Vitamin D deficiency state is endemic in the Kashmir valley of the Indian subcontinent. Clinicians frequently treat patients with Vitamin D for diverse clinical symptoms to improve the general health and to reduce the frailty of elderly and these doses may at times be inappropriately high. Vitamin D toxicity-induced acute kidney injury (AKI), often considered rare, can be life-threatening and associated with substantial morbidity if not identified promptly. We aimed to describe clinical and biochemical features, risk factors, and management of AKI patients with Vitamin D toxicity seen at a single tertiary care centre in Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India, between January 2014 and January 2016. Evaluation included detailed clinical history and biochemical tests including serum calcium, phosphorus, creatinine, intact parathyroid hormone, and 25-hydroxyvitamin D [25(OH)D]. Nineteen patients with Vitamin D toxicity-induced AKI could be identified. Clinical manifestations included nausea, vomiting, altered sensorium, constipation, pancreatitis, AKI, acute on chronic kidney disease, and weight loss. Median (range) age was 64 (45-89) years. Median (range) serum 25(OH)D level and median (range) total serum calcium level were 99 (190-988) ng/mL and 139 (119-152) mg/dL, respectively. Overdose of Vitamin D caused by prescription of megadoses of Vitamin D was the cause of AKI in all cases. Median (range) cumulative Vitamin D dose was 6,000,000 (3,600,000-9,000,000) IU. On three- and six-month follow-up, the creatinine and estimated glomerular filtration rate normalized and returned to baseline in all patients except three cases who had underlying chronic kidney disease. Three patients needed rehospitalization for another episode of AKI. Our data demonstrate an emergence of Vitamin D toxicity as a cause of AKI in this part of the world. Irrational use of Vitamin D in megadoses resulted in AKI in all cases. Persistence of Vitamin D in the body for longer time resulted in rehospitalization of patients with AKI. Awareness among health-care providers regarding the toxic potential of high doses of Vitamin D and cautious use of Vitamin D supplements can have immense value to prevent this AKI.
Background: Gastric cancer is a common malignancy all over the world, and our valley is not an exception. Under this background, we conducted the present study at our tertiary care hospital to look into the clinico-demographic profile of this disease. Aim was to determine the clinico-pathological and demographic profile of patients with carcinoma stomach attending to our tertiary care hospital. Methods: This prospective study was conducted in unit-II of department of general surgery in Shri Maharaja Harisingh hospital Srinagar, over a period of 5.5 years from July 2012 to December 2017. All patients with histopathological diagnosis of gastric malignancy were included and analysed. Results: Male to female ratio was 1.4:1 with mean age of 63.23 years. The most common histopathological type of gastric malignancy was adenocarcinoma (85.84%) followed by lymphoma. The most common location of the gastric cancer was distal third of the stomach. Fifty-seven patients (50.4%) were offered definitive surgery and 21(18.58%) were managed by palliative surgery. Out of 113 patients, 87 patients (76.9%) had present or past history of smoking. The most common presentation in our study was dyspepsia. Conclusions: Profile of gastric carcinoma in our institution is not in wide variance with that of other studies. A significant proportion of patients presented with an advanced or unresectable disease because of the delay in proper screening. All patients with history of dyspepsia (age >50 years) and anemia should undergo screening upper gastrointestinal (UGI) endoscopy at the earliest, so that we can detect the lesion at the initial stage.
Background: Although a rare entity, alveolar hydatid disease is associated with significant morbidity. This disease presents a diagnostic challenge because of its low prevalence, unfamiliarity and nonspecific presentation. Aim: To look about the clinical profile, diagnosis and management of these patients.Methods: This prospective study was conducted in the department of surgery at SMHS (Shri Maharaja Harisingh) hospital. All patients with a diagnosis of alveolar hydatid disease of liver during this time period were enrolled in the study.Results: Eight patients in our study were females and 5 patients were males. The age ranged from 21 to 56 years with mean age of 42.07±8.88 years (SD =8.88). The most common presentation in our study was pain abdomen (38%). The most common finding on physical examination was hepatomegaly (30.76%). CT (computerized tomography) scan abdomen gave an impression of alveolar hydatid disease in 5 patients, a suspicion of malignancy in 3 patients and tuberculosis in one patient, and a possibility of liver abscess in one patient. Results of tru cut biopsy were suggestive of alveolar hydatid disease in 4 out of 6 patients. Twelve patients were operated on elective basis (liver radical resection in 8 patients, while “laparotomy and only tumor biopsy” in 4 unresectable patients) and one patient on emergency basis, and all were subjected to histopathological examination. ABZ (albendazole) was given orally at a dosage of 10-15 mg/kg per day.Conclusions: Alveolar hydatid is a rare disease with atypical (unfamiliar) and nonspecific clinical features and atypical radiological features. Also, the disease is associated with significant morbidity, hence a high index of suspicion is needed along with supplementary imaging studies for timely intervention to prevent further complications arising from the disease.
Asthma and chronic obstructive pulmonary disease (COPD) are common diseases with a huge public fitness impact. The aim of this study was to investigate the prevalence of asthma COPD overlap syndrome (ACOS) amongst patients of obstructive airway disease and also to determine the clinical characteristics and demographic profile of such cases with overlap syndrome. Material and Methods: A hospital based, prospective, observational study was conducted on individuals of both sexes within the age group of 40 and 80 years. Patients with history suggestive of obstructive airway disease were subjected to pulmonary function test. Patients found to have obstructive pattern on pulmonary function test were subjected to sputum eosinophil count and serum IgE levels. Results: Of 130 patients enrolled in the study 59 (45.38%) were pure COPD, 48 (36.92%) were pure Asthma and 23 (17.69%) were ACOS phenotype. Also patients with ACOS phenotype were found to have more number of acute exacerbations and hospitalizations. Obstructive airway disorders encompass bronchial asthma and chronic obstructive pulmonary disease (COPD). Conclusion: A subset of patients with obstructive airway disease display characteristics of both asthma and COPD. Such patients are called having asthma COPD overlap syndrome (ACOS). But, the prevalence and the characteristics of these patients with ACOS are not nicely understood.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.