Comprehensive Analysis of Dementia Types and Risk Factors: A Study From a Tertiary Care Center in India.

Background and objective Dementia is a prevalent clinical syndrome characterized by memory impairment and cognitive dysfunction. Its global burden is expected to rise significantly, particularly in low- and middle-income countries. Understanding the spectrum of dementia types and associated risk factors is crucial for effective management. This study aims to elucidate the demographic profiles, clinical types, and risk factors of newly diagnosed dementia cases at a tertiary care hospital in India. Methods and materials A cross-sectional, hospital-based observational study was conducted on 81 patients at the Department of Medicine, Dr. D. Y. Patil Medical College, Hospital, and Research Centre, Pimpri, Pune, from February 2022 to January 2024. Ethical approval was obtained, and written consent was obtained from participants. Clinical diagnosis was based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) criteria, supported by cognitive assessment tools and laboratory/radiological investigations. Inclusion criteria encompassed individuals aged 18 years or older, presenting with clinical symptoms suggestive of dementia, having a Mini-Mental State Examination (MMSE) score of less than 24 and Montreal Cognitive Assessment (MoCA) score of less than 25, according to DSM-V criteria for dementia. Exclusion criteria included individuals with a history of head trauma or those below 18 years of age. Results Of the 81 participants, the majority (74.1%) were over 60 years old, with females comprising 59.3% of the sample. Alzheimer's disease was the most prevalent dementia subtype (34.5%), followed by vascular dementia (19.7%) and mixed dementia (13.5%). Other causes included Lewy body dementia (2.46%), Parkinson's dementia (4.9%), frontotemporal dementia (4.9%), and Creutzfeldt-Jakob disease (1.2%). Reversible causes accounted for a significant proportion of cases: alcohol-associated dementia (6.1%), hypothyroid-associated dementia (3.7%), HIV-associated dementia (2.46%), herpes simplex dementia (1.2%), neurosyphilis-associated dementia (1.2%), and normal pressure hydrocephalus (NPH)-associated dementia (2.4%). Analysis of risk factors revealed distinct patterns among different dementia types, emphasizing the role of cardiovascular and metabolic health. Conclusion This study provides insights into the demographic profiles, clinical types, and dementia risk factors in India. Addressing causes and managing cardiovascular/metabolic health is crucial for dementia prevention and management. Comprehensive care strategies and ongoing research efforts are essential for improving dementia outcomes and enhancing the quality of life for affected individuals and their families.

Tuberculosis in a Liver Cirrhosis Patient: A Management Conundrum.

This case report delves into the intricate challenges of managing tuberculosis (TB) in a 70-year-old male with decompensated chronic liver disease (DCLD) and a history of endoscopic variceal ligation. The patient, initially presenting with symptoms such as black-colored stools, breathlessness, and weight loss, was diagnosed with right-sided pneumonia alongside DCLD. Despite the administration of standard beta-lactam plus macrolide antibiotics, the patient exhibited no improvement. Subsequent bronchoscopy revealed Mycobacterium tuberculosis (MTB), prompting the initiation of first-line anti-tubercular therapy. However, the hepatotoxic response necessitated a switch to a modified regimen with non-hepatotoxic drugs, emphasizing the challenge of managing TB in cirrhotic patients. Effective management of MTB infection involves personalized administration of anti-TB drugs, taking into account the individual's chronic liver disease status. This case underscores the importance of treating tuberculosis in liver cirrhosis patients based on the Child-Turcotte-Pugh score. A tailored and vigilant approach is indispensable for the successful management of MTB infection.

A Unique Case of Prostate Carcinoma Presenting as Retroperitoneal Lymphadenopathy With Normal Levels of Prostate-Specific Antigen and a Prostate of Normal Size: A Case Report.

Despite the significant advancements in prostate-specific antigen (PSA) screening and the diverse array of available treatments, prostate cancer (PCa) still significantly contributes to cancer-related illness. The most prevalent sites for metastases are bones, distant lymph nodes, and abdominal organs. Nevertheless, metastasis to the renal and retroperitoneal regions originating from prostate cancer constitutes an exceptionally uncommon clinical occurrence. Metastatic PCa commonly presents with elevated serum PSA levels, a hallmark of its diagnostic profile. However, there are instances where patients exhibit atypical metastatic patterns or maintain normal PSA levels. In the case under consideration, the patient exhibited a periureteral tumor with an indeterminate primary origin, subsequently confirmed to be metastatic prostate cancer. This case underscores the importance of recognizing the varied and sometimes elusive presentations of metastatic PCa. Despite its rarity, the occurrence of renal and retroperitoneal metastasis emphasizes the need for vigilance and a comprehensive understanding of the diverse manifestations of advanced PCa for timely and accurate diagnosis, which is paramount in optimizing patient care and outcomes.

Post-extubation Stridor in a Case of Intracranial Bleed: Assessing Airway Patency Prior to Extubation Using Cuff Leak Test.

Laryngeal edema is a common complication of endotracheal intubation. It may range from mild and asymptomatic to respiratory distress and severe stridor leading to subsequent reintubation. It is crucial to assess the patency of the airway before extubation to identify patients with a risk of developing laryngeal edema. To prevent post-extubation laryngeal edema (PLE), intravenous corticosteroids or nebulized corticosteroids appear to be reasonably effective, reducing the need for reintubation by more than half. We present a case of a 59-year-old male who presented with an intracranial bleed and aspiration pneumonia. The patient developed PLE and was reintubated due to respiratory distress and treated with intravenous and nebulized corticosteroids. The patient was extubated two days later after adequate cuff leak test (CLT) results. If PLE causes respiratory distress, reintubation is the only definitive treatment and should not be delayed.

Tubercular meningitis complicated by weil's Syndrome - Management of tuberculosis in a patient with concurrent hepatic and renal dysfunction.

Weil's syndrome, a severe form of the disease, may present with symptoms such as jaundice, renal dysfunction, and hemorrhagic diathesis and it can progress to multi-organ failure leading to death. In patients with coinfection of tuberculosis with leptospirosis, there may be severe hepatic and renal dysfunction rendering the standard antitubercular therapy (ATT) regimen useless, thus requiring alternate drug selection and dose modification of antitubercular drugs. We present a case of a 57-year-old female who presented with high-grade fever and yellowish discoloration of the eyes. She was diagnosed with Weil's disease and started on treatment. She later developed altered sensorium and lumbar puncture was suggestive of tubercular meningitis. Due to her deranged renal and hepatic function tests, she was started on a modified regimen of ATT with intermittent dialysis. The patient responded to treatment and was shifted to the standard Isoniazid, Rifampicin, Pyrazinamide, Ethambutol (HRZE) regimen once renal and hepatic functions returned to normal.