RESUMEN
Sjogren's syndrome is a late-onset, slowly progressing autoimmune disease characterized by the destruction of the exocrine glands by lymphocytic infiltration, resulting in dry mouth (xerostomia) and dry eyes (keratoconjunctivitis sicca). Sjögren's syndrome may be associated with various autoimmune diseases, including systemic lupus erythematosus, rheumatoid arthritis, and systemic sclerosis. We report a case of a 34-year-old female who delivered a live baby 20 days ago. She presented in a postictal state after two episodes of tonic-clonic movements of limbs with altered sensorium with a history of headache for seven days. Further evaluation revealed that the subject had a history of multiple abortions and grittiness in her eyes. MRI showed signs of infarction in the left parietal lobe and magnetic resonance venography (MRV) suggested cavernous venous thrombosis. After an unwavering effort to rule out alternate causes, the rare correlation between primary Sjogren's syndrome and cerebral venous thrombosis was considered. Additional investigations were performed, which showed the patient to be positive for Anti SS-A (Ro52), Anti SS-B (La), and anti-centromere antibodies. The patient gradually improved with anti-edema measures and steroids and was discharged by day nine. We present this case to emphasize the neurological manifestation of Sjogren's syndrome, which may present as cerebral venous thrombosis.
RESUMEN
Diabetes mellitus comprises a group of common metabolic disorders that share the phenotype of hyperglycemia the potential role of hemostatic factors, particularly fibrinogen, in atherosclerosis and its complications has generated considerable attention. Fibrinogen, itself is determined by several modifiable and non-modifiable determinants like age, sex, smoking, body mass index (BMI), hypertension, alcoholism, glycemic control, lipid profile and urine albumin excretion rate. The present study is undertaken to know the levels of fibrinogen in type 2 diabetes mellitus and its relation with microvascular complications. MATERIAL: This is a cross section observational study. All patients, admitted to our hospital, who where a known case of Type 2 Diabetes mellitus where tested for fibrinogen levels and other investigations such as CBC, urine routine and ACR, Fundoscopy during the month of April 2020 to June 2021and were included in the study. All characteristics were summarized descriptively. For continuous variables, the summary statistics of mean, standard deviation (SD) were used. For categorical data, the number and percentage were used in the data summaries. Chi-square (χ2)/ Freeman Halton Fisher exact test was employed to determine the significance of differences between groups for categorical data. The difference of the means of analysis variables between two independent groups was tested by unpaired t test. The difference of the means of analysis variables between more than two independent groups was tested by ANOVA and F test of testing of equality of Variance. If the pvalue was < 0.05, then the results were considered to be statistically significant. OBSERVATION: A total of 70 patients were studied. The mean age was 45 years with a male preponderance of 61%. Of the total 70 studied, It was noted that in diabetics the mean fibrinogen level was very high (611mg/dl) which was observed to be very highly significant (p value <0.05). The duration of diabetes was more than 5 years in majority of cases that is 29 cases with mean duration of diabetes 7.5 years. Fibrinogen level was significantly correlated with HbA1C (p <0.05), urine albumin excretion measured by microalbuminuria (p< 0.05). Fibrinogen level was significantly higher in patients with retinopathy (p<0.05). ANOVA / Unpaired t test were used which showed duration of diabetes (p value <0.05)and microalbuminuria (p value < 0.05) to be independent risk factors. CONCLUSION: A significant association between fibrinogen levels and albumin excretion rate measured by micro albiminuria was documented . Because microalbiminuria is a well recognized powerful predictor of cardiovascular related illness and death in diabetes, fibrinogen levels can be considered as a potential additional risk fctor in patients with diabetes. On the basis of observation of this study, it may be conferred that hyperfibrinogenemia could be a mechanism of the increased micro and macrovascular risks faced by patients with Type 2 diabetes mellitus.