Gelatinous transformation of bone marrow: rare or underdiagnosed?

Gelatinous transformation of the bone marrow (GTBM) is a rare hematologic entity, which was first described by Paul Michael in 1930. GTBM is mostly associated with caloric intake/anorexia nervosa, although it also has been described accompanying other pathologic conditions, such as malignancy, systemic lupus erythematosus and HIV infections. Even though the diagnostic features of the hematopoietic tissue, such as hypoplasia, adipose cell atrophy, and deposition of a gelatinous substance in the bone marrow (which stains with Alcian blue at pH 2.5) are quite specific, the underlying pathogenic mechanisms remain poorly understood. Considering the evidence of reversibility—notably in cases of malnutrition and anorexia—this entity should be kept high on cards as a possible differential diagnosis of patients presenting with cytopenias and associated weight loss or starvation, especially in developing countries with nutritionally deprived populations. On an extensive review of the literature aimed at comprehensively addressing the evolution of the GTBM from the past century until now, we conclude that the lack of clinical suspicion and awareness regarding this pathologic entity has led to misdiagnosis and delayed diagnosis

EMPHYSEMATOUS PYELONEPHRITIS: A CASE REPORT

Emphysematous pyelonephritis is a rare life threatening fulminant necrotizing infection of the kidney with high mortality. It is characterized by characteristic gas formation within or around the kidney on radiological investigations, while E.Coli is the most common causative organism. We report a case of 60 year old female suffering from diabetes mellitus since 3 years, who presented with high grade fever, abdominal pain, vomiting and dysuria. She was diagnosed as a case of emphysematous pyelonephritis and successfully treated. KEYWORDS: Emphysematous pyelonephritis; Antibiotics

EMPHYSEMATOUS PYELONEPHRITIS: A CASE REPORT

Emphysematous pyelonephritis is a rare life threatening fulminant necrotizing infection of the kidney with high mortality. It is characterized by characteristic gas formation within or around the kidney on radiological investigations, while E.Coli is the most common causative organism. We report a case of 60 year old female suffering from diabetes mellitus since 3 years, who presented with high grade fever, abdominal pain, vomiting and dysuria. She was diagnosed as a case of emphysematous pyelonephritis and successfully treated. KEYWORDS: Emphysematous pyelonephritis; Antibiotics

Gelatinous transformation of bone marrow: rare or underdiagnosed?

Gelatinous transformation of the bone marrow (GTBM) is a rare hematologic entity, which was first described by Paul Michael in 1930. GTBM is mostly associated with caloric intake/anorexia nervosa, although it also has been described accompanying other pathologic conditions, such as malignancy, systemic lupus erythematosus and HIV infections. Even though the diagnostic features of the hematopoietic tissue, such as hypoplasia, adipose cell atrophy, and deposition of a gelatinous substance in the bone marrow (which stains with Alcian blue at pH 2.5) are quite specific, the underlying pathogenic mechanisms remain poorly understood. Considering the evidence of reversibility—notably in cases of malnutrition and anorexia—this entity should be kept high on cards as a possible differential diagnosis of patients presenting with cytopenias and associated weight loss or starvation, especially in developing countries with nutritionally deprived populations. On an extensive review of the literature aimed at comprehensively addressing the evolution of the GTBM from the past century until now, we conclude that the lack of clinical suspicion and awareness regarding this pathologic entity has led to misdiagnosis and delayed diagnosis

Atrial Myxoma – An unusual cause of ischemic stroke in young

Atrial myxomas are rare primary cardiac tumours with neurological manifestations being reported in 30% of cases. Though a rare cause of ischemic stroke in young patients, considering it as a possibility in absence of any obvious risk factors can help avoid misdiagnosis at early stages. We present a case of left atrial myxoma in a 36-year-old male with no known co-morbidities, showing an unusual clinical presentation of isolated bilateral painless vision loss. With multiple infarcts on Non Contrast Computerised Tomography (NCCT) and a suspicion of Atrial Myxoma on Transesophageal Echocardiography (TEE), patient was successfully managed surgically with confirmation of diagnosis on histopathology

Lung Abscess – Missed, then Found!

Lung abscess, a liquefactive necrosis of the lung tissue, presents as an air-fluid level in a cavity on chest X-ray. But sometimes it can entirely be missed on chest X-rays and can cause delay in diagnosis and so appropriate management. In such situations, computed tomography of chest can clinch the diagnosis. We are presenting here such a situation where lung abscess was detected on CT chest, whereas the chest radiography totally missed it

Prevalence of depression and anxiety in patients with diabetes mellitus at a secondary level government health-care facility in Northern India

Background: Diabetes is one of the largest global health emergencies of the 21st century. As per the International Diabetes Federation (IDF) in 2020, 463 million people have diabetes in the world and 88 million people in the Southeast Asia region. Seventy-seven million out of 88 million belong to India. The prevalence of diabetes in the population is 8.9%, according to the IDF. There exists a bidirectional association between diabetes and depression/anxiety, with both worsening each other's prognosis. The prevalence rates of depression could be up to three times higher in patients with type 1 diabetes and twice as high in people with type 2 diabetes, while anxiety disorders are seen in 40% of the patients with type 1 or 2 diabetes mellitus. Although no single cause has been identified for the positive correlation between diabetes and depression and anxiety, it is widely accepted that hypothalamic–pituitary–adrenal dysfunction, pro-inflammatory cytokines, and a host of other epigenetic factors are responsible for the increased prevalence. This study was undertaken to check the prevalence of anxiety and depression in patients with diabetes mellitus attending the outdoor clinics of internal medicine department at a district hospital, Fatehgarh Sahib, Punjab. Materials and Methods: Four hundred patients were included in our study. A semi-structured pro forma was used to collect demographic details, and anxiety and depression were screened using the Hamilton Anxiety and Depression Rating Scales, respectively. Data collected were subjected to statistical analysis. Results: Fifty-eight percent of the sample population had depression and 27% had anxiety, with a vast majority having mild symptoms. Gender and duration of diabetes were statistically significant variables affecting prevalence and severity, with females having a higher mean scores of depression and anxiety than males and higher scores with greater duration of the illness. Conclusions: This study implies need for routine screening of depression and anxiety symptoms in patients with diabetes mellitus and treating them at the earliest

Bilateral Tubercular Lung Abscess in a Diabetic Female

Liquefactive necrosis of the lung tissue caused by microbial infection, lung abscess is characterised by formation of cavities containing necrotic debris. In the vast majority of cases of lung abscess, polymicrobial bacteria can be found with predominance of anaerobes. Mycobacterium has been described as a very rare causative agent of community acquired lung abscess. We are presenting a case of middle aged diabetic female, who had bilateral lung abscesses, aetiology of which was established to be tubercular. Astonishing it may sound; based upon extensive web and library search, it's the first case report on tubercular lung abscess in a diabetic from India, and perhaps from the world itself

Vertigo in Elderly – Common but Complicated

Dizziness and its subtype vertigo are common complaints occurring in all age groups after teenage but, it become a major health problem in elderly because of the frequency with which it affects the elder population and leads to direct and indirect consequences. Causes of vertigo in the elderly are not totally different from young population but to some extent they are different too. In elderly, the causation of dizziness and vertigo is interplay multiple factors, so its diagnosis and management differs from other age groups. This review is aimed at highlighting the special aspects of dizziness and vertigo in the elderly

Idiopathic clubbing: A case report

Clubbing of the fingers and toes has been recognized as a clinical manifestation of intra thoracic disease from the earliest times. Hippocrates particularly described the condition as occurring with advanced phthisis and empyema and emphasized the importance of the changes as diagnostic of purulent pleural effusion. Many subsequent authors have described clubbing of the fingers associated with chronic disease of the heart or lungs, but it is still rare in medical literature to find the condition mentioned as being of primary origin. We here present the case of 24 years old female having developed clubbing of all fingers that had no found secondary cause after an extensive search and so thought to be of primary origin