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This case report details the clinical course of a 37-year-old male with multi-drug-resistant tuberculosis (MDR-TB) who initially presented with respiratory symptoms. Following a month of anti-TB therapy, the patient developed a painful chest swelling, diagnosed as empyema necessitans, with a subsequent spontaneous rupture leading to a pleurocutaneous fistula. Despite recommendations for surgery, the patient opted for active surveillance. The follow-up revealed symptom improvement. This case underscores the unique challenges of managing rare complications of MDR-TB, particularly when patients decline surgical interventions. The observed symptom improvement, despite the absence of surgery, illuminates the intricate decision-making process and alternative management strategies involved in addressing such complications, highlighting the complexities inherent in MDR-TB care.
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This study reports a case of differentiation syndrome, a rare complication of ATRA (all-trans-retinoic-acid) therapy, observed in a 20-year-old male with acute promyelocytic leukemia (APML). Following the initiation of ATRA therapy for APML, the patient presented with fever, bleeding gums, bloody stool, and mouth ulcers. After 36 hours, he developed respiratory distress, hypotension, tachycardia, and hypoxemia, leading to the diagnosis of differentiation syndrome. ATRA therapy was promptly discontinued, and the patient, exhibiting type 1 respiratory failure, necessitated intubation. The management included hydroxyurea, dexamethasone, vasopressors, intravenous fluids, and furosemide. After seven days, significant improvement was observed, underscoring the importance of recognizing and promptly addressing differentiation syndrome in APML patients undergoing ATRA therapy. This case emphasizes the necessity of ATRA discontinuation, coupled with the judicious use of steroids and hydroxyurea, in the effective management of differentiation syndrome.
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BACKGROUND: Xbox Kinect-based virtual reality, being a novel approach, has therapeutic benefits in rehabilitation and its use is encouraged in stroke rehabilitation of upper extremities. OBJECTIVE: Primary aim of the current study is to investigate the additional effects of Xbox Kinect training in combination with routine physiotherapy exercises based on each component of Fugl-Meyer Assessment Scale for Upper Extremity (FMA-UE). Moreover, effect of upper limb rehabilitation on cognitive functions was also assessed. METHODS: This study was a parallel arm randomized control trial. Fifty-six participants were recruited and randomly allocated to either an Xbox Kinect training group (XKGT) or exercise training group (ETG). Measures of concern were recorded using FMA-UE, Box and Block Test (BBT), and Montreal Cognitive Assessment (MOCA). Evaluation was conducted at baseline and after completion of intervention at the sixth week. RESULTS: There were significant differences from pre- to post-intervention scores of FMA-UE and BBT (p < 0.001) in both groups, whereas no difference was observed for MOCA (XKTG p value 0.417, ETG p value 0.113). At six-week follow-up there were significant differences between both groups in FMA-UE total score (p < 0.001), volitional movement within synergies (p < 0.001), wrist (p = 0.021), hand (p = 0.047), grasp (p = 0.006) and coordination/speed (p = 0.004), favoring the Xbox Kinect training group. CONCLUSION: To conclude, results indicate repetitive use of the hemiparetic upper extremity by Xbox Kinect-based upper limb rehabilitation training in addition to conventional therapy has a promising potential to enhance upper limb motor function for stroke patients.
RESUMEN
OBJECTIVE: Because of the globally increasing occurrence of diabetes mellitus (DM) in the population, exercise is becoming vitally important for prevention and disease management, along with medical and dietary interventions. This study was designed to test the hypothesis that women with DM would respond similarly to men with DM following supervised structured aerobic exercise training (SSAET) program. METHODS: This randomized, single blind, controlled clinical trial was conducted on 102 patients with T2DM with ranging in age from 40 to 70 years. All the participants were randomly allocated to either an experimental or a control group. The experimental group participated in an SSAET program, routine medication, and dietary plan, while the control group was treated with routine medication and dietary plan, for 25 weeks. Assessments of physical and biochemical variables were carried out at baseline and after 25 weeks' intervention and gender-based response to the SSAET program was analyzed. RESULTS: Both the male and female patients responded to 25 weeks of SSAET, routine medication, and dietary plan equally in the experimental group, whereas in the control group IL-6 and NOS-1 showed slight differences. All male and female patients in the experimental group treated with SSAET, routine medication, and dietary plan showed significant improvement in all variables (P < 0.05), while in the control group, deterioration or no change was noted except in HDL and LDL. CONCLUSION: SSAET is equally effective in both male and female patients with T2DM when compared with a non-exercise control group, but no gender-based difference was found. (Trial ID ISRCTN16466697/ http://orcid.org/0000-0002-6682-9896).
