Background. Many insurance companies require obese patients to lose weight prior to gastric bypass. From a previous study by the same authors, preoperative weight at surgery is strongly predictive of weight loss up to one year after surgery. This review aims to determine whether preoperative weight loss is also correlated with weight loss up to one year after surgery. Methods. Of the 186 results screened using PubMed, 12 studies were identified. A meta-analysis was performed to further classify studies (A class, B class, regression, and rejected). Results. Of all 12 studies, one met the criteria for A class, six were B class, four were regression, and one was rejected. Six studies supported our hypothesis, five were inconclusive, and no study refuted. Conclusions. Preoperative weight loss is additive to postsurgery weight loss as predicted from the weight at the time of surgery.
Purpura fulminans is an acute life threatening disorder characterized by cutaneous haemorrhagic manifestations and necrosis caused by disseminated intravascular coagulation and dermal vascular thrombosis. In this case a 60-year-old male presented with purpuric lesions over both upper and lower limbs and consumption coagulopathy following rickettsial infection. It was diagnosed as purpura fulminans secondary to rickettsial infection with disseminated intravascular coagulation and treated with replacement of platelets and coagulation factors along with antibiotics and doxycycline.
Cardiac amyloidosis is a manifestation of amyloidosis which is a multisystem disorder. This is difficult to diagnose, rare disease which eventually leads to the mortality. Diagnosis requires a high index of clinical suspicion along with echocardiographic clues like, diastolic dysfunction, bi-atrial enlargement and ventricular thickening. Treatment is mainly supportive with disappointing outcomes. We present a case of systemic amyloidosis with negative congo red staining, presenting with predominantly cardiac features.
A 55-year-old male presented to the hospital with fever and cough since the past one week. The fever was on and off with intermittent headache. He had been diagnosed with diabetes mellitus (DM) five years back for which he had taken oral hypoglycaemic which he discontinued after four months and has been on herbal therapy since.On admission the patient was afebrile (36.4degree), his pulse rate was 100 beats per minute and BP of 120/70 mmHg. Physical examination was normal, on auscultation of chest occasional coarse crepitations were found and rest of the systems was normal. Laboratory investigations revealed haemoglobin of 16.8 g/dL, total white blood cell of 28000 cells per cumm (80% neutrophil) and ESR of 50mm in first hour. Serum biochemistry showed creatinine 2.3mg/dL, blood glucose level was 374 mg/ dL, sodium 131 mmol/L, potassium 4.7 mmol/L. Urine analysis revealed a 1.5% glucose, ketone bodies, and albumin 2+. Chest radiograph showed left upper lobe homogenous opacity suggesting consolidation [Table/ Fig-1]. He was empirically started on ceftriaxone.His sputum was sent for analysis which showed fungal elements on KOH mount. Diagnostic nasal endoscopy showed extensive crests filling left nasal cavity and maxillary sinus which was suggestive of mucormycosis.The patient was started on insulin therapy and amphotericin B intravenously at 1.5mg/kg body weight for 21 days with oral fluconazole of 150mg daily for six weeks. Renal profile was ABSTRACTMucormycosis is the name given to several different diseases caused by fungi of the order mucorales. It is commonly seen in patients with decreased immunity like patients with chronic renal failure, organ transplantation, neutropenia and most commonly in those with poorly controlled diabetes. We present a case of 55-year-old diabetic man who presented with headache and fever diagnosed with pulmonary and maxillary sinus mucormycosis presenting as diabetic ketoacidosis.
Abstract:Pheochromocytomas are neuroendocrine, catecholamine-secreting tumors which are usually found in adrenal glands though they are occasionally seen in extra-adrenal locations. Classically the patients present with symptoms of headache, diaphoresis and tachycardia with hypertension. It is rarely associated with cardiovascular manifestations, such as angina pectoris, acute myocardial infarction, myocarditis, acute heart failure, and cardiogenic shock among others. We present here a case of extra-adrenal pheochromocytoma presenting with flash pulmonary edema secondary to myocarditis.
A 22-year-old female with seven months of amenorrhea presented with chronic headache since the past four months. She has been diagnosed with high blood pressure since the same time. She had a complete spontaneous pregnancy loss at six weeks of gestation, one year back. She also had vasculopathy of distal anterior and posterior tibial arteries which resulted in the obstruction of the arteries and gangrene of first 3 toes of left foot for which she underwent disarticulation [Table/ Fig-1].
Intentional consumption of pesticides is a very common method of suicide in rural India. The easy availability of pesticides in rural households and the lethal effect they have on humans has led to an increasing number of cases every year. We present a case of 40 year old male presenting with hemolysis secondary to consumption of Chlorpyriphos, an organophosphorus compound. Hemolysis presenting in a case of organophosphorus compound is a rare manifestation. In our case, the patient presented with dark colored urine ten days after the consumption which has not been seen or reported before.
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