Perinuclear anti neutrophil cytoplasmic antibody vasculitis with nonspecific muscle pain

This is a case report describing p-ANCA vasculitis presenting with nonspecific muscle pain. It is a very uncommon finding seen in p-ANCA vasculitis patients which they usually present with palpable purpura alone. In this case, along with nonspecific muscle pain, renal involvement of the disease has been explained and there are no upper and lower respiratory tract complaints which favours more towards microscopic polyangitis.

Correlation of Carotid Intima Media Thickness with Disease Activity in Ankylosing Spondylitis

Introduction: Ankylosing spondylitis (AS) is a chronicinflammatory disease involving the axial joints. It hasassociation with HLA- B27. Measurement of intima mediathickness (IMT) of common carotid artery has got a directco-relation with atherosclerosis and increased cardiovascularmortality. In AS patients there is high chance of developingatherosclerosis because of it’s chronic inflammatory nature.Thus the study tried to see the co-relation of IMT of commoncarotid artery with disease activity of AS and other functionalindex. Current research aimed to study the carotid IMT(CIMT) in AS patients and see the co-relation of CIMT withdisease activity.Material and methods: 53 patients satisfying ModifiedNew York criteria 1984 were included in study. History,physical examination and necessary investigations weredone. BASDAI and BASFI was calculated. Graphs wereplotted showing the BASDAI and BASFI co-relation with theCIMT.Results: Male:Female ratio was 3.4:1. Mean BASDAI scorewas 4.14±0.92 and mean BASFI was 4.27±2.02. MeanCIMT (average of right and left carotid) of all the patientswas 0.63±0.19 mm. There was significant co-relation foundbetween CIMT and BASFI (r=+0.6411, p,0.001) thoughno such co-relation was found with BASDAI (r=-0.2462,p=0.075). There was a significant negative co-relationbetween CIMT and ESR (r=-0.3602, p=0.008) though no suchsignificant co-relation was seen with C-RP.Conclusion: Our study concludes that the patients with longerduration of disease have increased CIMT and decreasedfunctional index. This suggests that if disease is present forlonger duration, there may be increased risk of atherosclerosis.

Endoscopic Study of Dyspepsia with Special Reference to Helicobacter pylori

Introduction: In our day to day practice we encountermany patients who present with dyspepsia. Approximately50% of world’s population is estimated to be infected withHelicobacter pylori. The prevalence of this bacterium ishigher in developing countries when compared to developedcountries. The aim of this study was to look at the uppergastrointestinal (GI) tract endoscopic findings in patientspresenting with dyspepsia and the presence of H.pyloriinfection in those patients.Material and methods: It was a prospective study involving107 patients over a period of 10 months visiting the outpatientdepartment of Assam Medical College and Hospital fordyspepsia and meeting the inclusion criteria. Patientsunderwent upper GI endoscopy and tissue sampling fordetection of urease enzyme production by H.pylori.Results: 74 males and 33 females participated in the studywith mean age of 39.6 years (SD ± 12.10). 74% of studypopulation tested positive for H.pylori infection by detectionof urease enzyme produced by H.pylori. 77.5% of the studypopulation had ulcer in stomach or duodenum as detected byupper GI endoscopy.Conclusion: This study shows that H.pylori infection isdetected in a significant number of patients presenting withdyspepsia with no other specific risk factors for acid pepticdisease (eg: alcohol, smoking, usage of NSAID).

Phenytoin toxicity as a forgoer of schizophrenia like psychosis: a case report

This is a case report describing the toxicity of phenytoin overdose. It is very uncommon to find an anti-epileptic drug causing psychosis and till date only a few studies have found such a co-relation. A psychiatric patient was admitted in our department of medicine with the complain of ingestion of 30 tablets of phenytoin. On examination he was found to have auditory and visual hallucinations. He was restless and had an ill sustained concentration. First and foremost, thing was to stop the prescribed phenytoin tablets and sedate the patient with haloperidol and promethazine. Then, he was switched over to Levetiracetam 500 mg i.v. thrice daily, Clobazam 10 mg once daily and Resperidone 3 mg twice daily. On investigation we found serum phenytoin level >40 mg/dl. This was sufficient to support our diagnosis as after stopping the drug his symptoms improved. There have been case reports of epileptic patient presenting with psychosis but usually after 10-15 years, unlike our case. In our case this time period was reduced to 12 hours as there was a triggering factor present. So, if a known epilepsy patient develops psychosis, the drug history should be given a big importance and if required serum phenytoin level should be assessed to come to the diagnosis of “phenytoin induced schizophrenia like psychosis.

A Study of the Clinico-Etiological Profile of Acute Encephalitis Syndrome Cases in a Tertiary Care Hospital of Upper Assam with Special Reference to Japanese Encephalitis

Introduction: Acute Encephalitis Syndrome is a major health problem in Assam, claiming thousands of lives every year and crippling the survivors. Japanese Encephalitis is the leading agent of this group. Much emphasis has been given to the vaccination drive but the effort has not been fruitful. This study aims to explore the common presentations of these diseases, the causative agents and the vaccination status of those affected. Material and methods: This is a single centre observational study carried out in Unit-V of the Department of Medicine of Assam Medical College and Hospital, Dibrugarh for a period of two years. Acute Encephalitis Syndrome was defined as per World Health Organisation definition. Data were collected and serum and CSF were analysed in search of the etiologic agent. Results: Of the 74 cases studied, 37 tested positive for Japanese Encephalitis. Fever, altered sensorium and seizure were the most common presentations. Herpes Simplex had 50% mortality, the highest among all the agents tested for. Only 2 out of 37 cases had been vaccinated against Japanese Encephalitis. Conclusion: Acute Encephalitis Syndrome is a major threat to public health, particularly in Assam. Adequate vaccination coverage could prevent significant morbidity and mortality.