Sunday, September 25, 2016

A 25 Year Old Man Presents With Cough, Low grade fever And Night sweats For 3 Weeks


A 25 -year-old man from the third world country presents to his doctor with a persistent cough for 3 weeks, low grade fever, and night sweats. His chest x-ray  is shown above. The X ray shows mediastinal and right hilar lymphadenopathy and right upper lobe consolidation concerning
for primary tuberculosis (shown by arrows).
The patient's sputum is sent for acid-fast bacillus (AFB) stain and cultures, and the results show acid-fast bacilli consistent with Mycobacterium species.
While culture results are pending, the patient is started on 4 antituberculosis drugs. Fortunately, the sputum  culture result shows pan susceptible Mycobacterium tuberculosis, and his treatment is continued.

Case Discussion:

Tuberculosis:
Introduction: Tuberculosis (TB) is a bacterial infection caused by Mycobacterium . tuberculosis, an
obligate intracellular pathogen that is aerobic, acid fast, and non encapsulated.
TB primarily involves the lungs, although other organs are involved in one-third of cases.

More than 8 million cases occur annually around the world, with nearly 2 million TB-related deaths.  95% of TB deaths occur in low- and middle-income countries.

Risk Factors: Risk factors for infection or progression to active TB include:

• Populations who are at risk to overcrowding and malnutrition.
• HIV
• Immunocompromised states (e.g., cancer, treatment with tumor necrosis factor antagonists)
• Chronic diseases such as diabetes mellitus  or chronic renal failure/hemodialysis
• Malignancy.
• Genetic susceptibility.
• Injection drug users
• Smoking
• Personnel who work or live in high-risk settings (e.g., prisons, long-term care facilities, and hospitals).
• Adult women (ratio 2:1 adult man).
• Older age (both infection and progression).
• Children younger than 4 years of age who are exposed to high-risk individuals.
• Recent infection

Clinical Features: 

  • The disease may be asymptomatic in some patients.
  • TB can affect any organ system.

  • Manifestation of active TB can be classified as pulmonary or extrapulmonary.
  • Saturday, September 24, 2016

    Effect Of Hyperuricaemia On Kidney.

    The above picture shows uric acid kidney stone kept in the pathology lab. Let us briefly study the effects of Hyperuricaemia on kidney.

    Causes Of Hyperuricaemia: High levels of urate in blood is known as hyperuricaemia. It may result from increased turnover (15%) or reduced excretion of urate (85%)
    The causes are given below:

    • Drugs: cytotoxics, thiazides, loop diuretics,pyrazinamide
    • Increased cell turn over: Lymphoma, leukemia, psoariasisf, hemolysis, muscle death-rhabdomyolysis. 
    • Reduced excretion: Promary gout, chronic kidney disease, lead nephropathy, hyper parathyroidism, pre eclampsia
    • Others; Hypertension, Hyperlipedaemia 
    • Lesch-Nyhan syndrome - a disorder of purine synthesis
    Hyperuricaemia and Renal Failure: Severe renal failure from any cause may be associated with hyperuricaemia, and rarely this may cause gout. Sometimes the relationship of cause and effect is reversed so that it is hyperuricaemia that causes the renal failure. This can occur in cytotoxic treatment (tumor lysis syndrome) and in muscle necrosis.

    How Urate Causes Renal Failure?
    Urate is poorly soluble in water so over excretion can lead to crystal precipitation. Renal failure occurs most commonly becauseurate precipitates in the renal tubules. This may occur at a plasma level > 1.19mmol/L. In some instances uretric obstruction from urate crystals may occur. This responds to retrograde uretric catheterization and lavage.

    Thursday, September 22, 2016

    A Sucking Blister In A 3 Day Old Baby

    The picture above shows a blister on the of the hand of a 3 day old baby. This baby boy was delivered at full term to a healthy mother with no prenatal complications. Mother mentions that the baby is a vigorous feeder and seems hungry all the time. He has been sucking on his hands and wrists. The baby is otherwise asymptommatic. On examination of the lesion the underlying skin is non erythematous.

    What is the most likely diagnosis?

    A sucking blister

    A Case Of Cervical Spondylosis

    A 55 Year old Man is seen by his general physical with the complains of pain in his neck over the past 6 months. The pain has been gradually increasing but comes and goes with weeks without any pain. He mentions feeling stiffness in his neck early in the morning.
    The pain sometimes spreads to his right shoulder and he feels tingling sensation in his right arm and hand. A Neck X ray was ordered and showed features of Cervical spondylosis:



    Case Discussion

    Cervical Spondylosis: Is an age related degeneration (wear and tear) of the bones (vertebrae) and discs in the neck. It is also known as  cervical osteoarthritis

    According to certain studies more than 85% of people above the age of 60 years have cervical spondylosis but most of these people have no symptoms.

    Etiology and Pathophysiology: As a person ages , the bones and cartilage that make up the backbone and neck gradually starts to wear and tear and develop certain degenerative changes. These changes can include:

    Wednesday, September 21, 2016

    Treatment Of Supraventricular tachycardia in A Hemodynamically Unstable Patient



    A hemodynamically unstable patient is noted to have supraventricular tachycardia. The most appropriate treatment is

    A) Electrical synchronized cardioversion
    B) Carotid massage
    C) Adenosine
    D) Verapamil
    E) Digoxin

    Answer and Discussion
    The answer is A. Electrical synchronized cardioversion

    Supraventricular tachycardia is characterized by a rapid regular rhythm with a narrow QRS complex and abnormal P waves. The heart rate is usually 100 to 200 bpm. Some patients may be asymptomatic; others may experience chest pain, palpitations, and shortness of breath.

    Hemodynamically unstable patients with supraventricular tachycardia require immediate treatment with electrical synchronized cardioversion.