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Background: Acute febrile illness is very common among patients seeking hospital care in tropical country like India. This study was conducted to evaluate etiology and clinical profile of Acute Undifferentiated Febrile Illness (AUFI) in a tertiary care hospital.Methods: This study was conducted in 175 patients with acute febrile illness who were admitted in the medical wards and ICU from January 2018 to June 2019 in a tertiary care hospital. Clinical examination and investigations like complete hemogram, liver function test, renal function test, smear for malarial parasite, widal test, urine analysis blood and urine culture, antibody titters for dengue, Leptospirosis and imaging were done.Results: Out of 175, 94 (54%) were males and 81 (46%) were females. The commonest etiology was dengue (19%) followed by enteric fever (18%), scrub typhus (16%), malaria (14%), tuberculosis (6%) and leptospirosis (5%). 138 (79%) patients had less than 14 days of fever of which dengue was the most common and 37 (21%) patients had more than 14 days of fever with tuberculosis being predominate. Other common symptoms were chills/rigors, headache and myalgia seen in 77%, 71% and 42% respectively. Icterus was seen in malaria (42%) and leptospirosis (38%). Elevated transaminases levels were observed with dengue, leptospirosis, scrub typhus, enteric fever and malaria. ARDS was most common in scrub typhus.Conclusions: Among acute febrile illness, dengue and enteric fever were the most common in this study. A thorough and probing search for an eschar is very important in scrub typhus. The treating physician has to keep in mind the comprehensive list of differential diagnosis for patients with febrile illness and anticipating the complications.
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Pitutary adenomas are one of the commonest tumors of seller region of which prolactinomas and non- functioning adenomas predominate. The usual presentation are symptoms of endocrine dysfunction and mass effects. We present a case report of 37 year old male presenting with frontal headache and vomiting. Clinical observations revealed frontal bossing with enlarged hands and feet which arose a suspicion of Acromegaly. Investigations revealed elevated IGF 1 (insulin like growth factor) and growth hormone levels. Magnetic resonance image of the brain were done which showed pituitary adenoma. This case highlights the importance of clinical examination and the treating physician must have high clinical index of suspicion to detect endocrine dysfunction and use the modern techniques like stereotactic radio surgery (SRS).
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Background: Diabetes is the most common non-communicable disease known today. This study was conducted to assess the clinical profile and complications in patients with type 2 diabetes mellitus.Methods: A prospective study was carried out between April 2017 to April 2018 in patients attending a tertiary care hospital in Chennai. Patients with type 2 diabetes of age 25-80 years, minimum of 5 years duration were enrolled.Results: Out of 66 patients, 23(34.8%) were males whereas 43 (65.2%) were females. Mean age in this study population was 55.36 years with a standard deviation of 11.362. In present study, the mean fasting blood sugar level was 196.12±77.180, mean postprandial blood sugar level was 303.26±115.385 and the mean HbA1C levels was 10.95±2.369. 77.3% were on oral hypoglycaemic agents, 13.6% on insulin and 9.1% on combined therapy with oral hypoglycemic agents and insulin. The complications associated with diabetes found in present study were microvascular complications which include peripheral neuropathy 41(62.1%), retinopathy 31(46.96%), nephropathy 28 (42.42%). Peripheral neuropathy was found to be most commonly associated. Macrovascular complications include cardiovascular disease in 12.12% (n=8) and cerebrovascular disease in 4.54% (n=3). Autonomic neuropathy was found in 69.69% (n=46).Conclusions: The complications of DM are commonly seen in patients with poor glycaemic control. Among microvascular complications, peripheral neuropathy was most commonly seen. Autonomic neuropathy usually goes unnoticed and asymptomatic in most of the individuals. Increasing levels of HbA1c was found to be significantly correlated with neuropathy.
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Background: Secondary hyperparathyroidism (SHPT) is one of the less recognized complications in patients with chronic kidney disease (CKD). The prevalence of SHPT in various stages of CKD was evaluated by measuring the levels of intact parathyroid hormone (iPTH).Methods: This cross-sectional study was carried out in 100 CKD patients. Serum creatinine, calcium, phosphorous and iPTH levels were measured and statistical analysis was carried out using the SPSS software (IBM, NY, USA).Results: Among the 100 participants, the mean age (SD) was 59.3 (7.8) years. In our study population, 52% were men and the rest were females. Hypertension (75%) was the most common chronic morbidity. Prevalence of hyperparathyroidism among chronic kidney disease patients was 22% (95% CI: 14.7-30.9%). The prevalence of secondary hyperparathyroidism among dialysis and non-dialysis patients were 30% and 14% respectively which was statistically significant.Conclusions: SHPT is an important complication which is often underdiagnosed. Secondary hyperparathyroidism starts to develop when eGFR falls below 60ml/min. PTH levels starts to rise as the disease progress. Hence it is important for the treating physicians to monitor the PTH levels early in the course of CKD to prevent and treat bone mineral disease.