PATTERN OF ADDISONS DISEASE AND ADDISONION CRISIS IN PATIENTS PRESENTING TO TERTIARY HEALTH CARE HOSPITAL IN INDIA

2021 ◽  
pp. 109-112
Author(s):  
Jayprakash D. Shirpurwar ◽  
Jitendra R Ingole
Keyword(s):  
Adrenal Glands ◽  
Clinical Presentation ◽  
Signs And Symptoms ◽  
Care Hospital ◽  
Drug Induced ◽  
Steroid Abuse ◽  
Addisons Disease ◽  
Mucous Membranes ◽  
A Prospective Study ◽  
Symptoms And Signs

BACKGROUND: Thomas Addison described a group of patients with diseased adrenal glands at autopsy, with similar signs and symptoms before death; a condition now known as primary adrenal insufciency i.e. Addison's disease. Secondary adrenal insufciency also causes similar symptoms and signs that are due to reduced ACTH secretion from the pituitary gland. Sometimes these symptoms and signs can be subtle and nonspecic. Patients may experience fatigue, weakness, weight loss, and gastrointestinal upset, hyperpigmentation of the skin and mucous membranes. These symptoms are gradual in progression and worsen over years, making early diagnosis difcult. The clinical presentation of adrenal insufciency in India may be underdiagnosed and not paid sufcient attention to. We, therefore, studied the clinical prole of adrenal insufciency. METHODS: We used a prospective study as a study design. We studied 26 patients with adrenal insufciency for their etiology, clinical features, and various laboratory prole including autoantibodies and cortisol levels. RESULTS: Drug-induced adrenal insufciency (steroid abuse) etiology was present in 46.15% of the patients. Tuberculosis was the cause in 26.92% of the patients. Septicemic shock with multiorgan dysfunction syndrome was the etiology in 23.07% of patients. Postural hypotension and salt craving and hyponatremia were noted in about 30.76% of patients with s/o mineralocorticoid deciency. CONCLUSION: Steroid abuse was the most common cause of adrenal insufciency followed by septicemic shock and tuberculosis. Thus, a high index of clinical suspicion is required for a diagnosis of adrenal insufciency in the early stages for diagnosis and prompt treatment.

scholarly journals ANTI TUBERCULAR DRUGS INDUCED HEPATOTOXICITY IN A NEW TERTIARY CARE HOSPITAL OF A TRIBAL DISTRICT OF ODISHA

2021 ◽  
pp. 45-48
Author(s):  
MANAS RANJAN NAIK ◽  
MANORANJAN DASH ◽  
BIBHU PRASAD BEHERA ◽  
TRUPTI REKHA SWAIN
Keyword(s):  
Significant Influence ◽  
Liver Enzymes ◽  
Extrapulmonary Tuberculosis ◽  
Tertiary Care ◽  
Signs And Symptoms ◽  
Normal Liver ◽  
Care Hospital ◽  
Drug Induced ◽  
Medical College ◽  
A Prospective Study

Objective: India accounts for about one-fourth of the global TB burden. WHO TB statistics for India for 2018 gives an estimated incidence fig. of 2.69 million cases (199 per one lakh population). Drug-induced Hepatotoxicity is responsible for significant morbidity and mortality of the TB patient if these drugs continued after symptoms of hepatotoxicity develop. Whether the hepatotoxicity is due to individual drugs or due to additive effects is still unclear. The management therapy for TB patients with anti-TB DIH is imperative to ensure successful TB treatment and not recurrence DIH. Aim of the current study is to find out the pattern of Liver enzyme raised after antitubercular therapy in the tribal population of Koraput district where different phylogenetic populations reside where clinically it was observed by the physician little early onset of hepatotoxicity than national and international data. Methods: A prospective study was done after clearance from the Institutional Ethical Committee, Saheed Laxman Nayak Medical College, Koraput, from January 2019 to December 2019. Patients with>15 y of age with pulmonary and extrapulmonary tuberculosis with normal liver enzymes were included. Patients having abnormal liver enzymes before treatment, seropositive TB patients with human immunodeficiency virus infection, pregnant ladies and children<15 y of age were excluded. Results: Out of 922 patients in total; 4.78% (44) tuberculosis patients developed anti TB DIH. 68.18% (30) patients are below 50 y of age and 31.82% (14) are above 50 y of age group among TB patients with DIH. Age has no statistically significant influence on the occurrence of anti-TB DIH, but there is a statistically significant influence of sex on the occurrence of anti TB DIH. The mean occurrence of anti TB DIH is 18±18.16 d. One case of anti TB DIH patients shows signs and symptoms as early as on day 6th. The commonest symptoms are nausea and vomiting in 64% of patients who developed DIH. Interruption of ATT after DIH occurred in 79.54% of patients with recurrence in only 9.9% of patients after the reintroduction of ATT. Conclusion: Anti TB DIH mostly occurred between 7-28 d of starting the ATT in this geographical region. The duration of the anti TB ATT regimen is prolonged due to DIH. We recommend that all patients should have LTs 2 w after starting ATT, even if asymptomatic.

Concomitant Rash and Blood Dyscrasias in Geriatric Psychiatry Patients Treated with Carbamazepine

1998 ◽  
Vol 32 (9) ◽  
pp. 884-887 ◽  
Author(s):  
Marshall Cates ◽  
Richard Powers
Keyword(s):  
Blood Count ◽  
Geriatric Patients ◽  
Complete Blood Count ◽  
Case Reports ◽  
Signs And Symptoms ◽  
Geriatric Psychiatry ◽  
Drug Induced ◽  
Carbamazepine Therapy ◽  
A Prospective Study ◽  
The Relationship

BACKGROUND: Rashes and blood dyscrasias are disconcerting adverse effects associated with carbamazepine therapy. Rashes are quite common, as are mild blood dyscrasias, such as mild leukopenias. Fortunately, severe rashes and blood dyscrasias are rare. There are few reports on the relationship between carbamazepine-induced rashes and blood dyscrasias, including a prospective study in which rash appeared concomitantly with leukopenia and/or thrombocytopenia in 10 patients, two case reports in which simultaneous rash and agranulocytosis occurred, and two case reports in which rashes served as harbingers of fatal aplastic anemia. CASE REPORTS: We report two cases of concomitant rashes and blood dyscrasias in geriatric psychiatry patients receiving carbamazepine therapy for bipolar disorder. One patient was found to have a severe leukopenia within several days after rash onset. The other patient was discovered to have a severe leukopenia and thrombocytopenia within about a month after rash onset. DISCUSSION: Current hematologic monitoring guidelines for carbamazepine rely heavily on the recognition of signs and symptoms of blood dyscrasias by clinicians and patients. We believe that our cases support the suggestion that patients who develop rashes receive more vigilant monitoring of the complete blood count, should carbamazepine therapy be continued. Given the currently available case reports and the fact that the incidence of drug-induced blood dyscrasias increases with advanced age, this recommendation may be particularly relevant for geriatric patients. CONCLUSIONS: Further study is required to establish whether carbamazepine-induced concomitant rashes and blood dyscrasias are valid associations insofar as monitoring is concerned.

scholarly journals Clinical and etiological profile of neonatal sepsis in children admitted to tertiary care hospital

2020 ◽  
Vol 7 (8) ◽  
pp. 1714
Author(s):  
Jawad Nazir Wani ◽  
Vivek Pandita ◽  
Saleem Yousuf ◽  
Nusrat Yousuf
Keyword(s):  
Blood Culture ◽  
Neonatal Sepsis ◽  
Clinical Presentation ◽  
Tertiary Care ◽  
Abdominal Distension ◽  
Causative Organism ◽  
Care Hospital ◽  
Suspected Sepsis ◽  
High Index Of Suspicion ◽  
A Prospective Study

Background: Neonatal sepsis is leading cause of mortality in children. The clinical presentation of neonatal sepsis is non-specific and variable. This study was undertaken to study clinical and etiological profile of neonatal sepsis.Methods: This was a prospective study conducted over a period of one year from March 2018 to March 2019. The patients with clinically suspected sepsis were included in this study. Detailed history and examination was done in all patients. In addition to baseline investigations, C-reactive protein and blood culture was done in all patients. Blood culture was done prior to administration of antibiotics.Results: In this study there were total of 102 patients out of which 54 were male and 48 were female. Among 102 patients, 69 patients were premature born before 37 weeks of gestation. Prematurity   emerged to be the most common   risk factor. In this study 62% patients had EOS (<72 hours of life) and 38% had LOS (>72 hours of life). The most common presenting feature were refusal of feeds, lethargy, respiratory distress and hypothermia. Other features were seizures, abdominal distension, apnea and sclerema. Blood culture was positive in 41% patients. The most common organism isolated on culture was Kleibsella followed by E. coli.Conclusions: Neonatal sepsis is leading cause of mortality in children. Early diagnosis and treatment is of paramount importance to prevent mortality. The clinical presentation of neonatal sepsis is non-specific and variable. So, high index of suspicion is required to detect sepsis at earliest. Gram negative organism like Kleibsella and E. coli are the common causative organism in neonatal sepsis.

scholarly journals Frequency of complication, outcome and immunization of patients presenting with measles in a tertiary care hospital

2017 ◽  
Vol 1 (1) ◽  
pp. 30
Author(s):  
Mussarat Ameer
Keyword(s):  
Causes Of Death ◽  
Clinical Presentation ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Signs And Symptoms ◽  
Effective Vaccine ◽  
Care Hospital ◽  
Paediatric Ward ◽  
Paediatric Unit ◽  
Serious Disease

Introduction: Measles is a highly contagious, serious disease caused by a virus. The disease remains one of the leading causes of death among young children globally, despite the availability of a safe and effective vaccine. Objective: To describe the  frequency of complication, outcome and immunization of patients presenting with measles in a tertiary care hospital. Method: this pilot study is being conducted in  paediatric unit II, Abbasi Shaheed Hospital, Karachi from April to December 2016 among patients presenting with measles. All patients who presented with signs and symptoms suggestive of measles according to WHO criteria were included. Data  regarding demographic profile, duration of stay, clinical presentation, degree of  malnutrition, complication and outcome was collected and analyzed. Result: A total of 106/900 (12%) hospitalized patients with/without complications were included in this study. Out of 106 patient, 55(52%) were male and 51(48%) were females, the age group range was 4 months to 9 year. Patients shifted to P.I.C.U were 20(19%) of which 5(5%) expired and 15 were shifted to paediatric ward. Majority of the patients were incompletely vaccinated 52(49%), unvaccinated 28(26%), and 26 (24%) were completely vaccinated. The most common complication was pneumonia; followed by acute gastroenteritis, encephalitis, conjunctivitis, croup, dysentery, stomatitis,  pneumothorax. Majority of the patients Conclusion: Measles is still a serious threat to children in our population. The current study concluded that improving        immunization and nutritional status in children is essential for reducing morbidity and mortality.

scholarly journals A prospective study of N-acetylcysteine treatment in drug-induced fulminant hepatic failure

2019 ◽  
Vol 8 (5) ◽  
pp. 1000
Author(s):  
Tauseef Nabi ◽  
Nadeema Rafiq ◽  
Quratul Ain Arifa
Keyword(s):  
Length Of Hospital Stay ◽  
Signs And Symptoms ◽  
Control Group ◽  
Rapid Progression ◽  
Drug Induced ◽  
Life Threatening ◽  
Baseline Characteristics ◽  
A Prospective Study ◽  
Tuberculosis Therapy ◽  
Control Study

Background: Acute liver failure (ALF) is a rare but severe, life-threatening, complex, multisystemic gastroenterological emergency. Its rapid progression and high mortality demand early diagnosis and expert management. Drug-induced ALF (DI-ALF) remains the uncommon cause of ALF in India. To date, there is no established treatment for DI-ALF other than liver transplantation and little is known about the use of N-acetylcysteine (NAC) in DI-ALF. A prospective case-control study was carried with the aim to determine the effect of NAC on mortality of DI-FHF patients and also to evaluate the safety and efficacy of NAC use.Methods: A total of 18 patients with a diagnosis of DI-FHF were included in the study. 10 patients received NAC infusion for 72 hours whereas the control group received placebo. The variables evaluated were demographic, signs and symptoms, biochemical parameters, outcome and length of hospital stay.Results: Out of 18 DI-FHF patients, 13 (72.2%) had anti-tuberculosis therapy (ATT) induced FHF and 5 (27.8%) patients had ayurvedic induced FHF. The two groups were comparable for the various baseline characteristics (age, INR, alanine aminotransferase, creatinine, albumin, grade of encephalopathy, etc.). The mortality decreased to 20% with the use of NAC versus 75% in the control group (P=0.023). Use of NAC was associated with a shorter length of hospital stay of survived patients (P=0.043). Moreover, the overall survival was improved by NAC (P=0.023) in DI-FHF. ATT induced FHF showed better outcome as compared to ayurvedic induced FHF use (P=0.019).Conclusions: Author recommended the use of NAC along with conventional treatments in patients with DI-FHF in non-transplant centers while awaiting referrals. ATT induced FHF showed better outcome as compared to ayurvedic induced FHF with NAC administration and its use was safe.

scholarly journals A prospective study to analyze the etiology, prevalence, clinical presentation, age and sex wise distribution of thyrotoxicosis among thyroid disorders in a tertiary care hospital

2020 ◽  
Vol 7 (9) ◽  
pp. 2965
Author(s):  
Manoj Kumar Nirmalanandan ◽  
Kavitha Jayanthi Balachandran
Keyword(s):  
Early Diagnosis ◽  
Prospective Study ◽  
Clinical Presentation ◽  
Tertiary Care ◽  
Clinical Syndrome ◽  
Thyroid Disorders ◽  
Care Hospital ◽  
Medical College ◽  
A Prospective Study ◽  
Age And Sex

Background: Thyrotoxicosis is a clinical syndrome characterized by an excess of free thyroxine and triiodothyronine or both. One of the major and usual causes of thyrotoxicosis is Graves’ disease. Morbidity associated with the situation is very high and it demands early diagnosis and treatment. This can reduce the burden of the disease it imparts on the society. The aim of the study is to analyse the etiology, prevalence, clinical presentation, age, and sex-wise distribution of thyrotoxicosis among thyroid disorders presenting to Government Medical College, Thiruvananthapuram.Methods: It is a prospective study undertaken in tertiary care and teaching hospital over a period of one year. 2401 patients admitted in the general ward with thyroid disorders were included in the study. Definite inclusion and exclusion criteria were followed. Relevant blood tests were done in all cases.Results: On analysis of the data which were entered in excel format the prevalence of thyrotoxicosis was 2.5%. The majority of the study population was in the twenties and forties. Incidences in females were more mainly due to increased prevalence.Conclusions: By studying the etiology, prevalence, clinical presentation, age, and sex-wise distribution of Thyrotoxicosis, the disease burden in the population can be understood and early diagnosis and proper treatment can be instituted. Our study prevalence was comparable with similar studies done in other institutions. 

scholarly journals A prospective study on assessment of drug induced qt interval prolongationin inpatient department at a tertiary care hospital

2017 ◽  
Vol 08 (05) ◽  
pp. 16886-16889
Author(s):  
Ashkan Nejati ◽  
◽  
Hemraj Singh ◽  
Alireza Naghdi ◽  
◽  
...  
Keyword(s):  
Prospective Study ◽  
Qt Interval ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Drug Induced ◽  
A Prospective Study ◽  
Inpatient Department

scholarly journals OCULAR MANIFESTATIONS OF CORONAVIRUS DISEASE (COVID 19) AT A TERTIARY CARE HOSPITAL IN EASTERN INDIA

2020 ◽  
pp. 80-81
Author(s):  
Sushmita Mukherji ◽  
Sibaji Dasgupta ◽  
Soumen Karmakar
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Signs And Symptoms ◽  
Ocular Involvement ◽  
Care Hospital ◽  
Rt Pcr ◽  
Ocular Manifestations ◽  
Novel Coronavirus ◽  
A Prospective Study ◽  
Positive Results

Background: A Worldwide concern, Coronavirus disease 2019 (COVID-19) which is caused by a novel coronavirus termed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has been also found to be associated with ocular signs and symptoms. Apart from being transmitted among close contacts via respiratory droplets, it is being considered that ocular mucosa, its secretions can also be responsible for transmission. Aims and objectives: To see the different ocular manifestations in patients admitted with COVID-19 infection at a tertiary care hospital along with presence of the virus in ocular secretions. Materials and Methods: This was a prospective study on 80 patients admitted with SARS-CoV-2 infection diagnosed by Reverse transcriptase–polymerase chain reaction (RT-PCR) positive results and followed up during their hospital stay in COVID isolation wards, till discharge or death within a time period from 15th April,2020 to 10th August,2020. Results: Out of the 80 SARS-CoV-2 positive patients studied, 10(12.5%) patients had conjunctival chemosis, 8(10%) patients had conjunctival hyperaemia,12(15%) patients had epiphora and 9(11.25%) patients had increased ocular discharge. 5(6.25%) patients had positive results for SARS-CoV-2 RT-PCR in both conjunctival as well as nasopharyngeal swabs. Conclusion: Ocular involvement can be one of the different systemic involvements of SARS-CoV-2 infection and ocular secretion can be a potential source of transmission of the virus. Hence, ocular protection in the form of spectacles or face shields must be undertaken apart from the other barriers to reduce the possible chances of transmission of the disease.

scholarly journals Risk Factors For Drug Induced Hepatitis Under Dots Programme In General Population

2013 ◽  
Vol 10 (1) ◽  
pp. 19-26
Author(s):  
Gajanan S Gaude ◽  
J Hattiholi ◽  
AK Reyas
Keyword(s):  
Risk Factors ◽  
Alcohol Intake ◽  
Tertiary Care ◽  
Female Gender ◽  
Care Hospital ◽  
Drug Induced ◽  
Short Course ◽  
Short Course Chemotherapy ◽  
Independent Risk Factors ◽  
A Prospective Study

Background: Short course chemotherapy containing rifampicin and isoniazid in combination has proved to be highly effective under DOTS regimens in the treatment of tuberculosis, but one of its adverse effects is hepatotoxicity. Little however has been published regarding drug induced hepatitis (DH) under general programme conditions. In this study, we aimed to determine the prevalence of drug induced hepatitis and the risk factors associated with the development of hepatitis over a period of 5 years. Methodology: This was a prospective study done from 2007 to 2011 in a tertiary care hospital. A total of 116 patients were included in the study that presented with hepatitis due to short course chemotherapy and were being treated under various categories of drug regimens. Fourty cases were being followed up and other 76 were seen at the hospital for the first time after the development of hepatitis. The diagnostic criteria’s for drug-induced hepatitis were made according to the ATS criteria’s. Various risk factors were analyzed for the development of DH. Results: The prevalence of DH in the present study was 3.6%. It was observed that DH patients were older and their serum albumin levels were lower. Regular alcohol intake, more extensive disease radiologically and female gender were observed to be independent risk factors for the development of DH. No other risk factors analyzed had any signifi cant association with DH. Conclusion: Of the various risk factors analyzed, advanced age, hypoalbuminaemia, regular alcohol intake and advanced nature of the disease were independent risk factors for the development of DH. The risk of hepatitis in the presence of one or more of these risk factors may be increased. SAARC Journal of Tuberculosis, Lung Diseases & HIV/AIDS; 2013; X(1); 19-26 DOI: http://dx.doi.org/10.3126/saarctb.v10i1.8673

scholarly journals Clinical profile of typhoid fever in children at a tertiary care hospital: a cross sectional study

2017 ◽  
Vol 4 (6) ◽  
pp. 1951
Author(s):  
Siddiqui S. S. ◽  
Shivraj Kumar Koppa ◽  
Kale A. V.
Keyword(s):  
Typhoid Fever ◽  
Urban Areas ◽  
Enteric Fever ◽  
Clinical Presentation ◽  
Tap Water ◽  
Tertiary Care ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Drinking Water Source ◽  
Care Hospital

Background: In endemic areas such as India, traditional signs and symptoms in enteric fever are not often observed. Unusual presentations lead to diagnostic dilemma and may delay the diagnosis of typhoid fever. The present study describes the clinical presentation of enteric fever at a tertiary care centre in Aurangabad district of Maharashtra.Methods: The study was a hospital based prospective observational study done in paediatric ward of MGM Medical College, Aurangabad over a period of 18 month starting from 1st November 2013 to 31st April 2015. The parents of the children were informed about the research and its objectives, and written informed consent was obtained from them. Prior approval was taken from institutional ethics committee.  Children of age 2 -18 years who presented with fever of 5 days or more with clinical signs and symptoms suggestive of typhoid fever and positive Widal test or Typhidot tests were included in the study. The demographic and clinical features of the patients were described.Results: Total of 99 patients were included in the study. Majority of the children were between 2 - 7 year age group (45.4%). Out of 99 children, 57 were males and 42 were females. Majority of the cases were from urban areas accounting for 75%, which included urban slums. Drinking water source was tap water in 80% cases and bore well water in 20% cases. Only 36.4% of children had fever of less than one-week duration. 58.6% of the cases had fever of more than one week but less than two weeks. Continuous fever was noticed in majority of children (55.55%). All the children presented with fever as the main complaint (100%). Loss of appetite and headache were the next common complaints reported by 59.6% cases. Commonest sign noticed was toxic look (83.8%) followed by coated tongue (74.7%) and splenomegaly (61.6%). Hepatomegaly was also noted in 39.4% of cases.Conclusions: Clinical presentation in the study subjects was similar to available reports from literature.

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