Adult-onset Still’s disease with secondary hemophagocytic lymphohistiocytosis: a case report

Hemophagocytic lymphohistiocytosis (HLH) is an aggressive and life-threatening syndrome of excessive immune activation causing multi-organ dysfunction. HLH can be inherited genetically, but can also be secondary to infections, malignancy, immunosuppression, and autoimmune conditions. Adult-onset Still’s disease (AOSD) is an autoimmune disorder characterized by fevers, arthritis, and an evanescent rash. It can rarely predispose patients to HLH. Herein, we report a case of a 20-year-old male patient who presented with fever, joint pain, and rash for 1 month. On evaluation, he was diagnosed as a case of AOSD complicated with secondary HLH. A 23-year-old male, with no significant past medical history and family history, presented to our emergency department with complaints of fever with rash for the last 1 month. He had intermittent high-grade fever with chills, which was associated with evanescent rash involving the trunk and proximal upper limbs. There was no history of joint pain, cough, sore throat, burning micturition, or weight loss. On examination, the patient was conscious and oriented with a temperature of 101 °F, pulse rate of 100/min, blood pressure of 120/84 mmHg, and SpO2 of 98% on room air. Physical examination revealed salmon-colored maculopapular rash, cervical lymphadenopathy, and mild splenomegaly. The rest of the physical examination was unremarkable. Lab investigations revealed pancytopenia, transaminitis, elevated CRP with low ESR, highly elevated ferritin, elevated LDH, hypofibrinogenemia, and sterile blood and urine cultures. ANA by ELISA, rheumatoid factor, IGRA, dengue IgM, rapid malaria Ag, typhoid IgM, Leptospira IgM and scrub IgM were reported negative. The patient met the diagnostic criteria for AOSD and HLH, and a diagnosis of HLH secondary to AOSD was made. He was given pulse iv methylprednisolone for 5 days, His general condition improved over the week. Then he was switched to oral prednisolone 60 mg once daily. There were no more episodes of fever, and he was discharged after one week on a tapering dose of steroids. AOSD is a rare autoinflammatory condition which often presents as a diagnostic challenge. A high index of suspicion is important for the diagnosis of HLH, and prompt initiation of treatment is of utmost importance, as it is a rapidly progressive life-threatening condition

Prescription pattern of antibiotics in paediatric inpatients at a tertiary care hospital in North East India

Background: Paediatric antibiotic prescription is a major concern in terms of public health since infections are the most frequent cause of childhood disease. The aim of this hospital-based cross sectional study was to assess the pattern of antibiotic use in the paediatric ward of RIMS hospital, Manipur, India.Methods: A retrospective study of six months duration was carried out for the month of October 2016 to March 2017. A total number of 200 patients case sheets were utilized for our study from paediatric in-patients department of RIMS hospital, Manipur. The data collected was then analysed for various prescribing indicators as laid down by world health organisation (WHO) for analysis of drug use parameters.Results: The mean age of paediatric patient was 2.1 years. The average number of drugs per encounter was 5.14. The average number of antibiotic per patient was 2.11. In present study antibiotic were 41% of total drugs prescribed. Most common prevalence of disease among study patients sample was acute gastroenteritis. The most commonly prescribed antibiotic was Ceftriaxone followed by Amikacin. In present study 8.2% of antibiotics were prescribed in generic name. Polypharmacy was evident from the study.Conclusions: Antibiotic prescribing in children is relatively high in RIMS, Imphal, Manipur. Prescription of broad-spectrum antibiotics though has increased demonstrably which   h may result in development of bacterial resistance; however, development of guidelines for antibiotic prescription and use of appropriate drugs for the disease can result in minimizing the unfavourable use of antibiotics in children

Evaluation of the pancreatic malignancy with MRI & MDCT modalities

Background:Detection of pancreatic abnormality by routine noninvasive radiological method namely plain radiography and gastrointestinal barium studies is possible but these tests are insensitive and nonspecific. In earlier era more invasive tests like retroperitoneal air insufflations with tomography used never achieved wide spread clinical application and isotope scan proved disappointing owing to their false positive rates. Material & Methods:The present retrospective study was conducted at department of Department of Radiology at MRI Centre, M.B. Govt. Hospital, Udaipur. The study duration was December 2012 to November 2014. The study group of 100 patients, with suspected pancreatic diseases were examined using either MDCT scan or MRI or both as prime diagnostic modality.Results: In the present study, Pancreatic carcinoma is a hypo vascular mass so it does not enhance at all or show a mild enhancement on post contrast study. In this study out of 14 cases, 14 cases showed mild post contrast enhancement and 2 cases showed no enhancement at all. on CECT examination, out of 10 cases of head mass, 8 cases were hypo dense and 2 were Isodense and showed dilated MPD in 9 cases 90.00% which were most common finding followed by dilated CBD in 8 cases (80.00%) and invasion of other organs in 2 cases (20%). On MRI examination, out of 4 cases of head carcinoma, 3 appeared hyperintense & 1 appeared hypointense and showed dilatation of MPD & CBD in all cases and invasion of organ in one case. Out of 14 cases of head carcinoma, 4 (28.57%) cases showed distal metastasis in liver. Out of 7 cases of body-tail mass, six appeared hypo dense and one appeared on NCCT. Distant metastasis and dilated MPD were found in 4 cases and CBD were dilated in any one case of body mass. Conclusion: We concluded from the present study that Dual-phasic contrast-enhanced MDCT in the pancreatic parenchymal and the venous phase is the method of choice for detection and staging of pancreatic cancer, inflammatory lesions and its vascular complications. For detection of small, hyper vascular neuroendocrine tumors, no single imaging method will reveal all tumors. In this respect, MDCT and MRI are complementary methods

A comprehensive overview of Gokshura (Tribulus terrestris Linn.)

Gokshura (Tribulus terrestris Linn.) is very revered herb of the Indian Ayurvedic system of medicine for treatment of various kinds of diseases. Its various parts conatain variety of chemical constituents which are found medicinally important. Although the review articles on this plant are already published, this review article is presented to compile the complete literature review of Gokshura from Brihatrayi and updated information on its pharmacological activities, which are performed by widely different experiments. Various studies which are done on Gokshura revealed the result that the plant possesses Antiurolithiatic, Antimicrobial, Antihelminthic, Cardiotonic, Anti- inflammatory, Hypolipidemic, Immunomodulatory, Antispasmodic, Analgesic, Aphrodisiac, Antidiabetic, Anti-tumour, Hepato-protective, Anticarious, Anti-oxidant, CNS modulator properties. Considering its therapeutic values, a review has been done to gather complete information on different aspects of Gokshura

An Adaptive Approach for Eigenfaces - based Facial Recognition

The fundamental target is to show the specific faces and recognize the pictures from the substantial number of put away faces with some continuous variety with dropping down the dimensionality space. Her we focus on to diminish the space eccentrics and to got the exact feature vectors and consider all the previous approaches for the same .This paper focuses on mathematical rigor and the conventional methodology aspects over the face recognition classifier. Considering all the conventional approach for Eigen face approaches this paper presents a comparative analysis in more efficient manner. The focus is not to make a new classifier but to analyze the conventional approach with proposed method

A comparative study of clinical and radiological outcome between cages and morselized bone graft in transforaminal lumbar interbody fusion surgery: a hospital-based study

Background: Degenerative spinal diseases resulting in neuropathic backache are managed by nerve root decompression with instrumented interbody fusion is the treatment of choice for these groups of patients when not managed conservatively.Methods: Hospital based, comparative, retrospective study was carried out in such patients who underwent transforaminal lumbar interbody fusion (TLIF) with either cage with bone graft or stand-alone autologous morselized bone graft. The clinical and radiological outcomes were compared in these two methods of interbody fusion to assess any significant difference between them. A total of 20 patients with lumbar canal stenosis and degenerative grade 1/2 spondylolisthesis who failed conservative management were operated by TLIF approach and were evaluated for post-operative improvement in Oswestry disability index (ODI) and interbody fusion on imaging at 6 months and 1 year postoperatively. Vertebral level of surgical intervention, intra-operative blood loss and duration of surgery were recorded for each patient along with complications, if any.Results: In our study there was no significant difference in the clinical and radiological outcome between the two methods of interbody fusion. Although the group which was offered morselized bone graft with cage showed slightly better clinical outcome at 6 months of follow up, both showed no significant difference in ODI at 1 year of follow up.Conclusions: With this study, we can conclude that both the methods have similar clinical and radiological outcome with similar patient satisfaction and can be interchangeably employed for interbody fusion according to surgeon’s and patient’s preferences

Post-COVID-19 Disease Associated with Mucormycosis and Guillain-Barré Syndrome: A Causal Association or Just a Coincidence?

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Originating from Wuhan, China, COVID-19 has rapidly spread worldwide. COVID-19 is primarily considered to be a respiratory illness, but with time there is enough evidence about the extrapulmonary manifestations of the disease. One of the neurological manifestations is Guillain-Barré syndrome (GBS). It may be associated with mucormycosis, with majority of cases occurring in India. Here, we report a case of a 40-year-old male patient, a known case of hypertension and diabetes mellitus who presented with the complaints of fever, cough and shortness of breath since May 10, 2021. He was found to be RT-PCR positive for COVID-19 on May 12, 2021. While recovering from COVID-19, on May 25, he was suspected to have rhino-orbital mucormycosis, which was confirmed on tissue specimen. While recovering from rhino-orbital mucormycosis, on July 26, the patient complained of weakness in bilateral lower limbs, followed by weakness in both upper limbs after 2 days. GBS was confirmed on nerve conduction study (NCS) and cerebrospinal fluid (CSF) examination. Patient was treated with intravenous immunoglobulin (IVIG), and while on treatment, the patient showed no significant improvement. Invasive ventilation was started in view of respiratory muscle involvement. The patient also developed autonomic dysfunction. He went into cardiac arrest and despite best efforts, couldn’t be revived. Currently, to the best of our knowledge, there is no data to tell that both mucormycosis and GBS can occur in association with COVID-19. This case aims to raise awareness among the healthcare providers for this type of association. COVID-19 may be a cause or it may just be a mere coincidence, needs further stud

Dental Smart Materials

Dental materials are stable and have greater durability if they do not react with the environment and remain passive. At the same time, it is hoped that the materials will be well accepted and will cause neither harm nor injury. This is an entirely negative approach to material tolerance and biocompatibility. This outlook hides the possibility through which positive gains can be achieved by using materials that behave in a more dynamic fashion in the environment in which they are placed. The current dental materials are improvised. The use of smart materials has made a great revolution in dentistry, which includes the use of restorative materials, such as smart composites, smart ceramics, compomers, resin-modified glass ionomer, amorphous calcium phosphate–releasing pit, and fissure sealants and other materials, such as orthodontic shape memory alloys, smart burs, etc.&nbsp

Descriptive study of functional outcome and complication of fracture calcaneum treated with locking calcaneum plate

Background: Fracture of calcaneum accounts for about 2% of all fractures and 75% of all calcaneum fractures are intra-articular. Numerous controversies existed regarding optimal treatment of displaced intraarticular calcaneum fractures. In this study evaluate post-operative functional outcome and complication of fracture calcaneum treated with locking calcaneum plate.Methods: This hospital based prospective descriptive study was conducted on 108 patients (120 calcaneum fracture) operated between July 2016 to December 2018 by open reduction and internal fixation with locking calcaneum plate through extensive lateral approach at Department of Orthopaedics, SMS Medical college and hospital, Jaipur. All close displaced intraarticular calcaneal fracture was included in the study.Results: Average duration between injury and surgery was 8.3±2.97 days. Out of 120 calcaneum fracture 52 fractures (43.33%) were Sander’s type II, 52 fractures (43.33%) were Sander’s type III, and 16 fractures (13.33%) were Sander’s type IV. Pain on weight bearing was noted in 20 patients (16.66%) implant prominence was noted in 8 patients and delayed wound healing was seen in 4 patients. Maryland foot score was excellent in 44 fracture (36.67%), good in 56 fractures (46.67%), fair in 8 fractures (6.67%), and poor in 12 fractures (10%).Conclusions: Open reduction and internal fixation (ORIF) with locking calcaneum plate in an indicated case, with respect to soft tissue envelope and early rehabilitation, leads to better therapeutic results as compared to other operative technique