ABSTRACT Plain radiographs can still be of considerable diagnostic value for recognizing Brodie's abscess, especially in resource constrained settings.
Abstract We report the case of a 62‐year‐old man who presented with shortness of breath, cough, bilateral lower limbs' swelling, and blackish discoloration of multiple fingertips over the past 2 months. Anti‐Ribonucleoprotein antibodies were found to be present, and gadolinium‐based cardiac MRI showed non‐vascular subendocardial enhancement with diffuse symmetrical thickening of the left ventricular wall. A diagnosis of Mixed connective tissue disease with secondary cardiac amyloidosis was thus made, and the patient was successfully managed with intravenous cyclophosphamide, corticosteroids, and other supportive measures. Although extremely rare, this case shows that secondary cardiac amyloidosis should be considered while managing patients with MCTD.
Aortic aneurysm is a potentially life-threatening condition with higher incidence in patients with systemic lupus erythematosus(SLE). Patients usually present with nonspecific symptoms and diagnosis is typically made incidentally through imaging studies. Management strategies include medical therapy to control inflammation and hypertension, surgical intervention for large or symptomatic aneursyms, and close monitoring for early detection of complications. We present a case of a 49-year female with multiple joint pain and other nonspecific symptoms for 7 years. Anti-ds DNA and ANA titre were significantly high and CT angiogram showed ascending aortic aneurysm measuring 5.5 cm. Conservative management was started with steroids, hydroxychloroquine, and antihypertensives, while awaiting surgery. However she suddenly collapsed, probably due to aneurysm rupture and could not be revived. Our case report therefore emphasizes the importance of close surveillance and timely intervention to minimize the morbidity and mortality in these patients.
Introduction: Ultrasonography is a commonly used medical imaging technique to evaluate the kidneys and has become the preferred modality for the assessment of renal pathology. However, limited data are available on the normal renal parameters in Nepalese adults. The aim of this study was to establish normal reference ranges for renal size in healthy medical students using ultrasonography. Methods: A total of 100 healthy undergraduate medical students (64 males; 36 females) between the first and internship years (age 19-29 years) were studied. Ultrasonography was performed using a single and specific ultrasound machine with 1-7MHz transducer. Results: The study showed the left kidney was slightly longer than the right (10.46 ± 0.68cm vs 10.13 ± 0.65cm; p=0.04), but the right kidney had a significantly larger thickness (2.80 ± 0.76cm vs 2.99 ± 0.68cm; p=0.01) and volume. A strong positive correlation was found between the renal parameters of one side with another side (Length: r=0.63,p<0.001; Breadth: r=0.42, p<0.001; Thickness: r=0.51, p<001; Volume: r=0.57, p<0.001). There were significant differences in renal length and volume based on sex, height, weight, and body mass index while other parameters were not significant. Weight was found to affect renal length more than height. Conclusion: The left kidney was slightly longer than the right kidney. There was a strong positive correlation between the right and left kidney parameters. The study also found significant associations between renal length and height, weight, and body mass index.
Toxic epidermal necrolysis (TEN) is a rare, acute and potentially fatal skin condition usually induced by drugs. Although much attention is focused on the life threatening acute cutaneous and sight threatening ocular manifestations of this disease, chronic pulmonary complications like bronchiolitis obliterans are occasionally encountered. However, little is known about its incidence, pathogenesis, clinical course and outcome in children recovering from TEN.We report a five-year-old boy who presented four months after the first manifestation of drug-induced TEN with cough and shortness of breath and was subsequently diagnosed with bronchiolitis obliterans. He was treated with supportive therapy that improved his hypercapnia allowing him to be discharged on domiciliary oxygen, chest physiotherapy and bronchodilators.This case highlights the need to be vigilant for adverse drug reactions and consider chronic pulmonary complications like Bronchiolitis Obliterans in children recovering from TEN.
Abstract Aim We aim to review the literature to collate and describe features of encephalitides arising from autoantibodies against leucine‐rich glioma‐inactivated 1 (LGI1), gamma aminobutyric acid receptor (GABABR), and contactin‐associated protein‐like 2 (CASPR2) in Asian populations and compare them with findings of Western studies. Methods Peer‐reviewed articles published till 24 May 2020 were searched, and original, full‐text studies from Asia with serum/CSF antibody‐based diagnosis and at least 2 patients were selected. Twenty‐four studies with 263 patients (139 anti‐LGI1, 114 anti‐GAGABR, and 10 anti‐CASPR2) were included. Data were pooled to produce descriptive information on demographics, clinical characteristics, diagnostics, treatments, and outcome. Results The mean age was 54.2 (anti‐LGI1), 55.2 (anti‐GABABR), and 47.7 years (anti‐CASPR2), with an overall male predominance of 62.0%. Commonest clinical features across all types were seizures (87.5%), memory deficits (80.7%), psychiatric disturbances (75.9%), and altered consciousness (52.9%). Four anti‐LGI1, 40 anti‐GABABR, and 1 anti‐CASPR2 patients had tumors. CSF, MRI, and EEG were abnormal in 33.3%, 54.1%, and 75% patients in anti‐LGI1; 60.0%, 49.6%, and 85.7% in anti‐GABABR; and 50%, 44.4%, and 100% in anti‐CASPR2 patients, respectively. 95.6% patients received first‐line therapy alone (steroids/IVIG/Plasma therapy), and 4.4% received second‐line therapy (rituximab/cyclophosphamide). 91.7%, 63.6%, and 70% of patients had favorable outcomes (modified Rankin Score 0–2) with mortality rates at 2.5%, 23.2%, and 0% in the three types, respectively. Conclusion Our findings suggest that these disorders present in Asian patients at a relatively young age often with features of seizures, memory deficits, and psychiatric disturbances and usually demonstrate a favorable clinical outcome.
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