Valproic acid induced pancreatitis: a case report

Valproic acid is a commonly used antiepileptic drug. Apart from its common side effect there is definite association between valproic acid therapy and acute pancreatitis. Since 1979, many cases of acute pancreatitis induced by valproic acid have been published in medical literature. Here we are reporting a case of valproic acid induced acute pancreatitis in a 27 years old boy. The treatment is supportive, re-challenge is hazardous and should be avoided

Eye of the tiger sign in neurodegeneration with brain iron accumulation: a case report

Neurodegeneration with brain iron accumulation (NBIA) is a rare autosomal recessive disorder characterized by abnormal accumulation of ferritin in globus pallidus of brain. Magnetic resonance imaging (MRI) of brain demonstrates a characteristic ‘eye-of-the-tiger’ sign. We describe a case of NBIA in a child with classical clinical and MRI of brain features

Leptospirosis complicated with meningoencephalitis and pancreatitis – A case report

In severe leptospirosis multi organ involvement is common. Pancreatitis and meningo encephalitis are two\ud uncommon manifestations of leptospirosis. Our patient presented with fever, jaundice, altered sensorium and\ud subsequently developed severe pain abdomen. He was finally diagnosed as having icteic leptospirosis\ud complicated with pancreatitis and meningoencephalitis. Simultaneous presence of these two complications in a\ud patient of leptospirosis probably not been documented before

Cerebral infarction: an unusual manifestation of viper snake bite

Snake envenomation causes significant mortality and morbidity. Viper bite usually present with local cellulites, renal failure and bleeding disorders. Thrombotic manifestation of snake bite is rarely reported and early administration of Anti-Snake Venom Serum (ASV) also reduces the risk of thrombotic complications. Cerebral infarction in case of viper bite may be due to hypotension, hypercoagulability or direct action of venom on vessel wall. We report a rare case of viper bite, presented with renal failure and cerebral infarction in spite of early ASV institution. The thrombotic manifestation in this case was possibly due to disseminated intravascular coagulation

Lupus cystitis with hydroureteronephrosis in a young female with lupus nephritis

Systemic lupus erythematosus is an autoimmune, multisystem disorder. Lupus nephritis is a common manifestation of SLE. Though rare, SLE may also involve lower urinary tract in the form of lupus cystitis with associated complications like hydroureteronephrosis. Lupus cystitis may present with gastro intestinal (GI) symptoms as the initial manifestation. The case reported herein is concerned with concomitant lupus nephritis and cystitis in a young female who also had associated GI symptoms and hydroureteronephrosis

Weight monitoring as an indicator of re-hospitalization in patients with heart failure

Background: Predicting the development of acute decompensated heart failure (ADHF) in chronic heart failure patients remains a challenge. Standard management of HF involves patient weight monitoring as it is generally accepted that body weight increase, reflecting fluid retention, may be of value in heralding imminent decompensation. Aim of the study was to evaluate body weight increment as an indicator of re-hospitalization in patients with heart failure.Methods: Fifty seven patients with principal diagnosis of heart failure, who got re-hospitalised due to decompensation as evidenced by deterioration of symptoms with increase in body weight, were analysed and compared with the parameters at last discharge with an attempt to look for the association between increase in weight and clinical deterioration.Results: Mean age of patients examined was 58.5 years. 54.4% of the patients were male. Mean weight of patients on re-hospitalization was 52.2 kg as compared to 48.8 kg at last discharge (p<0.05). 57.9% and 42.1% of patients presented in NYHA class IV & III respectively on re-hospitalization whereas all patients were discharged previously in NYHA class II status. Pearson chi-square test of association showed a significant deterioration of functional status (NYHA) in those having increase in weight ≥3kg as compared to <3 kg (p<0.05).Conclusions: A simple weight monitoring of heart failure patients can alert patients and their clinicians in early stages of decompensation preventing re-hospitalization

A study on patients with coronary artery disease with special reference to bone mineral density

Background: Osteoporosis and Coronary artery disease are known to share common risk factors, like inflammation, but a direct relationship between the two has not been established. Some of the previous studies showed low BMD (osteoporosis and/orosteopenia) as an independent predictive factor for coronary artery disease in ambulatory patients. However, some reports have failed to demonstrate a direct relationship between low bone mineral density (BMD) and CAD or cardiovascular risk factors. This study was carried out to estimate bone mineral density (BMD) in patients with coronary artery disease (CAD) and also to evaluate the association between bone mineral density and coronary artery disease.Methods: Hospital based prospective observational study, involving 96 consecutive patients who were referred for coronary angiography for the evaluation of established or suspected CAD and also patients who had acute coronary syndrome (ACS) are enrolled in this study. BMD was determined for the lumbar spine (L2-L4) and femoral neck using DXA scan.Results: The total number of subjects was 96. Out of 96, 24 (25%) patients were females and remaining 72 (75%) were males. Coronary angiography was carried out in all patients. 42 patients from the total had coronary angiography proven single vessel disease (SVD), 33 patients had double vessel disease (DVD) and 21 patients had triple vessel disease (TVD). DXA scan was carried out in all patients. T- score of neck of femur region and lumbar spine was calculated. Neither the presence of significant coronary stenoses ≥50% in two or more coronary vessels nor the prevalence of severe coronary stenoses ≥70% differed significantly between patients with normal bone density, osteopenia, or osteoporosis (p<0.05, respectively).Conclusions: The result of this study suggests that in patients undergoing coronary angiography for the evaluation of CAD, the prevalence of low BMD is high; however, there is no statistically significant relationship between osteoporosis, osteopenia and coronary artery disease state

Severe leptospirosis and secondary hemophagocytic syndrome: A rare case from Indian subcontinent

Hemophagocytic syndrome (HPS) is a rare clinicopathological condition resulting from dysregulation of the immune system. This unusual clinical syndrome is characterized by fever, cytopenia, liver dysfunction, increased ferritin level and hemophagocytosis of bone marrow. We report a case of a 40 year old male with severe leptospirosis and secondary hemophagocytosis who presented to us with high grade fever and jaundice and later was complicated by multi organ dysfunction and death despite aggressive management. Our case highlights leptospirosis as a rare cause of HPS. A high index of clinical suspicion and prompt treatment for HPS in patients with severe leptospirosis with progressive multi-organ dysfunction despite antimicrobial therapy, is very important as the condition otherwise carries a very high mortality

SEVERE LEPTOSPIROSIS AND SECONDARY HEMOPHAGOCYTIC SYNDROME: A RARE CASE FROM INDIAN SUBCONTINENT

Hemophagocytic syndrome (HPS) is a rare clinicopathological condition resulting from dysregulation of the immune system. This unusual clinical syndrome is characterized by fever, cytopenia, liver dysfunction, increased ferritin level and hemophagocytosis of bone marrow. We report a case of a 40-year-old male with severe leptospirosis and secondary hemophagocytosis who presented to us with high grade fever and jaundice and later was complicated by multi organ dysfunction and death despite aggressive management. Our case highlights leptospirosis as a rare cause of HPS. A high index of clinical suspicion and prompt treatment for HPS in patients with severe leptospirosis with progressive multi-organ dysfunction despite antimicrobial therapy, is very important as the condition otherwise carries a very high mortality