ABSTRACT
The development of novel medications with previously unidentified action mechanisms is required due to the increasing in antibiotic resistance amongst dangerous microbes. The major goal of the research was to develop in silico and in vitro antibacterial methods for designing an active thiol substituted oxadiazole inhibitor targeting gram-negative and gram-positive bacteria's GlmS receptor. 1,3,4-Oxadiazole was proposed as a scaffold, and the possibility of its synthesis was examined. The least amount of free energy in the ligand configurations was chosen. Analyses of the novel molecules' characteristics were done using ADMET studies. There were four distinct reactions used in the synthesis processes. As the first reagent, substituted carboxylic acids were utilized. Synthesized compounds were characterized by spectral studies and minimum inhibitory concentration was evaluated by in vitro antibacterial examinations of synthesized compounds. Ciprofloxacin served as the study's reference drug. Based on in vitro studies and in silico molecular docking, ROS1-4 established strong binding energy, while ROS3 revealed significant antibacterial activity. These findings support the hypothesis that the proposed scaffold significantly inhibits the GlmS receptor protein.
ABSTRACT
Infective endocarditis is an unconventional infectious disease nonetheless life-threatening. A roundabout of 3% to 5% cases of Streptococcalinfective endocarditis is caused by nutritionally variant Streptococci (NVS). Granulicatella species is one of the atypical causes of infective endocarditis. In this context, the authors are disclosing a case of infective endocarditis in an underlying rheumatic heart disease patient, caused by Granulicatella adiacens. The patient had breathlessness for the past four months, on and off fever for two months anew and mid-diastolic murmur with vegetation in aortic valve as appeared by echocardiogram. The blood cultures were tested positive for Granulicatella adiacens. The patient was successfully treated with intravenous vancomycin for a period of six weeks.
ABSTRACT
Scorpion sting can present with multiple clinical presentations ranging from local swelling to cardiogenic shock. Scorpion sting affects many organ which can cause myocarditis, cardiogenic shock, acute renal dysfunction and respiratory collapse. Central nervous system involvement can cause encephalopathy, seizures, subarachnoid haemorrhage, and ischemic stroke. Cerebral bleed is a rare presentation of scorpion sting.Here we present a case of scorpion sting with unusual central nervous system (CNS) presentation of gangliocapsular bleed.
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Respiratory paralysis due to hypokalemia is a rare entity in Sjogren抯syndrome. Apart from distal renal tubular acidosis (RTA) and hypokalemia the clinical symptoms like dryness of eye, mouth and parotid swelling were absent in our case. Due to this rarity in this pattern of presenting the symptoms, the differential diagnosis of autoimmune disease is often missed and it will eventually end up in a fatal condition. Hypokalemia causes muscle weakness gradually and there will be sudden onset of respiratory paralysis which could be dangerous to the individual. Although there is the presence of rare combination of symptoms clinical history, blood gas analysis, urine analysis and ANA profile will help in the appropriate diagnosis. Herewe report a rare case of male Sjogren抯 syndrome presenting with respiratory paralysis due to hypokalemia.
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Background: Acute febrile illness is very common among patients seeking hospital care in tropical country like India. This study was conducted to evaluate etiology and clinical profile of Acute Undifferentiated Febrile Illness (AUFI) in a tertiary care hospital.Methods: This study was conducted in 175 patients with acute febrile illness who were admitted in the medical wards and ICU from January 2018 to June 2019 in a tertiary care hospital. Clinical examination and investigations like complete hemogram, liver function test, renal function test, smear for malarial parasite, widal test, urine analysis blood and urine culture, antibody titters for dengue, Leptospirosis and imaging were done.Results: Out of 175, 94 (54%) were males and 81 (46%) were females. The commonest etiology was dengue (19%) followed by enteric fever (18%), scrub typhus (16%), malaria (14%), tuberculosis (6%) and leptospirosis (5%). 138 (79%) patients had less than 14 days of fever of which dengue was the most common and 37 (21%) patients had more than 14 days of fever with tuberculosis being predominate. Other common symptoms were chills/rigors, headache and myalgia seen in 77%, 71% and 42% respectively. Icterus was seen in malaria (42%) and leptospirosis (38%). Elevated transaminases levels were observed with dengue, leptospirosis, scrub typhus, enteric fever and malaria. ARDS was most common in scrub typhus.Conclusions: Among acute febrile illness, dengue and enteric fever were the most common in this study. A thorough and probing search for an eschar is very important in scrub typhus. The treating physician has to keep in mind the comprehensive list of differential diagnosis for patients with febrile illness and anticipating the complications.
ABSTRACT
Pitutary adenomas are one of the commonest tumors of seller region of which prolactinomas and non- functioning adenomas predominate. The usual presentation are symptoms of endocrine dysfunction and mass effects. We present a case report of 37 year old male presenting with frontal headache and vomiting. Clinical observations revealed frontal bossing with enlarged hands and feet which arose a suspicion of Acromegaly. Investigations revealed elevated IGF 1 (insulin like growth factor) and growth hormone levels. Magnetic resonance image of the brain were done which showed pituitary adenoma. This case highlights the importance of clinical examination and the treating physician must have high clinical index of suspicion to detect endocrine dysfunction and use the modern techniques like stereotactic radio surgery (SRS).
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Background: Diabetes is the most common non-communicable disease known today. This study was conducted to assess the clinical profile and complications in patients with type 2 diabetes mellitus.Methods: A prospective study was carried out between April 2017 to April 2018 in patients attending a tertiary care hospital in Chennai. Patients with type 2 diabetes of age 25-80 years, minimum of 5 years duration were enrolled.Results: Out of 66 patients, 23(34.8%) were males whereas 43 (65.2%) were females. Mean age in this study population was 55.36 years with a standard deviation of 11.362. In present study, the mean fasting blood sugar level was 196.12±77.180, mean postprandial blood sugar level was 303.26±115.385 and the mean HbA1C levels was 10.95±2.369. 77.3% were on oral hypoglycaemic agents, 13.6% on insulin and 9.1% on combined therapy with oral hypoglycemic agents and insulin. The complications associated with diabetes found in present study were microvascular complications which include peripheral neuropathy 41(62.1%), retinopathy 31(46.96%), nephropathy 28 (42.42%). Peripheral neuropathy was found to be most commonly associated. Macrovascular complications include cardiovascular disease in 12.12% (n=8) and cerebrovascular disease in 4.54% (n=3). Autonomic neuropathy was found in 69.69% (n=46).Conclusions: The complications of DM are commonly seen in patients with poor glycaemic control. Among microvascular complications, peripheral neuropathy was most commonly seen. Autonomic neuropathy usually goes unnoticed and asymptomatic in most of the individuals. Increasing levels of HbA1c was found to be significantly correlated with neuropathy.
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Background: Secondary hyperparathyroidism (SHPT) is one of the less recognized complications in patients with chronic kidney disease (CKD). The prevalence of SHPT in various stages of CKD was evaluated by measuring the levels of intact parathyroid hormone (iPTH).Methods: This cross-sectional study was carried out in 100 CKD patients. Serum creatinine, calcium, phosphorous and iPTH levels were measured and statistical analysis was carried out using the SPSS software (IBM, NY, USA).Results: Among the 100 participants, the mean age (SD) was 59.3 (7.8) years. In our study population, 52% were men and the rest were females. Hypertension (75%) was the most common chronic morbidity. Prevalence of hyperparathyroidism among chronic kidney disease patients was 22% (95% CI: 14.7-30.9%). The prevalence of secondary hyperparathyroidism among dialysis and non-dialysis patients were 30% and 14% respectively which was statistically significant.Conclusions: SHPT is an important complication which is often underdiagnosed. Secondary hyperparathyroidism starts to develop when eGFR falls below 60ml/min. PTH levels starts to rise as the disease progress. Hence it is important for the treating physicians to monitor the PTH levels early in the course of CKD to prevent and treat bone mineral disease.
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Background: Idiopathic inflammatory myopathies (IIMs) are a group of chronic systemic autoimmune diseases characterized by proximal muscle weakness and elevated muscle enzymes. Aim and Objective was to analyze the demographic profile of patients with idiopathic inflammatory myopathies (IIM).Methods: This was a cross sectional observational study conducted over a period of two years (2016-2018). After obtaining institutional ethical committee clearance, informed consent from patients. 16 patients who fulfilled the criteria were included in the study. The demographic and the clinical data were analysed.Results: The mean age was 47.3±11.2 years. The study showed female predominance. ANA was positive in 11(68.7%) patients. Among the 16 patients, 5 (31.25%) had polymyositis and 11 (68.7%) had dermatomyositis. The median enzymes levels were creatinine kinase 1134 U/L, lactic dehydrogenase 477U/L, ALT (alanine aminotransferase) 154 IU/L, AST (aspartate aminotransferase) 236IU/L. Raynaud's phenomenon was seen in 37.5%. In our study, 31.25% had hypothyroidism and 6.25% had diabetic mellitus. On follow up 37.5% developed interstitial lung disease (ILD) and 18.75% were found to have malignancy.Conclusions: Steroids and immunomodulators are the mainstay of treatment in patients with idiopathic inflammatory myositis. All our patients improved with steroids. It is important to evaluate these patients during early stages and follow up to prevent complications.
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Background: Autoimmune haemolytic anaemia (AIHA) is relatively uncommon condition with grave consequences, if not diagnosed and treated early. The literature on the clinical outcome and response to treatment is relatively scarce. Aim was to study the clinic-pathological profile and the treatment outcomes in patients with AIHA.Methods: Around 25 patients with AIHA attending a tertiary care hospital over a period of one year were included in the study. The patients were divided based on severity of anaemia and etiology. All the patients data were analysed for the demographic data, clinico -pathological findings and the response to treatment. All the patients data were analysed using SPSS software (version 22).Results: Out of 25 patients, 76% were females and 24% were males. Based on severity of anaemia, 60%, 28% and 8% had severe, moderate and mild anaemia. Around 48% of the patients had thrombocytopenia along with anaemia. 8 (32%) and 17 (68%) patients have primary and secondary AIHAs respectively. In our study the commonest cause for the secondary AIHA was Systemic Lupus Erythematosus (SLE) followed by haematological malignancy, primary Sjogrens, Anti-phospholipid antibody (APLA) syndrome, carcinoma colon and Wilsons disease. Hepatosplenomegaly and lymphadenopathy were present in 36% and 4% respectively. Out of 22 (88%) patients on corticosteroid therapy, 15 (60%) patients responded to corticosteroids alone and 6(24%) patients required corticosteroid plus immunosuppressive therapy.Conclusions: AIHA has to be ruled out in all anaemia patients with indirect hyperbilirubinemia and abnormal peripheral smear. Secondary AIHA is more common than primary. Corticosteroids and immunosuppressive agents are the mainstay of treatment of AIHA.