Dapsone hypersensitivity syndrome-rare complication of dapsone therapy

Among several other adverse effects of dapsone therapy, dapsone hypersensitivity syndrome is extremely rare but most life-threatening complication. Here we report a case of severe dapsone hypersensitivity syndrome in a 27-year-old female student diagnosed as immune thrombocytopenic purpura on dapsone therapy who was admitted with remittent fever, lymphadenopathy and skin rash and was managed successfully with drug withdrawal and systemic glucocorticoid therapy. The idea of reporting this case is to recognise the rare potentially life threatening adverse effect of dapsone therapy, its timely diagnosis and favourable outcome with systemic glucocorticoid therapy

Understanding, acknowledging and accepting the knowledge regarding the complication of post-placental intrauterine contraceptive device insertion

Background: Intrauterine devices are an effective and increasingly popular from of reversible contraception and are most effective method of long-term contraception. Post placental intrauterine contraceptive devices insertion is done within 48 hours of birth which is ideal period ass women are strongly motivated to do so at this time. Aim was to understand knowledge, acceptance and complication of post placental intrauterine contractive device insertion.Methods: This was a prospective observational study conducted in obstetrics and gynecology department of a tertiary care centre from 1st September 2021 to 28th February 2022.Results: Total 84 patient were counselled out which 50 were willing for PPIUCD out of which 48 (58%) patients PPIUCD was inserted and 2 patients were deferred.Conclusions: PPIUCD was accepted in 50 (60%) of counselled total patients out which most of the patient were 20-29 years having graduate degrees and were mutipara most common cause of acceptance was that it is long term method of contraception most of the patient were counselled intrapartum and had vaginal method of delivery patient were minimum complications with most common complication of missing threads and expulsion

An analytical study of 50 women presenting with an adnexal mass

Background: The aim of this study was to detect and determine the origin of adnexal mass and to narrow down the diagnosis. Also, to determine the reliability of the bimanual pelvic examination in diagnosing adnexal mass and to determine clinical, radiological and histopathological co-relation of adnexal mass. Adnexal mass lesions are fairly common among women (with a prevalence of 0.17% to 5.9% in asymptomatic women and 7.1% to 12% in symptomatic women) of all age group but very common among reproductive age. Differential diagnosis of adnexal mass is difficult and complex. Recognition of the severity of the problem, appropriate and timely evaluation and treatment with good outcome is the goal.Methods: Prospective, observational study of 50 patients with suspected various adnexal masses were conducted for a period of 1.5yr i.e. from November 2014 to May 2016. All patients underwent pelvic and ultrasonography examination. All patients later underwent surgery. Results were correlated later.Results: The patient ages ranged from 19 to 58 with a mean age of 31.5. Most common site of origin of adnexal masses is the Ovary (Rt. 38% and Lt. 34%) Most common adnexal masses on histopathological diagnosis are mucinous cyst adenoma (20%), Benign and mature cystic teratoma (16% and 6%) and serous cyst adenoma (10%). About 92% patients with adnexal mass presents with abdominal pain as a chief complaint.Conclusions: Although bimanual palpation of the adnexal masses may not allow a very specific diagnosis, clinically useful information can usually be obtained and hence it is particularly useful as a first step in assessment of adnexal masses and as an adjunct to morphological assessment of ovarian lesions. Ultrasonography is an important noninvasive investigation and is helpful in diagnosing most of these cases, but the histopathological examination of specimen obtained from laparotomy of adnexal mass is the gold standard for confirming the diagnosis

PREVALENCE AND RISK FACTORS OF GASTROESOPHAGEAL REFLUX DISEASE (GERD) IN ADULT KASHMIRI POPULATION

Objective: The study was conducted with the objective of studying the prevalence of gastroesophageal reflux disease (GERD) and to study various factors associated with it in adult Kashmiri population.Methods: It was a community based prospective cross-sectional observational study conducted by the Department of Medicine and Gastroenterology, GMC Srinagar over a period of 24 mo upon native Kashmiris from urban as well as rural areas as a study group. A total of 2600 subjects above the age of 18 y were studied and the overall prevalence of disease was calculated and also the associated (risk) factors were looked for.Results: The overall prevalence of 20.3% was seen in the study population with female gender being more prone to the development of disease (p<0.001). Other factors of greater significance included body mass index (BMI), smoking, physical activity, intake of spicy foods, posture after meals, dinner to sleep time, non-steroidal anti-inflammatory drug (NSAID) intake and some underlying ailments like asthma and history of abdominal surgery.Conclusion: The overall prevalence of GERD in Kashmiri community is 20.3% with females being more prone with a definite role of factors like BMI, smoking, physical activity, posture after meals, dinner to sleep time interval, intake of spicy foods, drugs and also the co-morbidities

Levels of protein C and soluble thrombomodulin in critically ill patients with acute kidney injury: a multicenter prospective observational study.

Endothelial dysfunction contributes to the development of acute kidney injury (AKI) in animal models of ischemia reperfusion injury and sepsis. There are limited data on markers of endothelial dysfunction in human AKI. We hypothesized that Protein C (PC) and soluble thrombomodulin (sTM) levels could predict AKI. We conducted a multicenter prospective study in 80 patients to assess the relationship of PC and sTM levels to AKI, defined by the AKIN creatinine (AKI Scr) and urine output criteria (AKI UO). We measured marker levels for up to 10 days from intensive care unit admission. We used area under the curve (AUC) and time-dependent multivariable Cox proportional hazard model to predict AKI and logistic regression to predict mortality/non-renal recovery. Protein C and sTM were not different in patients with AKI UO only versus no AKI. On intensive care unit admission, as PC levels are usually lower with AKI Scr, the AUC to predict the absence of AKI was 0.63 (95%CI 0.44-0.78). The AUC using log10 sTM levels to predict AKI was 0.77 (95%CI 0.62-0.89), which predicted AKI Scr better than serum and urine neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C, urine kidney injury molecule-1 and liver-fatty acid-binding protein. In multivariable models, PC and urine NGAL levels independently predicted AKI (p=0.04 and 0.02) and PC levels independently predicted mortality/non-renal recovery (p=0.04). In our study, PC and sTM levels can predict AKI Scr but are not modified during AKI UO alone. PC levels could independently predict mortality/non-renal recovery. Additional larger studies are needed to define the relationship between markers of endothelial dysfunction and AKI

Objective assessment of progressive increase in bite force post surgical correction of mandibular fractures using Nupai bite scan analyser

Background: Fracture of mandible is a common condition which is increasing in incidence in the trauma centers due to increasing motor vehicles and failure to abide by traffic regulations. Patients undergo surgical open reduction and internal fixation where post-operative occlusion and normal masticatory functions are targeted. Bite force can be taken as a guide of normal masticatory function of an individual which is dependent upon craniomandibular biomechanics. The aim of the study was to analyse bite force measurements post-operatively in patients who underwent open reduction and internal fixation for mandible fractures at different sites.Methods: Molar bite force was recorded in 31 post-operative patients who underwent open surgical procedure for fracture mandible in the department of plastic surgery from January 2018 to June 2019 by a pre-scale bite force recorder-Nupai bite force prescale system (FujiTM). Various parameters were recorded pre and post-operatively including age, gender, history, comorbidities, requirement of MMF, site and number of fractures and age of injury. Bite force were compared and improvement of bite force every 2 weeks was noted and analyzed upto 6 weeks postoperatively.Results: Bite force improvement was seen in all types of mandible fractures irrespective of the site and type of fractures over a period of 6 weeks post-operatively. This improvement was however not statistically significant. Decreased time interval form injury to surgery resulted in improved bite force measurements though not statistically significant.Conclusions: Although objective improvement in bite force could be demonstrated but extensive study involving more subjects and more patient variables would have statistical significance