Hypocalcemia due to hypoparathyroidism may manifest as serious neurologic symptoms such as seizures, movement disorders, or raised intracranial pressure. Several patients were observed to have these dangerous neurologic complications even without subtle signs of hypocalcemia like tetany, chvostek's sign or carpopedal spasms. We present a case of recurrent hypocalcemic seizures due to congenital hypoparathyroidism.
BACKGROUNDCurrently available literature highlights association of hypovitaminosis D with chronic diseases such as diabetes mellitus and systemic hypertension, but there are very few studies on role of vitamin D in pulmonary tuberculosis (PTB) in our population. MATERIALS AND METHODSVitamin D levels in 180 cases of newly diagnosed active pulmonary tuberculosis (Both sputum positive and sputum negative) and 180 age and gender matched healthy controls were estimated. 25 Hydroxy vitamin D3 levels were estimated by sensitive fully automated Chemiluminescent Immunoassay (CLIA) technique. Vitamin D3 levels were categorised as sufficient, insufficient and deficient. Patients were followed for six months for final outcome (Tuberculosis cured/not cured). RESULTSOut of 180 cases, 95 (52.78%) were sputum positive and the remaining 85 (47.22%) were sputum negative. Mean vitamin D levels were significantly low in cases (12.23 ± 5.99 ng/mL) as compared to controls (18.7 ± 10.19 ng/mL) (p value <0.001). Among the 180 cases, 158 (87.78%) had vitamin D deficiency, 18 (10%) had vitamin D insufficiency; whereas among controls, 105 (58.33%) had vitamin D deficiency, 46 (25.56%) had vitamin D insufficiency. The prevalence of vitamin D deficiency and vitamin D insufficiency was higher among cases compared to controls (p-value < 0.05). CONCLUSIONThere is significant deficiency of Vitamin D in patients with PTB. More prospective designed studies are needed to firmly establish the direction of association between PTB and vitamin D deficiency (VDD).
Diabetic myonecrosis, one of the complications of chronic, inadequately controlled diabetes mellitus is seen more commonly in lower extremities and in females. We report a case of diabetic myonecrosis in upper extremities, an underreported complication of diabetes in a male from a tertiary care hospital in Mumbai. Diabetic myonecrosis usually responds to conservative management, but the long-term prognosis of the condition is poor. Identification and correct diagnosis of diabetic myonecrosis is important to avoid wrong treatment which could result in unnecessary complications.
Background: Endoscopic retrograde cholangiopancreatography (ERCP) is a complex procedure which is commonly performed at various centres. It causes considerable amount of pain and discomfort to patients, and various centres have their own protocols regarding its management. Authors aim to study the efficacy of intravenous diclofenac as a premedication to reduce the pain and discomfort during and after ERCP.Methods: This was a randomized placebo-controlled trial evaluating 40 patients. The pain and degree of discomfort was investigated using a 4- point ordinal scale questionnaire.Results: The use of intravenous diclofenac as premedication for ERCP significantly reduces pain and discomfort during and after the procedure.Conclusions: Intravenous diclofenac should be used as a premedication for ERCP procedure as it significantly reduces the pain and discomfort during and after the procedure.
BACKGROUNDObjective-To examine cardiovascular manifestations in patients with hypothyroidism. MATERIALS AND METHODSIn this observational study, adult hypothyroid patients were screened for cardiovascular disease. Symptoms of hypothyroidism, cardiovascular system related symptoms, T3, T4 and Thyroid Stimulating Hormone (TSH) were compared between male and female patients. Association between thyroid stimulating hormone and heart disease was also evaluated. RESULTSHundred patients (male 32% and female 68%) with mean age of 39.2 + 9.28 years were enrolled. More number of females showed weight gain over a period of two years as compared to males (p= 0.0217). Dry skin was more common in females as compared to males (p= 0.0336). More females reported breathlessness and chest pain as compared to males (breathlessness p= 0.0187; chest pain p= 0.0008). Pulse rate of female patients was significantly lower than male patients (p= 0.0081). More number of females had raised jugular venous pressure as compared to males (41% vs 19%, p= 0.0475). Diastolic blood pressure was higher in females than in males (p= 0.023). There was no difference in the mean T3 (52.43 ± 14.35 pg/mL vs 46.53 ± 14.19 pg/mL; p= 0.1776), T4 level (4.48 ± 0.97 vs 4.06 ± 0.97; p= 0.1630) or TSH level (31.19 ± 11.9 vs 42.21 ± 26.98; p= 0.1260) between males and females. Number of females with cardiomegaly was higher compared to males [26 (38%) vs 2 (6%); p < 0.0001]. Significant association was observed between higher TSH and presence of breathlessness, chest discomfort and palpitations (p < 0.05). Significantly, more patients with higher TSH showed significantly more heart rate, raised jugular venous pressure and diastolic blood pressure (p < 0.05). Higher TSH was associated with pericardial effusion in more proportion of patients (p= 0.007). CONCLUSIONCardiac dysfunction is common in patients with hypothyroidism. Screening and treatment of cardiovascular disease in hypothyroidism may help to reduce morbidity and mortality in hypothyroidism. KEYWORDS BACKGROUNDHypothyroidism is a common endocrinological problem in clinical practice. The reported incidences of clinical hypothyroidism range from 0.5 to 1.9% in women and less than 1% in men. Subclinical hypothyroidism is more common than clinical hypothyroidism, both in females and males. 1 The prevalence of subclinical hypothyroidism is about 4 -10.5%. 2 Both clinical and subclinical hypothyroidism are shown to be associated with cardiovascular manifestations. As heart is
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