scholarly journals OUTCOME OF STRICTUROPLASTY IN PATIENTS WITH INTESTINAL TUBERCULOSIS

2012 ◽  
Vol 19 (03) ◽  
pp. 411-417
Author(s):  
G. M. KHAN BALOCH ◽  
KHALID HUSSAIN QURESHI ◽  
ASIM BHATTI
Keyword(s):  
Weight Loss ◽  
Past History ◽  
Intestinal Tuberculosis ◽  
Case Series ◽  
Wound Dehiscence ◽  
Low Grade ◽  
Pain Abdomen ◽  
History Of ◽  
Extra Pulmonary ◽  
Easy Operation

Introduction: Abdominal TB is one of the most prevalent forms of extra-pulmonary disease and is prevalent all over the world.Gastrointestinal involvement had been reported to be 55-90%. This study aimed to determine the outcome of stricturoplasty in patients withintestinal tuberculosis. Objective: To determine the outcome of stricturoplasty in patients with intestinal tuberculosis. Study Design:Descriptive case series. Setting: Department of General Surgery, Nishtar Hospital Multan. Duration with dates: Three years from January2009 to December 2011. Subjects & Methods: 120 patients of intestinal TB, who presented with intestinal obstruction in emergency and withsigns and symptoms of intestinal TB in outdoor patient department were selected. History of contact, family history of tuberculosis,immunization, past history of tuberculosis was taken. Diagnosis was confirmed by histopathology. Laparatomy was done in all cases andstricturoplasty was performed. Patients were followed up during hospitalization. Postoperative complications were noted. All information wererecorded on a proforma. Results: Out of 120 patients, 56.7% were male and 43.3% were female having age between 14 to 70 years. Mainpresenting symptoms were pain abdomen, vomiting, distension of abdomen, weight loss, anorexia and low grade fever with sweats. Maincomplications after stricturoplasty were chest infection 40(33.3%), wound dehiscence in 16(13.3%), leakage in 12(10%), recurrence in20(16.7%), scar pigmentation in 12(10%), keloid in 12(10%) patients and herniation in 8(6.7%) patients. Conclusions: Stricturoplasty is a safe,simple and easy operation, particularly useful at small peripheral hospitals with limited staff and resources.

A CASE OF SPINAL TUBERCULOSIS MISEVALUATED AS INTESTINAL OBSTRUCTION

2021 ◽  
pp. 32-33
Author(s):  
Chepuri Sagar
Keyword(s):  
Intestinal Obstruction ◽  
Spinal Tuberculosis ◽  
Low Grade ◽  
X Ray ◽  
Pott’S Disease ◽  
Pain Abdomen ◽  
Chief Complaints ◽  
History Of ◽  
Extra Pulmonary ◽  
Tuberculosis Of Spine

Tuberculosis of spine (Pott's disease) is a frequently encountered extra pulmonary form of tuberculosis and is the most dangerous form . We report a case of spinal tuberculosis which present with clinical features of intestinal obstruction. A 45 1 year old male patient came to general surgery out patient department with chief complaints of pain abdomen since two weeks, constipation since two weeks and distension of abdomen since 10 days. History of fever present since 2 months low grade on and off. Case was evaluated with X ray erect abdomen, colonoscopy, CT abdomen which showing features of tuberculosis of spine. Patients of tuberculosis of spine can be asymptomatic and sometimes diagnosis is made incidentally during the course of evaluation for other symptoms

scholarly journals P045 Nothing is too 'cagey' for the rheumatologist

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Muhammad F Kazmi
Keyword(s):  
Weight Loss ◽  
Inflammatory Markers ◽  
Low Grade ◽  
Careful Monitoring ◽  
Chronic Infections ◽  
Asian Origin ◽  
Travel History ◽  
Chest Clinic ◽  
History Of ◽  
Inflammatory Changes

Abstract Background/Aims  Rheumatological conditions can present with a number of non-specific features like arthralgia, fever, fatigue, weight loss along with raised inflammatory markers and positive antibodies. Due to this, when similar symptoms are referred for input it is very important to consider other ‘mimics’. We report a case of Pigeon fancier’s lung presenting with these symptoms which was referred as likely connective tissue disease. Methods  A 52-year-old lady of South Asian origin was referred by her GP with six month history of 3kg weight loss, arthralgia, fatigue, low grade fever and persistently raised inflammatory markers (ESR ranging from 50-64 mm/hr, CRP 10-14 mg/L, normal BMI). On further questioning there was history of mouth ulcers, non-specific rash, occasional cough but no Raynaud’s or joint swelling. Blood investigations showed weakly positive ANA and RF but negative ENA, DNA, antiCCP , CK, C3,C4. C-ANCA was positive but PR3 negative. CXR was clear and tests for chronic infections including TB were negative. Due to lack of objective CTD signs, plan was to take a careful monitoring approach to see if clinical features evolved. A month later due to worsening cough, a CT chest/abdomen arranged by GP showed ground-glass changes consistent with pneumonitis and hence her rheumatology appointment was expedited to see if there was an autoimmune unifying diagnosis. She was also referred by her GP to the chest clinic in view of CT report and mild shortness of breath. Results  On further review, again there were no objective CTD signs. On direct questioning there was history of travelling before worsening chest symptoms to South Asia. Also around a year before her symptoms started she was given an African grey parrot. Based on this, serology for Avian precipitin was checked which showed strongly positive IgG antibodies to avian antigens (Budgerigar droppings and feathers, Pigeon feathers IgG Abs) confirming the diagnosis of pigeon fanciers lung. She fulfilled the diagnostic criteria and was asked to avoid the trigger. Urgent respiratory input was arranged where diagnosis was agreed with and disease was deemed sub-acute in presentation. Due to PFTs showing low transfer factor of 38%, Prednisolone was started with significant improvement within few days. Review of CT chest only showed inflammatory changes and no established fibrosis predicting excellent prognosis as delay in treatment can cause irreversible pulmonary fibrosis. Conclusion  A number of conditions can mimic rheumatological conditions which usually turn out to be either infectious or malignant in origin. This case highlights the importance of considering other differentials and along with taking a travel history also asking for other possible triggers like pets. In similar scenarios the diagnosis may be ‘cagey’ but as rheumatologists we are expected to answers questions which others can’t. Disclosure  M.F. Kazmi: None.

scholarly journals Levels of TB-IGRA may help to differentiate between intestinal tuberculosis and Crohn’s disease in patients with positive results

2020 ◽  
Vol 13 ◽  
pp. 175628482092200
Author(s):  
Yujie Zhao ◽  
Meilin Xu ◽  
Liang Chen ◽  
Zhanju Liu ◽  
Xiaomin Sun
Keyword(s):  
Weight Loss ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Intestinal Tuberculosis ◽  
Clinical Manifestations ◽  
Final Analysis ◽  
Interferon Gamma Release Assay ◽  
Significant Difference ◽  
History Of ◽  
Diagnosis Criteria

Aim: The aim of this study was to investigate the significance of positive tuberculosis interferon gamma release assay (TB-IGRA) in the differential diagnosis of intestinal tuberculosis (ITB) and Crohn’s disease (CD) patients, and to find a suitable threshold to help distinguishing CD from tuberculosis (TB), so as to provide better recommendations for clinical treatment. Methods: A retrospective study was performed including 484 patients who underwent TB-IGRA testing for suspected CD or ITB treated in the Shanghai Tenth People’s Hospital of Tongji University between January 2015 and May 2018. According to the diagnostic criteria, 307 patients, including 272 CD and 35 ITB patients, were recruited for the final analysis. We comprehensively and systematically collected their clinical manifestations, and analyzed the influence of TB-IGRA values referring to diagnosis criteria, and the possible causes of false positives. The receiver operator characteristic (ROC) curve and the cut-off value were applied to distinguish between ITB and CD patients. Results: Of the 56 patients with suspected CD enrolled, 23 were finally diagnosed with CD and 33 with ITB. In patients with TB-IGRA ⩾ 100 pg/ml, 4 cases were CD and 29 cases were ITB, while 19 cases were CD and 4 cases were ITB in patients with TB-IGRA < 100 pg/ml ( p < 0.05). TB-IGRA ⩾ 100 pg/ml indicated a high possibility of TB infection, with a sensitivity of 88% and a specificity of 74%. Three out of the four CD patients with TB-IGRA ⩾ 100 pg/ml had a history of tuberculosis, while only 1 of the 19 CD patients with TB-IGRA < 100 pg/ml had a history of tuberculosis ( p < 0.05). The average duration of ITB was 7 months, and that of CD was 46.8 months, thus a significant difference ( p < 0.05) was observed. Perianal lesions such as anal fistula or abscess were found in all CD patients. Among ITB patients, 8 out of 15 patients with TB-IGRA ⩾ 400 pg/ml experienced weight loss, while only 1 out of 18 patients with TB-IGRA < 400 pg/ml underwent weight loss ( p < 0.05). Conclusion: Patients with CD have longer duration of disease, and perianal lesions are more common in CD. ITB patients with TB-IGRA ⩾ 400 pg/ml experience weight loss more readily, which indicates that TB-IGRA value may be correlated positively with the severity of ITB. In patients with CD and ITB, TB-IGRA = 100 pg/ml may be a cut-off value of TB-IGRA. For patients with TB-IGRA ⩾ 100 pg/ml, it is recommended to use diagnostic anti-TB treatment first. Comprehensive analysis and judgment are required for patients with TB-IGRA from 14 pg/ml to 99 pg/ml. TB-IGRA false positivity may occur in patients with a history of TB infection.

scholarly journals ADHD, ODD, and CD: Do They Belong to a Common Psychopathological Spectrum? A Case Series

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Sayanti Ghosh ◽  
Mausumi Sinha
Keyword(s):  
Conduct Disorder ◽  
Past History ◽  
Case Series ◽  
Externalizing Disorders ◽  
Developmental Pathways ◽  
Hyperactivity Disorder ◽  
Oppositional Defiant ◽  
Symptom Profile ◽  
History Of ◽  
Shared Risk

Purpose of Research. Numerous studies have reported comorbidities, overlapping symptoms, and shared risk factors among cases of attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD) and conduct disorder (CD). We present three adolescent males aged 13–16 years with conduct disorder having past history of ADHD and ODD.Principal Result. The symptom profile especially in domains of aggression, hostility, and emotionality as well as the manner of progression from ADHD to ODD and CD in the above cases shows a similar pattern.Conclusion. These common developmental pathways and overlapping symptoms suggest the possibility of a common psychopathological spectrum encompassing the three externalizing disorders.

scholarly journals Optic Disc Neovascularization in Vogt-Koyanagi-Harada Disease- A Case Series and Literature Review

2021 ◽  
Author(s):  
Lagan Paul ◽  
Shalin Shah ◽  
Manisha Agarwal ◽  
Shalini Singh
Keyword(s):  
Optic Nerve ◽  
Literature Review ◽  
Case Series ◽  
Vascular Occlusion ◽  
Autoimmune Disorder ◽  
The Body ◽  
Low Grade ◽  
Retinal Vessels ◽  
History Of ◽  
Vkh Disease

Abstract BackgroundVogt–Koyanagi–Harada (VKH) disease is an autoimmune disorder which affects numerous organs of the body. We report two cases of Optic Nerve Head neovascularisation (NVD) in diagnosed cases of Vogt Koyanagi Harada(VKH) disease.FindingsCase 1: A 40 years female presented with acute loss of vision in both eyes for 10 days. She had multiple serous detachments in both eyes and diagnosed as acute VKH disease. After treatment, she was observed to have NVD later on OCT Angiography(OCTA). Case 2: A 52 years old man presented with history of sudden blackouts in front of left eye since 4 months. He was a case of chronic VKH and NVD was seen clinically and on OCTA. ConclusionThe exact etiopathogenesis of neovascularization in Harada’s disease is unclear. The low grade inflammations acts as a stimulus and can induce disc neovascularization even in the absence of vascular occlusion. ONH vessels appear to be more susceptible to developing NVD than retinal vessels in presence of chronic inflammation.

scholarly journals A Physiotherapeutic Approach Along with Bronchodilators to Control Bronchial Asthma in a 35 Year Old Adult: A Case Report

2021 ◽  
pp. 121-125
Author(s):  
Nupur Thombare ◽  
Madhumita Yadav ◽  
Pratik Phansopkar
Keyword(s):  
Chest Pain ◽  
Bronchial Asthma ◽  
Past History ◽  
Common Disease ◽  
Low Grade ◽  
It Use ◽  
Postural Drainage ◽  
Old Adult ◽  
Night Sweats ◽  
History Of

Background: Bronchial asthma is a common disease characterized by the generalized narrowing of intrapulmonary airways accompanied by breathlessness and wheezing, which differs in severity spontaneously or as a result of treatment. Asthma is caused by bronchial wall inflammation and constriction due to the hyper-reactivity of their smooth muscle, resulting in a series of spasmodic wheezing attacks and shortness of breath (SOB). Case description: The patient was a 35 year old female presented with a complaint of dry cough with mucoid expectoration and chest pain since 3 weeks. The cough was progressive and aggravating while walking or while doing any sort of activity and it use to relieve at rest. She also complained of Modified Medical Research Council (MMRC) grade 2 breathlessness along with palpitation while doing household work. She had chest pain while coughing on left side over the 2nd intercostal space which was gradually progressive and 7/10 on VAS. She also had low grade fever, cold with chills and night sweats. The patient had a history of seasonal variation, dust allergies and biomass exposure. She was given medications but was not relieved so she was referred for physiotherapy. Physiotherapy treatment was started. Patients sleep was disturbed. The patient had no past history. Family history is not present. Diagnosis: The patient was diagnosed with bronchial asthma. Outcomes & conclusion: This case study showed that breathing exercise, postural drainage and proper relaxation of the patient may reduce the symptoms associated with bronchial asthma also the peak flow values may increase with breathing retraining. Pain reduces with reduction in cough and episodes of dyspnoea. Also educating the patient about prevention of asthmatic episodes help the patient in many ways. Along with bronchodilators physiotherapy plays an integral part in treating the patient with bronchial asthma.

scholarly journals Diffuse Dermal Angiomatosis of the Breasts: A Case Series of 8 Patients

2021 ◽  
Vol 5 (3) ◽  
pp. 301-306
Author(s):  
Landon Kaleb Hobbs ◽  
Darren Guffy ◽  
R. Hal Flowers
Keyword(s):  
Weight Loss ◽  
Smoking Cessation ◽  
Reduction Mammaplasty ◽  
Case Series ◽  
Retrospective Chart Review ◽  
Standard Of Care ◽  
Smoking History ◽  
Potential Association ◽  
Significant Difference ◽  
History Of

Background: Diffuse dermal angiomatosis (DDA) is a rare, reactive vascular disorder of the skin. Association with vascular disease, smoking, and large pendulous breasts has been reported. No standard of care exists but benefit with medication and reduction mammaplasty has been reported. Methods: We report a case of a 49-year-old obese female with a history of smoking who presented with DDA that improved with smoking cessation and pentoxifylline prior to reduction mammaplasty. We also performed a retrospective chart review of all patients with DDA seen at our institution between 2010 and 2020. Results: Eight female patients with DDA affecting the breasts were evaluated at our institution. The mean age was 49.5 years. Five of the patients noted symptoms at presentation. Obesity was seen in 7 (87.5%) patients and 5 (63%) had a smoking history. There was no significant difference between symptomatic and asymptomatic groups in regard to age, t4=-0.63, p=0.56, but BMI trended higher in the symptomatic group, t6=2.27, p=0.06. Three patients (38%) were noted to have fibromyalgia. All symptomatic patients saw improvement in their symptoms with treatments including reduction mammaplasty (1 patient), aspirin (1 patient), pentoxifylline (3 patients), smoking cessation (2 patients), and/or weight loss (1 patient). Conclusions: Our series is the second largest series of DDA of the breasts and confirms many reported associations including obesity, smoking, and large pendulous breasts. We report the first known case of improvement with weight loss as a sole intervention, as well as identify a novel potential association between DDA and fibromyalgia.

scholarly journals Hashimoto’s Thyroiditis Presenting as Bilateral Ovarian Masses in an Adolescent

2021 ◽  
Vol 2 (2) ◽  
pp. 81-85
Author(s):  
Paapa Dasari ◽  
Nitin M ◽  
Chitra Thiyagarajan
Keyword(s):  
Ovarian Cyst ◽  
Hashimoto’S Thyroiditis ◽  
Emergency Services ◽  
Past History ◽  
Cyst Formation ◽  
Hashimoto's Thyroiditis ◽  
Pain Abdomen ◽  
History Of ◽  
Ovarian Masses

Hypothyroidism can cause significant reproductive morbidity and its association with ovarian cyst formation is rare and when it occurs in children, it is referred to as Van Wyk and Grumbach syndrome. An 18-year-old girl was referred to our emergency services with suspicion of torsion ovarian cyst with USG findings as she had pain abdomen and vomiting of 3 days duration. She was provisionally prepared for laparoscopic surgery but on revaluation by USG bilateral thecaleutein cysts measuring 7x6.8x3.5 cms (right) and 10x6.8 x3.2 cms (left) were diagnosed. Her TSH level was 483 mI U/L . On probing she revealed past history of diagnosis of hypothyroidism and discontinuation of thyroxin therapy after taking for 6 months. Her anti TPO antibodies were >1300 IU/mL. USG thyroid revealed features suggestive of Hashimoto’s thyroiditis. She was counselled and started on thyroxin therapy with a dose of 4µg/kg and after 2 months of follow up the ovarian cysts have regressed and ovaries appeared normal on USG.

scholarly journals Picture Quiz: An unusual cause of headache

2005 ◽  
Vol 4 (1) ◽  
pp. 27-27
Author(s):  
Satyen Shukla ◽  
◽  
V Anand ◽  
Keyword(s):  
Weight Loss ◽  
Past History ◽  
Cardiac Symptoms ◽  
History Of ◽  
Occipital Headache

A sixty-six year old lady was admitted after describing two ‘vacant’ episodes with collapse. She had also complained of chronic fronto-occipital headache and more than 10kg weight loss over the preceding three month period. She denied any gastrointestinal, respiratory or cardiac symptoms. She was a non-smoker and did not drink alcohol regularly. She had a past history of hypertension and hypothyroidism for which she was taking ramipril and thyroxine. On examination she appeared cachexic, but no other abnormality was detected.

scholarly journals Disseminated Tuberculosis Causing Addison’s Disease in an Adult Diabetic Patient

2016 ◽  
Vol 33 (1) ◽  
pp. 44-47
Author(s):  
Nazmul Kabir Qureshi ◽  
Zafar Ahmed Latif
Keyword(s):  
Weight Loss ◽  
Past History ◽  
Gastrointestinal Symptoms ◽  
Adrenal Crisis ◽  
Endocrine Glands ◽  
Acth Stimulation Test ◽  
Acth Stimulation ◽  
The Face ◽  
History Of ◽  
Low Cortisol

Tuberculosis may affect many of the endocrine glands including the hypothalamus, pituitary, thyroid with adrenal gland being the commonest. We describe a patient presented with recurrent spontaneous hypoglycemia, hypotension, fever, weight loss and cough. Along with this clinical picture, high ACTH in the face of low cortisol was compatible with diagnosis of Addison’s disease. Rapid ACTH stimulation test affirmed the diagnosis. Disseminated TB affecting adrenal glands was supported by CXR, USG, CT Abdomen and FNAC. Adrenal Crisis was led by add-on bacterial pneumonia. Patient made good recovery with treatment for adrenal crisis and subsequently with standard antitubercular regimen and steroid replacement therapy. Tuberculosis, although uncommon but potentially devastating cause of adrenal failure, merits consideration when fever, weight loss, gastrointestinal symptoms, hyponatremia, hyperkalemia are observed in patients with features of active tuberculosis or past history of tuberculosisJ Bangladesh Coll Phys Surg 2015; 33(1): 44-47

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