Pulmonary embolism as presenting feature of membranous nephropathy induced nephrotic syndrome

Severe pulmonary embolism as first-time presentation of Nephrotic syndrome is rare but Nephrotic syndrome secondary to membranous nephropathy (MN) may impose a greater thrombotic risk for unclear reasons. Here, we report the case of a 36-year-old female patient presented with complaints of sudden onset of shortness of breath since 4-5 days and features of right-sided heart failure. There was no preceding history of any chronic disease or renal disease. She was diagnosed as having a bilateral severe pulmonary embolism. Extensive workup and renal biopsy were done which was suggestive of primary membranous nephropathy

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

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

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

Assessment of pulmonary function in patients with type 2 diabetes mellitus: a case-control study

Background:As other microvascular complications, respiratory involvement is far less studied among patients with type-2 Diabetes Mellitus (DM). Objective: to study the extent of pulmonary function limitation among patients with type-2 DM.  Methods:Hospital based matched case-control study.Results:Total of 90 cases and 90 controls matched for age, sex, height and weight were recruited. Patients with DM had neuropathy [63.3% (57; male=27: Female: 30)], retinopathy [44.4% (40; male=22: Female: 18)], nephropathy [41.1% (37; male=17: Female: 20)] and microalbuminuria [14.4% (13; male=5: Female: 8)]. All cases and 88 controls observed with FEV1:FVC ratio of >70.0%, further assessment for delineation of normal and restrictive pattern patients with high level of predicted values of FEV1 as compare to FVC showed that significantly (P = 0.00) more (Cases: 76.6%; Controls: 42.2%) cases had FEV1 >FVC predicted levels as compare to controls, means among diabetics odds of restrictive pattern of lung abnormality is four times (OR: 4.4; CI: 2.3-8.5) more as compare to non-diabetics. In addition a long duration of DM was significantly (r: 0.39; P = 0.00) positively correlated with lung dysfunction.  Conclusion: Patients with type 2 DM patients as compare to its controls observed with restrictive pattern of lung dysfunction.

The effect of pre-operative carbohydrate loading in femur fracture:a randomized controlled trial

BACKGROUND: Femur fracture is a major burden among elderly people, leading patients to be bedridden for a long time in the hospital. The body is more likely to be in a catabolic state as a result of the prolonged fasting period required for surgery, leading to an increase in insulin resistance. Pre-operative carbohydrate loading has been shown to improve postoperative outcomes in several countries. The study aimed to evaluate the effect of pre-operative carbohydrate loading in femur fracture surgery. METHODS: This study was single-center, hospital-based, open-label, parallel-group randomized controlled trial conducted between August 2020 and November 2021. A total of 66 participants, aged 50 years and above having femur fractures planned for surgery were included in this study and assigned to the control (n = 33) and study (n = 33) groups through computer-generated random numbers. The control group was kept fasting from midnight to the next morning as in existence while the study group was intervened with carbohydrate loading according to the Enhanced Recovery After Surgery (ERAS) protocol. The pre-operative nutritional status was identified and the postoperative outcomes were measured using the Visual Analogue Score (VAS), Cumulative Ambulatory Score (CAS), and Modified Barthel Index (MBI) scoring systems. Statistical analyses were performed using the Chi-square test and the Student’s two-sample t-test to compare the outcomes between the two groups. RESULTS: All the participants completed the study. There was a significant reduction in the average postoperative pain in the carbohydrate loading group (VAS: 4.8 (SD ± 1.8), 95% CI: 4.7–5.4) as compared to the control group (VAS: 6.1 (SD ± 2.1), 95% CI: 5.3–6.8). The average CAS showed a significant improvement in regaining the mobility function of participants in the study group (CAS: 8.1 (SD ± 2.8), 95% CI: 7.1–9.1) than that of the control group (CAS: 6.8 (SD ± 2.8), 95% CI: 5.8–7.8). The mean MBI score of the participants at the time of discharge from the hospital was higher in the study group (MBI:13.1 (SD ± 2.3), 95% CI: 12.2–13.9) compared to the control group (MBI: 11.8 (SD ± 3.1), 95% CI:10.6–12.9). Similarly, the length of hospital stay after surgery had decreased in the study group than in the control group. CONCLUSIONS: The uptake of carbohydrate loading showed reduced post-operative pain, enhanced functional mobility, and decreased length of hospital stay. This study warrants larger trials to show the effect of pre-operative carbohydrate loading in a clinical setting. TRIAL REGISTRATION: NCT04838366, first registered on 09/042021 (https://clinicaltrials.gov/ct2/show/NCT04838366). SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12891-022-05766-z