RESUMO
Cerebral salt wasting syndrome (CSWS) is often an unrecognized cause of hyponatremia that occurs in the setting of intracranial lesions. It is important to differentiate CSWS from the syndrome of inappropriate ADH secretion, as this would alter the management of hyponatremia. We describe a case of CSWS that occurred in association with a non-functioning pituitary adenoma.
Assuntos
Adenoma/complicações , Idoso , Humanos , Hiponatremia/etiologia , Síndrome de Secreção Inadequada de HAD/etiologia , Imageamento por Ressonância Magnética , Masculino , Neoplasias Hipofisárias/complicaçõesRESUMO
Diabetes mellitus and hypertension are both major public health problems in our country, which co-exist frequently resulting in significant morbidity and mortality. The reported prevalence of hypertension in diabetes varies widely but is probably 1.5-2 times higher than that reported in the general population. In type 2 diabetics many are hypertensives at the time of diagnosis, while in type 1 diabetes, hypertension is predominantly associated with the development of nephropathy. Hypertension in diabetes is due to several pathophysiological mechanisms which include increased volume expansion, altered sodium homeostasis, increased peripheral vascular resistance, hyperinsulinaemia, insulin resistance, etc. The presence of hypertension in diabetic patients increases the mortality 4-5 folds, largely through coronary artery disease and stroke. It may also be an aetiological factor in the development of nephropathy and retinopathy. Treatment of hypertension in a diabetic has considerable therapeutic advantages and should be carried out vigorously. Lifestyle modifications have a useful role in the treatment of mild hypertension and have a beneficial effect on other cardiovascular risk factors. The choice of antihypertensive agents should be based on their potential impact on the metabolic abnormalities observed in diabetics. Amongst the currently available antihypertensive agents, ACE inhibitors and calcium channel blockers are the favoured agents.
Assuntos
Complicações do Diabetes , Humanos , Hipertensão/epidemiologia , PrevalênciaAssuntos
Adolescente , Adulto , Calcinose/complicações , Colangiopancreatografia Retrógrada Endoscópica , Doença Crônica , Diabetes Mellitus/diagnóstico , Angiopatias Diabéticas/diagnóstico , Feminino , Humanos , Masculino , Pancreatite/complicações , Prognóstico , Medição de Risco , Estudos de Amostragem , UltrassonografiaAssuntos
Administração por Inalação , Hormônio Adrenocorticotrópico/sangue , Antiasmáticos/administração & dosagem , Anti-Inflamatórios/administração & dosagem , Asma/tratamento farmacológico , Beclometasona/administração & dosagem , Hormônio Liberador da Corticotropina/diagnóstico , Humanos , Hidrocortisona/sangue , Sistema Hipotálamo-Hipofisário/fisiologia , Testes de Função Adreno-Hipofisária , Sistema Hipófise-Suprarrenal/fisiologia , Sensibilidade e EspecificidadeRESUMO
Diabetes can affect the nervous system in several ways. Of all the neurological complications of diabetes, peripheral neuropathy is by far the commonest and has been extensively studied. The involvement of central nervous system can be in several forms. The underlying damage may be due to involvement of the large and small cerebral blood vessels as also due to metabolic derangement caused by prolonged hypoglycemia, anoxia or ketoacidosis. The neurological emergencies that occur in diabetes can be: 1) atherothrombotic and lacunar strokes; 2) convulsive disorder in the setting of both hypo and hyperglycemia; 3) coma; 4) cranial neuropathies; and 5) acute proximal muscle weakness. In patients with diabetes, atherothrombotic stroke is associated with poor outcome. Hyperglycemia at the time of stroke is an important risk factor for an adverse outcome than chronic stable diabetic state. Proper management of diabetes in these acute situations is crucial for a better outcome of the underlying disease process.
Assuntos
Infarto Cerebral/etiologia , Complicações do Diabetes , Diabetes Mellitus/terapia , Coma Diabético/etiologia , Cetoacidose Diabética/complicações , Neuropatias Diabéticas/fisiopatologia , Serviços Médicos de Emergência , Glucocorticoides/administração & dosagem , Humanos , Hiperglicemia/complicações , Hipoglicemia/complicações , Doenças do Sistema Nervoso/etiologia , Fatores de Risco , Convulsões/etiologia , Acidente Vascular Cerebral/etiologiaAssuntos
Adulto , Feminino , Humanos , Índia , Osteogênese Imperfeita/diagnóstico , Fotografação , Prognóstico , Índice de Gravidade de DoençaAssuntos
Idoso , Complicações do Diabetes , Diabetes Mellitus/fisiopatologia , Feminino , Humanos , Hiperglicemia/etiologia , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Período Pós-Prandial/fisiologia , Gravidez , Gravidez em Diabéticas/complicações , alfa-Glucosidases/antagonistas & inibidoresAssuntos
Tecido Adiposo/metabolismo , Adulto , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Retardo do Crescimento Fetal/complicações , Predisposição Genética para Doença , Humanos , Índia/epidemiologia , Resistência à Insulina/genética , Distúrbios Nutricionais , Gravidez , Complicações na GravidezRESUMO
An unusual presentation of a viperine snake bite presenting with ischaemic damage to the major organs like brain and heart leading to cerebrovascular accident and acute myocardial infarction along with acute renal failure and disseminated intravascular coagulopathy (DIC) is described in this report.
Assuntos
Adulto , Animais , Transtornos Cerebrovasculares/diagnóstico , Diagnóstico Diferencial , Coagulação Intravascular Disseminada/diagnóstico , Evolução Fatal , Humanos , Índia , Injúria Renal Aguda/diagnóstico , Masculino , Infarto do Miocárdio/diagnóstico , Índice de Gravidade de Doença , Mordeduras de Serpentes/diagnóstico , ViperidaeRESUMO
Central diabetes insipidus frequently occurs due to tumours in the region of pituitary or hypothalamus or following surgical trauma to these regions. Rarely it has been reported following cranial irradiation. We report the case of a middle aged woman who underwent surgical removal of a frontal capillary hemangioblastoma and received cranial irradiation. She presented ten months later with features of diabetes insipidus which was confirmed to be of central origin. She responded well to desmopressin nasal spray. Radiation induced damage to the hypothalmo-pituitary axis presents usually with anterior pituitary hormone deficiencies, most commonly that of growth hormone. Presentation as central diabetes insipidus is very uncommon.
Assuntos
Neoplasias Cerebelares/radioterapia , Irradiação Craniana/efeitos adversos , Desamino Arginina Vasopressina/administração & dosagem , Diabetes Insípido/tratamento farmacológico , Feminino , Seguimentos , Hemangioblastoma/radioterapia , Humanos , Pessoa de Meia-Idade , Medição de RiscoRESUMO
Falciparum malaria presents with protean manifestations and is associated with a variety of complications and has a high mortality. One hundred and fifty-eight consecutive cases of falciparum malaria were studied with respect to the clinical presentation, complications, and response to treatment. The mean age of patients was 38.60 +/- 15.45 years and majority of them were males i.e., males being 110 (69.62%) and females being 48 (30.37%). The commonest presenting manifestations were fever with chill and rigor (98.10%), altered sensorium (48.10%), algid malaria (18.35%), and jaundice (27.21%). The other presenting features being oliguria (6.96%) and bleeding manifestations due to disseminated intravascular coagulation (DIC) (4.43%). The frequently encountered complications were anaemia (74.68%), jaundice (40.50%), cerebral malaria (45.56%), thrombocytopenia (40.50%) and renal failure (24.68%). Most of the patients i.e., 126 (79.74%) recovered with treatment and 32 (20.25%) succumbed. Higher mortality was associated with higher parasite count, presence of complications like anaemia, jaundice, renal failure, DIC, adult respiratory distress syndrome (ARDS), and septicaemia. Most of the deaths were encountered in patients where there was delay in clinical diagnosis, in the pre-hospital phase, and consequent presentation in multiorgan failure. Early diagnosis and institution of specific therapy were rewarding in the remaining patients in this series.
Assuntos
Adulto , Estudos Transversais , Países em Desenvolvimento , Feminino , Humanos , Incidência , Índia , Malária Falciparum/diagnóstico , Masculino , Pessoa de Meia-IdadeRESUMO
The development of malignancy in the setting of pre-existing connective tissue disease is well known. We report two cases of rheumatoid arthritis who developed malignancy--multiple myeloma in one of them and carcinoma cervix in the other. Case 1 was a 62 year old man, who developed multiple myeloma three years after the onset of rheumatoid arthritis. Case 2 was a 61 year old female with history of rheumatoid arthritis for two years and who developed carcinoma cervix.
Assuntos
Artrite Reumatoide/complicações , Carcinoma de Células Escamosas/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/complicações , Neoplasias do Colo do Útero/complicaçõesRESUMO
BACKGROUND: Hepatocellular jaundice occurring in patients with falciparum malaria has been called as malarial hepatitis. METHODS: We studied 95 consecutive patients admitted with falciparum malaria. Of these 20 had evidence of malarial hepatitis. Their clinical presentation, complications and response to treatment was compared with that of patients without evidence of malarial hepatitis. RESULTS: The clinical presentation of these patients was not different from those without hepatitis. However, the incidence of complications such as renal failure (60% vs 25%; X2 = 8.47, p < 0.01), Adult Respiratory Distress Syndrome (35% vs 3%; X2 = 18.13, p < 0.001) and septicemia (20% vs 6%; X2 = 4.01, p < 0.05) was significantly higher. The mortality also was higher in the group of patients with malarial hepatitis (40% vs 17%; X2 = 4.85, p < 0.05). CONCLUSIONS: We conclude that the presence of hepatitis in patients with falciparum malaria indicates a more severe illness with a higher incidence of complications and a poor prognosis.