Comparative study on the efficacy of intra-articular steroid injection through glenohumeral versus subacromial approach in the treatment of adhesive capsulitis

Background: Objective of the study was to compare the efficacy between gleno-humeral and sub-acromial approach of intra-articular steroid injection in the management of adhesive capsulitis.Methods: This study was a randomized parallel group, open label, interventional study conducted during the period of May 2018 to October 2019. Patients with stage1 or stage2 adhesive capsulitis of shoulder (n=56) were selected and after computer generated randomization they were allocated into two groups (gleno-humeral and sub-acromial) consisting of 28 patients in each group. Gleno-humeral and sub-acromial group received intra-articular injection of 40 mg (1ml) depot methylprednisolone acetate with 2 ml of 2% lignocaine through gleno-humeral and sub-acromial approach respectively along with physical therapy. Primary outcome measure was improvement of range of motion of intervened shoulder joint from the baseline to 3rd and 6th weeks post injection. Secondary outcome measures were VAS, physician and patient’s global assessment of pain and functional status.Results: At baseline and 3rd post-injection none of the outcome parameters showed statistically significant difference between those two groups. At 6th post-injection sub-acromial group showed statistically significant improvement in active flexion (p value=0.040), passive flexion (p value=0.024), passive abduction (p value=0.044) and physician’s global assessment score (p value=0.017).Conclusions: Sub-acromial approach of injection is better than gleno-humeral approach in terms of improvement in flexion, passive abduction and physician’s global assessment score at 6th post-injection in patients with stage1 or stage2 adhesive capsulitis

Clinical and doppler monitoring of patients with Takayasu arteritis with ITAS 2010 and CDUS-K score respectively following medical intervention: a 12 months follow-up study

Background: The objective of the present study was to monitor the disease activity of Takayasu arteritis clinically by the Indian Takayasu Activity Score 2010 (ITAS) and ultra sonographically by Colour Doppler Ultrasound-Kolkata (CDUS-K) Score after 12months of treatment with methotrexate and steroid, and to find the correlation between these two scores.Methods: Around 25 Angiographically proven Takayasu arteritis patients were treated with Methotrexate (15mg weekly) and Steroids (1mg/kg/day for 6weeks and then tapered) for 12months. Wilcoxon matched pair signed rank test was done to assess the change in ITAS 2010 with treatment. A correlation study was done between ITAS 2010 and change in CDUS-K scores at the end of 12months.Results: By Wilcoxon’s matched pair signed rank test, a non-significant change of ITAS 2010 (p=0.066) was observed at the end of 12months, which means that the treatment helps to control the disease progression by preventing a significant increase in ITAS 2010. Strong correlation (correlation coefficient of 0.878, 95% CI = 0.602 to 1.000) was found between the ITAS 2010 and change in CDUS-K scores at 12months follow up.Conclusions: The combination of Methotrexate and steroids helps to control the disease progression in Takayasu arteritis. Colour doppler ultrasonography may serve as a reliable and safe surrogate disease activity measure at follow up, as it avoids the radioactivity exposure and invasiveness of angiography

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

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

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

Face of the giant panda sign in Wilson disease

Wilson disease usually presents with neurologic or hepatic manifestations. Magnetic resonance imaging (MRI) of the brain is very informative in diagnosiing of this disease, especially in patients with neurological features. High T2 signal intensity in the corpus striatum is the most commonly encountered MRI finding. The 'face of the giant panda' sign is seen on axial T2-weighted MRI, and results from abnormal signal intensities in the midbrain. Though uncommon, the sign is considered as the pathognomonic MRI sign of Wilson disease

Unilateral sternocostoclavicular hyperostosis in a patient with ankylosing spondylitis: A case report with color Doppler ultrasonogram findings

Sternocostoclavicular hyperostosis is a chronic inflammatory disorder affecting the sternoclavicular joint and upper ribs. There is a strong association with seronegative spondyloarthropathy in which bilateral involvement is common. Ultrasonography and Color Doppler findings of this entity have not been described previously, to the best of our knowledge. We describe the findings in a patient of ankylosing spondylitis who was referred for unilateral sternoclavicular joint swelling

Association of Angiogenic and Inflammatory Markers with Power Doppler Ultrasound Vascularity Grade and DAS28-CRP in Early Rheumatoid Arthritis: A Comparative Analysis

Objective. Upregulation of various proinflammatory and angiogenic mediators orchestrates the typical pathological synovial alterations in rheumatoid arthritis (RA). DAS28-CRP is commonly used for assessment of RA disease activity and power Doppler ultrasonography (PDUS) is an important modality for assessing synovial vascularity. This study was intended to look for the association of various inflammatory and angiogenic mediators, with respect to different PDUS vascularity grades and disease activity status, in early RA patients. Methods. 50 early RA patients (<6 months disease duration) with either moderate or high disease activity and 30 healthy controls were included in this study. RA patients were subcategorized based on PDUS vascularity grading of wrist joints. Serum levels of proinflammatory cytokines [tumor necrosis factor-α (TNF- α); interleukin-6(IL-6)] and angiogenic markers [angiopoietin-1 and 2 (Ang-1 and Ang-2); vascular endothelial growth factor (VEGF) ] were measured and compared among different patient subgroups. Results. Among 50 patients, 22 and 28 patients had moderate and high DAS28-CRP score, respectively. Patients with grade 3 PDUS score, even with moderate DAS value, showed a significant rise in Ang-1 (p<0.02), VEGF (p<0.008), Ang-2 (p <0.001), and TNF-α (p<0.005) level compared to grade 2 PDUS patients with high DAS values. Conclusion. Higher serum level of angiogenic and inflammatory markers was noted among patients with moderate disease activity but with advanced PDUS vascularity (grade 3) in comparison to high disease activity group with less severe PDUS vascularity (grade 2). PDUS vascularity grading better reflects some markers of angiogenesis and inflammation, than composite disease activity index