RESUMO
Toxoplasmosis is an obligate intracellular, food borne parasite disease with variable clinical presentation. Although the neurological presentation of toxoplasmosis in immunocompetent patients is uncommon, broad differential diagnosis should be kept in consideration when attending to similar patients. Twenty years old man with no known co-morbid conditions presented with fever and unilateral limb weakness for three weeks. It increased gradually, associated with altered level of consciousness for the last five days, diagnosed as acute toxoplasmosis. MRI Brain showed multiple ring enhancing lesions in frontal, parietal and temporal lobes. Serology for toxoplasmosis denoted raised IgM levels 36IU/mL [cut off value > 18IU/ mL]. This case report describes the clinical presentation and management of neurological toxoplasmosis in immunocompetent patient. Early diagnosis and prompt management can resolve the symptoms at an earlier stage
RESUMO
Background: Acute Kidney Injury is not a single disease but rather a syndrome comprising of multiple clinical conditions. The high rate of morbidity associated with AKI poses a burden on both the public as well as private sector. Small changes in serum creatinine concentrations associated with a substantial increase in the risk of morbidity. Therefore, detection of even small changes in kidney injury has an important prognostic value to avoid chances of hemo-dialysis and the associated risks which can result in both better outcomes as well as lowering financial burden on the patient as well as the state
Methods: A sample size of 100 patients was included as calculated by taking reported incidence of 36%. Patient's baseline and maximum creatinine was taken during ICU stay together with urine output monitoring during first 48 hours. Staging of acute kidney injury [AKI] was done by Acute Kidney Injury Network [AKIN] criteria. Outcome of renal failure was assessed on the basis of full, partial and no recovery
Results: Out of 100 patients, 52% were in stage 1, 32% were in stage 2 and 16% were in stage 3. AKI was common in females; present in 37 males and 63 females; [p value <0.05]. Full renal recovery was achieved in 62 patients [62%] of AKI; 25 patients [25%] were partial recovered, and in 13 patients [13%] recovery could not be achieved. Recovery was significantly lower [25%] and potentially greater in stage1 [79%].The chi square between outcome and acute kidney injury revealed statistical significant value [p value <0.001]. Hemodialysis requirement was significantly higher in AKI stage3 [62%] than AKI stage1 [4%]; [P < 0.001]. There were no significant differences in duration of ICU stay, age and mortality
Conclusion: Our study showed the morbidity and mortality associated with rising creatinine with increasing stages of acute kidney injury. Recovery in stage 1 was significantly higher and lower in stage 3 and therefore emphasis is required on early diagnosis and timely management of AKI that can prevent patients from distressing and life threatening problems
RESUMO
Autoimmune pancreatitis is a rare fibroinflamatory disorder of the pancreas with immunoglobulin G 4[IgG4] associated systemic disease which is steroid responsive.1,2 It has a variable clinical presentation ranging from obstructive jaundice, abdominal pain, steatorrhea and diabetes mellitus. In general presentation of autoimmune pancreatitis as acute pancreatitis is considered to be uncommon. The article presents a case of a 30 years old female newly diagnosed as diabetes mellitus presented with obstructive jaundice with raised lipase and amylase treated as acute pancreatitis. Due to persistent elevation of amylase and lipase and deranged liver function test she was further evaluated her CT findings were typical of autoimmune pancreatitis with raised serum IgG4 levels diagnosed as autoimmune pancreatitis. She was treated with steroids and responded well and after few months presented with relapse