Pulmonary tuberculosis in an adult presenting with severe hyponatremia: A case report and review of literature.

Key Clinical Message: Identifying pulmonary pathology while evaluating electrolyte disorders is crucial for optimal patient management. Physicians working in endemic regions of tuberculosis should consider this pathology as a differential for electrolyte imbalances. Abstract: Hyponatremia, a common electrolyte imbalance, can arise from various underlying etiologies such as diuretics, diarrhea, vomiting, congestive heart failure, and liver and renal disease. We present a case report of a 74-year-old man highlighting the association between pulmonary tuberculosis (TB) and the development of hyponatremia. GeneXpert assay of the patient's sputum sample led to the identification of underlying active pulmonary TB as the cause of hyponatremia. The patient was started on anti-TB therapy, and concurrent fluid restriction and sodium supplementation were initiated to correct the electrolyte imbalance. Over the next 3 days, the patient demonstrated clinical improvement with the resolution of hyponatremia. This case also highlights the importance of considering TB as a potential etiology in patients presenting with hyponatremia, especially in endemic areas. Further research is warranted to explore the mechanistic pathways linking pulmonary TB and hyponatremia, aiding in the development of targeted therapeutic interventions.

Cardiac amyloidosis: evolving pathogenesis, multimodal diagnostics, and principles of treatment.

Amyloidosis is a protein deposition disorder in which insoluble fibril structures accumulate in the bodily tissues damaging the organ function. Cardiac amyloidosis is a severe but under-reported medical condition characterized by the accumulation of amyloid in the extracellular area of the myocardium, which results in thickening and stiffening of ventricular walls. Cardiac amyloidosis has recently gained much attention with its slowly surging incidence. With this study, we seek to comprehensively compile the pathophysiology and clinical picture of cardiac amyloidosis subtypes, extending a clinically oriented, up-to-date clinical approach to diagnosis and therapy. Cardiac amyloidosis can be caused by rare genetic mutations which may be inherited or acquired. The growing incidence can be attributed to advancements in imaging methods and other diagnostic modalities. Most occurrences of cardiac amyloidosis result from two forms of precursor protein: transthyretin [TTR] amyloid and immunoglobulin-derived light-chain amyloid. Prompt identification of cardiac amyloidosis can facilitate the implementation of evolving therapeutic interventions to enhance the outcomes. The modalities for the management of CA have evolved significantly in the last ten years. Apart from therapies for modifying disease and heart failure, a myriad of novel therapeutic approaches that target specific aspects of the disease, including gene therapies, are being researched. These aim at impeding its progression and improving clinical outcomes. See also Figure 1(Fig. 1).

Abdominal cocoon syndrome. A rare cause of mechanical intestinal obstruction: A case report.

INTRODUCTION AND IMPORTANCE: Abdominal Cocoon Syndrome (ACS) also known as Idiopathic. Sclerosing Peritonitis, is a rare cause of Mechanical Intestinal Obstruction. CASE PRESENTATION: We present a 59-year-old man with severe intestinal blockage symptoms for three days. Rectum had a noticeable amount of abdominal fat. To rule out the more common causes of mechanical blockage, a CT scan revealed the presence of a rare condition called Cocoon Syndrome, which necessitated exploratory laparotomy and adhesiolysis surgery. After the surgery, the patient was declared stable and was released from the hospital. CLINICAL DISCUSSION: The diagnosis of a tuberculous abdominal cocoon before surgery is a real challenge. CONCLUSION: Recognizing and understanding this entity, as well as the usual radiological findings, may help in its appropriate treatment.

The RIPASA scoring system: A new Era in appendicitis diagnosis.

Introduction: Even though acute appendicitis is a common acute abdominal disease, it is nonetheless difficult to detect. In order to minimize the risk of complications and negative exploratory procedures, early and accurate diagnosis is critical.We aimed to compare the predictive accuracy of the RIPASA score in diagnosing acute appendicitis with the gold standard of histopathological proven appendicitis as the gold standard. Methodology: A Prospective Cohort Study was conducted from December 2021 to May 2022 at KRL Hospital. A total of 171 patients who sought treatment for acute RIF pain or suspected appendicitis were included in the study. Patients' surgical proclivities were judged in part based on images and surgeon's expertise. SPSS version 26 was used to enter and analyze the data. This was done using a chi-square test and a Kendall's Tau (Kendall Rank Correlation Coefficient) to evaluate both groups of patients. Results: At diagnosis, the mean age was 37.93 10.36 years. Kendall's Tau and Chi Square were shown to be significant in contrast to Alvarado scoring. RIPASA Scoring exhibited a 98.02% positive predictive value, a 96.75% sensitivity, an 82.35% specificity, and 95.3% diagnostic accuracy. Conclusion: The RIPASA score is superior to the Alvarado score when it comes to detecting acute appendicitis in Asian populations. With a brief medical history, a clinical examination, and two simple procedures, parameters can be simply and swiftly obtained in any demographic circumstance.

Irritable bowel syndrome in adults: Prevalence and risk factors.

Introduction: The prevalence of irritable bowel syndrome (IBS) ranges from 7 to 18% over the world. We aimed to assess the prevalence and risk factors of irritable bowel syndrome in adults. Methodology: We conducted a cross-sectional study of IBS prevalence and risk factors from March to May 2022 at KRL Hospital Islamabad. 300 people were given Pre-validated Performa's. Our research adheres to the principles outlined in the Helsinki Declaration. The PSS was used to measures how much stress a person has felt in the past month.The higher the score, the more stressed the person appears to be. A variety of mental health disorders can be evaluated using this method. Data on dietary and lifestyle factors associated with IBS for the last 12 months was also collected from the participants. Results: The majority of patients, 70%, were classed as Grade 1 and 146 (48.66%) reported abdominal pain associated with defecation. 162 (54%) individuals reported high levels of tea consumed, 81 (27%) consumed coffee and 57 (19%) reported carbonated drinks consumed. 139 individuals reported having Vigorous-Intensity activity, out of which 69 (49.64%) spend 60 min of vigorous activity in a day. Conclusion: Screening patients for IBS on a regular basis is critical, especially in the younger demographic. If a patient experiences any symptoms of IBS, they should contact their doctor immediately. Consider the care of patients with chronic gastrointestinal complaints, particularly in women and those at greater risk of developing the illness.