Hypersplenism in a young girl: managed non-surgically

A 16-years-old female, non-alcoholic, presented with pain in left hypochondrium and distention of abdomen. Her USG Abdomen, portal vein doppler and CT abdomen revealed chronic thrombosis of intrahepatic portion of portal vein with multiple collaterals and gross splenomegaly suggestive of portal hypertension. Trans jugular liver biopsy showed no regeneration or fibrosis of liver. Endoscopy showed grade III oesophageal and gastric varices. Splenic artery embolisation was done for hypersplenism. Post procedure CT abdomen revealed large areas of splenic infarction-sequelae of splenic artery embolization.

A case of SLE with pancreatitis

Systemic lupus erythematosus (SLE) is a chronic, autoimmune inflammatory disease characterized by the presence of autoantibodies, immune complex formation, and multiple organ system involvement. Gastrointestinal manifestations are common in SLE patients, but acute pancreatitis is rare. Here we present a case of a 23 yrs. old male who came to the medicine OPD with the chief complaints of pain in abdomen, swelling all over the body since, 8 days and multiple joint pain for 1 and half months. On examination he was febrile pallor present with anasarca, periorbital edema with heliotrope around both eyes. Dry and xerotic ski over the face, butterfly rash present. Blood investigations, USG and CECT suggestive of acute panceatitis. Patient was treated in ICU for pancreatitis. Patient was found to be hypothyroid and treated with thyroid supplements. ANA BLOT was suggestive of SLE. Renal biopsy showed diffuse proliferative lupus nephritis. Hence our patient had pancreatitis possibly due to SLE induced hypertriglyceridemia.

Left ventricular diastolic dysfunction in asymptomatic type 2 diabetes mellitus patients

Background: Diastolic dysfunction has been described as an early sign of diabetic heart muscle disease preceding the systolic damage. The pathogenesis of ventricular dysfunction remains unknown and has been somewhat controversial. So far, very few population-based studies have been carried out in India, to demonstrate the prevalence of diastolic dysfunction in diabetic subjects. Hence the present study was done at our tertiary care centre to detect left diastolic dysfunction in asymptomatic type 2 diabetes individuals and to use echo-cardiologic assessment as an early detector of left diastolic dysfunction. The aim of this study was to detect left diastolic dysfunction in asymptomatic type 2 diabetes individuals and to use echocardiologic assessment as an early detector of left diastolic dysfunction.Methods: A hospital based cross-sectional observational study was conducted with 50 patients for echocardiographic evaluation of diastolic dysfunction in asymptomatic Type 2 Diabetes Mellitus. E/A <1 and increase in LA size was considered as the evidence of left ventricular Diastolic Dysfunction.Results: 15 (30%) patients were detected with Left Ventricular Diastolic Dysfunction (LVDD) among the 50 patients under study.Conclusions: Diastolic dysfunction in patients with diabetes is present in 30% of patients even when diabetes is present at a younger age, and is of a shorter duration. This dysfunction is suggestive of pre-clinical diabetic cardiomyopathy. E/A, DT and peak A velocity are sensitive indices of diastolic LV dysfunction. Thus, diastolic dysfunction can be used as an early indicator, as it is a precursor to increased LV hypertrophy and clinical left ventricular dysfunction

A Clinical Study of the Use of Savary‑Gilliard Dilators in Corrosive Esophageal Strictures without the Use of Fluoroscopy: A Reality in Resource‑Limited Settings in a Developing Country

Context: Corrosive compounds are either acids or alkalis, and their ingestion can cause esophageal strictures which may be tortuous and multiple. Aims: The aim of study was to assess therapeutic efficacy and safety of dilatation using Savary‑Gilliard dilators in these patients without the use of fluoroscopy. Settings and Design: A cross‑sectional observational study, conducted for 18 months in a tertiary care teaching hospital in Western India. Subjects and Methods: Ten dysphagic patients who had a history of corrosive ingestion 2 months or more before presentation, who had documented esophageal strictures on endoscopy were included. Barium swallow and endoscopy confirmed the site, length, and number of strictures. Dilatation with Savary‑Gilliard dilators was done without the use of fluoroscopy with the help of guide wire in “rule of threes.” Patients were followed up immediately and for 12 months. Descriptive statistics, mean, and SD were applied in EPI info version 7 software. Results: The mean age of 29 + 6.5 years and 70% were females. About 80% had dysphagia Grades III and IV. On endoscopy, 40% had strictures at multiple sites and 60% of patients had strictures more than 5 cm in length. 50% strictures were very tight. Number of patients in whom there was the passage of one dilator more than the stricture in the first session were 80%. A mean of 8.28 sessions of dilatation were required. Adequate dysphagia relief was achieved in 8 (80%) patients, while there were 2 failures. A total of 180 dilatations were performed on these 10 patients of corrosive strictures over a period of 12 months. One minor perforation occurred in this study. Conclusions: In resource‑limited settings such as India, dilatation without fluoroscopy can be considered as effective and safe initial management for corrosive strictures

Hypoplastic acute myeloid leukemia-M4: A rare case report

Hypocellular acute myeloid leukemia (AML) is defined as AML with bone marrow cellularity <20%. Hypocellular AML is an infrequent entity. Its frequency ranges between 5% and 12% of all cases of AML. Hypocellular variants of acute leukemia almost always have a myeloid phenotype and usually develop secondary to radiation or chemotherapy. We report a rare case of Hypocellular AML-M4 occurring in a 60-year-old woman who was incidentally found to be positive for HIV

Correlation of serum parathyroid hormone with mineral bone disease in chronic kidney disease patients

Background: Mineral bone disease (MBD) is a systemic disorder of mineral and bone metabolism due to chronic kidney disease (CKD). Bone disease in CKD is due to secondary hyperparathyroidism. Serum intact parathyroid hormone (iPTH) level estimation is a potential noninvasive method for the diagnosis of MBD at early stage. Aim: Treating renal bone disease should be one of the primary aims of therapy for CKD. Evaluation of the biochemical parameters of CKD-MBD (primarily phosphorus, calcium, parathyroid hormone, and Vitamin D levels) as early as CKD stage 3, and an assessment of bone status (by the best means available), should be used to guide treatment decisions. The adverse effects of high phosphorus intake relative to renal clearance (including stimulation of hyperparathyroidism) precede hyperphosphatemia, which presents late in CKD. Early reduction of phosphorus load may ameliorate these adverse effects. Evidence that calcium load may influence progression of vascular calcification with effects on mortality, should also be considered when choosing the type and dose of phosphate binder to be used. MBD in CKD has high morbidity and mortality and hence it is important to detect it at an early stage. iPTH levels can be highly sensitive and it is one of the useful noninvasive biochemical parameters to detect MBD in CKD. Materials and Methods: This was an observational study carried out in a tertiary care teaching hospital. The study involved 60 patients of CKD. Detailed history, physical examination, and biochemical parameters were assessed in all of them. Results: There was a significant association between hypertension, diabetes with nephropathy, and highly significant association between serum iPTH and raised blood urea levels in MBD group, however there was no significant association between duration of CKD, hemoglobin, creatinine, uric acid, phosphorous, calcium, and alkaline phosphatase with MBD. Conclusions: MBD in CKD can be detected at early stage by the use of noninvasive methods of estimation of serum iPTH levels

Images in medicine - Gouty arthritis

Gout is a disorder of uric acid metabolism, characterised by deposition of monosodium urate crystals in joints and periarticular soft tissues as well as renal calculi and chronic nephropathy. The accumulation of crystals in the joints and periarticular soft tissue may cause recurrent episodes inflammatory arthritis. Over the years chronic form may occur with presence of tophi and chronic arthropathy frequently in peripheral and rarely in axial joints. Surgical intervention is usually reserved for cases of recurrent attacks with deformities, severe pain and joint destructions

Diagnostic Upper Gastrointestinal Endoscopy and Prevalence of Helicobacter Pylori Infection in Dyspeptic Type 2 Diabetes Mellitus Patients

Introduction: Multisystem involvement is a norm in Type 2 diabetes mellitus (T2DM). Dyspepsia is a common gastrointestinal (GI) tract symptom in people with diabetes. We aimed to study the esophageal, gastric, and duodenal mucosal changes; presence of Helicobacter pylori (HP) infection; and its significance in dyspeptic diabetes patients. Materials and Methods: A prospective observational study done on 287 patients (147 patient with diabetes and 140 nondiabetic controls) with dyspepsia of more than 6 months duration. All patients underwent upper GI endoscopy and evaluation for HP infection. Gross and histopathological examination (HPE) features of biopsies from the esophagus, stomach (fundus, body, and antrum), and duodenum were analyzed and rapid urease test as well as HPE was done for HP detection. Statistical analysis was done and results were expressed as mean ± standard deviation. P < 0.05 was considered to be statistically significant. Results: Average age for dyspeptic T2DM patients was 56.0 ± 8.44 years. Total 67.35% diabetes patients were addicted to tobacco. Epigastric pain and heartburn were the most common symptoms. Antral gastritis was the most common gross (75.08%) and HPE (70.38%) finding in patients with diabetes. In all, 44.21% patients with diabetes tested positive for HP infection, and there was a statistically significant association of HP with T2DM when compared with nondiabetics (P < 0.00001). However, HP infection did not correlate significantly with either glycosylated hemoglobin (HbA1c) or duration of T2DM. Conclusion: Antral gastritis was a common finding in dyspeptic diabetic patients. HP infection although associated with T2DM dyspeptic patients, was not associated with either uncontrolled sugar levels or duration of diabetes