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.

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.