Rheumatoid arthritis 1st time presenting with bilateral pleural effusion- A rare presentation

Rheumatoid arthritis is the most common chronic autoimmune disorder involving joints and extra-axial system. Varied presentations have been described in the literature. Pulmonary involvement is also common. Inflammatory pleural effusions are an uncommon complication and are rarely seen in about 2% to 5% of patients with rheumatoid arthritis. Here, we present an interesting case where the patient presented with bilateral pleural effusion early in the disease. On further evaluation of the patient and the pleural fluid, it was found to be consistent with pleural effusion secondary to rheumatoid arthritis. The patient responded to oral non-steroidal antiinflammatory drugs along with disease-modifying agents

Thyrotoxic neuropathy - a case report

Thyrotoxic neuropathy is a rare entity in literature. The association between thyrotoxicosis and neuropathy is under-recognized. We here present a rare case report in which patient was presented with ascending sensory-motor paralysis coupled with respiratory muscle weakness which closely resembles Guillain–Barré syndrome (GBS). But relevant history suggested thyrotoxic features, thus a timely focused investigation revealed the diagnosis. It was confirmed in nerve conduction studies (NCS) and other necessary investigations ruled out other differential diagnosis. Patient was treated with anti-thyroid drugs. On follow up patient’s power improved and NCS after 6 months came out to be normal which established the diagnosis. Thyrotoxic neuropathy is a close differential diagnosis of LGBS and other commonly encountered neuroparalytic illnesses. So high degree of suspicion is needed to diagnose this potentially treatable neuropathy

Lymphocytic hypophysitis masquerading as transient secondary hyperadrenalism followed by panhypopituitarism

Lymphocytic hypophysitis (LH) is a rare inflammatory disease of the pituitary gland. This condition strikingly shows femalepreponderance and commonly affects women during pregnancy or in the post-partum period. It’s a clinical presentation and radiologicalfeatures may mimic pituitary adenoma. Though its treatment modality is uncertain steroid remains the 1st option for treatment. Here,we report an unusual case of LHin a 21-year-old female patient where initially, the patient presented with hyperadrenalism andsecondary hyperthyroidism followed by pan-hypopituitarism (Addisonian crisis) which is attributed to initial autoimmune destructionof the gland followed by subsequent fibrosis. Thus, it is a rare case report which exquisitely explains this rare presentation and suchcases should be investigated thoroughly since there are many differential and response to steroids is remarkable

Liver cirrhosis first time presented with delirium unveiled as accidental secondary hypothermia

Liver cirrhosis is a condition which is defined histopathologically but cannot be diagnosed clinically without any non-invasive tests. There are various etiologies of cirrhosis such as alcoholic liver disease, chronic viral hepatitis B, C, and non-alcoholic fatty liver diseases. Liver, not only function as an organ for detoxification, conjugation, and synthesis but also it regulates body heat. Cirrhosis patients thus are prone to body heat loss and hyperthermia. We present a case with undiagnosed liver cirrhosis patient, 1st time presenting with altered sensorium, revealed as accidental secondary hypothermia with ECG changes of hypothermia. The patient treated for hypothermia only after which she recovered

A study to compare the efficacy of intermittent versus continuous regimen of pantaprazole in the management of upper gastrointestinal bleed (non variceal)

Background: UGI bleeding is defined as bleeding that occurs in the digestive tract proximal to the ligament of treitz. Intermittent dosage regimen IV bolus and high dose IV continuous infusion forms helps in achieving and maintaining this pH goal of more than 6 which forms optimal environment for peptic ulcer healing and clot stabilization to occur. Theoretically, high-dose IV continuous infusion should provide the most potent acid suppression. Aims and objective was to compare the efficacy of intermittent dose of pantoprazole given for 3 days i.e. 40mg intravenous twice a day versus continuous infusion dose of pantaprazole i.e. 80mg intravenous bolus followed by 8mg/hour for first 72hours in the treatment of UGI bleed.Methods: Patients of UGI bleed were randomly assigned to receive either continuous or intermittent regimen of pantaprazole as a part of management.Results: Among 118 patients of peptic ulcer disease, 7 patients had rebleed and 111 patients had no rebleed.3 patients among 59 patients who received continuous regimen and 4 patients among 59 patients who received intermittent regimen had rebleed with a total of 7 patients among 118 patients. Among 118 patients only 2 patients of the total had need for surgery for stabilization. Among 59 patients who received continuous regimen 2 patients needed surgery while none of the 59 patients who received intermittent regimen needed for surgery. Of the 118 patients 10 patients had mortality at the end of 30 day period. In both the regimes 5 patients died.Conclusions: The difference between Rockall score of the intermittent and continuous regimen group was statistically insignificant. The incidence of rebleed was 5.1 % for continuous and 6.7% for intermittent regimen which was statiscally insignificant. The incidence of mortality was similar 8.5%in both regimen

Mechanistic Insight into the Reactivation of BCAII Enzyme from Denatured and Molten Globule States by Eukaryotic Ribosomes and Domain V rRNAs

In all life forms, decoding of messenger-RNA into polypeptide chain is accomplished by the ribosome. Several protein chaperones are known to bind at the exit of ribosomal tunnel to ensure proper folding of the nascent chain by inhibiting their premature folding in the densely crowded environment of the cell. However, accumulating evidence suggests that ribosome may play a chaperone role in protein folding events in vitro. Ribosome-mediated folding of denatured proteins by prokaryotic ribosomes has been studied extensively. The RNA-assisted chaperone activity of the prokaryotic ribosome has been attributed to the domain V, a span of 23S rRNA at the intersubunit side of the large subunit encompassing the Peptidyl Transferase Centre. Evidently, this functional property of ribosome is unrelated to the nascent chain protein folding at the exit of the ribosomal tunnel. Here, we seek to scrutinize whether this unique function is conserved in a primitive kinetoplastid group of eukaryotic species Leishmania donovani where the ribosome structure possesses distinct additional features and appears markedly different compared to other higher eukaryotic ribosomes. Bovine Carbonic Anhydrase II (BCAII) enzyme was considered as the model protein. Our results manifest that domain V of the large subunit rRNA of Leishmania ribosomes preserves chaperone activity suggesting that ribosome-mediated protein folding is, indeed, a conserved phenomenon. Further, we aimed to investigate the mechanism underpinning the ribosome-assisted protein reactivation process. Interestingly, the surface plasmon resonance binding analyses exhibit that rRNA guides productive folding by directly interacting with molten globule-like states of the protein. In contrast, native protein shows no notable affinity to the rRNA. Thus, our study not only confirms conserved, RNA-mediated chaperoning role of ribosome but also provides crucial insight into the mechanism of the process

Nephrocalcinosis in a patient with extrapulmonary tuberculosis – A rare entity

Nephrocalcinosis is a rare condition in clinical practice where there is an increased renal deposition of calcium. Varied causes of this condition have been given in literature, and tuberculosis (TB) has been an important one. Hypercalcemia is a known complication of granulomatous diseases. We report a rare case explicitly showing relationship of extrapulmonary (genitourinary) TB with nephrocalcinosis