Case Report on Chiari Syndrome

Chiari Malformation is a rare condition. A condition known as Chiari malformation occurs when brain tissue spreads into the spinal canal. When a portion of your skull is excessively small or malformed, it presses on your brain and forces it downward. Chiari malformation is a rare occurrence, although the increased use of imaging testing has resulted in more diagnosis. Case Presentation: A 18-year-old boy was admitted to the hospital with the following symptoms: Tingling sensation, numbness over left hand since 2 to 3 months. Neck bend toward right side, pain in left hand since 6 month. Difficulty during eating by hand since 2 to 3 month. On physical examination, indicated a bright attentive person with pale conjunctiva and no symptoms of icterus. He had a tachycardia, bilateral pitting pedal edema and a swollen abdomen with shifting dullness, all of which pointed to as cites. He had a history of intermittent abdominal pain. On admission he complaint of new onset of dyspnea on exertion, fatigue and abdominal swelling. The rest of all physical examination was normal, with no skin changes and an intact arterial pulses in all four extremities. Conclusion: The primary focus of this case study is on professional management and outstanding nursing care, which may provide the holistic care that Chiari Syndrome necessitates while also effectively managing the challenging case. After a full recovery, the patient's comprehensive health care team collaborates to help the patient regain his or her previous level of independence and satisfaction.

Case Report on Cirrhosis of Liver

Liver is the second largest organ in human body, more than 5,000 separate bodily functions .including helping blood to clot, cleansing the blood of toxins to converting food into nutrients to control hormone levels, fighting infections and illness, regenerating back after injury and metabolizing cholesterol, glucose, iron and controlling their levels. A 56- years old patient was admitted in AVBRH on date 9/12/2020 in ICU with the chief complaint of abdominal distension, breathlessness on exertion, pedal edema, fever since 8 days. After admitted in hospital all investigation was done including blood test, ECG, fluid cytology, peripheral smear, ultrasonography, etc. All investigation conducted and then final diagnosis confirmed as cirrhosis of liver. Patient was not having any history of communicable disease or any hereditary disease but he has history of hypertension and type II Diabetes mellitus for 12 years. Patient was COVID-19 negative and admitted in intensive care unit. Patient had been undergone with various investigations like physical examination, blood test, CSF fluid examination, ascitic fluid examination, fluid cytology, peripheral smear, ultrasonography, RT-PCR etc. Patient was treated with tab. farobact ER 300 mg BD, tab. Lasix 40 mg OD, tab. Udilive 300 mg BD, tab. Rifagut 300 mg BD, tab. Metformin 500 mg OD, tab. Amlo 5mg OD, syp. Duphalac 30ml HS. Monitor vital signs, maintain input output, Monitoring and managing potential complications like, bleeding and haemorrhage, hepatic encephalopathy, fluid volume excess, monitor laboratory tests as indicated, Identify and assess for pedal edema. Conclusion: Cirrhosis of the liver is one of the final stages of liver disease. It is a serious condition, causing scarring and permanent damage to the liver. Life expectancy depends on the stage and type of cirrhosis of liver. Cirrhosis progresses, more and more scar tissue forms, making it difficult for the liver to function (decompensated cirrhosis). Advanced cirrhosis is life-threatening. If liver cirrhosis is diagnosed early and the cause is treated, further damage can be limited and, rarely, reversed.

Comparison Between Lercanidipine and Amlodipine for Efficacy and Tolerability in Patients with Hypertension

Introduction: Hypertension has been perceived as a worldwide health worry for non-industrial nations and is hardly depicted in a considerable lot of these nations. Objectives: The main objective of the study is to find the Comparison between lercanidipine and amlodipine for efficacy and tolerability in patients with hypertension. Material and methods: This cross sectional, comparative study was conducted in PIMS during January 2021 to June 2021. After permission from hospital ethical committee, total 120 patients meeting the inclusion and exclusion criteria will be enrolled in the study from Medical Emergency and admitted in PIMS. Detailed history, physical examination and necessary investigations will be done to meet the inclusion and exclusion criteria. Informed consent will be obtained. Results: The data was collected from 120 patients of both male and female. Table 01 shows the mean values of systolic and diastolic BP according to age and gender. The mean systolic and diastolic BP of all the study subjects were 124.2 ± 15.0 mmHg and 83.4 ± 9.5 mmHg, respectively. In men, the highest mean systolic BP and mean diastolic BP were among the eldest age group and preceding eldest age group. Conclusion: It is concluded that lercanidipine is associated with considerably lower incidence of vasodilation related side effects than amlodipine, especially pedal edema. Key words: Hypertension, Efficacy, Drugs, Therapy

Budd Chiari syndrome in a patient with Celiac disease: A rare entity

Celiac disease is an immune mediated enteropathy that causes malabsorption. It is associated with a number of autoimmune diseases, however is rarely associated with Budd chiari syndrome. We present a case of a young girl who was a diagnosed case of celiac disease and had presented with abdominal distension along with pedal edema. Her initial workup was all negative while ultrasound abdomen along with CT scan abdomen had given the impression of Budd chiari syndrome. She was managed with gluten free diet, diuretics along with anticoagulants.

Clinico–pathological spectrum of pancytopaenia

Pancytopaenia involves reduction in all the three haematological cell lines leading to the clinical manifestations related to anaemia, leucopaenia and thrombocytopaenia. These features can manifest either alone or in different combinations. Treatment depends on the accurate diagnosis for which pathological investigations are mandatory.The study was conducted with the aims and objectives of evaluating the different clinical and haematological parameters in cases presenting with pancytopaenia. Further, the cases were further divided based on their aetiology.A total of 64 cases were included in the present study. Detailed clinical, peripheral blood and bone marrow findings were studied.Majority of the patients belonged to the age group of 16-25 years. There was a slight female preponderance in our study in the ratio of 1:1.06 for M:F. The commonest clinical presentation was generalised weakness in 55 (85.9%) cases, followed by dyspnoea in 35 (54.7%) and fever in 30 (46.9%) patients. Pallor was the commonest examination finding observed in 60 (93.8%) cases followed by pedal edema in 19 (29.7%) patients. Among RBC morphology, normocytic normochromic picture was the commonest 18(28.1%), while bone marrow finding of erythroid hyperplasia with megaloblastic maturation was observed in 20 (31.2%) patients. Overall, megaloblastic anaemia was observed in 24 (37.5%) patients.Pancytopaenia is an important haematological manifestation in routine clinical practice. Timely, early and accurate diagnosis can save many morbidity and mortalities.

Management of IUGR with Pregnancy induced hypertension by Ayurveda Regimen: A Case Report

A Christain women aged 29 yrs visited OPD of NIA demmed to be university on (24/04/2021) with the complaint of Amenorhoea 9 months (G2P1A0L1) associated with itching on upper and lower extremities since 3 month. She also complaints of swelling in her leg, which resembles us towards the pedal edema. She also complaints of severe hyperacidity, chest pain on and off, occasional headache since 10 days in the first visit. Her L.M.P.-15/08/2020, E.D.D: 22/05/21 and P.O.G.-35 weeks 6 days. Diagnostic assessment was done by USG and Laboratory investigations and Clinical examination. The findings of USG revealed Single live intrauterine pregnancy of 34 weeks 6 days with mild IUGR, mild oligohydramnios. Loop of cord around neck, Normal fetoplacental blood flow pattern. Placenta was Grade III With calcified. In Ayurvedic classics lakshanas of Garbhakshaya, Garbhasosha, Vatabhipanna Garbha are near to signs and symptoms of IUGR. Ksheera vasti was planned along with it oral medications Avipatikar Churna, Pittantak Churna , Kapardika Bhasma, Shankha Bhasma and Gokshura Churna in combination, Phalasarpi, Swarna Vasanta malati rasa and Punarnavastak Kwatha. Patient got relief from Severe oedema. The other complaints like severe hyperacidity, Headache were relieved. Then after her B.P. was 110/70 throughout. Fetal movements were good after Vasti procedure due to which patient felt well relaxed. Patient got her labor pain and delivered on 8th May with the weight 2.2kg male child at Government Hospital. The delivery was uneventful. After ksheeravasti there was increase in weight of the baby around 118gms. Just in six days Vasti provided such a enormous change. Keywords: IUGR, Pregnancy Induced hypertension, Ksheera Vasti, Punarnavastak kwatha, Gokshura Churna

AN INNOVATIVE PHYSICAL THERAPY APPROACH TOWARDS A COMPLEX CASE OF PIVD WITH VARICOSE VEINS

PIVD is the protrusion from the nucleus pulposus through the rent within the annulus fibrosis. L4-L5, L5-S1 discs are most commonly affected in 95 percent of lumbar disc herniation. As we grow older the discs which are present in our vertebral column, become less flexible and begin to harden, making it more susceptible to tears. The herniated disc may be caused by a single undue strain or injury. However, as disc degeneration progresses with age, a few people may suffer herniated discs from more minor activities or twists. The patient was a 38-year-old female who presented with a complaint of pain in the neck & back which was 8 on Vas, pain in both limbs ( upper & lower) which was 7 on Vas, Numbness present in Upper limb fingers, Stiffness in all joints along with pedal edema. The patient also had a varicose vein on both lower limbs grade 3. She was admitted to the hospital because she was not able to even get up from the bed due to pain. She was working in a mess for 8 years the work included prolonged standing, bending down, lifting heavy weights, and sitting on the floor for a long period. Due to pain, she was not able to continue her work. Ayurvedic treatment along with physiotherapy treatment was going on. The patient had the same complaints before 12 months she was relieved by physiotherapy. The patient had three laser sessions done for a varicose vein but was not relieved before 1 year. According to the clinical presentation and Radiological findings the patient was diagnosed with PIVD. This case study shows that regular exercise, traction, back strengthening exercise, use of modalities such as IFT, and following proper ergonomics would reduce the symptoms associated with PIVD and varicose veins

Invasive Rhino-Cerebral Mycormycosis

Mr. Rameshwaran, 51 years who admitted in a private hospital with left upper and lower limb weakness and slowing of speech. He is a known case of Diabetes Mellitus, Systemic Hypertension and CVA. He was an allergic to POSCONAZOLE. On the day of admission, he was conscious and oriented. His BP was 160/90mm of Hg. On examination, he was dehydrated, bilateral pedal edema and right side hemiparesis. Investigations reveals that increased serum urea and creatinine, GFR below 26ml/min, low serum sodium and potassium. MRI shows that large acute infarct. ENT opinion reveals that presence of fungal mass in orbit and secondary to vasculitis. He was treated by corticosteroids, diuretics and anti-platelet. He was advised for physiotherapy, speech therapy, restricted salt and fluids.

Incidental Pheochromocytoma: Silent but Violent

Background: Pheochromocytoma is a rare catecholamine secreting neuroendocrine tumor. It arises from the chromaffin cells of adrenal medulla. It is diagnosed in 5–6.5% of adrenal incidentalomas which is not common. The usual clinical presentation includes the classic triad of sweating, headache and tachycardia. However, asymptomatic cases are seen in 8% of the patients with pheochromocytoma. We present a clinically asymptomatic patient diagnosed during work up of adrenal incidentaloma. The possible etiology for silent presentation includes one of the following:(i) Presence of a smaller functional tissue (ii)Accelerated turnover of the tumor causing release of the unmetabolized catecholamines in small amounts (iii) Pulsatile tumor secretion (iv)Tumors triggered by stress (v) Laboratory errors due to inappropriate handling of specimen at high-temperature (vi) False negative test results secondary to caffeine ingestion in the prior 24 hours. Clinical Case: 59 years old Caucasian female with past medical history of type 2 diabetes mellitus, obesity, essential hypertension, nonischemic cardiomyopathy, and asthma presented to the emergency room with complaints of worsening shortness of breath and pedal edema for 1 month. Physical exam: Blood pressure 146/78 mm of Hg and heart rate 82 beats/min, mild pedal edema, no pulmonary crackles. On imaging, CT angio chest showed irregularly enhancing right adrenal mass measuring 3.4 cm. This adrenal incidentaloma was not visualized on imaging done 5 years ago. Further, MRI abdomen revealed 4.1 cm right adrenal mass. Laboratory testing showed high total plasma metanephrines: 890 pg/ml (< or = 205), 24-hour urine metanephrines: 2337 (140–785), A1C: 10%. This confirmed the diagnosis of adrenal pheochromocytoma. Preoperatively, she was started on phenoxybenzamine 10 mg BID and encouraged on liberal salt intake. During the course, her blood pressure and heart rate were monitored daily. She underwent right adrenalectomy. Surgical pathology revealed 4.1 cm pheochromocytoma, negative margins with extension to the adipose tissues and vascular invasion, PASS score = 4. Post operatively, patient declined to get labs done. Due to high risk behavior of the tumor, patient needs to be monitored annually for lifelong. Conclusion: Pheochromocytoma is an uncommon tumor with varied clinical presentation. It can manifest itself widely from being silent to aggressive disease. This warrants high suspicion, early detection and management, thereby reducing the morbidity and mortality. Lately, there has been increased incidence of adrenal incidentalomas owing to widespread use of radiological investigations. We report a case of incidental pheochromocytoma which is biochemically active but clinically asymptomatic. This emphasizes the importance of being more vigilant during the evaluation of adrenal incidentalomas.

Preoperative Amlodipine Is More Efficacious Than Prazosin in Preventing Intraoperative Haemodynamic Instability in Pheochromocytoma/Paraganglioma Patients: Interim Analysis of a Pilot Randomized Controlled Study

Background: Preoperative blockade with α-blockers is recommended in patients with pheochromocytoma/paraganglioma (PPGL). The data on calcium channel blockade (CCB) in PPGL is scarce. We aim to compare the efficacy of CCB and α-blockers on intraoperative haemodynamic instability (HDI) in PPGL. Methods: In the interim analysis of this monocentric, pilot, open-label, randomized controlled trial, patients with solitary, secretory, and nonmetastatic PPGL were randomized to oral prazosin (maximum 30mg, n=9) or amlodipine (maximum 20mg, n=11). The primary outcomes were the episodes and duration of hypertension (SBP≥160mmHg) and hypotension (MAP<60mmHg) and duration of HDI (hypertension and/or hypotension) as a percentage of total surgical time (from induction of anaesthesia to skin closure). Findings: The median (IQR) episodes (2 [1–3] vs. 0 [0–1], p 0·002) and duration of hypertension (19 [14–42] min vs. 0 [0–3] min, p 0·001) and intraoperative HDI duration (22·85±18.4% vs 2·44±2·4%, CI 8·68-32·14%, p 0·002) were significantly higher in the prazosin arm than the amlodipine arm whereas episodes and duration of hypotension did not differ between the two groups. There was no perioperative mortality whereas one patient had intraoperative ST depression on the electrocardiogram. The drug-related adverse effects were pedal edema (1 in amlodipine), dizziness (1 in prazosin), and tachycardia (6 in prazosin and 3 in amlodipine). Interpretation: Preoperative blockade with amlodipine was more efficacious than prazosin in preventing intraoperative HDI in PPGL. Larger studies that compare preoperative blockade with amlodipine and both competitive and noncompetitive α-blockers inPPGL patients of various biochemical phenotypes are warranted.