Acute pancreatitis complicated by encephalopathy

Pancreatic encephalopathy is a frequently under-diagnosed and rare complication of acute pancreatitis. It denotes the occurrence of neuropsychiatric abnormalities in the setting of acute pancreatic inflammation, and presents with neurological symptoms that may persist even after the resolution of all metabolic parameters. Here we present the case of a 42 year old male patient presenting with altered sensorium and focal neurological deficit during the course of acute pancreatitis. The patient was treated conservatively, and later improved with supportive care.

To Study the Extent of Delay in Diagnosis and Treatment under DOTS.

Present study was prospectively carried out at the 3 DOTS cum Microscopy Centres, associated with LRS Institute of Tuberculosis and Respiratory Disease. A pre-tested and pre-designed questionnaire was developed to study the objectives and the patients were interviewed with the questionnaire at beginning of treatment. Among the 311 patients who were included in the study , 158 patients consisted of different type of delay. In the study maximum delay was patient delay (43.08%) i.e. in DOTS maximum delay is due to patients reporting to the clinic after onset of symptoms. Diagnosis delay was found in only 7.34% cases, indicating that the diagnosis in DOTS is efficient. Treatment delay consisted of 22.5% among study among study population i.e. late initiation of treatment under DOTS is a major issue on which the system have to concentrate.

Celiac disease: association with adult-onset Still's disease: apropos of a clinical case.

Adult-onset Still's disease (AOSD) is a rheumatic disorder of unknown etiology characterized by a triad of fever, polyarthritis and evanescent rash. We present a case report of a 28-year-old female who presented with complaints of fever, joint pains, rash, weakness for the past 4 years and diarrhea for the past 2 years. On investigation the patient was diagnosed to be a case of AOSD. Duodenal biopsy report was suggestive of celiac disease with a positive IgA tissue transglutaminase and anti-endomysial antibody. The patient was started on weekly methotrexate and gluten-free diet and her symptoms gradually improved. The patient remains in our follow-up and is doing well.

The 2003 outbreak of Dengue fever in Delhi, India.

Dengue fever (DF) and Dengue hemorrhagic fever (DHF) are widespread in Southeast Asia. An outbreak of DF/DHF in Delhi in 2003 started during September, reached its peak in October-November, and lasted until early December. This study describes the clinical and laboratory data of the 185 cases of DF/DHF admitted to Lok Nayak Hospital, New Delhi. The mean age of the patients was 26 +/- 10 years. Fever was present in all the cases with an average duration of fever being 4.5 +/- 1.2 days with headache (61.6%), backache, (57.8%), vomiting (50.8%) and abdominal pain (21%) being the other presenting complaints. Hemorrhagic manifestations in the form of a positive tourniquet test (21%), gum bleeding and epistaxis (40%), hematemesis (22%), skin rashes (20%) and melena (14%) were also observed. Hepatomegaly and splenomegaly were observed in 10% and 5% of cases, respectively. Laboratory investigations revealed thrombocytopenia (with a platelet count of < 100,000/microl) in about 61.39% of cases, Leukopenia (WBC <3,000/mm2) and hemoconcentration (Hct >20% of expected for age and sex) were found in 68% and 52% of the cases, respectively. The mortality rate was 2.7%. Despite widespread measures taken to control outbreaks of DF, it caused major outbreaks. More stringent measures in the form of vector control, improved sanitation and health education are needed to decrease morbidity, mortality and health care costs caused by a preventable disease.