TB ascitis in cirrhosis of liver – A case report

To diagnose the cause of ascitis in cirrhosis of liver is difficult clinically as fluid is also present in cirrhosis with portal hypertension. The other diseases causing ascitis can also occur in cirrhosis of liver with portal hypertension. In tropical countries like India tuberculous ascitis is very common, hence tuberculous ascitis can occur even in presence of cirrhosis of liver with portal hypertension. In this case report, 45 years old male presented with tuberculous ascitis in cirrhosis of liver. This points out that tuberculous ascitis should be thought of even in presence of cirrhosis of liver or cirrhosis of liver with portal hypertension. The patient recovered completely with anti-tubercular treatment without any complications or toxicity. The role of anti-tubercular treatment and its toxicity in the presence of liver cirrhosis is also discussed.

Significance of sputum cultures in diagnosis of invasive pulmonary aspergillosis in acute leukemia A meta analysis

The diagnosis of Invasive Pulmonary Aspergillosis (IPA) and therapy with Amphotericin B appear to improve survival, but the early diagnosis is difficult. There are no pathognomonic clinical findings for IPA. The commonest presentation is compatible with any of bacterial, fungal, viral or protozoan infections. In addition, IPA may coexist with or arise during the therapy of other infections in immune compromised patients. It was thought that ante mortem isolation of Aspergillus species from respiratory secretions in pathologically confirmed cases occur infrequently. Demonstration of tissue invasion by fungal hyphae remained the accepted standard for diagnosis of IPA. Sputum culture is regarded as not useful for the diagnosis of IPA. Colonization of aspergillus may occur without invasion, hence, culture of respiratory secretions were not reliable. Aggressive diagnostic methods to establish the diagnosis of IPA are warranted. However there may exist important subsets of patients where sputum culture of Aspergillus may still be diagnostically useful. The underlying disease, i.e. immune suppression, neutropenia/ leukemia is a critical factor in selecting patients where sputum cultures may be useful. The degree of immune suppression increases, the diagnostic specificity of isolation of aspergillus from sputum. In this article, a meta analysis of 21 studies, spanning 27 years, the methods adopted for diagnosing IPA by various authors is analysed and discussed. The detailed pathogenesis of IPA is also discussed.

Development of nephropathy in Type II Diabetes Mellitus with norm albuminuria, micro albuminuria, and macro proteinuria

Earlier Diabetic nephropathy was thought to be a rare complication in Type II Diabetic patients. The incidence and prevalence of nephropathy in Type II Diabetes have been under estimated in the past probably because most patients with nephropathy succumbed to cardiovascular disease, even before nephropathy could manifest clinically. The current study was done to screen Type II diabetic patients for micro albuminuria and macro albuminuria, to identify the risk factors for development of nephropathy, and to note association of other micro vascular and macro vascular complications, and compare them with diabetics without proteinuria.

Emphysema, dilatation of ascending aorta and mitral valve prolapse in Marfan syndrome – A case report

Marfan syndrome is an autosomal dominant, multisystem connective tissue disorder. Mutations are present in the FBN1 gene on chromosome 15, which encodes for the connective tissue protein fibrillin, occasionally a mutation in TGFBR1 or 2. This disorder is characterized by skeletal, cardiovascular and ocular abnormalities. Pulmonary abnormalities occur in approximately 10% of patients, the commonest being spontaneous pneumothorax and emphysema. Cardiovascular abnormalities being Mitral valve prolapse (MVP), is a relatively frequent abnormality and Aortic dilatation. Aortic root dilatation is one of the cardinal features of Marfan syndrome. But aorta may be dilated anywhere in its course, most common being ascending aorta. In this case report, a 17 years old boy with Marfan syndrome presented with combination of emphysema, dilatation of ascending aorta, mitral valve prolapse, which is rare.

A clinical study of CNS Tuberculomas

Thirty cases of CNS Tuberculomas were studied as suggested by the CT Scan Brain (Plain and Contrast) from 2007 to 2009, at Gandhi Medical College, Hyderabad, India. It was most common in second and third decade of life. The most common clinical presentation was convulsions. Routine investigations did not yield the diagnosis of tuberculosis. All patients were treated with Anti Tuberculous Treatment (ATT), for 6 months and oral steroids. ATT consisted of 2 months of intensive phase of HRZE and 4 months of continuation phase of HR. No surgical intervention was done. After completion of chemotherapy, they were followed up for 6 months. Repeat CT Scans were done, which showed clearance of all tuberculomas.

Thyrotoxic cardiomyopathy – A case report

Cardiomyopathy is an uncommon presentation in hyperthyroid patients. There are very few case reports of thyrotoxic cardiomyopathy. The mechanism due to which cardiomyopathy occurs in hyperthyroid patients is not very well understood. After extensive literature search, it was found that some of the mechanisms described which include genomic, non-genomic and direct action of Thyroid hormone on the cardiac muscle may cause cardiomyopathy. In this case report, a case of Multinodular goitre with cardiomyopathy is described.

Malignant Lymphoma of the pelvis A case report

Lipomas are most common benign tumours derived from adipose tissue. Lipoma breast is somewhat difficult to diagnose clinically because of fatty consistency of breast. Lipoma breast measuring more than 10 cm in diameter or weighing more than 1 kg is called giant lipoma of breast which is infrequently observed because of rarity in size and location, with only very few case reports available in literature. Here, we have reported a case of this rare entity in 80 years old female who presented with complaints of painless lump in her right breast at our hospital

Role of blood pressure control in all acute cerebrovascular accidents with hypertension

Various risk factors have been implicated in causation of stroke but hypertension remains the single most important treatable risk factor in all age groups, and it is the one which seems to have a direct relation to incidence. Furthermore antihypertensive therapy has been observed to be effective in reducing the incidence of CVD (cerebrovascular disease). The interaction between hypertension, antihypertensive treatment and stroke is a complex one. Nevertheless the conclusion is that antihypertensive treatment has definite beneficial effects on stroke. Limited data are available to guide the choice of a target for the systolic blood-pressure level when treating acute hypertensive response in patients with intra cerebral hemorrhage. In this study, a total of 55 patients who presented with CVD and with hypertension (stage 1 and 2 of JNC 7) were included in this study. Out of 55, 37 (67%) cases are ischemic and 18 (33%) cases were due to cerebral hemorrhage. In ischemic stroke 35 (63.5%) cases are thrombotic, 2 (3.5%) are embolic strokes. All patients were given treatment with oral Nifedipine retard preparation 10-20mg q 8th hourly or Angiotensin converting enzyme inhibitors (which also stabilizes endothelium of the vasculature), along with other conservative treatment and physiotherapy. Patients with intra cerebral haemorrhage were treated with Nimodipine 60 mg q 8th hourly along with antihypertensive treatment. In our study, the reduction of blood pressure improved the outcome, and their Blood Pressure normalized without any complications. Blood pressure reduction in acute stroke, irrespective of the etiology improved the outcome. In our study, we reduced the BP in all acute CVA patients with E. A. Ashok Kumar, P. Jijiya Bai. Role of blood pressure control in all acute cerebrovascular accidents with hypertension. IAIM, 2016; 3(8): 111-125. Page 112 hypertension to normal within 24-48 hours. This study suggested BP control improves the outcome, when compared to fatalities in other studies, where BP is not reduced acutely.

The role of corticosteroids in primary antiphospholipid antibody syndrome presenting as cerebral venous thrombosis in young females at peripartum

The clinical study of cerebral venous thrombosis in antiphospholipid antibody syndrome in young females at peripartum was done to study the incidence of antiphospholipid antibodies in highly susceptible population groups most commonly at peripartum women. The presence of these antibodies points towards increased susceptibility to thrombosis and ischemic stroke apart from other manifestations in peripartum period. The age group most affected was between 20-25 years. Most of them were primipara. Many of the patients underwent Cesarean section before the presentation with the specific neurological complaint. None of the patients gave positive history for use of oral contraceptive pills. This study showed a 69% incidence of antiphospholipid antibodies out of the total patients studied. It was also found that 66% of the APL positive patients had radiological evidence of cerebral venous thrombosis. To help clarify the significance of aCL in CVT, this study was systematically analyzed and the clinical, radiological, treatment, and outcome information of patients with CVT tested for aCL immunereactivity at our institution and the pertinent literature was systematically reviewed. It was also studied that the most of the patients improved with corticosteroids.

The role of ACE inhibitors in retarding the progression of non diabetic chronic kidney disease by controlling blood pressure and proteinuria.

Lowering of blood pressure itself lowers urinary protein excretion rate and slows rate of GFR decline in chronic renal disease. There are data that suggests that ACE inhibitors improve glomerular barrier size selective function in experimental and human renal disease by directly lowering the mean dimensions of large unselective pores. A reduction in urinary protein excretion correlates with improved renal function and survival in non diabetic and diabetic renal disease. The initial reduction in rate of excretion inversely correlates with long term preservation of renal function in patient without diabetes treated with angiotensin converting enzyme inhibitors. In this study of 97 patients, the results showed that antihypertensive regimens of ace inhibitors group were more effective than non ace inhibitor in slowing progression of non diabetic chronic kidney disease. The presence of proteinuria in non diabetic chronic kidney disease is a strong indication for treatment with ace inhibitors. A brief epidemiology and pathophysiology is also discussed to understand the role of hypertension and proteinuria in chronic kidney disease.

Skeletal fluorosis with progressive quadriparesis U.M.N. type, non compressive myelopathy, chronic kidney disease and secondary hyperparathyroidism and hypothyroidism – A case report.

Endemic fluorosis leads to dental fluorosis, skeletal fluorosis and visceral fluorosis. This case described about the crippling skeletal fluorosis with neurological manifestations in the form of myelopathy, due to exposure to high fluoride level in water for many years. The complications of fluoride deposition in bones resulted in generalised sclerosis, osteophytosis, with narrowing of inter vertebral disc spaces in vertebral column. In this case the skeletal fluorosis leads to severe spastic quadriparesis. This case had features of visceral fluorosis; the affected organs include thyroid gland with hypothyroidism, parathyroid gland with secondary hyperparathyroidism, pancreas with intra pancreatic calcification and the kidneys with chronic kidney disease.

Catastrophic antiphospholipid syndrome – A case report.

Catastrophic antiphospholipid syndrome (CAPS) is a rare, potentially life-threatening condition, acute in onset , characterized by diffuse vascular thrombosis, leading to multiple organ failure in a short period of time in the presence of positive antiphospholipid antibodies (aPL). Lupus anticoagulant and anticardiolipin antibodies are the predominant antibodies associated with CAPS. Treatment options for CAPS include anticoagulation, steroids, plasma exchange, cyclophosphamide therapy, and intravenous immunoglobulin therapy. The high rate of mortality warrants greater awareness among clinicians for early diagnosis and treatment of CAPS. In this case report, 30-yearold post-partum female presented with progressive weakness, shortness of breath of grade IV and swelling of all the four limbs of 15 days duration with an episode of seizure. Investigations revealed MRV - cortical sinus venous thrombosis (CSVT) of transverse and sigmoid sinus, Raised anti-ds DNA anticardiolipin and lupus anticoagulant, 24 hour urinary proteins – 540 mg/day indicating clinical lupus nephritis. Weakness of all the limbs with areflexia indicated acute inflammatory demyelinating polyneuropathy (AIDP). 2D echocardiography- post partum dilated cardiomyopathy (DCMP).

Cerebral sinus venous thrombosis in hypothyroidism, hyponatremia and hypertension – A case report.

45-years-old male, hypertensive presented to the emergency in a state of unconsciousness after an attack of GTCS. Investigations revealed hypothyroidism, hyponatremia and Cerebral Sinus Venous Thrombosis (CSVT) on CT scan and CT Venogram. Other routine investigations were normal. This rare presentation of CSVT with hypothyroidism and hyponatremia was corrected with Eltroxin alone

Skeletal flourosis and chronic renal failure.

Flourosis has a world wide occurence posing a serious health problems. Approximately 25 to 30 million people are exposed to water polluted with flouride. Half to one million people are suffering from severe forms of flouride intoxication in our country. In Telengana,Flourosis was detected as early as in 1937, the problem being acute in Nalgonda District. It is observed that hidden renal disease is one of the main factors for development of skeletal flourosis early. Individuals suffering from latent renal disease develop skeletal flourosis early,even while consuming low levels of flouride. In this study, 52 cases of skeletal flourosis with chronic renal failure were described between 1983 to 1998. A detailed clinical evaluation and skeletal survey were carried out for flourosis. Renal function tests were carried out to assess renal function. Ultra sound examination of abdomen was carried out to assess the size of the kidneys. The results and pathophysiology were also discussed.