Fibrocalculus pancreatic diabetes in western Orissa.

Skiagram proved 35 cases of fibrocalculus pancreatic diabetes in order to analyse the clinical profile and its correlation with different descriptive epidemiological parameters were studied. Mean age was 25.17 +/- 7.85 years and male to female ratio was 6:1; 65.7% patients were poor (income < Rs 500 per month) and another 28.6% having average income (Rs 500 to Rs 1,000 per month); 74.3% came from rural areas having a family size of about > or = 7 members and sanitation was poor in all the cases. Mean body mass index was 15.93 +/- 3. Severe diabetes (ie, fasting blood sugar level > 251 mg%) and moderately severe diabetes (ie, fasting blood sugar level > 181 mg% but < 250 mg%) were noted in 51.4% and 11.4% cases respectively. Recurrent pain abdomen, infections, neuropathy, retinopathy, nephropathy and keto-acidosis were observed in 52.2%, 40.0%, 42.9%, 8.6%, 11.4% and 2.9% cases respectively. Mean soluble insulin requirement was 41.81 +/- 13.94 units. Four cases in whom pancreatic lithotomy was done, showed less insulin requirement and disappearance of pain. Parotid swelling, chronic diarrhoea and insulin resistance were not observed. Insulin requirement, epidemiological and biochemical parameters were similar to other young diabetics.

Malaria and Widal reaction.

Widal reaction was studied in 52 patients having malaria parasites in the peripheral blood smear. Twenty had Plasmodium vivax, 26 had Plasmodium falciparum and the rest had mixed (both vivax and falciparum) infections. Widal test for both O and H antigens of Salmonella typhi was positive in high titres in 3 falciparum, 3 vivax and 2 cases of mixed infection. Of these 8 cases, one had been treated for typhoid fever 3 months back and again one month back for relapse. Blood culture for Salmonella typhi was negative in all. All were cured after antimalarial therapy. The positive Widal reaction may be false.

Platelet adhesiveness in diabetes mellitus with relation to treatment.

To determine whether diabetes mellitus alters the function of platelets, a study on platelet adhesiveness in 30 controls and 75 newly diagnosed diabetics (25 cases of type-1 and 50 cases of type-II) before and after treatment was undertaken. The platelet adhesiveness was 68.83 +/- 6.09% (mean + SD) in type-I diabetics, 72.43 +/- 6.10% in type-II diabetics and 56.31 +/- 9.62% in controls (p less than 0.001 for all comparisons). In complicated diabetics (54 cases) the platelet adhesiveness was 72.33 +/- 5.99% and in uncomplicated diabetics (21 cases) it was 67.33 +/- 5.82% (p less than 0.05). Platelet adhesiveness was significantly reduced after treatment (with insulin it was 62.12 +/- 7.46%, with phenformin 62.10 +/- 8.63 and with tolbutamide 67.12 +/- 7.97%) when compared with pretreatment values. Platelet adhesiveness had no significant correlation with blood sugar and serum cholesterol levels. These results support the concept that platelet adhesiveness is high in diabetes mellitus and is reduced with control of diabetic state after treatment.

Tetanus with local palsy.

Five cases of tetanus with local palsy are reported. They presented with palatal palsy, pseudohernia, paralysis of both lower limbs, 3rd and 7th cranial nerve palsies and only 7th nerve palsy. Except the last tetanus became generalised in all.

Organophosphorus poisoning and intermediate neurotoxic syndrome.

Very few cases of the "intermediate neurotoxic syndrome", a type of neurotoxic effect or organophosphate compound have been reported in the literature. We are reporting a case that developed the clinical features of such type of neurotoxic effect after 55 hours of taking the organophosphorus compound.

Yellow oleander (cerbera thevetia) poisoning with jaundice and renal failure.

Jaundice and renal failure in yellow oleander poisoning have not been reported previously. Similarly no post-mortem report has shown renal tabular necrosis and glomerular pathology, liver and brain changes in this poisoning. Four cases of yellow oleander poisoning with jaundice and renal failure and the postmortem findings in another three cases are reported.