Visceral Leishmaniasis In A Native Kashmiri Boy.

Leishmaniasis, though widely prevalent in South Asia, is not seen in the Kashmir valley where the cold climatic conditions create a hostile environment for the growth of the parasite or its vector, the sandfly. However, a few cases of cutaneous leishmaniasis have been documented from the hot and arid Uri belt of Kashmir. We present a case of visceral leishmaniasis in a boy hailing from Uri, a rarity in this region.

Haemophilic Arthropathy

Bleeding into joints and soft tissues are the hallmark of haemophilia. The severity of manifestations co-relates with deficiency of the factor. The resorption of intra-articular blood induces reactive synovitis and causes cartilage damage, finally causing complete destruction of it. We hereby report a similar case and highlight various rheumatic manifestations of haemophilia and its management.

Acute Disseminated Encephalomyelitis

Acute disseminated encephalomyelitis is a multifocul inflammatory myelinopathy of the CNS which is generally but not exclusively monophasic. Typically it follows after vaccination or some viral infection. The diagnosis is difficult due to insensitivity of CT imaging and lack of pathognomic clinical and laboratory features. We highlight the role of MRI in diagnosing an unusual case of ADEM presenting to us with fever, seizures, hemiparesis and drowsiness who improved remarkably with methyl prednisolone therapy.

Reflex Sympathetic Dystrophy Syndrome

Reflex Sympathetic Dystrophy (RSD) or Complex Regional Pain Syndome Type-I (CRPS-I), a disease of unknown prevalance, complicates any minor trauma, stroke, myocardial infection, colle’s fracture, peripheral nerve injury and in one-fourth of cases without any precipitant factor. An awareness of RSD and the injuries, illnesses and drugs that can provoke it is the first step to learn for an early treatment and better outcome. Here we present a neglected case of RSD following minor trauma who presented to us after 6-7 months of onset of disease. Delay in treatment resulted in partial recovery of the patient.

Serum magnesium levels in chronic renal failure. Clinical significance and correlation with sodium potassium and calcium.

Fifty cases with chronic renal failure and 25 age and sex matched normal healthy controls were studied. The mean serum magnesium level was significantly higher (4.10 +/- 0.85 mg/dl) in the patients as compared to controls (2.40 +/- 0.14 mg/dl; p less than 0.001) and levels rose progressively with deterioration in renal function. Significantly higher serum magnesium levels were observed in patients of chronic renal failure with encephalopathy than in those without. Greater the impairment in level of consciousness, higher was the magnesium level. Improvement in neurological status correlated well with fall in serum magnesium level. The fall was significantly higher in patients on dialysis as compared to non-dialysed patients. Serum magnesium is a worthwhile tool in assessing duration of disease, morbidity and mortality in patients with chronic renal failure. Its estimation may help in evaluating conservative treatment and dialysis in chronic renal failure.

Hypoglycemic responses to insulin in normothermic and hyperthermic young dogs.

The present study was conducted in 10 healthy young dogs in which pattern of hypoglycemia to injected insulin (0.12 U/kg I.V.) was studied at normothermic (38.5 degrees C) and hyperthermic (42.5 degrees C) body temperatures. Average maximum fall in plasma glucose concentration from the control level was 44.3% and 53.8% in normothermic and hyperthermic dogs respectively. The hypoglycemic response to injected insulin was much greater and prolonged in hyperthermic dogs. The recovery of plasma glucose to preinjection level was also very sluggish and incomplete in these dogs. The above changes in hyperthermic animals may be due to enhanced secretion of insulin, as well as an increased sensitivity to injected insulin. The slow recovery of plasma glucose to preinjection level following insulin administration in hyperthermic dogs would indicate inefficient feedback mechanisms which normally operate to raise the plasma glucose during hypoglycemia.