BACKGROUND Vitamin D deficiency is widely prevalent across all ages, races, geographical regions and socioeconomic strata. There is ample evidence indicating role of vitamin D in insulin secretion and insulin resistance in patients with type 2 diabetes mellitus. Evidence shows that Vitamin D deficiency can affect the glycaemic control in type 2 diabetes mellitus. Objective-To study the association between serum 25-hydroxyvitamin D levels with glycaemic control in patients of type 2 diabetes mellitus. MATERIALS AND METHODS This case series study was performed on 50 consecutive patients of type 2 diabetes mellitus of 30 to 60 years admitted in General Medicine Ward at Goa Medical College. Serum 25-hydroxyvitamin D levels were assessed using Fully Automated Chemiluminescent Immunoassay (CLIA). Patients with renal failure, type 1 diabetes, chronic illness, pregnancy, thyroid disorders and previous intake of calcium and vitamin D were excluded from the study. The relationship between serum 25-hydroxyvitamin D levels and HbA1c, fasting blood glucose and postprandial blood glucose levels was assessed. RESULTS 72% of the study population had vitamin D deficiency and 26% of the study group had insufficiency of the vitamin and the remaining 2% had normal 25-hydroxyvitamin D levels. The type 2 diabetic individuals with vitamin D deficiency showed a poor glycaemic control as evidenced by inverse relationship of serum vitamin D levels with FBSL and PPBSL values. There was inverse association between the low serum 25-hydroxyvitamin D levels and elevated HbA1c in the study population. CONCLUSION Vitamin D deficiency may be associated with impairment of glycaemic control in type 2 diabetes mellitus.
This study describes a rare case of a 19 year old girl who presented with features of subcutaneous emphysema and pneumomediastinum to the emergency department in whom further investigation revealed pulmonary and neurotuberculosis. Tuberculosis presenting as pneumomediastinum and subcutaneous emphysema is a rare, but an important entity and a better knowledge of this condition can help in the early diagnosis and adequate management of tuberculosis.
Acute aortic thrombosis is an uncommon vascular emergency that can present with neurologic symptoms like acute paraplegia due to spinal cord ischemia. It frequently causes mortality unless appropriate diagnosis is followed immediately by proper management. Individuals with COVID-19 have coagulopathy with hyper inflammatory response which predisposes to both venous and arterial thrombotic events, especially in severe patients. We report a rare case of 63-year-old COVID-19 patient presenting as acute flaccid paraplegia with hematuria secondary to acute extensive aortic thrombus. CT scan showed bilateral COVID-19 pneumonia inspite of absence of respiratory symptoms. All patients with thrombotic events should be investigated for COVID-19 pneumonia as patients may not have typical respiratory symptoms.
The occurrence of adverse drug reactions (ADRs) to more than one drug in quick succession can cause diagnostic dilemma to the doctor and increased burden of suffering to the patient. We present a single case report of a 23 year old female who developed rash and agranulocytosis in quick succession as ADRs to phenytoin and levetiracetam respectively. These antiepileptic drugs (AEDs) were prescribed as prophylaxis against post traumatic seizures (PTS). Hence a proper rationale for the prophylactic treatment of PTS and pharmacovigilance for early detection of adverse drug reactions is the need of the hour.
Snakebite is classified by the WHO as a neglected tropical disease. Neurotoxic snake bites pose a great diagnostic challenge to the physicians in tropical and subtropical regions of the world. There is considerable variation between individual patients in the clinical manifestations following envenoming by neurotoxic snake bite. Here authors describe a rare case who presented to emergency department as acute acalculous cholecystitis following unknown neurotoxic snake bite. This acalculous cholecystitis resolved post administration of anti-snake venom. The possibility of this rare but potentially fatal complication needs to be considered in patients with snake bite and abdominal symptoms so that prompt management can prevent mortality in such patients.
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