Introduction. Lymphatic filariasis (LF) and leprosy are both endemic in India. These diseases are on the World Health Organization (WHO) list of neglected tropical diseases (NTDs), as they affect the most marginalized communities in the world, resulting in deformities and functional limitation. We report the first case of asymptomatic filariasis and leprosy co-morbidity in a patient with suspected Guillain-Barré syndrome. Case presentation. A 55-year-old male who was a farmer by occupation presented to the Neurology Outpatient Department (OPD) of our institute with complaints of weakness in all four limbs for the last 15 days. After admission, a detailed history revealed that the patient had been taking multi-drug therapy (MDT) for leprosy for the previous 6 months. After symptomatic management of the presenting complaints, the patient was sent to the Department of Microbiology for a consultation and sixsite slit-skin sampling. The initial screening of Ziehl-Neelsen (ZN)-stained smears under a 10× objective led to the incidental finding of sheathed structures resembling microfilaria (Mf) on the smear made from ear lobules. In addition, short acid-fast bacilli (AFB) were also observed under the oil-immersion objective. Conclusion. We emphasize that a high index of suspicion and thorough screening of smears by a microbiologist is essential in specimens obtained from any body site.
Background: The study of hypothyroidism in pregnancy was done with the aim of determining the effect of hypothyroidism on maternal and perinatal outcome. This study also aimed to decide whether universal screening of pregnant women for hypothyroidism is justified.Methods: A prospective observational study was done over a period of 1 year from October 2011 to September 2012, on pregnant women attending the OPD of Obs and Gynae department. Serum TSH is the most convenient and best test to diagnose hypothyroidism in pregnancy in first trimester. Ideal serum TSH level during pregnancy is 0.5-2.5µIU/ml in first trimester and 0.5-3µIU/ml in second and third trimester. First trimester booking visit is the ideal time for initial evaluation. Thereafter serum TSH should be measured at 6 weeks interval for necessary dose adjustments. Levothyroxine is the drug of choice. It should be started at 1.6-2µg/kg/day. If serum TSH is raised but fT4 is normal, treatment can be started with 25-75µg/day.Results: Inadequately treated hypothyroid pregnant women had higher incidence of maternal complications in comparison to adequately treated hypothyroid patients, like threatened abortion (11.1% vs 1.5%), antepartum hemorrhage (7.4% vs 1.5%), premature rupture of membrane (14.8% vs 3.0%), preterm labour (18.5% vs 1.5%), postpartum hemorrhage (9.3% vs 4.5%), anemia (16.7% vs 9.1%) and intrauterine death (9.3% vs 0%). Perinatal complications were also higher like fetal distress (33.3% vs 13.6%) and low birth weight (16.7% vs 4.5%).Incidence of caesarean section was higher in hypothyroid women in comparison to control group (29.2% vs 19.2%).Conclusions: This study shows that there is an association between inadequately treated hypothyroidism and adverse maternal and perinatal outcome. Those who were detected early and adequately treated had outcome similar to control group.
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