Digital infarct and mononeuritis in a middle aged female: always suspect Antineutrophil cytoplasmic antibodies associated vasculitis

Vasculitis is a process caused by inflammation of blood vessel walls and results in a variety of disorders. Small-vessel vasculitis (vasculitis involving arteries, venules and capillaries) should be suspected in any patient who presents with a multisystem disease that is not caused by an infectious or malignant process. Testing for Antineutrophil cytoplasmic antibody (ANCA) is the basis of classification of small vessel vasculitis into ANCA associated and non - ANCA associated vasculitis. Apart from cutaneous manifestations like palpable purpura and vasculitic urticaria, digital gangrene in a patient with evidence of mononeuritis multiplex is highly suggestive of ANCA associated vasculitis (AAV). Clinically most of these vasculitides have overlapping clinical presentations and similar treatment. Early diagnosis and rapid initiation of treatment of AAV is recommended rather than ordering for definitive tests (e.g. histopathology or angiograms) since delay in treatment can result in serious end organ damage (pulmonary or renal).

Where Did It Go? A Case Report of Accidental Tooth Ingestion during a Simple Tooth Extraction.

Ingestion of foreign bodies accidentally can be seen commonly in emergencies usually in children, elderly, mentally impaired, or alcoholic individuals. Ingestion of a foreign body is more common than aspiration of a foreign body. Aspiration represents a serious medical situation whereas ingestion of a tooth is a less serious situation as the tooth will be egested due to peristaltic movements of the gastrointestinal tract. Here is a case report of tooth ingestion during a simple dental extraction which could have turned into a serious medical situation, had the patient aspirated the tooth.

ST elevation - An indication of reversible neurogenic myocardial dysfunction in patients with head injury.

This report describes a patient who presented with signs of meningitis four days after head injury. The patient had ST elevation on electrocardiography along with hypotension and positive tropinin T test, mimicking inferior wall infarction. The ST changes resolved within 48 hours of intensive care management. Subsequent investigations failed to document any myocardial infarction.

Awareness Status about HIV-AIDS among Indian Railway's Employees and their Family Members.

A house to house survey was conducted in December 2005 in the Railway Colony of Shamli, located in the state of Uttar Pradesh, India using a semistructured questionnaire to study the awareness level regarding HIV/AIDS among Indian Railway's employees and their family members. Information regarding demographic characteristics and knowledge about various aspects of HIV/AIDS was recorded by a trained staff nurse of the local Railway Medical Unit from at least one person, aged 15 years to 59 years, from each household. Among 293 individuals interviewed, majority were males (61.8%), aged > 30 years (56.6%) and literate (85.3%). Majority were aware about existence of HIV infection in India (92.5%), AIDS is a fatal disease (92.8%) and laboratory tests are available for detecting HIV infection (89.4%). Although most of them knew the correct routes of HIV transmission viz. sexual (91.5%), parentral (90.8%), perinatal route (86.3%) and blood transfusion (86.0%), misconceptions such as transmission through shaking hands (89.1%), hugging (88.4%), sharing utensils (82.6%), mosquito bite (74.1%) and using public toilets (73.4%) were also observed. Most of them were also aware about preventive measures. Knowledge about various aspects was observed to be significantly higher among females, among individuals aged < 45 years and literate individuals. The findings highlight the need of intensified health education focusing on removal of misconceptions and further improvement in awareness level of the study population.