Symmetric Peripheral Gangrene Associated with H1N1 Infection.

More and more cases of H1N1 influenza are being detected in India and so also the variety of complications this virus can cause. Here, we report a case of symmetric peripheral gangrene following H1N1 infection.

Acute kidney injury in a patient with membranous nephropathy - a case report.

Acute Kidney Injury (AKI) is one of the most challenging problems faced by clinicians in the tropics owing to its fast-changing burden. Acute Kidney Injury is an important complication of membranous nephropathy. Causes are varied and include hypovolumia, crescentic conversion of preexisting nephropathy, renal vein thrombosis, NSAID'S, vasculitis, and sepsis. In this case report we discuss the case of membranous nephropathy in a young adult complicated by AKI. This report highlights the importance of early renal biopsy in patients with post GE AKI not improving on hemodialysis. Here we also discuss the potential differentials to be considered in a case of membranous nephropathy with AKI.

A study on interleukin -1ß and lipid profile as markers of cardiovascular risk in rheumatoid arthritis.

INTRODUCTION: The dyslipidaemia in Rheumatoid Arthritis (RA) is associated with accelerated atherosclerosis. A prospective clinical evaluation study was undertaken to find out the proportion of the rheumatoid arthritis patients who were suffering from dyslipidaemia, the change in the lipid levels and the disease activity after an intervention with antirheumatic therapy. AIMS AND OBJECTIVES: To study the disease activity in Rheumatoid arthritis patients by measuring the serum levels of interleukin-1ß (IL-1 ß), to find out the proportion of rheumatoid arthritis patients who were suffering from dyslipidaemia, to correlate the disease activity with the lipid profile and to look for the change in the lipid levels and the disease activity after an intervention with antirheumatic therapy. MATERIAL AND METHODS: This study was done on 30 RA patients (fulfilling the American College of Rheumatology criteria). The lipid profile estimation was done by an enzymatic, colourimetric method and IL-1ß was estimated by a chemiluminescence method. Dyslipidaemia was defined by taking the cut-off values of the NCEP-ATPIII guidelines. The patients with other comorbid illnesses and those who were on statins were excluded. The patients were followed up after 12 weeks of starting with the anti-rheumatic therapy. RESULTS: 36.7% of the patients had high total cholesterols, 53.3% of the patients had high triacylglycerol levels, 73.3% of the patients had decreased HDL-cholesterol and 33.3% of the patients had high LDL-cholesterols. 86.7% of the patients had IL-1ß levels which were above the reference range. After the treatment, the number of patients with dyslipidaemia came down, with 23.3% patients having high total cholesterol levels, 43.3% of the patients having elevated triacylglycerol levels, 46.7% patients having low HDL-cholesterol levels and 20% patients having elevated LDL-cholesterol levels. 66.7% of the patients had IL-1ß which was above the reference range. CONCLUSION: The proportion of dyslipidaemic patients had decreased in the follow up visit, along with a decrease in the disease activity, as were indicated by the decreased levels of IL-1ß. The management of dyslipidaemia in RA should be a part of the general cardiovascular risk management. Therefore, a good control of the disease activity should be given priority, so that both the quality of life and the long-term outcomes can be improved.

Sjogren's thrombocytopenia.

Primary Sjogren's is a multisystem autoimmune disease which predominantly affects the exocrine glands. pSS may occasionally present in an atypical way which may defy correct diagnosis for a considerable period of time. Clinically important immune-mediated cytopenia (or a combination of cytopenias) may be the first manifestation of an occult SS and have only been rarely described with Sjogren's. This case exemplifies the atypical presentation of pSS and hence should be considered in the differential diagnosis of patients with unexplained cytopenias.

An unusual case of Henoch-Schönlein purpura.

Vasculitis has protean manifestations with etiological non-specificity of histological lesions. The natural history of Henoch-Schönlein purpura in adults is less well established. We report an adult female patient who presented with palpable skin purpura and was evaluated to have IgA nephritis who remains stable on treatment with cyclophosphamide and steroids.