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.

Obesity: a global health problem

Since time immemorial, obesity has engulfed the mankind. It’s a pandemic. The prevalence is increasing by leaps and bound. Evidences date back to 30,000 BC. Earlier it was linked to wealth and status and it took a long time for it to be considered as a disease. This change in mind-set of the people occurred in mid-19th century. Different formulas for calculating the BMI (Body Mass Index) were invented which was different for the world and the South-East Asians. Slowly it became a topic for research among the scientific society and first priority was given to finding out the cause of obesity. It could not be pointed down to one as many factors were found to contribute to the menace of obesity. Age, gender, genetics, environment, food habits, various co-morbid conditions and the list of contributing factors is endless. Studies done at the molecular level have shown that various cytokines like TNF, Interleukins, Monocyte Chemoattractant Protein, adipokines, etc., have been implicated in the pathogenesis of obesity. The first line in the management of obesity is to take preventive measure. Those who have started to develop the disease should undergo a few non-pharmacological treatment options like lifestyle modification, change in food habits and behavioural therapy. Initially drugs like fenfluramine and sibrutramine were developed. With newer researches coming up more safer and consistent molecules like Tesofensin have been found and undergoing trial. If not benefited by medical treatment the last option what remains for the patient is bariatric surgery but they are too costly for general population to afford. Finally, it is best seen that it is wise enough to follow the saying “Prevention is better than cure” for a disease with such a vast etiology.