central India.

Background The high prevalence of thyroid dysfunction in patients with chronic kidney disease (CKD) indicates a major correlation between the progression of CKD and thyroid dysfunction. In this study, we highlighted thyroid dysfunction and its relation to the severity and different stages of CKDs. Materials and methods From October 2018 to September 2020, 200 cases with CKD, admitted under the Department of Medicine at a rural teaching hospital in central India, were selected for the study. The collected data was analyzed and correlated using the Chi-square test, and the parameters suggested the presence or absence of low T3 syndrome, low T4 syndrome, and primary hypothyroidism. Results Out of 200 patients enrolled, 181 (91.5%) had thyroid abnormalities. Among these patients, the presence of low T3 syndrome was 57%, low T4 syndrome was 23%, and primary hypothyroidism was 10.5%. It was reported that as the CKD stages advanced, TSH levels increased with a statistically significant difference (p=0.04). Conclusions As kidney function progressively deteriorated, specifically in stage five, the chances of occurrence of hypothyroidism increased.

Ankle brachial index and its correlation with cardiovascular risk factors in pre-diabetes: Two-year cross-sectional study.

Background: A state of impaired glucose tolerance is called prediabetes. The diagnosis of prediabetes is controversial, yet it still puts a person at risk for developing diabetes. The ankle-brachial index (ABI) is useful for identifying persons at risk for peripheral artery disease and for diagnosing the condition in those who have symptoms in their lower extremities and subclinical atherosclerosis. This study highlights ABI and its correlation with cardiovascular risk factors like lipid profile and anthropometric measurement including neck circumference in prediabetes so that primary care physicians may be able to diagnose early before advancing to diabetes. Materials and Methods: This cross-sectional study of 2 years duration from December 2020 to September 2022 was conducted in the Department of Medicine, at a tertiary care teaching hospital situated in a rural area. Patients with pre-diabetes were enrolled and Ankle Brachial Index was calculated. The correlation of ABI with anthropometric measures and lipid profile was assessed. Results: On calculating ABI by manual method 21% which is 42 out of 200 had low ABI (<0.9). On the other hand, on calculating ABI by probe method low range of ABI was found to be 37% which is 74 patients out of 200. There was a significant correlation between ABI and body mass index and lipid profile. The diagnostic performance of ABI < 0.9 had 56.8% sensitivity and 100.0% specificity. Conclusion: ABI can be used as a noninvasive and cost-effective modality for assessing subclinical atherosclerosis in patients with prediabetes and thus prevent its morbid complications even assessed at the primary care physician level.

Migraine and Neuromodulation: A Literature Review.

Migraine is not only known to be one of the most common causes of a headache around the globe but is also the leading neurologic cause of disability worldwide. Migraine has significant social and economic effects. It not only hampers patients' quality of life but also hampers work, public conduct, and family life. Migraine is one of the leading causes of morbidity in the world, so effective management is critical. Currently, medical management is the mainstay remedial approach for migraine, but with time, non-pharmacological approaches, especially neuromodulation, are gaining popularity with a shred of solid backing evidence. Neuromodulation is the process in which specific devices are used to excite the central nervous system or peripheral nervous system with electric or magnetic, or any other form of energy to regulate the abnormal behavior of neural pathways that have occurred due to the disease process. Neuromodulation devices as approved by Food and Drug Administration include non-invasive Vagus nerve stimulators, single-pulse transcranial magnetic stimulators, and transcutaneous supraorbital neurostimulators. The purpose of this study is to summarize the information about the advances relating to neuromodulation concerning managing and preventing migraine. This Narrative review article is prepared after analyzing various research papers and publications on PubMed and Google Scholar. This article holds brief information on understanding neuromodulation, its mechanism, its implication in managing migraine, and its different modalities with their mechanism of action and contraindications. These neuromodulation techniques can certainly be used to deal with acute migraine attacks and inhibit their progression to chronic illness. Research is required on the application of neuromodulation in the early diagnosis of migraine, which is what we still lack as a whole medical fraternity.

Post-Transfusion Simultaneous Thrombotic Thrombocytopenic Purpura and Hemolytic Uremic Syndrome: A Rare Occurrence.

Endothelial cell injury, intravascular platelet-fibrin thrombi, and vascular damage are found in hemolytic uremic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP). The two disorders frequently manifest independently and are the important causes of acute renal damage. Acute kidney injury developed in our patient after blood transfusion and later on, the patient developed neurological complications. The patient was managed symptomatically and conservatively. Plasmapheresis and corticosteroid administration showed improved results.

Monkeypox: The Re-emerging Terror.

Monkeypox is a zoonotic Orthopoxvirus called human Monkeypox. It has symptoms that resemble or are pretty similar to smallpox. Monkeypox virus belongs to the genus Orthopoxvirus, which also includes cowpox, vaccinia, and variola viruses. The World Health Organization confirmed in 1970 that the primary virus is the Orthopoxvirus infecting humans after smallpox elimination. Clinically distinguishing the condition from varicella and smallpox is challenging for a clinician. Although the mortality rate of this disease is low, new tests are being tried and studied, which are required for a more accurate and quick diagnosis because the lab diagnosis is the key to the detection of illness and its monitoring. The illness or the virus is endemic to parts of western and central Africa. Surveillance in underdeveloped rural regions is challenging but manageable with evidence-based techniques and training materials for public health professionals. However, as in the present scenario, the disease is having a worldwide outbreak in various countries, and recently India detected its first case on 15 July 2022 in New Delhi. The widespread disease is due to trading exotic pets and international travel. Since smallpox vaccinations are not administered to people regularly, epidemiological studies are required. New medications and vaccines provide hope for treating and preventing Monkeypox; however, further study is required before they can be used effectively. Also, there is a requirement for advanced scientific studies in the etiology, epidemiology, and biological structure of the virus in the endemic zones to know and halt the spread of infection to humans.

Impact of Serum Amylase Level in the Outcome of Acute Organophosphorus Poisoning: 2-Year Cross-Sectional Study at Rural Teaching Hospital.

Introduction Prompt recognition and aggressive management of acute intoxication due to organophosphorus poisoning are essential to minimize the morbidity and mortality. The present study was undertaken to know the prognosis and outcome of organophosphorus poisoning patients with the estimation of low-cost enzymes like the serum amylase level in a population with financial constraints. Methods In this cross-sectional study, we had enrolled 100 cases that had a history of exposure to organophosphorus compounds, and the serum amylase level was measured in all the patients. We assessed the outcome of all the patients in the form of discharge, need of ventilators, intensive care unit stay, and death. Results The mean serum amylase level in discharge patients was 335.40 ± 192.45, and in the patients who died it was 843.37 ± 22.60. It was significant to predict the outcome ( t -value 7.07, p -value 0.0001, statistically significant). Conclusion Serum amylase level shows significant correlation with clinical outcomes in organophosphorus poisoning.

Comparative study between conventional and 4 mm manual small-incision cataract surgery.

Purpose: Comparative study of intraoperative and postoperative complications, visual outcomes, and cost-effectiveness between conventional and 4-mm manual small-incision cataract surgery with MVR blade. Methods: In total, 600 patients having nuclear sclerosis grade I-IV were operated under peribulbar anesthesia and were divided into two groups of 300 each. In group A (300), conventional small-incision cataract surgery was done, whereas in group B (300), 4-mm manual small-incision cataract surgery was performed through a 4-mm sclerocorneal tunnel. A wire vectis was passed through the 4-mm incision below the nucleus to stabilize it, and a 20-G MVR blade was introduced from 11o'clock limbus and nucleus was bisected into two halves, which were removed through main incision. Cortical wash was given, and foldable IOL was implanted. Intraoperative and postoperative complications between the two groups were compared. Postoperative visual outcome and surgically induced astigmatism between the two groups was studied. Results: The most common intraoperative complication was hyphema (11.33%) and irido-dialysis (8.00%), whereas postoperatively, striate keratopathy (36.33%) and hyphema (19.33%) were common. Short-term complications such as striate keratopathy, hyphema, and irido-dialysis were significantly more in group B, and long-term results in terms of visual outcome and surgically induced astigmatism were significantly less in group B. Conclusion: Although intraoperative and short-term postoperative complications were observed more in 4-mm manual small-incision cataract surgery, it was found to be more effective in terms of surgically induced astigmatism and final visual outcome. In addition, it is cost-effective as compared to phacoemulsification.

Efficacy of Oral Versus Injectable Iron in Patients With Chronic Kidney Disease: A Two-Year Cross-Sectional Study Conducted at a Rural Teaching Hospital.

Aim Anaemia (particularly iron deficiency) is of important concern in patients with chronic kidney disease (CKD) as it reflects the outcome of the disease. Current recommendations for the use of intravenous iron (IV) therapy in the management of anaemia in such patients are limited. This study highlights the comparison of oral to intravenous iron in patients with chronic kidney disease. Materials and methods This is a prospective case-control study comparing intravenous iron to oral iron in chronic kidney disease patients admitted to the Medicine Department of Acharya Vinoba Bhave Rural Hospital, in central India from October 2018 to October 2020. A total of 150 patients were divided into two groups of 75 each, one receiving oral iron (ferrous sulfate 325 mg tablets) and the other intravenous iron (IV iron sucrose). Results Serum iron, serum ferritin, and transferrin saturation (TS) showed increased levels in the IV iron group than in the oral iron group. In the IV group, a statistically significant increase was found in haemoglobin levels after therapy among all stages of kidney disease (p<0.05) while the same was not reported in the oral iron group. Conclusion IV iron sucrose therapy had been found to be effective, well-tolerated, and more successful than oral iron treatment in chronic kidney disease patients as far as the parameter of iron deficiency anaemia is concerned.

Surgical Management of Cerebellopontine Angle (CPA) Lipoma Presenting As Trigeminal Neuralgia: A Case Report.

The report details an instance of a 35-year-old male, who came to our hospital with a two-year history of typical trigeminal neuralgia on the left side, predominantly in V2 and V3 dermatomes. The patient was started on medications, but pain could not be controlled by increasing doses and adjuvant medications over the last three months. A lesion was seen on the MRI in the left cerebellopontine angle (CPA) region, hyperintense on T1W and decreased on fat-suppressed imaging, characteristic of lipoma. Being an intractable case, surgery was offered to the patient. Following this, a left retromastoid suboccipital craniectomy was done, and lipoma was excised, decompressing the trigeminal nerve and relieving neuralgia symptoms. In the post-op period, the patient was completely pain-free, but he developed left-sided hearing loss and left facial palsy, Brackmann grade 4, which improved to Brackmann grade 3 on the three-month follow-up.