Paroxysmal Nocturnal Haemoglobinuria (PNH) is a rare type of acquired Haemolytic anaemia that is described as a triad of acquired intravascular Haemolysis, venous thrombosis and anaemia with pancytopenia sometimes due to bone marrow failure. However the classical triad may not be observed at once and fever due to leucocytopenia may confuse the clinical picture. Since this is a rare disease, other epidemiologically common causes may be attributed to the illness. We report a case of PNH with a rare association of malaria due to Falciparum and Vivax species which was undiagnosed for 6 years in a young man.
BACKGROUND:Pesticide poisoning is a public health problem in developing countries. The anticholinesterase effect of OP compound is observed by decrease in serum pseudo cholinesterase level. The present study was designed to evaluate the relationship between the serum cholinesterase level and mortality following OP compound poisoning since it is not conclusive in previous studies. MATERIAL AND
Background: There has been a steady increase in the use of organophosphates (OPs) as pesticides in most of the developing countries including India for more than 50 years. OPs tend to be the commonest cause of poisoning worldwide and are persistently and deliberately used in suicides in Agrarian areas. As stated by WHO, 3 million cases of pesticide poisoning occur every year, of these about 1 million are accidental and 2 million are suicidal poisonings, resulting in more than 0.25 million deaths per year. As there is limited availability of facilities and resources in developing countries, all OP poisoning patients are not managed in intensive care units. Hence it is important to understand the clinical features and other factors that indicate severity of poisoning which should be identified in the initial examination.Methods: It was a hospital based prospective study of 100 OP poisoning patients that were attending to casualty of BIMS Hospital and Medical College Belagavi, India. Over a period, patients fulfilling inclusion criteria were included and patients were categorized according to Peradeniya Organophosphorus Poisoning (POP) scale. Serum cholinesterase level measured at the time of admission.Results: The patients were in the age group of 18 to 70 years. Majority of the patients were in the age group of 21-30 years (51%). Sixty nine percent of the patients were from rural areas and 38% of them were farmers. Sixty nine percent of patients were from low socioeconomic stratum. Major route of intake of poison was ingestion. Eighty four percent of patients consumed poison with a suicidal intent. In this study, authors observed that there is a significant correlation between the severity of poisoning categorized by the POP scale and the serum cholinesterase at the time of initial presentation of the patients (P<0.001).Conclusions: Present study concluded that significant correlation between the degree of derangement in serum cholinesterase level and severity of poisoning at the initial presentation. Higher the score on the POP scale, the greater was the degree of derangement in the serum cholinesterase level.
INTRODUCTIONThe delay in onset of acute MI in women compared to men is presumably due to pre-menopausal exposure to endogenous ovarian estrogen.1 In females CAD is increased around the time of menopause when the estrogen in plasma begins to decline. It is observed in studies that atheromatous fatty streak and atheromatous plaque exist both in men and in women. The extent of fatty streak in both men and women is a function of plasma level of LDL cholesterol and in women, VLDL cholesterol, which is closely related to the triglyceride level. The lesions in female are more lipid filled, rich in macrophage and less densely fibrous.2 Thus, lesion could be more unstable under certain circumstances. Likewise, coronary calcification is half as that of men on ultrafast computed tomography until age 60, 3 when difference between age narrows. Recognition of chest pain of cardio vascular etiology in women is difficult to diagnose because,• It is not expected • Atypical, non-cardiac chest pains are more common in women compared to men.True angina may not be typical. Because of atypical symptoms misdiagnosis is common. The reason for lack of classic anginal symptom in spite of having validated myocardial ischemia is unknown. The greater incidence of silent MI in women may be related to atypicality of chest pain presentation. 1 ABSTRACTBackground: Acute myocardial infarction differs in women and men with respect to risk factors and clinical presentation. There are studies carried out worldwide on this issue but few from India. This study was done to study the sex based differences in the risk factors and clinical features of acute MI in patients with Indian ethnicity. Methods: Comparative prospective study consisting of 100 women as study group and 100 men as control group with acute MI, who were admitted in a tertiary care hospital, from December 2016 to June 2017. Results: Chest pain was the main complaint in majority of the women (82%) and men (88%). Radiation of chest pain (87%) and sweating (90%) were significantly present in men compared to women (65% and 62% respectively), while breathlessness was significantly present in women (78%) compared to men (64%) and fatigue in women (76%) significantly more than men (55%). Smoking was a significant risk factor in men (69%) compared to women (5%), while diabetes mellitus was a significant risk factor in women (62%) compared to men (39%). Conclusions: Women with acute MI had more atypical presentation of symptoms, similar risk factors, compared to men except for smoking which was more significant in men and diabetes more common in women.
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