Hypokalaemia and its subsequent complications are more often seen in children rather than in adults and are more common with falciparum malaria. This is a case of a 26-year-old male with Plasmodium vivax malaria who had developed paraparesis secondary to hypokalaemia. His treatment involved correction of the potassium level as well as the treatment of malaria. Such an atypical manifestation of malaria in an adult has not been previously documented.

On inquiry there was history of orthopnea and paroxysmal nocturnal dyspnea.There was no history of cough, hemoptysis, fever, joint pain, headache, malaise, weight loss, loss of appetite or any other systemic manifestation. No history of tuberculosis or tuberculosis contact.Patient consulted a chest physician initially and was suspected of having bronchial asthma and started on formoterol and budesonide rotahaler for the same. ABSTRACTTakayasu's arteritis is a rare systemic, inflammatory large vessel vasculitis of unknown etiology that most commonly affects women of childbearing age. It is defined as granulomatous inflammation of the aorta and its major branches. We describe a 27 years old female who presented with dyspnea in the emergency medicine department of DY patil hospital, Maharashtra, India. The initial examination showed signs of heart failure along with unequal pulses bilaterally with difference in systolic BP in bilateral upper limb of more than 10 mm Hg. Patient underwent routine investigations like ECG / 2D-echo / cardiac markers. 2decho was suggestive of severe pulmonary hypertension with dilated cardiomyopathy. Further investigation in view of physical findings and 2decho report led to the diagnosis of takayasu's arteritis.

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Introduction: Systemic lupus erythematosus (SLE) is a chronic inflammatory disease of unknown etiology that can affect virtually every organ in the body. Presentation of a patient can vary considerabaly. Many a times, pleurisy, coughing, and/or dyspnea are the first clues either to lung involvement or to SLE itself. In this case report we present a patient who was diagnosised with SLE along with pulmonary diagnosis of interstitial lung diasese (ILD). Case report: A 40 year old female presented with swelling of both lower extremities, facial puffiness for one month and dry cough for past 3 years. Examination revealed painful joints and bilateral fine crepts at the bases of lungs. Patient's ANA and anti-double stranded DNA indicated SLE. Pulmonary function test showed restrictive pattern of lung disease compatible with interstitial lung disease (ILD), which was supported by High resolution computed tomography thorax. 2D echocardiography revealed mild tricuspid rgurgitation and pulmonary artery systolic pressure of 80 mm of mercury. Based on the clinical and laboratory findings present in this patient, a final diagnosis of SLE with ILD and pulmonary hypertension was made. Treatment included immunosuppresive therapy, mycophenolate mofetil, pirfenidone and sildenafil. Mild improvement of respiratory symptoms was noted in the patient. Conclusion: Careful history taking, clinical examination and appropriate clinical investigations helped us in clinching the diagnosis. Further research is required to understand the mechanisms responsible for ILD in SLE patients and how these cases can be treated effectively.

Scleroderma is systemic multi organ autoimmune disorder characterized by hardening of skin. Also known as systemic sclerosis. Estimated annual incidences of approximately 19 cases per million persons. The limited skin disease has a 10-year survival rate of 71%, whereas those with diffuse skin disease have a 10-year survival rate of just 21%. Risk is higher in women than men and peak in individuals aged 30-50 years. It has no definitive treatment. It may be limited or diffuse depending upon manifestations of symptoms or signs affecting internal organs especially lungs, heart, or kidney. We report a case of scleroderma with pulmonary hypertension and interstitial lung disease in our hospital who presented with tightening of skin, joint pain, dysphagia, and breathlessness. On examination skin appeared dark, shiny, and tight, with loss of hair, paraesthesia and digital ulceration. Patient also has history of Raynaud's phenomenon. On investigation, Scl-70 and ANA (antinuclear antibodies) by enzyme immunoassay came positive. HRCT thorax was suggestive of interstitial fibrosis and PFT revealed moderate restriction. On 2D echocardiography, mild pulmonary hypertension was present while barium swallow showed motility disorder involving oesophagus. On view of extensive systemic involvement like skin, respiratory system, gastrointestinal system and heart, we would like to present this rare disorder.

<b><i>Introduction:</i></b> The prevalence of nonalcoholic fatty liver disease (NAFLD) is increasing and is fueled by a twin-epidemic of obesity and diabetes mellitus in India. The objective of the study was to estimate various noninvasive NAFLD scores (NINS) for the baseline risk-assessment of NAFLD in patients with type 2 diabetes mellitus (T2DM). <b><i>Methods:</i></b> An observational, cross-sectional, open label, study of investigator-rated NINS was conducted ensuring adherence to relevant ethical standards. <b><i>Results:</i></b> In a 3-month period, 29 patients with T2DM were enrolled (age [mean ± SD]: 55.8 ± 9.72 years; men [<i>n</i>, %]: 18, 62%). One patient (3.45%) by fibrosis-4 index (cutoff for advanced fibrosis ≥2.67) and by AST to platelet ratio index (cutoff ≥0.98); 2 (6.90%) by NAFLD fibrosis score (cutoff ≥0.676); 20 (69%) by body mass index (BMI), AST to ALT ratio, and DM score (BARD; cuff-off ≥2); and 27 (93.10%) by BMI, age, ALT, triglyceride score (cutoff ≥1) indicated high risk for advanced hepatic fibrosis. Only the BARD score (median [min-max]: 3 [1–4]) was elevated above the cutoff values while other scores were below cutoff values. The study failed to demonstrate any correlation between age, gender, anthropometric and metabolic parameters, and NINS. <b><i>Conclusion:</i></b> While this study did not demonstrate significant elevation of NINS, scores were found be elevated in some T2DM patients and they may be at high risk of advanced liver fibrosis. Further well-designed studies in this domain are required for early detection, management, and reducing the burden of liver disease in Indian patients with diabetes.

Tetanus is rare diagnosis in the post vaccination era ,although it continues to have signicant morbidity and mortality worldwide. High risk population groups carpenters, mechanics, laborer's and soldiers with unknown history of tetanus vaccination. This is a report of a 40 year male, laborer by occupation with an incomplete immunization history who presented to the emergency department with classical triad of trismus, risus sardonicus and opisthotonos and was diagnosed as tetanus. This report highlights the importance of prompt diagnosis, treatment, and prevention of tetanus. It also points out the importance of booster vaccination, as tetanus still remains an important cause of morbidity and mortality in the post vaccination era.

Paraquat is one of the most dangerous poisons in the medical eld as Ingestion of small quantities (>10mL) may damage lung irreversibly and also lead to renal failure causing to death. The paraquat is sold in more than 130 countries around the world to be used in small as well as large farms. The easy availability of this poison makes it a commonly employed agent for suicide. More than 93% of deaths due to paraquat poisoning are suicidal in nature and most of them are occurring in developing countries. The clinical features vary from case to case based on the amount and type of compound consumed. As it is a fatal condition, early diagnosis and proper management is warranted which can reduce the morbidity and mortalities. But sometimes early diagnosis may not save the victim as in our case. We present a case wherein the victim succumbed to acute respiratory distress following consumption of paraquat.