Journal of Integrated Health Sciences

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Background: Sepsis has remained a leading cause of bed occupancy and mortality in medical ICU around the world. There is limited epidemiological information from south Asian countries about the prognostic factors for the outcome in such patients which is very important in planning for treatment strategies. Aim: We investigated various prognostic factors for sepsis and also the use of APACHE II scoring system as a prognostic tool. Methodology: We analysed 50 patients with sepsis admitted to medical ICU. All demographic, etiological, clinical and investigatory parameters were recorded and APACHE II score was calculated for all patients on the day of admission. Patients were followed till discharge or death in hospital. Results: Among wide range of primary diseases causing sepsis in our study, tropical sepsis was one of the major contributors which differ from the western studies. Overall mortality was 28% which is comparable to other parts of the world. Demographic profiles including sex, area of residence and socio-economic status except increasing age did not correlate well with mortality in sepsis patients. Central nervous system and respiratory system involvement led to highest mortality (52%). Number of organ systems involved was found to be statistically significant predictive factor for mortality in severe sepsis (p <0.05). Mean APACHE II score of study patients was 22.84 ± 7.57. Severity grading of sepsis as per APACHE II scoring system correlated very well with mortality (p <0.05) but it did not correlate with length of ICU stay. Conclusion: In the era of many complex scoring systems, along with traditional prognostic factors, age old APACHE II scoring system is still a very user-friendly and inexpensive method which can be used at the bedside for mortality prediction in sepsis patients.

A middle aged male patient was diagnosed with B-cell non-Hodgkin's Lymphoma and treated with Rituximab, Doxorubicin, Vincristine, and Cyclophosphamide(R-CHOP) chemotherapy regimen for 6 months. Four months after the chemotherapy patient presented with symptoms of heart failure. There was no significant history of any cardiac disease in the past. Chest X-ray was done with showed enlarged cardiac silhouette. Echocardiography was done which revealed a dilated cardiomyopathy with severe left ventricular (LV) systolic dysfunction. Chest X ray before starting the chemotherapy had normal cardiac silhouette. Echocardiography reports before starting the chemotherapy were within normal limits with normal sized heart and normal ejection fraction. Patient was managed with optimal drugs and echocardiography was repeated after 1 year which showed an improved LV systolic function with ejection fraction of around 40%. This led to the diagnosis of Doxorubicin induced cardiomyopathy.

Tuberous sclerosis is a genetic disorder affecting cellular differentiation, proliferation, and maturation. This cellular process gets disarranged and results in hamartomas formation in multiple organs of body the body including, the kidneys. Kidney involvement is usually bilateral and asymptomatic. We report a case of bilateral renal angiomyolipomas who presented with hematuria and pain.

Aim: To study the various socio-demographic factors associated with anaemia among adolescents. Methodology: A Community based cross sectional descriptive study. Hajipur village, a rural field practice area of Department of Community Medicine, Katihar Medical College, Katihar, Bihar. Four hundred adolescents (213 boys and 187 girls). Systematic random sampling technique was used. Data collected was entered in Microsoft Office Excel and analysed by using SPSS version 20.0. Results: Among 400 adolescents(213 boys and 187 girls) the largest number of adolescents 41.5% belonged to 10-14 years age group followed by 32.5% and 26% in the 15-17years and 18-19 years age groups respectively. Factors such as level of education of adolescents, mother's education, socioeconomic status, father's occupation, family type were found to be significantly associated (p<.0001) with the prevalence of anaemia in adolescents. Conclusion: It was concluded that adolescent's illiteracy and mother's illiteracy, low socioeconomic status, father's occupation such as labourer, nuclear families were significantly associated (p<.0001) with high prevalence of anaemia among adolescents. It is essential to implement adolescent friendly health services as recommended by WHO to improve the nutritional status.

Background: Major depressive disorder (MDD) is characterized by depressed mood along with excessive fatigability, psychomotor agitation or retardation, weight loss or gain,patients diagnosed with MDD decreased interest in pleasurable activities and feelings of hopelessness and worthlessness for a minimum period of 2 weeks. Guidelines like NICE guidelines, Indian Psychiatric Association guidelines that are available might not be specific for all patients. Therefore, department of Psychiatry SBKSMI&RC designed Evidence Based Treatment Protocols for the same. Hence, patients attending psychiatry OPD are treated with this protocol. Our aim was study of outcome of Major Depressive Disorder treatment as per evidence based treatment protocol devised by Department of Psychiatry. Methodology: Treatment naïve 50 MDD subjects were recruited. The severity was assessed using Montgomery-Asberg Depression Rating Scale (MADRS). All subjects were given antidepressant monotherapy from the following group-Selective Serotonin Reuptake Inhibitors (SSRI), Selective Norepinephrine Reuptake Inhibitors (SNRI), Norepinephrine Dopamine Reuptake Inhibitors (NDRI) & Noradrenergic & specific Serotonergic Antagonist (NaSSA) at optimal dosage for 8 weeks after which MADRS was repeated. Subjects still symptomatic (score>6) were augmented with another antidepressant at optimal doses from group other than what was given at baseline for next 8 weeks after which the outcome was assessed. Results: 72% of patients became asymptomatic (MADRS score <6) after 8 weeks of treatment. Majority of improvement was seen in mild category. 80% became asymptomatic after 8 weeks of augmentation & this was most effective in severe category. Conclusion: 80% of subjects became asymptomatic who received adequate drug trial at optimal doses according to stage-1 of our treatment protocol for MDD which implies that evidence based protocol that we designed for MDD is efficacious.

This report is of an atypical case of mycetoma at unusual site simulating sexually transmitted infection. Most lesions described in literature are on the foot and lower legs while our patient had lesions at perineum and thigh.

A 30 year old woman residing at Khargaon, M.P., presented with complaints of abnormal behavior, decreased sleep, unable to perform routine activity and headache in psychiatry OPD of Dhiraj General Hospital. She was referred to medicine OPD for the complaints of fever and skin rash. On examination, she had terminal neck rigidity and brisk deep reflexes but normal plantar reflexes. On investigation she had pancytopenia with normal CT brain and CSF examination. ANA was positive. She had four positive criteria as per American college of Rheumatology Classification of SLE (updated in 1997) and thus diagnosis of SLE was made. On higher mental state examination she had poor affect, mood swings, delusions and poor judgment. Her orientation was normal. Memory and cognition appeared normal however it was difficult to test it as she did not co-operate. Patient was treated with steroid and immunosuppressive therapy and showed improvement. This suggests the importance of neurological and psychiatric examination in case of SLE.

Online since 02^nd August 2018.