BACKGROUND Japanese Encephalitis is one of the most common causes of Acute Encephalitic Syndrome in Asia. During the period of June to August in 2014 an epidemic occurred in Assam, a northestern state of India. METHODS Patients admitted in the Medicine Department in Gauhati Medical College and Hospital (GMCH), Guwahati, Assam, India, with clinical features of Acute Encephalitic Syndrome (AES) i.e. acute onset fever and a change in mental status (including symptoms such as confusion, disorientation, coma, or inability to talk) and/or new onset seizures (excluding simple febrile seizures) from June to August 2014 underwent ELISA for Japanese Encephalitis Immunoglobulin M in cerebrospinal fluid (CSF) at the time of admission. Clinical features, demographic profile and laboratory investigations were recorded in positive patients. RESULTS 226 AES patients were admitted in 6 different units of Medicine ward in GMCH, out of which 76 patients were diagnosed to be JE positive with CSF IgM ESLIA, coming from 17 districts of Assam. Out of 76 patients, 69 patients were from rural area, only 7 patients were from urban area. 59 (77.63%) patients were farmers or daily labourers by occupation and 23 (30.26%) patients were illiterate. Mean age of patients was 47.7 years and male to female ratio was 1.7:1. Mean duration of fever was 6.5 days, convulsion was found in 13.15% patients, out of which most common was generalised seizure (9.2%). 55.2% patients had meningeal signs, 23.68% patients had focal neurological deficits in the form of hemiparesis and monoparesis and mean GCS score was 9.28. Extra pyramidal features present in patients were rigidity (23.68%), abnormal posturing (15.78%) and abnormal movements (23.68%). 23.68% patients had Leukocytosis and Thrombocytopenia was found in 21 (27.6%) patients. Mean CSF cell count was 34.34 cells/mm 3 with mean 29.67% polymorphs, mean CSF protein and sugar was 56.15 mg/dl and 66.92 mg/dl respectively. Serum bilirubin level was normal however elevated liver enzymes were present in 63.15% of patients. CT scan brain was done in 52 JE positive patients, cerebral oedema was found in 19 (36.52%) patients and hypodensities in thalamus, midbrain and basal ganglia was found in 16 (30.65%) patients. CONCLUSION One of the important findings of the present study is Thrombocytopenia and elevation of liver enzymes in JE patients which were not reported in previous studies except one study in Thailand and another in India in Paediatrics patients. Though the study was small it needs further studies to prove that thrombocytopenia and elevated liver enzymes may be an important complication of Japanese Encephalitis and should not be overlooked.
Hashimoto's thyroiditis is a part of the spectrum of autoimmune thyroid disease and it is found to be associated with other autoimmune diseases like Addison's disease, vitiligo, type1 diabetes mellitus, alopecia areata, pernicious anaemia etc. However its association with autoimmune haemolytic anaemia is uncommon. We reported a case of Hashimoto's thyroditis associated with haemolytic anaemia who responded with thyroxine replacement and oral prednisolone therapy.
BackgroundThe clinical condition of epidemic dropsy is caused by the consumption of edible oils contaminated with Argemone mexicana oil. Two of the most toxic alkaloids found in argemone oil are sanguinarine and dehydrosanguinarine, which cause capillary dilation, proliferation, and increased permeability. Extreme cardiac decompensation leading to congestive heart failure and glaucoma resulting in blindness are the most serious consequences of epidemic dropsy. Materials and methodsAll patients attending the medicine department of Tezpur Medical College and Hospital with clinical features of epidemic dropsy were included in the study after obtaining informed consent. All patients, after a complete history, underwent a thorough clinical examination, and findings were recorded using a preformed proforma. Along with routine blood examination, patients were also evaluated with echocardiography, ECG, and chest X-ray. Cooking oil samples obtained from patients were investigated for the presence of sanguinarine in a standardized laboratory with the help of the district authority. The statistical analysis was done using MS Excel 2017. ResultsOut of 38 patients, 36 were male (94.7%), and only two were female (5.2%). Male to female ratio was 18:1. This difference in sex ratio may be due to the fact that only severely ill patients attended our tertiary care hospital. In contrast, moderate and mildly ill patients were treated in local hospitals. The mean age of patients was 28.1 years, and the mean length of hospital stay was eight days. Bilateral pitting type of ankle edema was the most common clinical manifestation, and all 38 patients (100%) exhibited edema. A total of 76% of patients had dermatological manifestations. Sixty-two percent of patients had gastrointestinal manifestations. In cardiovascular manifestation, persistent tachycardia was seen in 52% of patients, pansystolic murmur was best heard in the apical area in 42% of patients, and 21 percent had evidence of a raised jugular venous pressure (JVP). Five percent of patients had pleural effusion. Sixteen percent of patients had ophthalmological manifestations. Eight patients (21%) required ICU care. The in-hospital fatality rate was 10.53% (n=4). Of the expired patients, 100% were male. The most common cause of death was cardiogenic shock (75%), followed by septic shock (25%). ConclusionFrom our study, it was found that most of the patients were male, with an age group of 25-45 years. The most common clinical manifestation was dependent edema, along with signs of heart failure. Other common manifestations were dermatological and gastrointestinal. The severity and outcome were directly related to the delay in seeking medical consultation and diagnosis.
Background: Rheumatoid arthritis is a chronic multisystem, immuno-inammatory disease characterized by articular and extra-articular manifestations. The disease's hallmark is synovial inammation and potential to cause cartilage damage, bone erosion, and subsequent damage to joint integrity. Rheumatoid arthritis is a systemic disease with a variety of extra-articular manifestations. The predominant well-recognized systemic manifestations include Sjogren's syndrome, pulmonary, cardiac, neurological, renal, gastrointestinal, dermal involvement, vasculitis, and Felty's syndrome. Regarding renal involvement in connective tissue disease, the focus is on systemic lupus erythematosus (SLE). The affection of kidneys in RA is more or less overlooked and mainly attributed to drugs (NSAIDs, DMARDs like gold and d-penicillamine, which are less commonly used in today's scenario. The other primary etiology of kidney involvement in RA is secondary amyloidosis, commonly associated with the long-term disease process. Vasculitis with RA is a relatively less common etiology of renal involvement in RA. Renal involvement in Rheumatoid arthritis has been well documented with a prevalence of 1-5%. Although impairment of renal function is often mild to moderate, renalrelated mortality signicantly contributes to the increased mortality of RA. The kidney is involved in RA with both glomerular and tubular damage. Renal damage in RA, however, is usually asymptomatic and is detected on laboratory investigation. It is often difcult to differentiate between damage due to disease activity and drugs used to treat RA. It is a hospita Methods: l based observational study conducted at Gauhati Medical college, Assam, for one year. All Adult (> 18 years) patients fullled the 2010 American College of Rheumatology Criteria for Rheumatoid arthritis were included. Patients with diabetes mellitus congestive heart failure, urinary tract infection, long standing and uncontrolled hypertension, preexisting renal disease , overlap syndrome and pregnant patients were excluded. Detailed clinical history was taken from all included patients regarding onset and duration of disease. Disease activity was measured using disease activity score -28 -(DAS-28). Routine investigation, ESR, CRP, renal function test, ultrasonography and urine for microalbuminuria were measured in all included patients. The maximum age was Results: 68 years, the minimum was 20 years, and the mean age was 40.22 ± 11.58. The study group included 38 females and 12 males accounting for 76% and 24%, respectively. The mean disease duration was 18.6 months with a range of 3-60 months. All patients presented with polyarthritis(100%). History of morning stiffness was present in 54% of patients, while 46% had generalized weakness and constitutional symptoms. In our study, microalbuminuria was found in 15 patients (30%). Mmicroalbuminuria was seen more commonly in the age group between 41-50 years. Microalbuminuria was signicantly associated with higher ESR values. Out of 15 patients positive for microalbuminuria, 13 patients had ESR >50, and 7 had ESR >100 with a p-value <0.001. Mean CRP was 42.45 mg/l in microalbuminuria-positive patients as compared to 16.19mg/l in microalbuminuria-negative patient. Out of 15 patients with microalbuminuria positive had evidence of erosion on x-ray, with a p-value of 0.017. Conclusion: From the present study, it can be concluded that the peak age of the disease is 31-50 years, with female preponderance. Polyarthritis is the most common presenting symptom, and most patients have an insidious onset. Constitutional symptoms like fever, malaise, and anorexia are more common among the extra-articular features. Asymptomatic renal involvement is common, and microalbuminuria is frequently seen in patients with Rheumatoid Arthritis. The presence of microalbuminuria is a sensitive indicator of increased renal vascular permeability in rheumatoid arthritis patients. Immunological methods for detecting microalbuminuria should be routinely used in all Rheumatoid Arthritis patients to detect renal involvement in its initial phase to devise the most appropriate treatment.
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