A case of Gilles de la Tourette's syndrome.

Gilles de la Tourette's syndrome is an uncommon illness associated with repetitive un-voluntary abnormal movements and utterance. It is often associated with other psychiatric morbidities. Management requires awareness of this uncommon illness, keen observation, relevant evaluation, and combination of pharmacology and psychotherapy for an optimal outcome. This case is brought out here for florid presentation and nuances of management.

Prevalence of Early Stages of Chronic Kidney Disease in Healthy Army Personnel.

INTRODUCTION: Chronic kidney disease (CKD) is associated with significant morbidity and mortality. Screening and detection of early stages of CKD can help institute interventions that may delay the progression of the disease. One aim was to study the prevalence of early stages of CKD in the Army. METHODS: A cross-sectional study of Army Personnel in an Army cantt in Central India was carried out. All participants filled a structured questionnaire and anthropometric data was collected. Investigative profile included routine urine exam, semi-quantitative microalbuminuria (MAU), serum creatinine, lipid profile and fasting blood glucose. Glomerular Filteration rate (eGFR) was calculated using the Modification of Diet in Renal Diseases (MDRD) study equation. RESULT: A total of 1920 subjects were examined with 731 (38.07%) from Arms and 1189 (61.93%) from Services. 348 were excluded and of the remaining 1572 subjects, 141 (8.97 %) had MAU and 157 (9.99 %) had deranged Albumin Creatinine Ratio (ACR). Mean eGFR by MDRD equation was 102 ± 25.84 ml/min/1.73m (2) . Early CKD was seen in 150 (9.54 %) with 84 (5.34 %) in stage I CKD, 55 (3.5%) in stage II and 11 (0.7%) in stage III. Multiple logistic regression showed BMI > 23, the presence of DM and HTN were independent risk factors for CKD. CONCLUSION: 9.54% of healthy army personnel were found to have early stages of CKD. Institution of screening programs can result in early detection of CKD.

Prevalence of early stages of chronic kidney disease in apparently healthy central government employees in India.

BACKGROUND: Chronic kidney disease (CKD) is associated with significant morbidity and mortality. US data show that 11-15.6% of population has CKD, but there is no data from India on early stages of CKD. The aim of this study was to estimate the prevalence of early stages of CKD using the Kidney Disease Quality Outcomes Initiative (KDOQI) guidelines in an Indian population. METHODS: A cross-sectional study of Indian central government employees over 18 years of age was carried out. Data on anthropometric profile and investigations including routine urine exam, semi-quantitative microalbuminuria (MAU), serum creatinine, lipid profile and fasting blood glucose (FPG) were collected. Estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Diseases (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations. RESULTS: A total of 3398 subjects, with 2244 (66.04%) males and 1154 (33.96%) females, were studied. Of the subjects, 9.96% (n = 284) were found to have MAU >30 mg/L, and 11.47% (n = 327) had a deranged albumin:creatinine ratio (ACR) of 30-300 mg/g. Mean GFR was 98 mL/min/1.73 m(2) (+/- 25.25) by the MDRD equation, and 100 mL/min/1.73 m(2) (+/- 19.48) by CKD-EPI. Using the MDRD equation for GFR, 189 (6.62%) had stage I CKD, 154 (5.40%) had stage II CKD and 86 (3.02%) had stage III CKD. By using the CKD-EPI equation, the corresponding percentages were 192 (6.73%), 122 (4.28%) and 60 (2.11%), respectively. Age >40 years, FPG >126 mg/dL and hypertension were found to be independent risk factors for CKD. CONCLUSIONS: Of the apparently healthy adult Indian central government employees, 15.04% and 13.12% were found to have early stages of CKD using the MDRD and CKD-EPI criteria for GFR, respectively.

Management of necrotizing myositis in a field hospital: a case report.

Necrotizing myositis is a rare and fatal disease of skeletal muscles caused by group A beta hemolytic streptococci (GABHS). Its early detection by advanced imaging forms the basis of current management strategy. Paucity of advanced imaging in field/rural hospitals necessitates adoption of management strategy excluding imaging as its basis. Such a protocol, based on our experience and literature, constitutes: i. Prompt recognition of the clinical triad: disproportionate pain; precipitous course; and early loss of power- in a swollen limb with/without preceding trauma. ii. Support of clinical suspicion by 2 ubiquitous laboratory tests: gram staining- of exudates from bullae/muscles to indicate GABHS infection; and CPK estimation- to indicate myonecrosis. iii. Replacement of empirical antibiotics with high intravenous doses of sodium penicillin and clindamycin. iv. Exploratory fasciotomy: to confirm myonecrosis without suppuration- its hallmark. v. Emergent radical debridement. vi. Primary closure with viable flaps - unconventional, if need be.