Kolkata, India
Kolkata, India

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Kumar K.,IPGMER | Kole A.K.,Nb Medical College | Karmakar P.S.,IPGMER | Ghosh A.,IPGMER
Rheumatology International | Year: 2012

To study the spectrum of thyroid disorders in systemic lupus erythematosus (SLE). Hundred SLE patients as per American Rheumatology Association(ARA) classification criteria underwent clinical examination, including assessment of disease activity (SLEDAI) and laboratory evaluation for serum triiodothyronine (T3),free thyroxine (FT4), thyroid stimulating hormone (TSH), antithyroperoxidase (TPO) antibody and antithyroglobulin (TG) antibody. Hundred age- and sex-matched apparently healthy individuals served as control. Thirty-six (36%) lupus patients had thyroid dysfunction when compared to 8 (8%) of controls and all of them were women. Primary hypothyroidism was the commonest dysfunction in 14 (14%), while subclinical hypothyroidism and subclinical hyperthyroidism was seen in 12 (12%) and 2 (2%), respectively. Eight (8%) had isolated low T3 consistent with sick euthyroid syndrome. Eighteen (50%) of thyroid dysfunction were autoimmune in nature (autoantibody positive) and rest 18 (50%) were non-autoimmune. Euthyroid state with the elevation of antibodies alone was seen in 12 (12%) of the lupus patients. In contrast, only 5 (5%) of controls had primary hypothyroidism and 3 (3%) had subclinical hypothyroidism, while none had hyperthyroidism. SLEDAI score and disease duration were compared between lupus patients with thyroid dysfunction to those with normal thyroid function. A statistically significant association was found between SLEDAI and thyroid dysfunction of sick euthyroid type.SLE disease duration had no statistically significant association with thyroid dysfunction. Prevalence of thyroid autoantibodies in lupus patients was 30% when compared to 10% of controls. Ninety-six (96%) of the SLE patients were ANA positive, while 4 (4%) of them were ANA negative but were anti-Sm antibody positive. There were no suggestions of any other autoimmune endocrine diseases like diabetes or Addison's disease (clinically and on baseline investigations) in our lupus cohort and hence no further work up was done for these diseases. Thyroid disorders are frequent in SLE and are multifactorial with a definite higher prevalence of hypothyroidism as well as thyroid autoantibodies. © 2010 Springer-Verlag.


Viswanathan R.,IPGMER | Singh A.K.,IPGMER | Basu S.,Indian National Institute of Cholera and Enteric Diseases | Chatterjee S.,IPGMER | And 2 more authors.
Archives of Disease in Childhood: Fetal and Neonatal Edition | Year: 2012

Objective: To study the organisms causing early and late onset neonatal sepsis, with special reference to multi-drug resistant gram negative bacilli, at two neonatal units (one urban, one rural) in India. Methods: Prospective surveillance study. Results: There were 159 episodes of sepsis (81 urban and 77 rural) affecting 158 babies. Gram negative bacilli caused 117 infections (68%) and predominated at both centres in both early and late sepsis. Klebsiella pneumoniae was the commonest organism, causing 61 infections (38.3%). In early sepsis (0-2 days), non-fermenting gram negative bacilli caused 42.1% of infections at the urban centre; there were no cases of early Group B Streptococcus sepsis. Late onset sepsis was mainly caused by gram negative bacilli at both centres. Multi-drug resistance of over 80% of early-onset gram negative organisms to ampicillin, third generation cephalosporins and gentamicin indicates that these multi-resistant organisms are almost certainly circulating widely in the community. The overall mortality from early sepsis was 27.3% (9 of 33) and from late sepsis was 26.2% (33 of 126). Gram negative bacilli caused all deaths from early sepsis and 87.5% of deaths from late sepsis. Conclusion: This study shows that multi-drug resistant gram negative bacilli are a major cause of early and late neonatal sepsis in India and are almost certainly widespread in the community.


Chakrabarti S.,IPGMER
Journal of Natural Science, Biology and Medicine | Year: 2015

Thyrotoxic periodic paralysis (TPP) is a rare, but serious condition characterized by acute paralytic attacks and hypokalemia in association with thyrotoxicosis. Although carbohydrate rich meals, strenuous exercise, alcohol, emotional stress are known precipitants of TPP, steroid treatment has rarely been reported to induce TPP. We report a case in which a patient with previously untreated Grave's disease developed TPP following administration of Intravenous hydrocortisone for control of severe anaphylaxis, which to best of our knowledge is very rare.


Bansal P.,IPGMER
Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia | Year: 2012

The most common primary malignant renal tumor is renal cell carcinoma (RCC), which accounts for 3% of all adult malignancies. Bellini duct carcinoma or collecting duct carcinoma is an unusual rare variant of RCC. This histologically distinct tumor is very rare, with less than 100 cases reported in the literature, and accounts for approximately 1% of all malignant renal epithelial tumors. We report two cases of collecting duct carcinoma and highlight the rarity of these tumors and their similarity to RCC.


Chakrabarti S.,IPGMER
Journal of Clinical and Diagnostic Research | Year: 2015

Cronkhite-Canada syndrome (CCS) is an extremely rare non-inherited condition characterized by gastrointestinal hamartomatous polyposis, alopecia, onychodystrophy, hyperpigmentation, weight loss and diarrhoea. The aetiology is probably autoimmune and diagnosis is based on history, physical examination, endoscopic findings of gastrointestinal polyposis, and histology. The disease is very rare; approximately 450 cases of CCS have been reported worldwide. The author reports a case of CCS in an elderly Indian male. © 2015, Journal of Clinical and Diagnostic Research. All Rights Reserved.


Dutta A.K.,IPGMER
Indian Journal of Clinical Biochemistry | Year: 2012

A 60-year-old patient suffering from easy fatigability was noted to have high total but normal conjugated bilirubin level though serum colour was pale. On further investigation the patient was found to be suffering from multiple myeloma and gamma globulin was possibly interfering with total bilirubin estimation. © 2012 Association of Clinical Biochemists of India.


Chakrabarti S.,IPGMER
Journal of Clinical and Diagnostic Research | Year: 2015

Amoebic liver abscess is the most frequent extra-intestinal manifestation of Entamoeba histolytica infection. Immunosuppression is known to predispose to amoebic liver abscess. Although amoebic liver abscess is seen more commonly in patients of Human-Immunodeficiency virus (HIV), first presentation of HIV sero-positive patient as multiple liver abscess is quite uncommon.The author reports an unusual case of multiple liver abscesses in an HIV seropositive patient. This middle aged male with history of multiple unprotected sexual encounters presented with spasmodic abdominal pain, fever, diarrhoea and weight loss along with generalised ill-health and painful liver enlargement. HIV-1 serology was found to be reactive. Imaging revealed an enlarged liver with multiple, irregular, hypoechoic foci characteristic of abscesses. Amoebic aetiology was later confirmed by percutaneous aspiration and microscopy. Administration of appropriate chemotherapeutics along with institution of antiretroviral therapy led to both clinical resolution as well as disappearance of lesions. © 2015, Journal of Clinical and Diagnostic Research. All right reserved.


Chakrabarti S.,IPGMER
Journal of Clinical and Diagnostic Research | Year: 2015

Although serum potassium levels are usually subnormal in Thyrotoxic Periodic Paralysis (TPP), but in exceptionally rare circumstances, it may be normal leading to the entity called normokalemic TPP. The diagnosis of normokalemic TPP is more often overlooked and/or delayed due to lack of awareness among the physicians and associated mild symptoms of hyperthyroidism. Here, the author describes the case of a 27-year-old male with newly diagnosed but untreated Grave’s disease and TPP who was normokalemic during the acute phase of paralysis. Hypokalemia was documented only after resolution of paralytic attacks during subsequent days of admission. The importance of the case report is to highlight upon the fact that TPP should always be considered in an “previously asymptomatic” young Asian individual with acute paralysis with or without hypokalemia, and thyroid function and serial potassium values should be evaluated for diagnosing the usual hypokalemic type or the more rarer variant normokalemic TPP. This case report also deserves mention as the patient of TPP had a notable feature of having preserved reflexes in the face of hypokalemia. © 2015, Journal of Clinical and Diagnostic Research. All rights reserved.


Chakrabarti S.,IPGMER
Journal of Clinical and Diagnostic Research | Year: 2015

Megaloblastic anaemia as a cause of pyrexia is a rare entity. Similarly, hyperpigmentation of skin has rarely been reported as the presenting manifestation of folate and/or vitamin B12 deficiency. The author reports the case of a patient who presented with fever and hyperpigmentation and was diagnosed to have megaloblastic anaemia secondary to vitamin B12 and folate deficiency after other infective, inflammatory/autoimmune, endocrine causes of pyrexia and hyperpigmentation were excluded by appropriate investigations. The patient responded remarkably well to the treatment with vitamin B12 and folic acid supplementation. Although presentation of megaloblastic anaemia as isolated fever or hyperpigmentation are noted in literature, simultaneous fever and hyperpigmentation as its initial presentation is exceedingly rare. © 2015, Journal of Clinical and Diagnostic Research. All rights reserved.


Nandi M.,IPGMER | Sarkar S.,IPGMER
Pediatric Nephrology | Year: 2012

Background: Common manifestations of hypersensitivity reactions to toxins of stinging insects range from local swelling to angioedema and anaphylaxis. Sometimes it may result in unusual manifestations like intravascular hemolysis, disseminated intravascular coagulation, rhabdomyolysis, etc. Acute kidney injury (AKI) due to immune-mediated acute interstitial nephritis is an extremely uncommon manifestation of insect stings. Case-Diagnosis/Treatment: A 9-year-old boy who developed renal failure from acute interstitial nephritis 7 days after getting stung by a swarm of wasps at multiple sites is described. He regained normal renal function after eight sessions of hemodialysis. Conclusions: Acute interstitial nephritis resulting in AKI may be either due to immune-mediated tubulointerstitial injury or acute cellular injury caused by obstruction by pigments like hemoglobin and myoglobin. Timely and appropriate supportive management usually cures the patient without any residual damage. The objective of reporting this case is to draw the attention of fellow clinicians towards the possibility of this unusual but life-threatening delayed complication in multiple wasp stings, even if there are no significant immediate reactions. © 2012 IPNA.

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