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  Citation statistics : Table of Contents
   2015| April-June  | Volume 27 | Issue 2  
    Online since June 29, 2015

 
 
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CASE REPORTS
Splenic abscess: a rare presentation
Mohit Bhatia, Hanumant Lohar, Daksha S Nirhale, Vishal Tomar
April-June 2015, 27(2):78-79
DOI:10.4103/1110-7782.159477  
Splenic abscess is a rare clinical entity with an incidence of 0.2-0.7% in autopsy-based studies. When untreated, splenic abscess is associated with nearly 100% mortality; in treated patients, the mortality rate is 16.6% during the first 90 days. It mostly occurs in patients with neoplasia, immunodeficiency, trauma, diabetes or splenic infarct. The incidence of splenic abscess is thought to be growing because of the increase in the number of immunocompromised patients who are particularly at risk for this disease and also because of the widespread use of diagnostic modalities. However, the optimal treatment for this remains unclear. We present a case of a 42-year-old man diagnosed with multiloculated splenic abscess and was subjected to splenectomy.
  1 1,121 130
Multinodular bilateral breast lesions diagnosed as primary breast lymphoma in a young lactating woman
Mohammad Akram, Ruquiya Afrose, Sadaf Hayat, Mohammed Naim
April-June 2015, 27(2):69-71
DOI:10.4103/1110-7782.159458  
Primary breast lymphoma (PBL) is a rare neoplasm that constitutes 0.4% of malignant breast lesions and 2% of extranodal lymphomas. It is seldom distinguished preoperatively from other common forms of breast cancer. Here, we report a case of a 30-year-old woman (para 3, gravida 0) who presented with multiple bilateral nodular swellings of the breast for 2-months duration, followed by bilateral axillary lymphadenopathy after 15 days, along with low-grade fever, and generalized weakness. On examination, she was found to have multiple firm nodular mass involving both the right and the left breast, along with multiple, bilateral, matted, axillary lymph nodes. A clinical diagnosis of bilateral breast carcinoma with axillary metastasis was made. Fine needle aspiration cytology of both the breast and axillary lymph node revealed monomorphic population of scattered lymphoid cells with moderate anisonucleosis and one to two prominent nucleoli. A cytological diagnosis of PBL was made, which was subsequently confirmed with histopathology and immunohistochemistry for leukocyte common antigen and CD20. Because PBLs are uncommon malignant lesions and they usually do not have characteristic clinical and imaging findings, fine needle aspiration cytology proves to be a simple, rapid, reliable, and cost-effective procedure for successful diagnosis of PBL.
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A case report of recurrent hypokalaemic periodic paralysis in a young male patient
Pulin Gupta, Vikas T Talreja, MS Dhananjaya, Sakshi Mittal
April-June 2015, 27(2):72-74
DOI:10.4103/1110-7782.158001  
A 21-year-old normotensive male patient presented with acute-onset flaccid paralysis with the history of a similar episode a few months back. Clinical and laboratory evaluation revealed lower motor neuron type of flaccid quadriparesis with hypokalaemia, normal anion gap metabolic acidosis, bicarbonaturia and transtubular potassium concentration gradient more than 7. Subsequently, urine acidification test (by ammonium chloride challenge test) was performed and diagnosis of renal tubular acidosis was established. The patient ultrasound did not show nephrocalcinosis, and history of recurrent diarrhoea preceding the attack revealed that the patient also had coeliac disease. The patient responded to conservative management (Sohl's solution) and gluten-free diet.
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Endovascular management of bowel ischemia secondary to portal and mesenteric vein thrombosis
Shaileshkumar S Garge, Pooja D Vyas, Bushra B Rasool, Krantikumar Rathod, Inder A Talwar
April-June 2015, 27(2):75-77
DOI:10.4103/1110-7782.159474  
Portal and mesenteric venous thrombosis (PMVT) is an uncommon disease, but it is a clinically important case of acute mesenteric ischemia. Its diagnosis is often delayed because of nonspecific abdominal symptoms. The treatment of PMVT involves anticoagulation therapy, alone or in combination with surgery. The addition of thrombolytic therapy to the treatment of PVMT may enhance the clearance of thrombus and hasten the clinical improvement. We herein present a case of bowel ischemia due to PVMT that was successfully treated with catheter-directed infusion of urokinase through the superior mesenteric artery and systemic anticoagulation in a patient with ascites and high blood international normalized ratio. We believe that this case demonstrates that slow and steady treatment with transarterial thrombolysis over 13 days can achieve the desired results compared with more aggressive transhepatic or transjugular thrombectomy or surgical thrombectomy, especially in high-risk patients with ascites and high international normalized ratio.
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ORIGINAL ARTICLES
Biopsy of the pancreas: the predictive value and therapeutic impact on autoimmune diabetes
Wael Nassar, Mostafa A Mostafa
April-June 2015, 27(2):48-52
DOI:10.4103/1110-7782.159449  
Diabetes mellitus is by definition an end-stage organ failure. Type 1 diabetes mellitus is an autoimmune disease. Autoinflammatory infiltrate appears to characterize the insulitis associated with type 1 diabetes mellitus. In recent times, a comprehensive composition of peri-islet capsules and their basement membrane (BM) has been described. Lymphocytic infiltration around the islets without invasion of the BM is the first step in disease induction (nondestructive insulitis phase). Invasion of the BM by leukocytic infiltration (destructive insulitis phase) occurs over a period of several years, offering good window for therapeutic intervention. Clinical symptoms appear only when 70-90% of β-cell mass are destroyed. These data emphasize on the importance of identification and classification of such pathologic features by performing a biopsy of the pancreas, along with histoimmunochemistry analysis at the prehyperglycemic stage in a high-risk, genetically predisposed, autoimmune-suspected patient, which may at least in part help in achieving new therapeutic approaches and halting the progression to end-stage pancreatic disease known as diabetes mellitus. In this review, we emphasize the predictive role biopsy of the pancreas can have, by building up a solid gold standard tool in the diagnosis, staging, and therapeutic follow-up of autoimmune diabetes mellitus.
  - 801 104
Undifferentiated spondyloarthritis is more frequently seen in women than in men
Sukran Erten, Orhan Küçüksahin, Ali Sahin, Nurdan Cay, Gulay G Ceylan
April-June 2015, 27(2):53-57
DOI:10.4103/1110-7782.158000  
Introduction Spondyloarthritis (SpA) are a group of inflammatory rheumatic diseases that share some common clinical and genetic features such as inflammatory back pain, peripheral arthritis, enthesitis, anterior uveitis, sacroiliitis, and HLA-B27 positivity. The aim of the present study was to describe the clinical, radiologic, and genetic features of patients with undifferentiated spondyloarthritis (uSpA) and ankylosing spondylitis (AS). Patients and methods This study included 225 SpA patients (134 uSpA and 91 AS) attending our Rheumatology Outpatient Clinic consecutively. Patients underwent peripheral and axial joint and enthesitis assessment, erythrocyte sedimentation rate or C-reactive protein determination, HLA-B27 tissue typing, radiographic evaluation, and sacroiliac MRI. Results In total, 26 of 91 AS patients and 115 of 134 uSpA patients were women (28.6 vs. 85.8%) and 65 of AS and 19 of uSpA were men (71.4 vs. 14.2%). The time for diagnosis was 15.82 ± 20.7 months for AS patients and 5.91 ± 3.63 months for uSpA patients. Diagnostic delay was 102.46 ± 88.99 (median 83, range 8-377) months for AS and 74.23 ± 60.7 (median 55.5, range 0-238) months for uSpA patients. HLA-B27 positivity was present in 51.6% of AS and 14.9% of uSpA patients. The mean BASDAI level of patients with AS was 6.4 ± 1.1 and that of uSpA patients was 4.8 ± 2.1. Conclusion SpA are frequent diseases and physicians other than rheumatologists should also be aware of them. uSpA is more frequent in women than men. Early diagnosis of SpA is important because early treatment with new biological therapies may lead to much better results than applying them in the advanced stages.
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Late initiation of dialysis in diabetic Egyptian patients
Salwa Ibrahim, Hatem Darwish, Ahmed Fayed
April-June 2015, 27(2):58-62
DOI:10.4103/1110-7782.159450  
Introduction The number of chronic kidney disease (CKD) patients has been increasing over the past two decades, both globally and in Egypt. In our current study we tried to identify the pattern of end-stage renal patients [chronic kidney disease stage 5 (CKD5)], who presented at a tertiary referral center (Cairo University Hospital, Kasr-Alainy School of Medicine), to identify the epidemiological characteristics, clinical presentation, hospital course, and outcome. Patients and methods This is a prospective analysis of all medical admissions through the emergency department (Department 6) of Kasr-Alainy School of Medicine, Cairo University, in 1 year from July 2010 to July 2011. We included patients with proven CKD 5 who needed to be started on renal replacement therapy. Results A total of 571 patients were identified, of whom 82 patients (36 males and 46 females) proved to have CKD5 and needed to be started on renal replacement therapy. The mean age of the included patients was 51.63 ΁ 14.7 years. Oliguria and vomiting were the most frequent symptoms, as seen in 52 cases (63.4%), followed by symptoms of volume overload in 24 patients (29.3%) and disturbed level of consciousness and fever in six patients (7.3%). Diabetic nephropathy was the most common cause of renal failure in our studied cohort (51.2%), followed by hypertension (22%); the cause was unknown in 25% of patients. Four patients (4.9%) died during their hospital stay. Conclusion In conclusion, our study showed that there is delayed referral for nephrology care and delayed initiation of dialysis when patients presented through the emergency department. Of particular interest was the fact that diabetic patients were most often subjected to this practice.
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Paraoxonase-1 activity in type 2 diabetes mellitus with and without nephropathy
Nehal H El-said, Mohammed M Nasr-Allah, Noha A Sadik, Saher A Sharaf
April-June 2015, 27(2):63-68
DOI:10.4103/1110-7782.159451  
Background Paraoxonase-1 (PON-1) is an enzyme synthesized in the liver that has antioxidant functions as it binds to the HDL particles and prevents the oxidation of LDL, which possibly plays a role in the prevention of atherosclerosis and coronary artery disease. Objectives To determine PON-1 activity in type 2 diabetic patients with and without diabetic nephropathy and its correlation with the lipid profile, disease duration, and glycemic status. Patients and methods This study was carried out on 30 patients with type 2 diabetes mellitus who attended the diabetes and endocrine clinic at Kasr Al Ainy Hospital, Cairo University, including 20 patients with evidence of diabetic nephropathy and 10 patients without diabetic nephropathy as well as 15 healthy age-matched control participants. Fasting blood sugar, 2 h postprandial blood sugar, total cholesterol, HDL, LDL, triglycerides, and serum creatinine were measured. PON-1 activity was detected using a colorimetric method. Results PON-1 activity was reduced significantly in diabetic patients with and without nephropathy, with mean 226.1 ΁ 135.4 and 221.7 ΁ 119.6 nmol/ml/min, respectively, versus 758.5 ΁ 353.9 nmol/ml/min in the control group (P < 0.001). PON-1 activity was not significantly different between diabetic patients with and without nephropathy. PON-1 activity was correlated negatively with HDL (r = −0.496, P = 0.026) in diabetic patients with nephropathy. PON-1 activity was not correlated significantly with disease duration and glycemic status. Conclusion PON-1 activity was significantly reduced in type 2 diabetes, but did not differ between diabetics with or without nephropathy.
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QUESTIONS AND ANSWERS
Questions and answers
Summeih Ali
April-June 2015, 27(2):80-86
DOI:10.4103/1110-7782.159479  
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REVIEW ARTICLE
Looking for the early marker of renal injury
Ahmed S.A. Zaky
April-June 2015, 27(2):45-47
DOI:10.4103/1110-7782.159446  
Acute Kidney Injury is a complex and increasingly common syndrome. Practically all available markers reflect functional impairment rather than a true direct mark of cellular injury. An ideal AKI biomarker should be accurate, reliable, easy to measure with a standard assay, noninvasive, reproducible, and sensitive and specific with defined cutoff values. Studies have identified a relatively small number of genes that are specifically altered in acute renal tubular injury. Kim-1 is one of the best-characterized urinary biomarkers to date in both experimental animals and humans with renal disease. Also NGAL is at the top of many researchers' lists. Other biomarkers include IL-18, N-acetyl-β-d-glucosaminidase, and urinary liver-type fatty acid binding protein.
  - 836 146
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