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A young female presented with oligoarthritis of the right hand, painful symmetrical quadriparesis, and darkening skin for 7 months. General physical examination showed hyperpigmentation on the face, neck, upper extremities, calcinosis cutis with swelling and tenderness in the right wrist, and interphalangeal joints with restriction of movements. Neurological examination revealed power in both upper limbs of 3/5 and 4/5 in both lower limbs, all deep tendon reflexes were diminished, and bilateral plantar was flexors. Investigations revealed creatinine phosphokinase - 3991 U/L, lactate dehydrogenase - 1009 mg/dL, antinuclear antibodies by enzyme-linked immunosorbent assay showed anticentromere antibodies positive, and anti-Mi2 positive. Electromyography was suggestive of myopathy. A muscle biopsy confirmed the diagnosis of dermatomyositis (DM). Hence, the diagnosis of limited scleroderma DM overlap syndrome was made. Serial electrocardiography showed sinus bradycardia and ventricular premature ectopics followed by sinus rhythm. She was treated with pulse therapy steroids, hydroxychloroquine, sulfasalazine, antiplatelets, and isoprenaline for cardiac involvement, with improvement in her symptoms. [ABSTRACT FROM AUTHOR]

A young female presented with facial puffiness and swelling in both lower limbs for 3 months, distension of the abdomen, and breathlessness on exertion for 1 month with a history of hypertension and hypothyroid on regular treatment. On general physical examination, there were pallor, bilateral pitting edema, tachycardia, and blood pressure of 190/100 mmHg. Abdominal examination revealed shifting dullness. Respiratory and cardiovascular systems were normal. Fundoscopy revealed Grade 1 papilledema, and the rest of the neurological examination was unremarkable. Investigations showed normocytic normochromic anemia, serum creatinine of 1.6 mg/dl, and hypoalbuminemia; urine R/E showed significant proteinuria; and anti-U1 ribonucleoprotein particle antibodies were positive. Two-dimensional echocardiography showed mild concentric left ventricular hypertrophy and mild pericardial effusion. Ultrasonography abdomen showed bilateral renal parenchymal disease and moderate ascites. Renal biopsy revealed diffuse proliferative glomerulonephritis and lupus nephritis Class IV. Renal manifestation is very rare in mixed connective tissue disease as an initial presentation. [ABSTRACT FROM AUTHOR]

Cerbera odollam belongs to the poisonous Apocynaceae family, which grows in coastal salt swamps, creeks and along river banks found in South India. The poisonous part of the plant is the kernel containing the toxin cerberin which is a cardiac glycoside that produces symptoms and signs similar to acute digoxin poisoning. The treatment is mainly symptomatic as well as administration of digoxin immune fab antibodies. Digoxin immune fab antibodies bind with cardiac glycosides to reduce their active concentration. However, there could be various barriers in developing countries in regard to the administration of DigiFab antibodies such as availability and affordability. Activated charcoal, a cheaper alternative, reduces gastrointestinal absorption and enterohepatic recirculation. Although its role in C. odollam poisoning remains unclear, there have been various trials where multidose activated charcoal has been beneficial in glycoside poisoning. We present a case report of a young female with an alleged history of consumption of an unknown plant compound, identified as C. odollam presenting with acute-onset vomiting, altered mental status and laboratory parameters showed hyperkalemia and thrombocytopenia. Electrocardiogram (ECG) showed sinus bradycardia followed by inverted tick mark sign. Serum digoxin levels were raised (4.2 ng/ml). The patient was stabilized with supportive measures and hemadsorption with 300 g of cellulose-coated activated charcoal, which led to the reversal of the ECG and laboratory parameters to normal, leading to the complete recovery of the patient. [ABSTRACT FROM AUTHOR]

Background: Obesity and overweight are becoming major health concerns worldwide. Hence, we studied the association between overweight and obesity with new-onset diabetes and hypertension in a selected rural population. Methodology: Community health workers made house-to-house visits, inviting adults >20 years of age who were at a higher risk of diabetes, from a predefined rural area of Maharashtra, to visit a mobile diabetes clinic operating in a hub and spoke manner. Sociodemographic data and anthropometric measurements were recorded. BMI and waist circumference was classified according to the WHO recommended cutoffs for Asians. Subjects with capillary blood fasting glucose of ≥126 mg/dL or random glucose of ≥200 mg/dL by glucometer were diagnosed as diabetes and blood pressure of ≥140/90 mmHg by sphygmomanometer were diagnosed as hypertension. Subjects with a known history of diabetes mellitus and hypertension were excluded. Results: Out of 29,324 total population, 16.5% of subjects were overweight and 26.4% were obese. Mean ± SD of BMI of the participants was 22.9 ± 4.1 kg/m2 in males and 22.4 ± 4.2 kg/m2 in females. Around 35% of males and 30.5% of females had a high waist circumference of ≥90 cm and ≥80 cm, respectively, 20.5% of subjects had newly diagnosed hypertension, and 11.4% of subjects had newly diagnosed diabetes mellitus. The occurrence of newly diagnosed hypertension and diabetes showed an increasing trend with increasing BMI. Conclusion: Our community-based screening suggested a high prevalence of overweight and obesity in rural India. There was a high prevalence of newly diagnosed hypertension and diabetes in this population. [ABSTRACT FROM AUTHOR]

Background: Electrolyte imbalance is an important cause of mortality and morbidity in cerebro vascular accident. Timely treatment can decrease the mortality. Objective: To study the electrolyte disturbances including serum and urinary sodium, potassium and chlorides in acute stroke with its comparison in ischaemic and haemorrhagic stroke. Methods: Serum electrolytes (sodium potassium and chlorides) and urinary electrolytes were investigated in 50 acute stroke patients in a tertiary care hospital. The data was analysed using Chi-square test using SPSS (Statistical package for social science) software. Results: Mean age of the patients was 54 years. 23 patients (46.0%) had haemorrhagic stroke and 27 (54.0%) had ischaemic stroke. 25 (50.0%) had dyselectrolytaemia which is statistically significant (p = 0.047). 10 (37.0%) ischaemic stroke patients and 6 (26.1%) haemorrhagic stroke patients had hyponatremia which is significant (p= 0.048). Conclusion: Hyponatremia was found more in ischemic strokes. [ABSTRACT FROM AUTHOR]

Nephrotic syndrome without haematuria following the sequelae of the infection is uncommon. The present case report describes nephrotic syndrome following varicella infection, without haematuria and hypertension in a 21-year-old young adult. The patient presented with four weeks history of fever, swelling of both feet and facial puffiness. General physical examination revealed vesicular lesions with skin crusts present on the face, trunk and extremities, Blood Pressure (BP)-110/70 mmHg, bilateral pedal oedema. Systemic examination was unremarkable. Laboratory data showed nephrotic range proteinuria, hypoalbuminaemia. Varicella Zoster Virus (VZV) was detected in blood through Polymerase Chain Reaction (PCR). Renal biopsy confirmed the diagnosis. Thus, viral glomerulopathies should be considered in patients following infection. [ABSTRACT FROM AUTHOR]

Juvenile myasthenia gravis is a rare disorder acquired in childhood, representing 10% to 15% of all cases of myasthenia gravis. Like the adult form, it is generally characterized by an autoimmune attack on acetylcholine receptors at the neuromuscular junction. Most patients present with ptosis, diplopia, and fatigability. More advanced cases may also have bulbar problems and limb weakness and may progress to paralysis of the respiratory muscles. [ABSTRACT FROM AUTHOR]

We report a young male of autosomal recessive limb girdle muscular dystrophy (LGMD) with positive family history presented with gradual onset proximal muscle weakness in all four limbs since eight years and thinning of shoulders, arms and thighs. Neurological examination revealed atrophy of both shoulders with wasting of both deltoids thinning of thighs and pseudo hypertrophy of both calves, hypotonia in all four limbs. Gower's sign was positive. Winging of scapula was present. Power was 3/5 at both shoulders, 4/5 at both elbows, 5/5 at both wrists, 3/5 at both hip joints, 3/5 at both knees, 5/5 at both ankles. All deep tendon reflexes and superficial reflexes were present with plantars bilateral flexors. Electromyography (EMG) showed myopathic pattern. He had elevated creatinine phosphokinase levels and muscle biopsy findings consistent with muscular dystrophy. [ABSTRACT FROM AUTHOR]