Takayasu arteritis presenting with massive cerebral ischemic infarction in a 15-year-old girl: a case report

Takayasu arteritis is a relatively rare type of large-vessel arteritis that primarily affects the aorta and its major branches, the coronary arteries, and the pulmonary arteries. Depending on the different groups of blood vessels involved in the disease process, the clinical presentation of Takayasu arteritis varies. Here we report a case of a girl presenting with a debilitating massive cerebral ischemic infarct that turned out to be a relatively rare first presentation of Takayasu arteritis. Case report of 15 years old adolescent female hailing from lower socio-economic status with past history of chronic headache, no significant family history, completely immunized presented with sudden onset weakness of right upper and lower limbs, which progressed over 1day with aphasia (recovering) with deviation of angle of mouth to left side On examination left radial ,carotid artery not palpable. Her laboratory results showed an elevated C-reactive protein and erythrocyte sedimentation rate, and subsequent CT angiography demonstrated narrowing and occlusion of the major branches of her aortic arch. We report the case of a patient with Takayasu arteritis presenting with a massive cerebral ischemic infarct and review the current literature on this topic. Conclusion of takayasu arteritis is a relatively rare disease with various and sometimes devastating clinical manifestations, such as massive cerebral ischemic infarction as in our case. Currently, there are multiple diagnostic tools and treatment options available, and more under investigation. Early, appropriate diagnosis and initiation of proper therapy could avoid further progression and reduce complications of the disease.

Acquired generalized lipodystrophy type 2-lawrence syndrome: a rare case report

Lawrence syndrome (Acquired Generalized Lipodystrophy) is a rare disorder, characterized by various dermatological and systemic manifestations such as lipodystrophy, hypertriglyceridemia, hepatomegaly, acanthosis nigricans and acromegaloid features. Because of its rare occurrence we are reporting a case with similar manifestations in a 10 years old child.

Correlation of serum creatine phosphokinase and serum cholinesterase in organophosphate poisoning in children

Background: Organophosphate (OP) poisoning is one of the most common pesticide poisoning in India in adolescents because of its easy availability. Serum pseudocholinesterase levels are commonly used to assess the severity and to know the prognosis in OP compound poisoning. Serum creatine phosphokinase (CPK) levels is another lab parameter which gets deranged in OP poisoning and has been tried in adults to assess the severity and to know the prognosis.'Authors objective was to study the correlation of serum pseudocholinesterase and serum CPK in organophosphate poisoning at admission and to compare outcome with serum CPK levels.Methods: All the children in the age group of 1 month to 18 yrs, who were admitted with the history of suspected OP compound poisoning were enrolled for the study. Estimation of cholinesterase and CPK levels were done at admission and after 1 week. Patients were categorised in to latent, mild, moderate and severe cases based on the S. Cholinesterase levels. These values were analysed to see the correlation.Results: Among 34 OP poisoning cases,13(38%) were males and 21(62%) were females. Mean age of study population was12.6+4.25 yrs. The median CPK values in latent, mild, moderate and severe cases were 121.5 IU/L,276.5 IU/L, 308IU/L and 467IU/L respectively (p=0.015). Spearman's rho Correlation coefficient was -0.522 between S. Cholinesterase and S CPK at admission which was significant. The median serum CPK level after 1week in non survivors was 2498.0IU/L and in survivors was 201.0IU/L (p0.014).Conclusions: There was a strong negative relationship between serum cholinesterase and serum CPK at admission in OP poisoning. Follow up values at 1 week showed that significantly high serum CPK and low cholinesterase, which was also significant and was associated with mortality.

Assessment of prescribing pattern and cost analysis of topical steroids for skin disorders in dermatological outpatient department of a tertiary care hospital

Background: Topical steroid is most commonly prescribed in non-infective dermatological conditions. Periodical Prescription audit is mandatory for the effective management. Hence the present study is designed to assess the prescribing pattern and cost analysis of topical steroids for various skin disorders in the dermatology OPD of a teaching hospital.Methods: This is a prospective observational study conducted in dermatology OPD of a teaching hospital from Jan-Mar 2019 in patients prescribed with topical steroids in all age groups after obtaining IEC approval. Data was analyzed for prescription pattern and cost analysis using descriptive statistics and expressed in percentage.Results: A total of 90 prescriptions were analyzed among which males were 45% and females were 55%, the common indications were eczema-27.7%, atopic dermatitis-25.5%, psoriasis-16.6%, dermatoses-13.3%, lichen planus-7.77% etc. Topical steroids commonly prescribed were super potent (Clobetasol 34.4% and Halobetasol 22.2%). Cream and ointment formulation were commonly used. Common adverse reactions were skin atrophy, hypopigmentation, acne. In prescribing pattern, specification of strength and quantity were lacking whereas instructions regarding area of application-44.4%, route of administration-83.3%, frequency and duration-91% were noted. In cost analysis, comparison is made between similar potency and clinical outcome. Of which, Clobetasol 0.05% and Betamethasone 0.01% is found to be cost effective compared to Halobetasol 0.05% and Mometasone 0.1% respectively.Conclusions: This study provides a limelight on prescribing pattern of topical steroids and emphasize periodic audit to rationalize the prescription with cost effectiveness.

Clinicopathological Correlation Of Hansen‘S Patients Over A Period Of 1 Year – A Retrospective Study In A Tertiary Care Hospital, At Kanchipuram District

Leprosy an ancient curable chronic infectious granulomatous disease. In the absence of the classic involvement of the peripheral nerves, the clinical manifestations of leprosy are diverse and can mimic a host of other skin disorders. The clinical classification of early lesions of leprosy is often difficult, where skin biopsy plays a crucial role in diagnosis.

Prognostic value of laboratory and radiological parameters in kerosene poisoning

Background: Kerosene poisoning, a commonly encountered situation in pediatric emergencies, caused varied systemic manifestations ranging from asymptomatic state to altered sensorium and cardiac arrhythmias. Gupta score has been traditionally used to prognosticate such cases. Limited number of studies have been done previously despite high incidence rates pertaining to laboratory and radiological features. Present study aimed to determine association between these features and outcome in terms of duration of stay.Methods: A retrospective study consisted of all children presented with kerosene poisoning from May 2017 to May 2018. CBC was done within 12 hours of presentation and CXR was taken after 6 hours of exposure. These values were compared against duration of stay to predict prognosis.Results: Most children were in age group of 1-3 years, male predominance 62.9%. Quantity of consumption didn't have any effect on outcome. Large proportion of children were asymptomatic 60%, followed by hurried breathing 31.5% - most frequent presenting complaint. Peak duration of consumption was 4 pm to 8 pm. CBC parameters- Hemoglobin status and WBC counts failed to have correlation with outcome in terms of duration of stay. CXR taken after 6 hours exposure- was imperative to predict outcome.Conclusions: Radiological features on CXR in addition to clinical symptoms could be used to decide likely outcome after kerosene consumption.