Abstract We report a case of a 30-year-old male with a history of alcohol consumption and intravenous drug abuse who presented with exertional breathlessness for a year. On admission, he developed chest pain and right-sided weakness. Imaging revealed a right internal capsule infarct, suggestive of an embolic stroke. Two-dimensional echocardiography showed mitral valve vegetations and features of rheumatic heart disease (RHD). Blood cultures grew Acinetobacter spp., a rare pathogen for native valve endocarditis (NVE). The patient was treated with meropenem and amikacin for 6 weeks, along with anticoagulation and supportive care. He improved symptomatically and was discharged after repeat blood cultures were negative. This case illustrates that while Acinetobacter is an uncommon cause of NVE, it should be considered, particularly in patients with significant risk factors such as intravenous drug abuse and RHD.

Asthma affects over 300 million people across the globe and involves chronic airway inflammation, reversible expiratory airflow limitation, and heightened airway responsiveness. Although asthma research and treatment have made substantial progress in recent years, both over- and under-diagnosis of asthma are frequent. In this overview, we highlight key updates from the 2024 Global Initiative for Asthma guidelines for optimal patient-centered asthma care. This article outlines the latest findings on asthma and its treatments, offering recommendations for evidence-based clinical practice.

Background: Magnesium deficiency has been reported in 20%–65% of patients in an intensive care unit (ICU) setting. They have mortality rates 2–3 times higher and prolonged hospitalization compared with those who have normal serum Mg levels. Objective: The objective of the study was to study serum magnesium levels in patients admitted to ICU and its association with sequential organ failure assessment (SOFA) score. Materials and Methods: A hospital-based cross-sectional study was carried out among 100 patients admitted to ICU. Detailed history, thorough physical examination, serum magnesium measurement, and routine investigations were performed. Based on serum magnesium levels, patients were divided into three groups: hypomagnesemia (<1.7 mg/dL), normomagnesemia (1.7–2.4 mg/dL), and hypermagnesemia (>2.4 mg/dL). SOFA score was calculated within 24 h of ICU admission. Results: Majority were male (65%). Majority were 41–60 years old (46%). Magnesium levels ranged from 1.0 mg/dL to 3.7 mg/dL, with a mean of 1.79 ± 0.59. The mean value of magnesium in the hypomagnesemia group was 1.225 ± 0.117, in the normomagnesemia group was 1.98 ± 0.2, and in the hypermagnesemia group was 2.96 ± 0.32. The mean SOFA score was significantly higher in patients with hypomagnesemia compared to patients with normomagnesemia and patients with hypermagnesemia ( P < 0.05). The incidence of hypomagnesemia was 57.6% in patients with diabetes mellitus compared to 32.8% in those without diabetes. This difference was found to be statistically significant ( P < 0.05). The odds of being diabetic in those with hypomagnesemia were 2.746 times more than those without hypomagnesemia. Conclusions: This study highlights the magnitude of magnesium disturbances on admission in critically ill patients admitted to ICU in the given settings. Hypomagnesemia is associated with a high SOFA score.

Fungal endocarditis in hemodialysis patient is a rare and extremely debilitating disease associated with high morbidity and mortality. The 2009 Infectious Diseases Society of America guidelines suggest the combined use of surgery and antibiotics to treat candidiasis; whereas, successful nonsurgical treatment of Candida endocarditis has been reported. Case Presentation: A patient with chronic kidney disease was admitted to the Intensive Care Unit (ICU) after experiencing fever with shortness of breath for last 15days and swelling of whole body for 1 week. Blood culture revealed Candida albicans infection. On further workup he was found to have infective endocarditis with a large vegetation across the tricuspid valve. He was treated with intravenous and oral antifungal therapy for eight weeks. Valvular surgery was not performed. The patient clinically improved. Central venous catheters and AV fistulae are major sources of infection. Strict adherence to hygiene rules and prevention guidelines are mandatory in hemodialysis patients to prevent infectious complications.

Abstract Background: Intestinal fibrosis is a complication of inflammatory bowel disease (IBD). Currently, there are no effective preventive measures or medical therapies for intestinal fibrosis. Surgery remains the only available strategy in the management of fibro stenotic enteropathies. However, more than 50% of patients undergoing surgery experience recurrence of stenosis. We assessed effects of glycoprotein nonmetastatic melanoma protein B (Gpnmb) on chronic colonic fibrosis induced by dextran sulfate sodium (DSS) in mice. Materials and Methods: GSE42768 mRNA microarray dataset was selected to carry out GEO2R bioinformatics analysis to predict differentially expressed genes. Chronic colonic inflammation-associated fibrosis was induced by DSS in mice. Twenty-four healthy male BALB/c were assigned to four groups: Control, model, T1: Intragastric administration of Thalidomide (Thal) 100 mg/kg.day beginning at day 18, T2: Intragastric administration of Thal (100 mg/kg.day) beginning at day 0 (n = 6 in each group). The colon was removed after modeling and assessed by pathological staining, Western blot, and reverse-transcription polymerase chain reaction. Col1α2, Gpnmb, Wnt1, and β-catenin antibodies were used. Results: The degree of chronic colitis and fibrosis was highest in the model group, and lowest in the control group. Thal treatment significantly alleviated DSS-induced chronic colitis and intestinal fibrosis, decreasing Gpnmb at both mRNA and Western blot levels. Expressions of Col1α2, Wnt1, and β-catenin got the same results. Conclusions: From bioinformatic analysis and fundamental experiment, we have illustrated that Gpnmb may stimulate the occurrence of intestinal fibrosis via Wnt1/β-catenin pathway. It may be a new therapeutic target for IBD-related intestinal fibrosis.

Background: Pneumonia is a major medical problem and is foremost infectious cause of death in developed countries. A rapid and reliable predictor might aid physicians in identifying hospitalization, intensive care unit admission, and treatment changes. B-type natriuretic peptide (BNP) has consistently been observed to improve the diagnosis and management of hospitalized patients with pneumonia. This investigation aimed to study the importance of BNP in the assessment of severity of pneumonia in a tertiary care center in South India. Subjects and Methods: A hospital-based observational research was carried out on patients admitted during the period of September 2016 to July 2018 with sample size of 108. All patients satisfying the inclusion criteria were enrolled. Detailed clinical history and physical examination findings were noted. Diagnostic criteria symptoms were recorded following the standard protocol. BNP was measured using the double-antibody sandwich enzyme-linked immunosorbent assay. The statistical analyses were done using the statistical software R version 3.6.3 and MS Excel. Results: Out of 108 patients, 48 (44.44%) were female and 60 (55.56%) were male. Of these, 45 (41.67%) patients identified with community-acquired pneumonia, 27 (25%) with health-care-associated pneumonia, 26 (24.07%) with aspiration pneumonia, and 10 (9.26%) with pneumonia with comorbid conditions. BNP levels among survivors and nonsurvivors were 193.52 ± 124.93 and 413.08 ± 149.38 pg/ml, respectively. The total mortality was 13/108 (12.04%). Out of 13 patients, 12 (92.31%) nonsurvivors had BNP level ≥200 pg/ml and 1 (7.69%) had 100–200 pg/ml. Conclusion: BNP levels could be a useful single prognostic marker for pneumonia. BNP levels correlated with the clinical severity of pneumonia.

Introduction: Nosocomial infections are infections; patients acquire while admitted to a health-care facility and generally develop 48 h or later after admission. These infections can lead to serious problems such as sepsis and even death. Materials and Methods: A prospective observational study was conducted for 6 months to estimate the incidence of nosocomial infections acquired in the medical intensive care unit (MICU), their risk factors, the causative pathogens, and the outcome. The patients admitted for more than 48 h to the MICU and willing to give consent were included in the study. Of 496 patients in MICU, 216 patients stayed 48 h and Acute Physiology and Chronic Health Evaluation II (APACHE II) score during the first 24 h of admission to the MICU. Results: The incidence of nosocomial infections in MICU was 14.9% (32 out of 216). Age, APACHE II score >13, MICU stay >7 days, and comorbidities such as peripheral venous line, central venous catheter, duration of urinary catheterization, duration of endotracheal intubation, nasogastric tube, and mechanical ventilator of >7 days were found to be independent risk factors of acquiring nosocomial infections (P < 0.05). Important causative organisms for nosocomial infections were Pseudomonas aeruginosa in 18 patients (32.72%), Escherichia coli in 11 (20.0%), Acinetobacter species in 8 (14.54%), and Klebsiella pneumoniae in seven patients (12.72%). Mortality among patients with nosocomial infections was 25% (8/32) and among those without nosocomial infections was 6.5% (12/184), P = 0.002. The length of ICU stay was higher in patients with nosocomial infections (15.42 ± 6.93 days) than in those without nosocomial infections (6.7 ± 5.14 days), P < 0.001. Conclusion: Nosocomial infections are common in ICU settings and contribute to significant mortality and morbidity. Infection control strategies are necessary to reduce nosocomial infection rates as well as ICU mortality and morbidity.

Abstract Introduction: Diabetes is one of the most significant health issues. Patients with type 2 diabetes mellitus (DM) are more susceptible to an elevated cardiovascular risk, including heart failure. Echocardiography should help in the early identification of these myocardial abnormalities that would help properly treat these individuals. Materials and Methods: The study was conducted over 18 months and focused on patients with diabetes and chronic heart failure who met inclusion and exclusion criteria. Ethical approval was obtained, and all patients provided their consent to participate in the study. The participants underwent a two-dimensional echocardiogram to assess their heart function, and relevant laboratory tests, imaging results, and information about medications received during their hospitalization were recorded. Results: As per The New British Society of Echocardiography criteria, 64 patients had impaired left ventricular ejection fraction (LVEF), and 31 had severely impaired LVEF. The majority of the patients with impaired LVEF, 53%, also had impaired right ventricular ejection fraction (RVEF). Of 31 patients with severely impaired LVEF, 58% also had severely impaired RVEF. The association between LVEF and RVEF is statistically significant (P < 0.05). There is a positive correlation between LVEF (%) and RVEF (%), which was statistically significant (P < 0.05). Severe dysfunction in LVEF is also present in patients with severe dysfunction of RVEF. Conclusion: The majority of patients who had reduced LVEF also had reduced RVEF, and this association was significant. While there was a correlation between glycosylated hemoglobin levels and both LVEF and RVEF, it was not statistically significant. Hence, patients who are identified to have lower LVEF should also be evaluated for RVEF.

Abstract Background and Aims: Traditional didactic lecture methods were previously dominant in medical education in India, where students tend to lose their concentration after 15–20 min of lectures. In the context of competency-based medical education, a teaching–learning method that includes pre- and posttests were hypothesized to have the potential to enhance the learning process and make difficult topics easier for students to understand. This method was implemented for phase 2 MBBS students at Rampurhat Government Medical College and Hospital in India. Materials and Methods: The study was conducted in the department of microbiology in October 2021, with 65 male and 33 female students who provided informed consent. All the students were allotted immunology topics and were asked to present seminars. The students were required to complete a pretest and posttest questionnaire covering key areas of immunology. The mean and standard deviation of the scores were calculated. Paired Student’s t-test was used to compare pre- and posttest scores, and P values were calculated using SPSS 20. A P < 0.05 was considered statistically significant. Results: The total number of correct responses on the posttest was significantly higher (P < 0.05) than the number of responses on the pretest. Gender-specific posttest responses were also significant (for males, P < 0.001; for females, P < 0.001). Overall marks were improved on the posttest, and the mean scores among all the students showed significant improvement in their posttest scores compared to their pretest scores. Conclusions: Evaluating students using a pretest and posttest was found to be a practical and feasible tool for learning. The majority of students reported that this method of learning helped them engage in critical thinking and understand topics more systematically, which they believed would contribute to their success as competent Indian Medical Graduates.