Acute Painful Peripheral Diabetic Neuropathy: A Life Limiting Morbidity and it’s Treatment

Diabetes is a pandemic disease and the painful neuropathy is one of the most debilitating complications. It is characterized by constant, sudden onset burning pain along with paresthesia and intermittent sharp, shooting pain, usually involving the extremities. It handicaps the daily activities of the patient, interferes with sleep and also affects the mood. Case: We report the case of a 30-year-old male, with Type 1 DM who presented with complaints of painful neuropathy in the lower extremities. Conclusion: Painful neuropathy is an increasing threat and is often not detected or misdiagnosed due to inconsistent definitions and lack of diagnostic criteria. The knowledge of this condition in very important not only to diagnose it but also to appropriately manage a case, from the widely available pharmacological options.

Rheumatoid Arthritis- Unique Combination of Rheumatic, Cardiac and Pulmonary Manifestation of a Multisystem Disorder

Rheumatic arthritis is a common inflammatory disease but combination of cardiac valvular dysfunction involving aortic valve calcification, tricuspid regurgitation and right atrioventricular enlargement with interstitial involvement of lung is very rare manifestation of this multisystem disorder.

Angiographic enigma: a single coronary artery with the right coronary artery originating from the distal left circumflex artery

An isolated single coronary artery [SCA] is a rare anomaly. A SCA originating from the left sinus of Valsalva is even rarer than one arising from the right. Most patients with a congenital coronary artery anomaly are asymptomatic. Herein, we report an extremely uncommon variant, where the right coronary artery arose from the distal segment of the left circumflex artery with slow coronary flow leading to myocardial ischemia

Schwarz type C myocardial bridge unraveled post-thrombus aspiration in a patient with hypertrophic cardiomyopathy

Hypertrophic cardiomyopathy [HCM], a heterogenous disease with diverse pathology and variable clinical course has a high prevalence of myocardial bridging. Despite the high prevalence of myocardial bridging in HCM patients, acute ST-elevation myocardial infarction [STEMI] due to concomitant atherothrombosis proximal to Schwarz type C myocardial bridge unraveled during trans-radial primary percutaneous intervention has rarely been reported in medical literature. Herein, we report a case of Schwarz type C myocardial bridge unmasked postthrombosuction in a patient with HCM presenting with acute STEMI. He had atherothrombosis proximal to the tunneled left anterior descending artery which was successfully stented with drug-eluting stent without the aid of intravascular ultrasound

Assessment of non-invasive models for liver fibrosis in chronic hepatitis B virus related liver disease patients in resource limited settings.

Context: A total of 350 million individuals are affected by chronic hepatitis B virus infection world-wide. Historically, liver biopsy has been instrumental in adequately assessing patients with chronic liver disease. A number of non-invasive models have been studied world-wide. Aim: The aim of this study is to assess the utility of non-invasive mathematical models of liver fi brosis in chronic hepatitis B (CHB). Indian patients in a resource limited setting using routinely performed non-invasive laboratory investigations. Settings and Design: A cross-sectional study carried out at a tertiary care center. Subjects and Methods: A total of 52 consecutive chronic liver disease patients who underwent percutaneous liver biopsy and 25 healthy controls were enrolled in the study. Routine laboratory investigations included serum aspartate aminotransferase (AST), Alanine aminotransferase (ALT), Gama glutamyl transpeptidase (GGT), total bilirubin, total cholesterol, prothrombin time and platelet count. Three non-invasive models for namely aspartate aminotransferase to platelet ratio index (APRI), Fibrosis 4 (FIB-4) and Forn’s index were calculated. Outcomes were compared for the assessment of best predictor of fi brosis by calculating the sensitivity, specifi city, positive predictive value (PPV) and negative predictive value (NPV) of each index. Statistical Analysis Used: Medcalc online software and by Microsoft Excel Worksheet. Chi-square test was used for signifi cance. P value < 0.05 was taken as signifi cant. Results: While the serum levels of AST, ALT and GGT were signifi cantly higher in patients group as compare with the healthy controls (P < 0.01), the platelet counts were signifi cantly lower in patient group as compared to the control group (P < 0.01). Mean value of all 3 indices were signifi cantly higher in patients group as compare with the controls (P < 0.01). Conclusions: Out of the three indices, APRI index with a NPV of 95% appeared to be a better model for excluding signifi cant liver fi brosis while FIB-4 with a PPV of 61% showed fair correlation with signifi cant fi brosis. Thus, these two non-invasive models for predicting of liver fi brosis, namely APRI and FIB-4, can be utilized in combination as screening tools in monitoring of CHB patients, especially in resource limiting settings.