Atrial fibrillation associated with high voltage electric shock in a young healthy female: a case report.

Atrial fibrillation is amongst the various arrhythmias resulting after electrical injury but its incidence has been reported to be extremely rare. Here we are reporting a case of 35 years old lady presenting to our Emergency department with atrial fibrillation with fast ventricular rate after accidentally being injured by high voltage electrical current. She was managed successfully with pharmacological cardioversion followed by a period of observation. The rhythm reverted back to normal sinus rhythm on 3rd day. This approach of management is amongst one of the few published cases where patient was managed conservatively.

Miller Fisher syndrome/acute motor axonal neuronopathy overlap an atypical manifestation of malaria: a case report.

Various types of neurological manifestations are described in P. falciparum/vivax malaria of which Guillian Barre syndrome and its variant like Miller Fisher Syndrome (MFS) and Acute Motor Axonal Neuronopathy (AMAN). We are reporting such an unusual case who presented with five days history of fever and weakness of three days duration. On investigations it turned out to be acute MFS/AMAN overlap with peripheral blood showing mixed infection having heavy parasitaemia of P. falciparum and P. vivax combine. All other causes of acute polyneuropathy were ruled out by history and relevant examination. Patient improved with Artemisinin based Combination Therapy (ACT) and other supportive measures.

Staphylococcus aureus septicemia presenting as disseminated intravascular coagulation - thrombotic thrombocytopenic purpura overlap and thrombus in inferior vena cava, right atrium and right ventricle: a case report.

Staphylococcal sepsis following furunculosis and complicated by suspected deep vein thrombosis and septic inferior vena caval, right atrium, right ventricle emboli accompanied by disseminated intravascular coagulation (DIC) - thrombotic thrombocytopenic overlap in a 65 years old lady is presented. She was managed successfully with antibiotics and anticoagulation. The case is reported for its rarity and brings to light the vivid manifestations of septicemia specially staphylococcal.

Hemichorea as a presentation of acute rheumatic fever: a case report.

Chorea is a major manifestation of acute RF and is the only evidence of RF in approximately 20% of cases. We report on a 15-year-old boy who presented with transient right side involuntary jerky movements, apical systolic murmur, sinus bradycardia, arthralgia, elevated antistreptolysin O titer and ESR, who was diagnosed with acute rheumatic fever and improved with haloperidol, prednisolone, digoxin, aspirin and furosemide and was given benzathine penicillin prophylaxis for future RF. Patient is faring well in follow up visits. We present our case because of its rarity.

Vitamin B12 and folic acid deficiency presenting as acute febrile illness: a case report.

Megaloblastic anemia is not uncommon in India, but data is insufficient regarding its presentation as pyrexia. We report the case of a patient who presented with pyrexia and anaemia, which after exclusion of infective, inflammatory or endocrine causes was attributed to megaloblastic anaemia secondary to vitamin B12 and folic acid deficiency. The patient’s fever responded to treatment of vitamin B12 and folic acid deficiency.

Endothelial dysfunction in patients with metabolic syndrome: a prospective study in a rural institute in India.

Background: The objective was to evaluate endothelial dysfunction in patients with metabolic syndrome. Methods: This prospective, cross-sectional, hospital based observational study included 45 patients with metabolic syndrome and 20 age and sex matched controls who attended hypertension clinic, diabetes clinic, general medicine OPD and patients admitted in wards department of medicine, UPRIMS&R, Saifai, Etawah, UP, India. All patients who fulfilled inclusion criteria were subjected to the color Doppler of the brachial artery in the department of radio-diagnosis of the same institute. Results: Of the 45 patients with metabolic syndrome included in the study, 22 patients (48.9%) were males and 23 patients (51.1%) were females. Ten males (45.5%) had a waist circumference of >90 cm whereas 20 females (87%) had waist circumference of >80 cm. 9 males (40.9%) had abnormal waist hip ratio whereas 22 females (95.7%) had abnormal waist hip ratio. 43 patients (95.6%) had a SBP >130 mm of Hg whereas 39 patients (86.7%) had a DBP >85 mm of Hg. 24 patients (53.3%) had impaired fasting blood sugar i.e. >100 mg/dl ,25 patients (55.6%) had a TGL level >150 mg/dl, and 9 males (40.0%) had HDL < 40 mg/dl whereas 18 females (78.3%) had HDL value < 50 mg/dl respectively. The mean brachial artery baseline diameter were 3.50 ± 0.39 mm in males and 3.25  0.29 mm in females respectively, FMD percentage was 14.91  3.56 in females and 14.53  4.02 in males, and GTN mediated dilatation were 27.67  9.83% in females and 27.62  6.85% in males respectively. Conclusion: Estimation of Endothelial Dysfunction in patients at risk of developing full blown Metabolic Syndrome may predict the cardiovascular morbidity and mortality in these individuals even before fulfilling the 3/5 criteria of NCEP/ATP III Guidelines for the diagnosis of metabolic syndrome.

A case of endometrial tuberculosis complicated by Pott’s spine with paraplegia.

Extra-pulmonary tuberculosis has shown an increasing trend in developing countries and accounts for 15-20% of total tuberculosis cases in India. Extra-pulmonary cases are usually diagnosed late due to vague and subtle signs & symptoms at a stage when major irreversible tissue damage had occurred. Tuberculosis is a chronic disease with infection remaining dormant for years in body to get activated whenever the immunity decreases. Spinal and cranial TB has the gravest manifestations, while the abdominal, female genital or pelvic TB poses a challenge because of lack of specific diagnostic tests. Here we are reporting a case of endometrial tuberculosis which was diagnosed very late, followed by treatment default and finally got complicated with Pott’s spine with paraplegia due to haematogenous spread. Timely intervention and anti-tubercular treatment improved the symptoms. It stresses on keeping the high suspicion of tuberculosis in unresponsive and persistent general symptoms.

Myxoedemic coma: an uncommon presentation of Sheehan syndrome.

This is a rare case of a 35 year old multiparous female who presented with electrolyte abnormality, hyponatremia in a setting of seizure and moderate pallor. She had a significant past history of childbirth complicated with post-partum haemorrhage after which she developed secondary amenorrhoea and lactation failure. Workup showed suppressed levels of all pituitary hormones and was treated as myxoedemic coma. A diagnosis of Sheehan’s syndrome presenting as myxoedemic coma - a rare but emergency presentation was made.

Pattern of macrovascular disease phenotypes amongst newly diagnosed type 2 diabetic patients in a rural institute in Uttar Pradesh, India.

Background: The objective of current study was to determine the proportion of Macrovascular Disease (MVD) phenotypes amongst newly diagnosed type 2 diabetic patients in our institute by dividing the cases into sub-groups according to the MVD sites involved (NMVD - no macrovascular disease; NSCS - non-significant carotid stenosis; CBVD - cerebrovascular disease; CAD - coronary artery disease; PAD - peripheral artery disease; PVD - polyvascular disease) and studying the anthropometric, clinical and laboratory parameters in each group. Methods: The study included a cohort of 136 newly diagnosed patients with T2 DM. Demographic, clinical and laboratory parameters were included in analyses. Standardized procedures were used to assess the risk factors of associated metabolic syndrome (MetS). Results: The proportion of patients with MVD was 27.94% amongst the participants in the study. The majority of patients with MVD were in the CAD group (15.44%). Age, male sex and smoking history were independent risk factors in the CAD and PAD groups (P <0.01). A low HDL-C value was an independent risk factor in the CAD and PVD group P = 0.03). Very high frequencies of MetS were observed in the PAD and PVD groups (90% and 91.7% respectively). Prevalence of PVD was three times more common in males as compared to that in females. All patients with PAD had associated CAD also. Conclusion: This study projects a high proportion of MVD amongst newly diagnosed Type 2 diabetics in rural sub-population in Uttar Pradesh. High rates of mortality and morbidity in these patients due to macroangiopathy warrant early screening of MVD to ensure timely preventive and therapeutic measures.

Acute intermittent porphyria with syndrome of inappropriate antidiuretic hormone secretion (SIADH) and neurological crisis, successfully treated with haemodialysis.

We report a 35 years old male, a case of Acute Intermittent Porphyria (AIP) with Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH) and neurological crisis for its rarity. Since specific parenteral medication (hemin) was not available, patient was empirically treated with haemodialysis with satisfactory outcome.

Prevalence & spectrum of congenital malformations in a prospective study at a teaching hospital.

A prospective survey for congenital malformations at birth, at a teaching hospital, over a period of two and half years on 9405 consecutive single births has shown that prevalence of major congenital malformations in live births was 1.6 per cent and in still births 16.4 per cent. There was no significant difference in the prevalence of congenital malformations between Hindus (2.0%) and Muslims (2.7%) but amongst Muslims with consanguinity the prevalence of congenital malformation was 4.6 per cent compared to 2.3 per cent in non-consanguineous Muslim spouses (P less than 0.05). Open neural tube defect was the single most common anomaly (31.7% of all malformations) occurring at a rate of 4.7 per 1000 single births, with equal prevalence of anencephaly and meningomyelocoele. Case control study showed that history of concomitant medical illness, drug intake during the first trimester, threatened abortion, hydramnios and pre-eclamptic toxaemia in the current pregnancy were significantly associated with the occurrence of congenital malformations.