An Observational Study on Metabolic Derangements in People Living with HIV.

BACKGROUND: HIV infection is a global pandemic. The adult HIV prevalence in India is 0.22%. Successful therapy is transforming HIV into a chronic medical condition, and there are many metabolic complications. This study aimed to evaluate the metabolic abnormalities in people living with HIV (PLHIV) who were on antiretroviral therapy (ART) for at least 2 years and compare it with ART-naïve patients as well as the effect of protease inhibitor-based (PI-based) and non-protease inhibitor-based (non-PI-based) ART was assessed. METHODOLOGY: Adult HIV-positive patients both ART-naïve and on ART for more than 2 years were included. Detailed history and clinical examination, including blood pressure and anthropometric measurements were done. This was followed by investigations like lipid profile including total cholesterol, triglyceride, high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C), fasting plasma glucose, and hemoglobin A1c (HbA1C) estimation. Standard statistical tools were utilized to assess derangements and association to therapy. RESULTS: The study was conducted for 1.5 years in a tertiary care hospital. A total of 70% of the study population was male with mean age of participants being 43.2 years, 40% were ART-naïve, 37% received non-PI-based ART, and 23% PI-based ART. The mean total cholesterol level and mean triglyceride value were significantly higher in the PI-based ART group than in the therapy-naïve group. The ART-naïve group was seen to have more subjects with abnormally low HDL-C values. The PI-based ART study subjects were found to have a greater number of cases of glucose intolerance in relation to the rest of the two groups significantly (p-value <0.001). The LDL-C systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI), and waist circumference had no association with the different ART regimens or with the HIV infection itself. CD4 T cell count at diagnosis in the three study groups was compared with all the variables of metabolic syndrome and no association was found. CONCLUSION: Total cholesterol, triglycerides, and glucose levels are the main parameters found to be affected in PLHIV on therapy.

Gastroduodenal tuberculosis: a case series and a management focused systematic review.

INTRODUCTION: Gastroduodenal tuberculosis is an uncommon form of abdominal tuberculosis. AREAS COVERED: We report our experience with five cases of gastroduodenal tuberculosis and present results of a systematic review on gastroduodenal tuberculosis regarding clinical presentation, endoscopic, imaging findings, and the diagnostic and therapeutic approach. EXPERT OPINION: The presentation of gastroduodenal tuberculosis is diverse and may include nonspecific abdominal pain or dyspepsia like symptoms apart from gastric outlet obstruction. Endoscopy may show presence of growth, ulcer, narrowing, or fistula on endoscopy. Endoscopic biopsy, well-biopsy, or mucosal resection of an elevated lesion are helpful. On microscopy, granuloma with or without acid fast bacilli positivity can be found. For treatment, standard antitubercular therapy should be given for 6 months. In patients with tight stricture, endoscopic balloon dilatation can be helpful. Surgery is reserved for patient with diagnostic dilemma, refractory stricture, or complications like perforation or fistula. Future research should focus on improving diagnosis with use of modern microbiological techniques like PCR and Xpert MTB/RIF.

Chronic Paraspinal Pain due to Multiple Aortic Aneurysms.

Aneurysms of the aorta are not uncommon, both of the thoracic aorta or the abdominal aorta and may be associated with congenital aortic valve diseases, cystic medial necrosis, Marfan's Syndrome or Ehlers-Danlos syndrome, or atherosclerosis. We report a case of a 46 year old smoker who had developed multiple aneurysms of the aorta in both the thoracic and abdominal parts and was incidentally diagnosed on work-up of a chronic back pain associated with venous prominence on left side of chest and left arm.

An uncommon initial presentation of snake bite-subarachnoid hemorrhage: A case report with literature review.

Snake bites are very common in India, particularly in West Bengal. Snake bite can cause various hematological, neuromyopathical complications. It can be very fatal if not detected and treated early. Timely intervention can save the patient. We are reporting a case of hematotoxic Russell viper snake bite presented with subarachnoid hemorrhage. Patient was successfully treated with antivenom serum (AVS) along with other conservative management. Subarachnoid hemorrhage as an initial presentation in viper bite is very rare and we discuss the case with proper literature review.

Digital Gangrene an Unusual Presentation of Takayasu's Arteritis.

CONTEXT: Takayasu arteritis (TA) is a chronic inflammatory disease involving large vessels like aorta and its major branches. It presents to clinician with features of arm claudication, stroke, asymmetrical pulse, or asymmetrical blood pressure in both limbs. Digital gangrene may be occurred secondary to various systemic diseases like diabetes, thrombophilic states, vascular embolism, and medium and small vessel vasculitis or infections. Through evaluation to diagnose the exact etiology and timely intervention is needed to prevent progression of the gangrene which at the time can be life-threatening. Digital gangrene as an initial presentation in TA is very rare. In medical literature, there are only few case reports have been reported. CASE REPORT: We are reporting a case of a 26-year-old female patient presented with right little finger and index finger gangrene, ultimately diagnosed as TA and responded dramatically to treatment. CONCLUSION: Though rare, TA should be taken in the differential diagnosis for work up in a case of digital gangrene and it necessitates more studies in this field to uncover the exact pathophysiology for such presentation.

Urinary Ascites - A Consequence of Intraoperative Injury.

Patients with complications after surgery often pose enormous challenges to physicians. We report the case of a young lady developing fever, oliguria and intractable ascites refererred to us after undergoing abdominal surgery. She was diagnosed subsequently to have a urinoma with urinary ascites masquerading as a case of sepsis. Percutaneous nephrostomy followed by definitive repair and reimplantation of ureter later led to subsidence of the symptoms.

A rare cause of seizures, parkinsonian, and cerebellar signs: brain calcinosis secondary to thyroidectomy.

CONTEXT: Post-thyroidectomy hypoparathyroidism presenting with Parkinsonian features and seizures with extensive intracranial calcifications is uncommon. Acquired intracranial calcification that affects structures other than the basal ganglia is rare. CASE REPORT: We report a case of a 45-year-old woman with a history of total thyroidectomy who presented with Parkinsonian features, cerebellar signs, and seizures. Brain imaging revealed extensive intracranial calcifications secondary to long-standing hypoparathyroidism. The patient was treated with intravenous (IV) calcium gluconate therapy and shifted to oral calcium and calcitriol therapy. Her symptoms improved markedly. At four months of follow up, the patient had not suffered another episode of seizure and was being gradually weaned off anti-Parkinsonian therapy. CONCLUSION: This case describes the rare finding of extensive intracranial calcifications in a case of iatrogenic hypoparathyroidism secondary to thyroidectomy with its wide array of features and its remarkable response to restoration of calcium levels to normal limits.

A case of ADEM following Chikungunya fever.

Chikungunya most often is a self-limiting febrile illness with polyarthritis and the virus is not known to be neurotropic. We are reporting a case of chikugunya fever presenting as acute demyelinating encephalomyelitis(ADEM) which is very rare.

Deep vein thrombosis: a rare signature of herpes zoster.

Reactivation of varicella zoster Infection is known to cause manifold complications. However, deep vein thrombosis has been rarely described as an associate. Here we present the case of a young immunocompetent male with such a predicament.

Spontaneous splenic rupture: A rare presentation of dengue fever.

Spontaneous rupture of the spleen with hemoperitoneum is a very rare, but serious manifestation of dengue fever (DF). We report a case of a young female who was presented with atraumatic abdominal pain, hypovolemic shock, anemia, ascites and hepatosplenomegaly with a recent history of a febrile illness. Subsequent investigations proved the presence of hemoperitoneum with spontaneous splenic rupture with seropositivity for DF. Early diagnosis and conservative management in this case resulted in a favorable outcome.

Hepatobiliary tuberculosis.

Hepatobiliary tuberculosis refers to the localized form of hepatic tuberculosis and is a distinct entity in which hepatobiliary involvement overwhelmingly dominates the clinical picture. Presentations are often delayed, and manifestations can be nonspecific. Fever is the most common symptom followed by abdominal pain, and hepatomegaly is the most common abnormality found on clinical examination. Abnormalities of the liver function tests are non-specific and hence not diagnostic. Ultrasound or computed tomography reveals single or complex masses, and guided biopsy is diagnostic either by demonstrating caseating granuloma or the organism by staining and culture. Treatment is with standard first-line antituberculous drugs. Endoscopic stenting gives an excellent outcome for symptomatic biliary strictures. The outcome in patients infected with Human Immunodeficiency virus depends on the level of underlying immunosuppression.

Acute pancreatitis : complication of chicken pox in an immunocompetent host.

Chicken pox is a benign self limited disease. But it may rarely be complicated with acute pancreatitis in otherwise healthy patient. We present a case of varicella pancreatitis and its marked recovery with acyclovir.

Gauchers disease presenting with portal hypertension.

Gauchers disease is a rare lysosomal storage disorder characterized by abnormal accumulation of lipid-laden macrophages in different organs. Though hepatosplenomegaly is commonly found, symptomatic presentation with portal hypertension is rare. We report a child with liver cirrhosis and bleeding esophageal varices who was diagnosed with Gaucher's disease.