Lupus with myositis in an adult Indian male

Systemic lupus erythematosus (SLE) is a chronic inflammatory disease that involves various organs and has a vast spectrum of multi system involvement. SLE is an autoimmune illness which is rarely found in males but when present holds a poor prognosis with a predisposition to develop various manifestations. This case involves a 50-year-old male who developed myositis as a complication of lupus despite adequate immunosuppressive therapy.

Massive pulmonary embolism – what you may be missing?

Our patient is a 68-year-old woman with no known comorbid illnesses, who presented with fever, cough and haemoptysis of 20-days duration. The fever was insidious in onset, intermittent, high grade and was associated with productive cough. There were intermittent episodes of scoughing up of blood-tinged sputum mixed with clots. She was evaluated at another centre and was diagnosed with a pulmonary embolism based on a computed tomographic imaging of the thorax. When she presentation to us, she was hemodynamically stable and her systemic examination was within normal limits. Her computed tomography (CT) scan were reviewed and she was labelled to have an intermediate risk pulmonary embolism. She was initiated on Injection enoxaparin and was simultaneously evaluated for the aetiology of her illness wherein an USG guided supraclavicular lymph node biopsy lead to a diagnosis of extrapulmonary tuberculosis. She was initiated on first line ATT and was discharged on the same. Anticoagulation was continued on discharge. She is currently doing well on follow up. Our objective is to shed light on the association between tuberculosis and pulmonary embolism and to emphasize the need for a thorough evaluation to identify an occult infective focus in patients presenting with venous thromboembolism

A case of concomitant connective tissue disorder and thrombotic thrombocytopenic purpura in an Indian middle aged female

Thrombotic thrombocytopenia (TTP) is a rare disease which is rarely present in adults. Adults usually have an acquired version of disease, associated with some underlying autoimmune disease. There has been paucity of literature about reports which shows the coexistence of connective tissue disorder in patients of acquired TTP. This is a case report of a female who presented with vague symptoms of breathlessness, abdominal pain and petechial rashes and was diagnosed as TTP, developed neurological complications but was stabilized by timely management through plasma exchanges and steroids. 

Escherichia coli mono articular septic arthritis of shoulder joint in an elderly female

Septic arthritis of the shoulder joint is a very rare entity to encounter in clinical practice. Escherichia coli (E. coli) pathogen isolation is only seen to occur in individuals with multiple comorbidities. We report a similar case of gram-negative E. coli urosepsis in a veteran female that transmitted hematogenously to the shoulder joint and how a prompt diagnosis and treatment prevented extension and damage of the joint space.

A study of waist circumference, waist-hip ratio as markers of type 2 diabetes mellitus and their correlation with family history of diabetes

Background: Type 2 Diabetes, is almost an ‘epidemic’ in India. A lot has to be done to prevent or at least postpone its onset. Hence finding bio-markers is important to warn people and create awareness. In India people pay a lot of importance to Family History, and though a positive family history, may predict Diabetes, we wanted to study its correlation to other bio-markers.Methods: Waist circumference, Waist hip ratio was measured in 184 Type 2 Diabetes patients .And history of Diabetes in mother, father or both was recorded .Data tabulated and subjected to statistical analysis.Results: Of the total number (n=184) type 2 diabetes patients studied, males were 93, females 91. 74.2 % males and 83.5 % females had a waist circumference above cut-off (90 cms for males and 80cms for females). 35 males and 42 females had a family history of diabetes. Of these, Father was diabetic in 16 males and 16 females, while mother was diabetic in 19 males and 26 females.Conclusions: Waist circumference and waist hip ratio above cut-off values emerged as common positive findings in majority of type 2 diabetic patients. Family history, individually as Paternal or Maternal Diabetes did not show statistically significant correlation with waist circumference or Waist-hip ratio

Hypersplenism in a young girl: managed non-surgically

A 16-years-old female, non-alcoholic, presented with pain in left hypochondrium and distention of abdomen. Her USG Abdomen, portal vein doppler and CT abdomen revealed chronic thrombosis of intrahepatic portion of portal vein with multiple collaterals and gross splenomegaly suggestive of portal hypertension. Trans jugular liver biopsy showed no regeneration or fibrosis of liver. Endoscopy showed grade III oesophageal and gastric varices. Splenic artery embolisation was done for hypersplenism. Post procedure CT abdomen revealed large areas of splenic infarction-sequelae of splenic artery embolization.

An interesting case of young onset diabetes mellitus

A 24 years old female, was admitted with symptoms of urinary tract infection. She was married and had bad obstetric history. She was known diabetic for 16 years of age and was on regular treatment with injection human insulin mixtard since the time of diagnosis, but had no episode of diabetic ketosis/ ketoacidosis. She had a positive family history of diabetes. She was further evaluated and was found to have normal C peptide levels and islet cell antibodies were found to be negative. Hence, the possibility of MODY (monogenic diabetes) was considered. Her genetic testing could not be done due to financial constraints. But a trial of sulfonylureas was given along with reduction in the dose of insulin to which she responded well and is presently well controlled

A study of waist circumference, waist-hip ratio as markers of type 2 diabetes mellitus and their correlation with family history of diabetes

Background: Type 2 Diabetes, is almost an ‘epidemic’ in India. A lot has to be done to prevent or at least postpone its onset. Hence finding bio-markers is important to warn people and create awareness. In India people pay a lot of importance to Family History, and though a positive family history, may predict Diabetes, we wanted to study its correlation to other bio-markers.Methods: Waist circumference, Waist hip ratio was measured in 184 Type 2 Diabetes patients .And history of Diabetes in mother, father or both was recorded .Data tabulated and subjected to statistical analysis.Results: Of the total number (n=184) type 2 diabetes patients studied, males were 93, females 91. 74.2 % males and 83.5 % females had a waist circumference above cut-off (90 cms for males and 80cms for females). 35 males and 42 females had a family history of diabetes. Of these, Father was diabetic in 16 males and 16 females, while mother was diabetic in 19 males and 26 females.Conclusions: Waist circumference and waist hip ratio above cut-off values emerged as common positive findings in majority of type 2 diabetic patients. Family history, individually as Paternal or Maternal Diabetes did not show statistically significant correlation with waist circumference or Waist-hip ratio

Images in medicine - Gouty arthritis

Gout is a disorder of uric acid metabolism, characterised by deposition of monosodium urate crystals in joints and periarticular soft tissues as well as renal calculi and chronic nephropathy. The accumulation of crystals in the joints and periarticular soft tissue may cause recurrent episodes inflammatory arthritis. Over the years chronic form may occur with presence of tophi and chronic arthropathy frequently in peripheral and rarely in axial joints. Surgical intervention is usually reserved for cases of recurrent attacks with deformities, severe pain and joint destructions