Clinical Utility of Acute-phase Reactants in Medicine

Acute-phase response is the sum of the systemic and metabolic changes occurred by release of acute-phase proteins in response to an inflammatory stimulus. The most important ones of these acute-phase reactants are erythrocyte sedimentation rate, C-reactive protein, fibrinogen, procalcitonin and ferritin. The most widely used ones are ESR and CRP while fibrinogen and ferritin are less commonly used. The other acute-phase reactants have limited role in routine clinical use. ESR and C-reactive protein have traditionally been used as markers for inflammation in infectious and noninfectious conditions. These markers have significant role in early diagnosis, in differentiating infectious from noninfectious causes, as a prognostic marker and in antibiotic guidance strategies. Procalcitonin and CRP are most commonly used in this regard. Although CRP is more specific than ESR, yet because of the high cost and limited availability, it has restricted clinical usage in developing countries. Not all acute-phase reactants behave the same way when stimulated; the concentration of some increases while others decrease in plasma

A case of Steroid Responsive Encephalopathy associated with Autoimmune Thyroiditis: A Diagnostic Dilemma

We present a case of 42 year-old female, who presented with generalized tonic-clonic seizures with altered sensorium, not responding to antiepileptic medications. She was a diagnosed case of hypothyroidism since last three years and was on replacement therapy. Her systemic examination including the neurological examination did not point to any specific diagnosis. Her routine investigations, brain imaging and CSF analysis were also within normal limits. Thyroid function test revealed raised thyroid stimulating hormone and anti-TPO antibody with normalT4 and T3 levels. Here we considered diagnosis of “Encephalopathy Associated with Autoimmune Thyroid Disease”. She was given intravenous methylprednisolone pulse to which she responded dramatically and seizures were controlled. She was discharged on oral anti-epileptics and steroids in a stable condition

Acute stroke as the initial presentation of Takayasu arteritis: Rare but not infrequent…

Takayasu arteritis is an idiopathic, autoimmune, large vessel vasculitis, mainly affecting the young adults. Its exact etiopathogenesis is not known and it has varied clinical presentations. Acute stroke as initial presentation of Takayasu arteritis is uncommonly reported. Herein we present a case of a 24-year-old female who came to our hospital emergency with sudden onset of weakness of left half of the body of one-day duration. Takayasu arteritis complicated with acute ischemic stroke was diagnosed on the basis of CT angiography findings. The patient was managed accordingly and discharged in a stable condition. Relevant literature is also reviewed. Although considered to be a rare disease, Takayasu arteritis is not infrequent. A high index of suspicion is required for early diagnosis, so as to reduce the significant morbidity associated with the disease

Delayed diagnosis of Scrub Typhus in Dengue epidemic: A Case Report

We report a case of scrub typhus presenting with fever and thrombocytopenia highlighting the wide variation in clinical presentations leading to delayed diagnosis in dengue epidemic. Fever and thrombocytopenia are the most common clinical presentation in viral haemorrhagic fever but others diseases like malaria, typhoid, leptospira, rickettsial and other arboviral diseases, should also be considered in the differential diagnosis. A high clinical suspicion of scrub typhus and early differentiation from other diseases is important as lethal complications can occur because of delay in diagnosis and treatment

Bilateral sacroiliitis: a rare cause for a common presentation

Fever and osteoarticular involvement of axial skeleton are hallmark clinical manifestations of brucellosis but other diseases like ankylosing spondylitis, tuberculosis, Paget’s disease of bone, sarcoidosis should also be considered as differential diagnosis. Brucellosis is an uncommon infectious disease in India. Signs and symptoms of the disease are highly variable, with musculoskeletal complaints occurring frequently. Authors hereby reported a case of brucellosis presenting with fever, polyathralgia, bilateral sacroiliitis and enthesitis. Knowledge of geographical distribution, evidence of exposure to the cattle and a high degree of clinical suspicion of brucellosis are very important for early differentiation from other diseases to prevent lethal complications and institute early treatment and a prompt recovery

Prevalence of gestational diabetes mellitus and its relationship with various risk factors in a tertiary care hospital in West Bengal with special reference to tribal population, India

Background: Gestational diabetes mellitus (GDM) is the most common medical complication and metabolic disorder of pregnancy. The aim and objective of this study was to determine the prevalence of GDM and its relationship with various risk factors with special reference to tribal population.Methods: The study was done in 200 patients between 24 and 28 weeks of gestation, attending antenatal outdoor in a tertiary care hospital of West Bengal.  These patients were given 75gm oral glucose irrespective of the last meal and their plasma glucose was estimated at 2hours. Patients with plasma glucose values ≥140 mg/dl were labelled as GDM. Patients who were diabetic before pregnancy or whose pre pregnancy body mass index was not known or was in labour or had chronic disease, were not included in the study.Results: Prevalence of GDM was 11% in whole population while it was 14.63% and 10.06% in tribal and non-tribal population respectively.  Prevalence of GDM and its correlation with most of risk factors in previous pregnancies was found to be significant in both non-tribal and tribal population. Family history of diabetes mellitus was the most prevalent risk factor in both non-tribal (9.4%) and tribal population (14.63%). There was no single most common risk factor among GDM patients found as there were multiple risk factors present with same frequency in both tribal and non-tribal population.Conclusions: The prevalence of GDM is 14.63% in the tribal population and 10.06% in non-tribal population which is not statically significant (P<0.407). The relation between the prevalence of GDM and risk factors was found to be significant for most of the risk factors

Study on the growth performance of the broiler after feeding of okara meal containing with or without non-starch polysaccharides degrading enzyme

Aim: The objective was to study the growth performance of the broiler birds after feeding Okara meal containing with or without non-starch polysaccharides degrading enzyme. Materials and Methods: 220 day-old broiler chicks were individually weighed and divided randomly into five treatment groups (T1 , T2 , T3 , T4 and T5 ) consisting of 44 chicks each which was further subdivided into four replicates of 11 chicks. The feed consumption in each replicates of five groups was recorded daily for a total period of 6 weeks experimental feeding. Results: The average total feed consumption of six weeks was 3948.10&#177;7.60, 4088.76&#177;8.30, 4415.33&#177;9.44, 4381.24&#177;9.25 and 4728.76&#177;10.05 (g) in groups T1 , T2 , T3 , T4 and T5 respectively. The differences were statistically non-significant (P>0.05) among the various groups. The average total body weight gain and average daily weight gain in birds of group T4 were significantly higher (P<0.01) than birds of other groups except T3 group. It showed that 25 percent replacement of ground nut cake with Okara meal and addition of non-starch polysaccharides degrading enzyme (provizyme-bro) had positive effect on growth performance of birds. The increase in weight in broilers of enzyme added group T4 in comparison to their counterpart without enzyme group (T2 and T3 ) attributed to degradation of non-starch polysaccharides in ration, thereby, enhancing the utilization of other nutrients. Conclusion: The findings indicated that 25 percent replacement of ground nut cake with Okara meal and addition of nonstarch polysaccharides degrading enzyme had positive effect on growth performance of birds. So, Okara meal feeding had no adverse effect on growth performance of the broilers. [Vet World 2013; 6(6.000): 325-328

A rare cause of nodular skin lesions with fever in an immunocompetent individual

Histoplasmosis is a fungal disease caused by the dimorphic fungus Histoplasma capsulatum. It is endemic to many parts of the world but is rarely seen in India. The fungus usually affects the immunocompromised patients and is rarely reported in immunocompetent hosts. We hereby report a case of the nodular skin lesion with fever lesion that finally turned out to have cutaneous histoplasmosis, from a non-endemic region of northern India and that too in an immunocompetent

Uncommon cause of persistent hypoxia in a patient with obstructive sleep apnea

We report a case of hypothyroidism, obstructive sleep apnea (OSA) with persistent daytime hypoxemia. Cause of hypoxemia was two arteriovenous (AV) malformations in the lower lobe of the lung. We must be alert to other causes of hypoxemia in patients of OSA with persistent daytime hypoxemia