Clinical Spectrum of Pulmonary and Extrapulmonary Tuberculosis in End Stage Renal Disease in Jammu.

One hundred patients of End Stage Renal Disease (ESRD) (mean age 50.5 years, S.D. 14.0341) during a period of one year from April 1, 2004 to March 31, 2005 were studied. Detailed clinical history, physical examination and laboratory investigations were recorded. Chi-square and Fischer-exact tests were used for statistical analysis. Sixteen cases of tuberculosis were detected in 100 ESRD patients. Fifteen of them were pulmonary and one extrapulmonary. Increased association of tuberculosis was seen in – diabetics as underlying cause for ESRD (37.5%), lower socioeconomic status (62%), male patients (68.75%), and patients > 35 years of age (87.5%). Anorexia was most common symptom (100%), followed by fever (87.5%) and cough (68.7%). Keeping in view of high incidence and prevalence of tuberculosis, patients of ESRD should always be screened for tuberculosis, requiring a high index of suspicion.

Megakaryocytic Aplasia.

Acquired Megakaryocytic aplasia is a rare disorder defined by severe thrambocytopenia with no other haematological and absent or severely marow megakaryocytes.

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.

The Spectrum of Renal Osteodystrophy: A Clinical, Biochemical, Radiological and Histopathological Study

The chief mineral source of Jammu province is bauxite, an aluminium ore, so a possibility of water being heavily polluted with aluminium is prevalent. Hence, in an effort to relate this regional geographical aspect with aluminium bone disease (ABD) in chronic renal failure (CRF), 50 cases of CRF were prospectively evaluated. Patients were subjected to a thorough history and clinical examination. Biochemical parameters along with raiological skeletal survey and iliac crest bone biopsies were undertaken. Sixty-eight per cent of CRF patients were also consuming aluminium containing phosphate binders (ACPB) at that time. The study revealed an occurrence of ABD in 10% of CRF patients. It was found predominantly superimposed upon osteomalacia (8%) and mixed osteodystrophy (2%). Superimposed ABD on osteomalacia was found more frequently in pre-dialysis (10.8%) than after haemodialysis group (7.69%). Moreover, the incidence of ABD superimposed on osteomalacia and mixed osteodystrophy was higher in the ACPB group (14.7%) than the post-haemodialysis group (7.69%). Correlating, the pre-dialysis, post-haemodialysis and ACPB ingestion status of CRF patients on one hand and histologically proven ABD on the other, it was deduced that the majority of cases of CRF having ABD was seen in ACPB ingestion group (14.7%) followed by pre-dialysis (10.8%) and post-haemodialysis (7.69%) groups. Thus it was concluded that in the present work, ACPB ingestion was the major source of aluminium deposition in bones of patients with CRF rather than the water used in dialysis or possible pollution of drinking water with aluminium in our province.