Case. A 34-year-old African-American female with a history of adult-onset Still's disease presented to an outside hospital with oligoarthritis. She experienced a generalized tonic-clonic seizure en route via ambulance, was intubated upon arrival, and transferred to the intensive care unit for treatment of suspected pneumonia and sepsis. She subsequently developed generalized cutaneous desquamation that progressed despite the cessation of antibiotics and other potential offending drugs which required transfer to our hospital's burn unit. She was suspected to have reactive hemophagocytic syndrome based on her clinical presentation of fever, rash, polyarthritis, elevated liver enzymes, coagulopathy, splenomegaly, normocytic anemia, thrombocytopenia, hypertriglyceridemia, hyperferritinemia, and hemophagocytosis visualized in bone marrow biopsy specimen. Magnetic resonance imaging demonstrated necrotic demyelination of the deep white matter and corona radiata. The patient developed multiorgan dysfunction and DIC without any other attributable etiology. Despite aggressive broad spectrum therapy and high dose of steroids she progressively deteriorated and eventually expired. Conclusion. Previous publications have highlighted the prevalence of necrotic leukoencephalopathy in children with familial hemophagocytic syndrome. Our patient demonstrated some uncommon features complicating her HLH including DIC and necrotic leukoencephalopathy, which are very rare entities in AOSD.
Forty patients (34 males and 6 females) with neurological complaints/manifestations and with a past history of multiple sexual partners attending the Government Rajaji Hospital, Madurai, India between April 1992 and October 1992 were investigated for neurosyphilis. Metabolic disorders, hypertension, ischaemic heart disease, arrhythmias and trauma were excluded. Seven males (17.5%) were found to have neurosyphilis. The youngest was 26 years old and the oldest was 47. All were married and of low socioeconomic background. Meningovascular syphilis was the predominant presentation (6:1). Associated cardiovascular involvement was noticed in one of the cases. There was no associated HIV infection in these cases. The incidence is higher than previous reports from this centre.
Background: Coronary artery disease (CAD) is the leading cause of death in India. There was increased incidence and prevalence of CAD in males than in females. There have been several studies going on across the globe to find a similar equation in males between testosterone and CAD. This study aimed at correlating the serum free testosterone level in CAD patients with the severity of obstruction of the coronary arteries proven by coronary angiogram. This was the first study in South India to correlate the serum free testosterone levels with the severity of obstruction of coronaries. Objective: This study was designed to correlate the serum free testosterone level in male patients above 40 years with proven or newly diagnosed CAD with the severity of obstruction of coronary arteries as evidenced from coronary angiogram. Materials and Methods: This was a hospital-based cross-sectional study conducted from November 2015 to August 2017 in a rural-based teaching tertiary care hospital in Puducherry, India. The sample size was 40, calculated using the formula n = 4 × σ2/d2 from the previous study of serum free testosterone in men with coronary artery atherosclerosis done by Lucyna Siemińska et al. Results: Of 40 patients in the study group, 30% had CAD, 20% had hypertension (HTN), 45% had diabetes mellitus, 45% were smokers, 37.5% were alcoholic, and only 5% had family history of (H/o) CAD. In the study, ejection fraction was < 60 in 80% and ≥ 60 in 20%. In the study, 42.5% had single-vessel disease, 27.5% had double-vessel disease, and 30% had triple-vessel disease. The mean serum testosterone was 4.5 ± 3.1 and the median serum testosterone was 3.3, which showed that most of the patients with CAD had their testosterone levels in the lower range of normal. Conclusion: From the observations made in this study, it was clear that the skewing of serum free testosterone levels toward the lower side of normal can be taken as an indirect evidence that serum free testosterone is inversely related to CAD. There was no significant difference in median testosterone levels with respect to the type of disease. However, a statistically significant positive association between H/o systemic HTN and serum free testosterone level was observed in patients with CAD.
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