Monaliza Lyngdoh | NEIGRIHMS - Academia.edu (original) (raw)

Papers by Monaliza Lyngdoh

Journal of Association of Physicians of India, 2014

To study the different clinical manifestations and complications associated with scrub typhus. A ... more To study the different clinical manifestations and complications associated with scrub typhus. A hospital based prospective observational study of patients of acute febrile illness above 18 years age. Diagnosis was based on clinical and serological data. A total of 61 patients were diagnosed with scrub typhus, with males more than females. Most (42.37%) belonged to 18 to 30 years age group. Fever with headache was the commonest presentation (94.91%). Multiorgan dysfunction syndrome was the most common complication (16.94%). The mortality rate was 8.47%. The study reveals the clinical manifestations and complications of a well known mite borne disease in the state of Meghalaya. The varied presentations and high mortality requires a high index of suspicion. The study highlights the clustering of cases during the months of September to November.

Objectives: To study the different clinical manifestations and complications associated with scru... more Objectives: To study the different clinical manifestations and complications associated with scrub typhus. Methods: A hospital based prospective observational study of patients of acute febrile illness above 18 years age. Diagnosis was based on clinical and serological data. Results: A total of 61 patients were diagnosed with scrub typhus, with males more than females. Most (42.37%) belonged to 18 to 30 years age group. Fever with headache was the commonest presentation (94.91%). Multiorgan dysfunction syndrome was the most common complication (16.94%). The mortality rate was 8.47%. Conclusion: The study reveals the clinical manifestations and complications of a well known mite borne disease in the state of Meghalaya. The varied presentations and high mortality requires a high index of suspicion. The study highlights the clustering of cases during the months of September to November.

International journal of biomedical research, 2017

Background: Several risk factors like age, sex, hypertension, diabetes, hyperlipidaemia, smoking ... more Background: Several risk factors like age, sex, hypertension, diabetes, hyperlipidaemia, smoking and alcohol intake have been previously been associated with stroke. However, differences have been postulated between the risk factors and the type of stroke Materials and Methods: Prospective observational study in 200 patients with stroke aged ? 18years of age. Patients with meningitis, head trauma, intracranial abscess and tumour were excluded. Routine biochemical, haematological and radiological investigations were done in all cases. The qualitative variables were analysed by chi-square tests. The quantitative variables were analysed by using paired t test and a p value of less than 0.05 was taken as significant. Results: The mean age was 60.912.9 years with a male to female ratio of 3.16:1. 52% of the stroke patients were haemorrhagic stroke while the rest 48 % were ischaemic stroke. The overall mean age of infarct cases was more than that of cases with haemorrhage (62.711.8 vs 59 ...

Cureus, 2021

Introduction: Immunoglobulin A (IgA) nephropathy is the commonest primary glomerulonephritis with... more Introduction: Immunoglobulin A (IgA) nephropathy is the commonest primary glomerulonephritis with a wide range of clinical presentations and laboratory findings. There is a paucity of studies regarding the significance of co-dominant immunoglobulin G (IgG) deposition in IgA nephropathy. Methods: The study included retrospective and prospective biopsy-proven cases of IgA nephropathy from 2013-2020 with a minimum of eight glomeruli. Clinical and laboratory parameters were analysed for the IgA and IgG co-dominant cases as compared to those of the non-IgG group. Results: A total of 58 cases of IgA nephropathy were included in the study out of which 25 biopsies (43.1%) were categorized as IgA plus IgG, and the rest 33 biopsies (56.8%) as the non-IgG group. A significant correlation was noted amongst the IgA plus IgG group with respect to the elevated mean arterial pressure (MAP) (p=0.038) and proteinuria (p=0.002) as compared to the non-IgG group. Amongst the MEST-C (mesangial hypercellu...

The Journal of the Association of Physicians of India, 2018

Aims and Objectives To study the clinical profile of patients with glomerular diseases and to stu... more Aims and Objectives To study the clinical profile of patients with glomerular diseases and to study pattern of glomerular diseases in adults. Methodology A hospital based retrospective observational study from North Eastern India that includes biopsy proven glomerular disease (GD) in adults. Patients with inadequate biopsy sampling; incomplete medical data and biopsy of transplanted kidney were excluded. Results and Observations A total of 102 patients were included of which 25 (24.5%) were male and 77(75.5%) were female with M: F ratio of 0.32:1. The mean age of presentation was 30.6 years. Nephrotic syndrome (57.8%) was the commonest clinical diagnosis followed by acute nephritic syndrome (31.4%), unexplained AKI (5.9%), unexplained CKD with normal kidney size (2.9%) and asymptomatic urine abnormality (1.9%). On histo-pathological analysis primary GD and secondary GD was diagnosed in 46(45.1%) and 53(52.0%) respectively. Overall Lupus nephritis (LN) was found to be the commonest (...

Arteriovenous malformations (AVM) of the brain are uncommon congenital lesions with a complex arr... more Arteriovenous malformations (AVM) of the brain are uncommon congenital lesions with a complex array of arterial to venous shunts. The common clinical manifestations include haemorrhage, seizures, headache, progressive neurologic defi cits and congestive cardiac failure. We report a child who presented with bilateral acquired ptosis, a very rare presentation of AVM which has not been previously reported.

There is an ever increasing need for awareness regarding the occurrence of an adverse drug reacti... more There is an ever increasing need for awareness regarding the occurrence of an adverse drug reaction (ADR) and the presence of drug to drug interaction (DDI), drug-food interaction and drug-disease interaction. Drug interactions refer to an interaction which can modify the response, nullify the response or produce potentially harmful effects when two or more drugs are administered simultaneously. When two or more drugs are combined it may sometimes cause dual toxicity which may result in greater toxicity than monotherapy.Drug interactions and related adverse effects need to be considered in all clinical settings when two or more drugs are administered for a particular diagnosis. Clinicians need to be aware that early detection and recognition of ADRs occurring due to polypharmacy is important to minimize unwanted health problems.This is of paramount importance to clinicians and other health providers so that an effective treatment outcome can be reached with little or no untoward eve...

Background: Tuberculosis has been associated with various biochemical abnormalities including low... more Background: Tuberculosis has been associated with various biochemical abnormalities including low hyponatremia, serum albumin, hypocalcaemia, low vitamin D levels. Methods: 50 patients aged ? 18years of age with of sputum positive pulmonary tuberculosis were included in the study. Renal function, liver function, electrolytes and Vitamin D levels were measured at 0, 2 and 6 months of anti-tuberculosis treatment. The qualitative variables were analysed by chi-square tests. The quantitative variables were analysed by using paired t test. Five percent probability level was considered as statistically significant i.e., p<0.05. Results: The mean age was 38.5 years with a male to female ratio of 1.08:1. Hyponatremia was present in 24% of the patients. The mean total serum protein value were 6.720.89,7.420.74 and 8.150.68 g/dl and serum albumin of 2.970.50, 3.370.39 and 3.750.37 g/dl respectively at 0, 2 and 6 months. The mean serum calcium values observed were 8.20.63, 8.820.68 and 9.45...

Journal of Family Medicine and Primary Care, 2020

Granulomatous polyangiitis (GPA) is a small vessel vasculitis commonly affecting the upper and lo... more Granulomatous polyangiitis (GPA) is a small vessel vasculitis commonly affecting the upper and lower respiratory tracts and kidneys. About 90% of the cases are associated with ANCA, namely, PR3-ANCA and MPO-ANCA. Herein, we describe a patient of GPA who presented with anasarca, sensory neuropathy, recurrent upper airway congestion, epistaxis, and rapidly progressive glomerulonephritis. Granulomatous interstitial nephritis and necrotizing granulomatous inflammation of the nasal septum were found on biopsy of the kidney and nasal septum, respectively both of which are rare findings. PR3-ANCA and MPO–ANCA were negative. Fulfilling the ACR criteria, this case of GPA proves that biopsy is still the gold standard of diagnosis.

The Journal of the Association of Physicians of India, 2016

Scrub typhus is a documented disease in Himachal Pradesh, but there have been no clinico-epidemio... more Scrub typhus is a documented disease in Himachal Pradesh, but there have been no clinico-epidemiological studies in this area. The present study is done with IgM ELISA as a diagnostic test which has higher sensitivity and specificity as most of previous studies had used Weil Felix test as a diagnostic test. This was a prospective observational study. All the patients more than 18 years of age with positive IgM ELISA for scrub typhus with or without eschar were included. The clinical profile was observed. IgM scrub typhus was done by kit method manufactured by InBios International, Inc. Total 330 patients were observed. Maximum patients were observed in August, September, and October. Fever was the most common presenting complaint. Eschar was present in 40.61% patients. Complications were seen in 71.2 %. The general physicians should be sensitized for the early diagnosis to reduce mortality.

Indian Journal of Medical Specialities, 2015

ABSTRACT Abstract Introduction Alcohol and its relationship to ill health have been recognized as... more ABSTRACT Abstract Introduction Alcohol and its relationship to ill health have been recognized as an important public health challenge even though alcohol use has been part of the cultural tradition in different societies. It is known that alcohol contributes to more than 200 different health problems. We planned to study the burden of the diseases and clinical presentations of alcoholism. Methods and results Two thousand adult patients (one thousand male and one thousand female) were selected by systematic random sampling from all hospital admissions into the Department of General Medicine from February 2012 to August 2013 and screened for alcohol related admissions including different alcohol related diseases. Results The prevalence of alcohol related admissions were 13.3% and 2.3% respectively in male and female patients. Majority of patients belonged to age group 31–50 years. The most common presentation in both sexes was chronic liver disease and its complications. Alcohol dependence syndrome was more common in males as compared to females. Conclusion Since alcohol related hospitalization in this region was found quite high and affecting predominantly people in the prime age between 30 and 50 years of both sexes, this has a significant impact on the health and economic burden of the society. Keywords Alcoholism; Alcohol related diseases; North eastern India

The Egyptian Rheumatologist, 2016

Background: Glycogen storage disease type I (GSD I) is a rare inherited metabolic disorder caused... more Background: Glycogen storage disease type I (GSD I) is a rare inherited metabolic disorder caused by deficient glucose-6-phosphatase (G6Pase) activity with a tendency to develop hypoglycaemia with secondary metabolic derangements including hyperlactacidemia, hyperlipidemia and hyperuricemia. Case presentation: We hereby report a rare case of a 23 year old female presenting with features of gouty arthritis attributed to be due to GSD I. The patient was admitted to the General Medicine

Journal of Arthritis, 2015

Introduction: Systemic Lupus erythematosus (SLE) is characterized by production of antibodies aga... more Introduction: Systemic Lupus erythematosus (SLE) is characterized by production of antibodies against various cellular antigens derived from nucleus, cytoplasm and cell membrane. Pulmonary manifestations of SLE can include a wide spectrum of diseases such as pleuritis, pneumonia, pulmonary embolism, pneumothorax and pulmonary haemorrhage. Acute lupus pneumonitis may mimic tuberculosis or other acute infectious pneumonia and the incidence varies from 0.9% to 11.7%. We report a case of lupus pneumonitis in a case of SLE mimicking pulmonary tuberculosis. Case: An 18 year old girl presented with history of cough with expectoration with occasional haemoptysis. She also had history of fever, swelling of hands and feet along with hair loss. On examination she was febrile and dyspneic, with moderate to severe anaemia, tachycardia, tachypnoea, and coarse crepitations over the chest. Sputum for acid fast bacilli, bacterial culture and fungal stains were negative. She was initially treated with broad spectrum antibiotics and then empirically with anti-tubercular therapy (ATT). However, as she failed to respond to ATT, further evaluation was done. Anti-nuclear antibodies and ds DNA were strongly positive. Urine analysis showed nephrotic range proteinuria. High resolution computed tomogram of the chest showed bilateral ground glassing suggestive of lupus pneumonitis (LP). A diagnosis of SLE with LP was made and the patient was put on corticosteroids which led to a dramatic response. Conclusion: SLE has a wide facade of presentations. Keeping this in mind, even in countries where tuberculosis is endemic, the differential diagnosis of SLE and LP should always be considered even where the clinical features and chest X-rays findings are suggestive of pulmonary tuberculosis.

Journal of Neurosciences in Rural Practice, 2015

ABSTRACTCentral nervous system (CNS) involvement is a known complication of scrub typhus which ra... more ABSTRACTCentral nervous system (CNS) involvement is a known complication of scrub typhus which range from mild meningitis to frank meninigoencephalitis. Aims and objectives: To study the clinical feature, laboratory parameters and response to treatment of scrub typhus meningitis/meningoencephalitis. Methods and Materials: This is a hospital based prospective observational study from North Eastern India. Diagnosis was based on clinical features and positive serological test (Weil's Felix test and IgM antibody card test). Results: 13 patients of scrub typhus with features of meningitis/meningoencephalitis were included. The mean duration of fever before presentation was 5.61±3.08 days and 4 (30.76 %) patients had eschar. Altered sensorium, headache, seizure and meningeal sign were present in 13 (100%), 13 (100%), 6 (46.15%) and 10 (76.92%) patients respectively. Mean CSF protein, glucose and Adenosine deaminase was 152.16±16.88mg/dl, 55.23±21.7mg/dl, and 16.98±7.37U/L respectively...

International Journal of Medical Science and Public Health, 2015

behavior but also glucose and energy homeostasis. [5] Renowned physiologist, Claude Bernard, was ... more behavior but also glucose and energy homeostasis. [5] Renowned physiologist, Claude Bernard, was the first to propose a role for the brain in both glucose homeostasis and diabetes pathogenesis. In his famous experiment, "la pigȗrediabétique," he demonstrated the induction of diabetes resulting in glucosuria by puncturing the floor of the fourth ventricle in rabbits. [6] The discovery of insulin, in 1921, and the subsequent identification of liver, muscle, and adipose tissue as principal targets of the powerful effects of insulin on glucose metabolism has overshadowed the importance of brain in glucose homeostasis and prevented the complete understanding of the pathophysiology of diabetes mellitus. The current treatment of diabetes is islet centered and revolves around the role of insulin. Treatment includes, principally, recombinant human insulin preparations, insulin secretagogues, and drugs that increase insulin sensitivity. These drugs are effective in controlling hyperglycemia and in addressing the consequences of diabetes, but they fail to address the underlying cause; hence, they control rather than cure the disease. [7] The role of the brain to control glucose homeostasis was again brought to light, in 1964, when two laboratories reported neurons within the hypothalamus responding to changes in the plasma glucose. [8,9] Recent studies of glucose-sensitive neurons in the ventromedial hypothalamic nucleus (VMN), the lateral hypothalamus, the arcuate nucleus, and even in the brain stem that possibly initiates counterregulatory response and Brain almost solely depends on glucose for its source of energy. Therefore, it is its vested interest to ensure the maintenance of glucose level at a normal physiological range, thereby ensuring the continuous adequate supply of glucose to brain cells. With recent studies, it is reported that glucose homeostasis is not only regulated by the pancreatic islets but also by a brain-centered glucoregulatory system (BCGS). Studies on glucose-sensitive neurons have implicated their role in counterregulation and meal initiation and termination. This review explores the mechanisms by which the hepatic glucose production (HGP) and systemic glucose homeostasis is controlled by insulin-dependent indirect pathway and insulin-independent glucose disposal mechanisms via the BCGS. The review also discusses the impact of a two-system control that includes the pancreatic islet and the BCGS on diabetes mellitus.

SpringerPlus, 2015

Background: Nimesulide is a non-steroidal anti-inflammatory drug with antipyretic and analgesic p... more Background: Nimesulide is a non-steroidal anti-inflammatory drug with antipyretic and analgesic properties, which is still used in many countries despite its known hepatotoxicity. Along with hepatotoxicity it has also been associated with several other Adverse Drug Reactions (ADRs) including leukocytoclastic vasculitis (LCV). Case description: A 38 year-old female presented with history of acute onset fever for which she took tablet nimesulide and paracetamol combination (100 mg Nimesulide + 500 mg paracetamol tablet), 1 tab three times daily for 4 days, following which she developed rash all over the body. She also had clinical and biochemical evidence of acute hepatitis. Histopathological examination of the skin rash documented the presence of LCV. She was managed symptomatically with anti-inflammatory and supportive therapy and was not further exposed to nimesulide. Discussion and evaluation: Our case demonstrates occurrence of acute hepatitis and LCV associated with nimesulide intake. The case meets the defining criteria for the diagnosis of LCV preceded by history of nimesulide intake. There was also clinical and biochemical evidence of hepato-cellular damage which supports the concurrent development of hepatitis along with the development of LCV following nimesulide use. To the best of our knowledge there is no previous published report of LCV and hepatitis occurring concurrently in the same patient following nimesulide intake. Nimesulide should be added to the list of agents associated with these serious adverse drug reactions. Conclusions: Nimesulide has been a contentious drug over many years. Under such evidence of serious ADRs the scientific community should consider ensuring strict pharmacovigilance with respect to its use especially in the developing countries where such monitoring systems are inadequate.

Annals of Medical and Health Sciences Research, 2015

Background: Scrub typhus is rampant in northern, eastern, and southern India. Central nervous sys... more Background: Scrub typhus is rampant in northern, eastern, and southern India. Central nervous system involvement in the form of meningitis or meningoencephalitis is common in scrub typhus. As specific laboratory methods remain inadequate or inaccessible in developing countries, prompt diagnosis is often difficult. Aim: The aim of this study was to characterize neurological complications in scrub typhus from northeastern region of India. Subjects and Methods: We did a prospective study of scrub meningoencephalitis at North Eastern Indira Gandhi Regional Institute of Medical Sciences among patients admitted to hospital between October 2009 and November 2011. The diagnosis was made based on the clinical pictures, presence of an eschar, and a positive Weil-Felix test (WFT) with a titer of >1:160 and if required a positive scrub IgM enzyme-linked immunosorbent assay. Lumbar puncture was performed in patients with headache, nuchal rigidity, altered sensorium or cranial nerve deficits, and magnetic resonance imaging (MRI) brain performed if needed. Results: Twenty-three patients of scrub typhus meningitis that were serologically confirmed were included in the study. There were 13 males and 10 females. Fever ≥1 week was the most common manifestation (39.1%).Interestingly, none had an eschar. Median cerebrospinal fluid (CSF) cell count, lymphocyte percentage, CSF protein, CSF glucose/blood glucose, CSF ADA were 17 cells/µL, 90%, 86 mg/dL, 0.6605 and 3.6 U/mL, respectively. All patients were treated with doxycycline. There was no mortality in our study. Conclusions: Absence of Eschar does not rule out scrub typhus. Clinical features and CSF findings can mimic tuberculous meningitis so misdiagnosis may lead to unwarranted prolonged empirical antituberculous therapy in cases of lymphocytic meningoencephalitis. Delay in treatment can be potentially fatal. WFT still serves as a useful and affordable diagnostic tool for this disease in resource-poor countries.

American Journal of Roentgenology, 1995

Cureus, 2021

Methotrexate, a folate antimetabolite and one of the first few anti-neoplastic drugs, is now a co... more Methotrexate, a folate antimetabolite and one of the first few anti-neoplastic drugs, is now a commonly used drug in the treatment of many inflammatory disorders ranging from diseases like rheumatoid arthritis to psoriasis. The life-threatening toxicity of methotrexate in inflammatory diseases is not commonly encountered. Here we report a case of life-threatening multiorgan failure from methotrexate toxicity, which was given for skin lesions suspected to be psoriasis.

Journal of Association of Physicians of India, 2014

To study the different clinical manifestations and complications associated with scrub typhus. A ... more To study the different clinical manifestations and complications associated with scrub typhus. A hospital based prospective observational study of patients of acute febrile illness above 18 years age. Diagnosis was based on clinical and serological data. A total of 61 patients were diagnosed with scrub typhus, with males more than females. Most (42.37%) belonged to 18 to 30 years age group. Fever with headache was the commonest presentation (94.91%). Multiorgan dysfunction syndrome was the most common complication (16.94%). The mortality rate was 8.47%. The study reveals the clinical manifestations and complications of a well known mite borne disease in the state of Meghalaya. The varied presentations and high mortality requires a high index of suspicion. The study highlights the clustering of cases during the months of September to November.

Objectives: To study the different clinical manifestations and complications associated with scru... more Objectives: To study the different clinical manifestations and complications associated with scrub typhus. Methods: A hospital based prospective observational study of patients of acute febrile illness above 18 years age. Diagnosis was based on clinical and serological data. Results: A total of 61 patients were diagnosed with scrub typhus, with males more than females. Most (42.37%) belonged to 18 to 30 years age group. Fever with headache was the commonest presentation (94.91%). Multiorgan dysfunction syndrome was the most common complication (16.94%). The mortality rate was 8.47%. Conclusion: The study reveals the clinical manifestations and complications of a well known mite borne disease in the state of Meghalaya. The varied presentations and high mortality requires a high index of suspicion. The study highlights the clustering of cases during the months of September to November.

International journal of biomedical research, 2017

Background: Several risk factors like age, sex, hypertension, diabetes, hyperlipidaemia, smoking ... more Background: Several risk factors like age, sex, hypertension, diabetes, hyperlipidaemia, smoking and alcohol intake have been previously been associated with stroke. However, differences have been postulated between the risk factors and the type of stroke Materials and Methods: Prospective observational study in 200 patients with stroke aged ? 18years of age. Patients with meningitis, head trauma, intracranial abscess and tumour were excluded. Routine biochemical, haematological and radiological investigations were done in all cases. The qualitative variables were analysed by chi-square tests. The quantitative variables were analysed by using paired t test and a p value of less than 0.05 was taken as significant. Results: The mean age was 60.912.9 years with a male to female ratio of 3.16:1. 52% of the stroke patients were haemorrhagic stroke while the rest 48 % were ischaemic stroke. The overall mean age of infarct cases was more than that of cases with haemorrhage (62.711.8 vs 59 ...

Cureus, 2021

Introduction: Immunoglobulin A (IgA) nephropathy is the commonest primary glomerulonephritis with... more Introduction: Immunoglobulin A (IgA) nephropathy is the commonest primary glomerulonephritis with a wide range of clinical presentations and laboratory findings. There is a paucity of studies regarding the significance of co-dominant immunoglobulin G (IgG) deposition in IgA nephropathy. Methods: The study included retrospective and prospective biopsy-proven cases of IgA nephropathy from 2013-2020 with a minimum of eight glomeruli. Clinical and laboratory parameters were analysed for the IgA and IgG co-dominant cases as compared to those of the non-IgG group. Results: A total of 58 cases of IgA nephropathy were included in the study out of which 25 biopsies (43.1%) were categorized as IgA plus IgG, and the rest 33 biopsies (56.8%) as the non-IgG group. A significant correlation was noted amongst the IgA plus IgG group with respect to the elevated mean arterial pressure (MAP) (p=0.038) and proteinuria (p=0.002) as compared to the non-IgG group. Amongst the MEST-C (mesangial hypercellu...

The Journal of the Association of Physicians of India, 2018

Aims and Objectives To study the clinical profile of patients with glomerular diseases and to stu... more Aims and Objectives To study the clinical profile of patients with glomerular diseases and to study pattern of glomerular diseases in adults. Methodology A hospital based retrospective observational study from North Eastern India that includes biopsy proven glomerular disease (GD) in adults. Patients with inadequate biopsy sampling; incomplete medical data and biopsy of transplanted kidney were excluded. Results and Observations A total of 102 patients were included of which 25 (24.5%) were male and 77(75.5%) were female with M: F ratio of 0.32:1. The mean age of presentation was 30.6 years. Nephrotic syndrome (57.8%) was the commonest clinical diagnosis followed by acute nephritic syndrome (31.4%), unexplained AKI (5.9%), unexplained CKD with normal kidney size (2.9%) and asymptomatic urine abnormality (1.9%). On histo-pathological analysis primary GD and secondary GD was diagnosed in 46(45.1%) and 53(52.0%) respectively. Overall Lupus nephritis (LN) was found to be the commonest (...

Arteriovenous malformations (AVM) of the brain are uncommon congenital lesions with a complex arr... more Arteriovenous malformations (AVM) of the brain are uncommon congenital lesions with a complex array of arterial to venous shunts. The common clinical manifestations include haemorrhage, seizures, headache, progressive neurologic defi cits and congestive cardiac failure. We report a child who presented with bilateral acquired ptosis, a very rare presentation of AVM which has not been previously reported.

There is an ever increasing need for awareness regarding the occurrence of an adverse drug reacti... more There is an ever increasing need for awareness regarding the occurrence of an adverse drug reaction (ADR) and the presence of drug to drug interaction (DDI), drug-food interaction and drug-disease interaction. Drug interactions refer to an interaction which can modify the response, nullify the response or produce potentially harmful effects when two or more drugs are administered simultaneously. When two or more drugs are combined it may sometimes cause dual toxicity which may result in greater toxicity than monotherapy.Drug interactions and related adverse effects need to be considered in all clinical settings when two or more drugs are administered for a particular diagnosis. Clinicians need to be aware that early detection and recognition of ADRs occurring due to polypharmacy is important to minimize unwanted health problems.This is of paramount importance to clinicians and other health providers so that an effective treatment outcome can be reached with little or no untoward eve...

Background: Tuberculosis has been associated with various biochemical abnormalities including low... more Background: Tuberculosis has been associated with various biochemical abnormalities including low hyponatremia, serum albumin, hypocalcaemia, low vitamin D levels. Methods: 50 patients aged ? 18years of age with of sputum positive pulmonary tuberculosis were included in the study. Renal function, liver function, electrolytes and Vitamin D levels were measured at 0, 2 and 6 months of anti-tuberculosis treatment. The qualitative variables were analysed by chi-square tests. The quantitative variables were analysed by using paired t test. Five percent probability level was considered as statistically significant i.e., p<0.05. Results: The mean age was 38.5 years with a male to female ratio of 1.08:1. Hyponatremia was present in 24% of the patients. The mean total serum protein value were 6.720.89,7.420.74 and 8.150.68 g/dl and serum albumin of 2.970.50, 3.370.39 and 3.750.37 g/dl respectively at 0, 2 and 6 months. The mean serum calcium values observed were 8.20.63, 8.820.68 and 9.45...

Journal of Family Medicine and Primary Care, 2020

Granulomatous polyangiitis (GPA) is a small vessel vasculitis commonly affecting the upper and lo... more Granulomatous polyangiitis (GPA) is a small vessel vasculitis commonly affecting the upper and lower respiratory tracts and kidneys. About 90% of the cases are associated with ANCA, namely, PR3-ANCA and MPO-ANCA. Herein, we describe a patient of GPA who presented with anasarca, sensory neuropathy, recurrent upper airway congestion, epistaxis, and rapidly progressive glomerulonephritis. Granulomatous interstitial nephritis and necrotizing granulomatous inflammation of the nasal septum were found on biopsy of the kidney and nasal septum, respectively both of which are rare findings. PR3-ANCA and MPO–ANCA were negative. Fulfilling the ACR criteria, this case of GPA proves that biopsy is still the gold standard of diagnosis.

The Journal of the Association of Physicians of India, 2016

Scrub typhus is a documented disease in Himachal Pradesh, but there have been no clinico-epidemio... more Scrub typhus is a documented disease in Himachal Pradesh, but there have been no clinico-epidemiological studies in this area. The present study is done with IgM ELISA as a diagnostic test which has higher sensitivity and specificity as most of previous studies had used Weil Felix test as a diagnostic test. This was a prospective observational study. All the patients more than 18 years of age with positive IgM ELISA for scrub typhus with or without eschar were included. The clinical profile was observed. IgM scrub typhus was done by kit method manufactured by InBios International, Inc. Total 330 patients were observed. Maximum patients were observed in August, September, and October. Fever was the most common presenting complaint. Eschar was present in 40.61% patients. Complications were seen in 71.2 %. The general physicians should be sensitized for the early diagnosis to reduce mortality.

Indian Journal of Medical Specialities, 2015

ABSTRACT Abstract Introduction Alcohol and its relationship to ill health have been recognized as... more ABSTRACT Abstract Introduction Alcohol and its relationship to ill health have been recognized as an important public health challenge even though alcohol use has been part of the cultural tradition in different societies. It is known that alcohol contributes to more than 200 different health problems. We planned to study the burden of the diseases and clinical presentations of alcoholism. Methods and results Two thousand adult patients (one thousand male and one thousand female) were selected by systematic random sampling from all hospital admissions into the Department of General Medicine from February 2012 to August 2013 and screened for alcohol related admissions including different alcohol related diseases. Results The prevalence of alcohol related admissions were 13.3% and 2.3% respectively in male and female patients. Majority of patients belonged to age group 31–50 years. The most common presentation in both sexes was chronic liver disease and its complications. Alcohol dependence syndrome was more common in males as compared to females. Conclusion Since alcohol related hospitalization in this region was found quite high and affecting predominantly people in the prime age between 30 and 50 years of both sexes, this has a significant impact on the health and economic burden of the society. Keywords Alcoholism; Alcohol related diseases; North eastern India

The Egyptian Rheumatologist, 2016

Background: Glycogen storage disease type I (GSD I) is a rare inherited metabolic disorder caused... more Background: Glycogen storage disease type I (GSD I) is a rare inherited metabolic disorder caused by deficient glucose-6-phosphatase (G6Pase) activity with a tendency to develop hypoglycaemia with secondary metabolic derangements including hyperlactacidemia, hyperlipidemia and hyperuricemia. Case presentation: We hereby report a rare case of a 23 year old female presenting with features of gouty arthritis attributed to be due to GSD I. The patient was admitted to the General Medicine

Journal of Arthritis, 2015

Introduction: Systemic Lupus erythematosus (SLE) is characterized by production of antibodies aga... more Introduction: Systemic Lupus erythematosus (SLE) is characterized by production of antibodies against various cellular antigens derived from nucleus, cytoplasm and cell membrane. Pulmonary manifestations of SLE can include a wide spectrum of diseases such as pleuritis, pneumonia, pulmonary embolism, pneumothorax and pulmonary haemorrhage. Acute lupus pneumonitis may mimic tuberculosis or other acute infectious pneumonia and the incidence varies from 0.9% to 11.7%. We report a case of lupus pneumonitis in a case of SLE mimicking pulmonary tuberculosis. Case: An 18 year old girl presented with history of cough with expectoration with occasional haemoptysis. She also had history of fever, swelling of hands and feet along with hair loss. On examination she was febrile and dyspneic, with moderate to severe anaemia, tachycardia, tachypnoea, and coarse crepitations over the chest. Sputum for acid fast bacilli, bacterial culture and fungal stains were negative. She was initially treated with broad spectrum antibiotics and then empirically with anti-tubercular therapy (ATT). However, as she failed to respond to ATT, further evaluation was done. Anti-nuclear antibodies and ds DNA were strongly positive. Urine analysis showed nephrotic range proteinuria. High resolution computed tomogram of the chest showed bilateral ground glassing suggestive of lupus pneumonitis (LP). A diagnosis of SLE with LP was made and the patient was put on corticosteroids which led to a dramatic response. Conclusion: SLE has a wide facade of presentations. Keeping this in mind, even in countries where tuberculosis is endemic, the differential diagnosis of SLE and LP should always be considered even where the clinical features and chest X-rays findings are suggestive of pulmonary tuberculosis.

Journal of Neurosciences in Rural Practice, 2015

ABSTRACTCentral nervous system (CNS) involvement is a known complication of scrub typhus which ra... more ABSTRACTCentral nervous system (CNS) involvement is a known complication of scrub typhus which range from mild meningitis to frank meninigoencephalitis. Aims and objectives: To study the clinical feature, laboratory parameters and response to treatment of scrub typhus meningitis/meningoencephalitis. Methods and Materials: This is a hospital based prospective observational study from North Eastern India. Diagnosis was based on clinical features and positive serological test (Weil's Felix test and IgM antibody card test). Results: 13 patients of scrub typhus with features of meningitis/meningoencephalitis were included. The mean duration of fever before presentation was 5.61±3.08 days and 4 (30.76 %) patients had eschar. Altered sensorium, headache, seizure and meningeal sign were present in 13 (100%), 13 (100%), 6 (46.15%) and 10 (76.92%) patients respectively. Mean CSF protein, glucose and Adenosine deaminase was 152.16±16.88mg/dl, 55.23±21.7mg/dl, and 16.98±7.37U/L respectively...

International Journal of Medical Science and Public Health, 2015

behavior but also glucose and energy homeostasis. [5] Renowned physiologist, Claude Bernard, was ... more behavior but also glucose and energy homeostasis. [5] Renowned physiologist, Claude Bernard, was the first to propose a role for the brain in both glucose homeostasis and diabetes pathogenesis. In his famous experiment, "la pigȗrediabétique," he demonstrated the induction of diabetes resulting in glucosuria by puncturing the floor of the fourth ventricle in rabbits. [6] The discovery of insulin, in 1921, and the subsequent identification of liver, muscle, and adipose tissue as principal targets of the powerful effects of insulin on glucose metabolism has overshadowed the importance of brain in glucose homeostasis and prevented the complete understanding of the pathophysiology of diabetes mellitus. The current treatment of diabetes is islet centered and revolves around the role of insulin. Treatment includes, principally, recombinant human insulin preparations, insulin secretagogues, and drugs that increase insulin sensitivity. These drugs are effective in controlling hyperglycemia and in addressing the consequences of diabetes, but they fail to address the underlying cause; hence, they control rather than cure the disease. [7] The role of the brain to control glucose homeostasis was again brought to light, in 1964, when two laboratories reported neurons within the hypothalamus responding to changes in the plasma glucose. [8,9] Recent studies of glucose-sensitive neurons in the ventromedial hypothalamic nucleus (VMN), the lateral hypothalamus, the arcuate nucleus, and even in the brain stem that possibly initiates counterregulatory response and Brain almost solely depends on glucose for its source of energy. Therefore, it is its vested interest to ensure the maintenance of glucose level at a normal physiological range, thereby ensuring the continuous adequate supply of glucose to brain cells. With recent studies, it is reported that glucose homeostasis is not only regulated by the pancreatic islets but also by a brain-centered glucoregulatory system (BCGS). Studies on glucose-sensitive neurons have implicated their role in counterregulation and meal initiation and termination. This review explores the mechanisms by which the hepatic glucose production (HGP) and systemic glucose homeostasis is controlled by insulin-dependent indirect pathway and insulin-independent glucose disposal mechanisms via the BCGS. The review also discusses the impact of a two-system control that includes the pancreatic islet and the BCGS on diabetes mellitus.

SpringerPlus, 2015

Background: Nimesulide is a non-steroidal anti-inflammatory drug with antipyretic and analgesic p... more Background: Nimesulide is a non-steroidal anti-inflammatory drug with antipyretic and analgesic properties, which is still used in many countries despite its known hepatotoxicity. Along with hepatotoxicity it has also been associated with several other Adverse Drug Reactions (ADRs) including leukocytoclastic vasculitis (LCV). Case description: A 38 year-old female presented with history of acute onset fever for which she took tablet nimesulide and paracetamol combination (100 mg Nimesulide + 500 mg paracetamol tablet), 1 tab three times daily for 4 days, following which she developed rash all over the body. She also had clinical and biochemical evidence of acute hepatitis. Histopathological examination of the skin rash documented the presence of LCV. She was managed symptomatically with anti-inflammatory and supportive therapy and was not further exposed to nimesulide. Discussion and evaluation: Our case demonstrates occurrence of acute hepatitis and LCV associated with nimesulide intake. The case meets the defining criteria for the diagnosis of LCV preceded by history of nimesulide intake. There was also clinical and biochemical evidence of hepato-cellular damage which supports the concurrent development of hepatitis along with the development of LCV following nimesulide use. To the best of our knowledge there is no previous published report of LCV and hepatitis occurring concurrently in the same patient following nimesulide intake. Nimesulide should be added to the list of agents associated with these serious adverse drug reactions. Conclusions: Nimesulide has been a contentious drug over many years. Under such evidence of serious ADRs the scientific community should consider ensuring strict pharmacovigilance with respect to its use especially in the developing countries where such monitoring systems are inadequate.

Annals of Medical and Health Sciences Research, 2015

Background: Scrub typhus is rampant in northern, eastern, and southern India. Central nervous sys... more Background: Scrub typhus is rampant in northern, eastern, and southern India. Central nervous system involvement in the form of meningitis or meningoencephalitis is common in scrub typhus. As specific laboratory methods remain inadequate or inaccessible in developing countries, prompt diagnosis is often difficult. Aim: The aim of this study was to characterize neurological complications in scrub typhus from northeastern region of India. Subjects and Methods: We did a prospective study of scrub meningoencephalitis at North Eastern Indira Gandhi Regional Institute of Medical Sciences among patients admitted to hospital between October 2009 and November 2011. The diagnosis was made based on the clinical pictures, presence of an eschar, and a positive Weil-Felix test (WFT) with a titer of >1:160 and if required a positive scrub IgM enzyme-linked immunosorbent assay. Lumbar puncture was performed in patients with headache, nuchal rigidity, altered sensorium or cranial nerve deficits, and magnetic resonance imaging (MRI) brain performed if needed. Results: Twenty-three patients of scrub typhus meningitis that were serologically confirmed were included in the study. There were 13 males and 10 females. Fever ≥1 week was the most common manifestation (39.1%).Interestingly, none had an eschar. Median cerebrospinal fluid (CSF) cell count, lymphocyte percentage, CSF protein, CSF glucose/blood glucose, CSF ADA were 17 cells/µL, 90%, 86 mg/dL, 0.6605 and 3.6 U/mL, respectively. All patients were treated with doxycycline. There was no mortality in our study. Conclusions: Absence of Eschar does not rule out scrub typhus. Clinical features and CSF findings can mimic tuberculous meningitis so misdiagnosis may lead to unwarranted prolonged empirical antituberculous therapy in cases of lymphocytic meningoencephalitis. Delay in treatment can be potentially fatal. WFT still serves as a useful and affordable diagnostic tool for this disease in resource-poor countries.

American Journal of Roentgenology, 1995

Cureus, 2021

Methotrexate, a folate antimetabolite and one of the first few anti-neoplastic drugs, is now a co... more Methotrexate, a folate antimetabolite and one of the first few anti-neoplastic drugs, is now a commonly used drug in the treatment of many inflammatory disorders ranging from diseases like rheumatoid arthritis to psoriasis. The life-threatening toxicity of methotrexate in inflammatory diseases is not commonly encountered. Here we report a case of life-threatening multiorgan failure from methotrexate toxicity, which was given for skin lesions suspected to be psoriasis.