ABSTRACT
A 27-year-old female presented to us with a short history of fever, jaundice, rash, and worsening hepatic dysfunction subsequent to treatment with intravenous antibiotics and alternative medicine for a urinary tract infection. The eosinophilia, lymphadenopathy, and transaminitis prompted us to consider a diagnosis of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) which can be fatal if not treated. The patient showed improvement in clinical and laboratory parameters after a course of steroids. This case is presented as DRESS syndrome that can prove rapidly fatal if not diagnosed and treated immediately.
ABSTRACT
Background: The prevalence of hypothyroidism in the developed world is about 4-5% and in India is 10.9%. The goal of treating hypothyroidism is to maintain thyrotropin (TSH) levels within the normal reference range. Studies have shown that even within the normal range of TSH, patients with low normal TSH (LNT) have better outcomes when compared to patients with high normal TSH (HNT). Aims and Objectives: Our study aimed to find whether patients treated at a dose of levothyroxine resulting in an LNT had improved clinical outcomes and biochemical parameters, when compared to those on a levothyroxine dose resulting in an HNT. Materials and Methods: 180 patients with hypothyroidism on treatment, who had a TSH of 0.27-4.2mIU/L and had been on treatment with a stable dose of at least 50 micrograms of levothyroxine for at least 6 months were administered the Thyroid Symptom Questionnaire. TSH was assayed. Blood pressure and BMI were measured. Serum lipids were measured by spectrophotometry. Results: We found that patients with LNT and HNT did not differ with respect to cognitive symptoms , feelings of coldness, lethargy and fatigue. However, patients with LNT had a better lipid profile (mean LDL 132.24 in HNT and 115.39 in LNT p= 0.08) and lower BMI (1.045kg/m 2 lower in LNT compared to HNT) compared to HNT. Conclusion: Treating patients with a dose of thyroxine titrated to achieve LNT might decrease the cardiovascular risk by improving the lipid profile and BMI.
ABSTRACT
The incidence of ischemic heart disease and myocardial infarction is increasing in developing nations. One measure that consistently improves outcomes in patients with myocardial infarction is early reperfusion. In resource-constrained settings, reperfusion is often achieved with thrombolysis rather than percutaneous coronary intervention. Our study aimed to determine, by using electrocardiographic criteria, the failure rate of reperfusion with thrombolysis by streptokinase in patients presenting to a tertiary hospital in south India. We also aimed to find the factors associated with failure of thrombolysis in the population under study. Methods: Patients diagnosed to have acute myocardial infarction and thrombolysed with streptokinase were taken for the study. Failure of thrombolysis was defined by electrocardiographic criteria as less than 50% resolution in ST segment elevation in the worst affected lead after thrombolysis. Results: Reperfusion with streptokinase had a high rate of failure. Diabetes smoking longer symptom needle time and higher admission rates and blood pressure and heart rates were factors associated with failure. Conclusion: Thrombolysis with streptokinase has a high rate of failure and certain specific factors are associated with reperfusion failure.