These autoantibodies likely develop in children with KD during the acute stage and may persist for many years. There is no concrete evidence to suggest that these children are at increased risk of developing an autoimmune disease in the future. However, there is some justification for prolonged surveillance for development of autoimmune manifestations.
Crytococcus neoformans is an encapsulated yeast that frequently affects immune-compromised patients, although increasingly being detected in the immune-competent host as well. We report a case of disseminated cryptococcosis in a young child in whom no immune deficiency was yet identified. A 4-year-old child presented with high-grade fever, intermittent abdominal pain and generalized skin eruptions for the past two months. He had pallor, firm lymphadenopathy, skin lesions with scarring and firm hepatosplenomegaly. Magnetic resonance imaging of brain and bone-marrow aspiration were normal. Fine-needle-aspiration-cytology of cervical lymph nodes demonstrated Cryptococcus. Serum latex-agglutination test showed a positive titer (1:256). Cryptococcus culture was sterile. The patient received intravenous liposomal amphotericin-B and oral flucytosine for 8 weeks followed by oral fluconazole. Disseminated cryptococcosis with involvement of reticuloendothelial and dermatological systems is rare. Early diagnosis and timely management of associated complications would be life saving.
A 36-year-old woman presented with dyspnoea on exertion for 5 years. She was evaluated elsewhere and diagnosed to have severe mitral stenosis. She was referred for mitral valve replacement to our centre. Echocardiography revealed a thickened aortic valve with mild aortic regurgitation, with transaortic gradient suggestive of mild aortic stenosis, in addition to severe rheumatic mitral stenosis. Detailed echocardiographic analysis and cardiac catheterisation revealed features suggestive of moderate to severe aortic stenosis. Detailed assessment of aortic valve needs to be done in patients with coexistent mitral stenosis. Each modality for assessment of aortic stenosis has its own limitations and a decision regarding treatment needs to be taken based on combined analysis of all the parameters. Dimensionless velocity index is a relatively less time-consuming, flow independent measure of aortic stenosis. Prompt recognition of this concealed aortic stenosis helps to avoid repeat valve surgery. Subsequently, patient was sent for dual valve replacement.
Preeclampsia is a hypertensive disorder of pregnancy affecting 6–12% of the population. There are various risk factors for the development of preeclampsia, ranging from advanced maternal age to genetics. The proposed etiologies for preeclampsia are abnormal placentation, immunological intolerance, endothelial damage, and genetic inheritance. The pathogenesis includes endothelial activation and dysfunction leading to vasospasm. Preeclampsia is divided into two stages: asymptomatic and symptomatic stages. Preeclampsia causes multiple organ involvement, namely central nervous system, respiratory, cardiovascular, hematological dysfunction, HELLP (hemolysis elevated liver enzymes, low platelets) syndrome, endocrine, renal, hepatic, and uteroplacental dysfunction. These organ dysfunctions increase morbidity and mortality in preeclamptic pregnant patients.
Background: Preeclampsia is a multisystem disorder which affects about 2% of pregnancies and
represents a major threat to mother and foetus when it emerges. In some women this condition sets in a
subtle way and gradually such women develop severe degree of preeclampsia leading to dreadful complications. Uterine
artery doppler velocimetry is a non-invasive method to examine the uteroplacental circulation that provides indirect evidence of
blood ow and is proposed a predictive test for preeclampsia. This prospective observational study was performed to assess
the usefulness of uterine artery Doppler in predicting preeclampsia.
Methods: 50 high risk and 50 low risk singleton pregnancies between 16-28 weeks of gestational age with uterine artery doppler
study were followed up till delivery or development of preeclampsia to determine maternal and fetal outcome.
Results: Sensitivity and specicity of abnormal uterine artery doppler study for prediction of preeclampsia were 90 % and 70 %
in high-risk and 42 % and 90 % in low-risk group, respectively. Positive predictive value and negative predictive value was 92 %
and 63 % in high risk group and 42 % and 90 % in low risk group respectively.
Conclusions: Mid trimester doppler velocimetry of uterine artery can be used as a reliable screening test for prediction of
preeclampsia in both high-risk and low-risk women.
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