Laxmikant Ramkumarsingh Tomar

Serum organochlorine pesticide levels in patients with metabolic syndrome

Introduction: Organochlorine pesticides (OCPs) are endocrinal disruptors that tend to accumulate in adipose tissue and have been found to be associated with Metabolic Syndrome (MS). Aim and Objectives: 1. To measure serum OCP levels in patients of MS and control subjects, 2. To identify differences, if any, in serum OCP levels, in patients with MS and control subjects. Materials and Methods: Cross-sectional study was conducted in the Departments of Medicine and Biochemistry at University College of Medical Sciences (UCMS) and Guru Teg Bahadur Hospital (GTBH), Delhi. Nine OCPs [α-HCH (Hexachlorocyclohexane), β-HCH, g-HCH, α-endosulfan, β-endosulfan, aldrin, dieldrin, p, p’-DDT (Dichloro-diphenyl-trichloro-ethane), and p, p’-DDE (Dichloro-diphenyl-dichloro-ethylene)] were studied. Fifty subjects ≥18 years with MS (study group) and 50 age and sex-matched controls were included in the study. Exclusion criteria: (1) Persons having chronic occupational exposure to OCPs such as workers of pesticide factories, (2) Recent exposure to OCPs within 4 weeks. Results: Levels of all nine OCPs were higher in cases as compared to controls. However, only the mean value of β-HCH in cases (8.40 ± 8.64 ng/ml) was significantly (P < 0.001) higher as compared to controls (2.58 ± 2.34 ng/ml). After adjustment of confounding factors like age, sex, smoking, alcohol, and body mass index (BMI), only β-HCH and aldrin levels were positively and significantly associated with the risk of having MS. Adjusted Odds Ratio (OR) was 1.34 [CI = 1.14-1.57 (P < 0.001)] and 1.23 [CI = 1.01-1.50 (P = 0.045)], respectively. Conclusion: There was a significant association of β- HCH and aldrin levels with MS.

A rare presentation of methanol toxicity

Methanol is a highly toxic alcohol resembling ethanol in smell and taste. Methanol poisoning is a lethal form of poisoning that can cause severe metabolic acidosis, visual disturbances, and neurological deficit. Brain lesions typically described in methanol toxicity are in the form of hemorrhagic and non-hemorrhagic necrosis of the basal ganglia and sub-cortical white matter. To our knowledge, lesions in the parietal, temporal, or frontal areas of cerebrum and cerebellar hemispheres have been rarely reported so far. We herewith report this rare presentation.

Complicated malaria: a rare presentation of Plasmodium ovale.

Malaria has emerged as a major public health problem worldwide. Complications are commonly seen in Plasmodium falciparum (P. falciparum) and Plasmodium vivax (P. vivax) infection, but due to Plasmodium ovale (P. ovale) infection is rarely described in literature. Here we report a case of severe disease due to P. ovale infection complicated with jaundice, thrombocytopenia, hypotension and acute renal failure.

Typhoid and dengue coinfection: case reports.

Both dengue and typhoid fever have emerged as major public health problems in India. Coinfection with both these diseases is rarely reported. Here we report two confirmed cases of concurrent illness of dengue with typhoid fever; both patients were managed as outpatients and recovered completely.

Acute viral hepatitis E presenting with haemolytic anaemia and acute renal failure in a patient with glucose-6-phosphate dehydrogenase deficiency.

The association of acute hepatitis E viral (HEV) infection with glucose-6-phosphate dehydrogenase (G6PD) deficiency leading to extensive intravascular haemolysis is a very rare clinical entity. Here we discuss such a patient, who presented with acute HEV illness, developed severe intravascular haemolysis and unusually high levels of bilirubin, complicated by acute renal failure (ARF), and was later on found to have a deficiency of G6PD. The patient recovered completely with haemodialysis and supportive management.

Temporomandibular joint ankylosis in ankylosing spondylitis: A case report and review of literature

Ankylosing spondylitis (AS) is a chronic systemic inflammatory disorder. It primarily affects the axial skeleton through involvement of the peripheral joint scan occurs. Temporomandibular joint (TMJ) involvement in AS varies from 4% to 35%. Here, we present a case of a 35-year-old male, follow-up of AS from last 8 years on nonsteroidal anti-inflammatory drugs, presented with fresh complaints of painfully restricted movements of jaw during swallowing. Computer tomography of patient demonstrates articular cartilage changes with disc and joint abnormalities.

Splenic abscess: Plasmodium vivax with secondary Escherichia coli infection

Splenic abscess is a rare clinical entity as described in literature. The incidence is in the range of 0.14–0.7% and it has a high mortality rate. Hence, it is important to know its clinical presentation and complications, so that it can be treated early. We report a 40-year-old diabetic man who presented with fever with chills and rigor for the last 9 days and heaviness in the left hypochondrium for the last 6 days. He was initially diagnosed as having splenomegaly due to Plasmodium vivax (P. vivax), but was later found to have a splenic abscess due to Escherichia coli (E. coli). This was successfully managed by catheter drainage (CD) and antibiotic treatment.

An unusual presentation of dose dependent SIADH secondary to mirtazapine therapy

Australian & New Zealand Journal of Psychiatry, 49(11) punishment. JS shared these beliefs, founded on a brief drug addiction in her 20s for which she felt extreme guilt. The voice also commanded her to perform humiliating acts as retribution, including removing clothing ‘at the mailbox’ and simulating sex. This episode occurred in the setting of 3 years of worsening depressive symptoms, secondary to isolation and an unintimate marriage. Psychodynamically, JS experienced an unaffectionate upbringing, which may have influenced poor attachment and an inability to form meaningful adult relationships. Further more, depression severity and a history of fervent religiosity may have contributed to the bizarre construct of her delusions, an unusual feature of depressive psychosis. Organic causes were excluded and a provisional diagnosis of psychotic depression with erotomanic features was made. She was initiated on 5 mg olanzapine daily, which resulted in improvement in her psychotic and mood symptoms. Erotomania may be classified as a primary (Diagnostic and Statistical Manual of Mental Disorders–Fifth Edition [DSM-V] delusional disorder) or secondary condition, associated with schizophrenia, bipolar affective disorder and major depression. Aetiologically, hypothesised contributing factors (Jordan et al., 2006) include the following:

Diffuse melanonychia as a clue to vitamin B12 deficiency.

Nail changes are often considered a mirror of internal disease. Here, we present a case report of a 16-year-old girl whose primary complaint was nail hyperpigmentation, and who was later diagnosed as having megaloblastic anaemia. Melanonychia is defined as blackish discoloration of the nail plate. It has been reported rarely in vitamin B12 deficiency, in the form of longitudinal melanonychia, with a diffuse bluish discoloration and reticular pattern. This is reversible with vitamin B12 treatment.

Carpal Tunnel Syndrome in Sarcoidosis: A Case Report of a Rare Neurologic Manifestation.

INTRODUCTION Sarcoidosis is a multisystemic inflammatory disease with myriad clinical manifestations. Neurologic involvement in sarcoidosis is uncommon. Peripheral neuropathic presentations include mononeuropathy, mononeuritis multiplex, and generalized sensory, motor, autonomic, and sensorimotor polyneuropathies. CASE PRESENTATION We report a case of carpal tunnel syndrome caused by sarcoidosis in a 30-year-old woman. Other causes of carpal tunnel syndrome were ruled out. The patient responded well to the standard line of corticosteroid treatment and wrist splinting. DISCUSSION Carpal tunnel syndrome caused by sarcoidosis is a rare presentation. The mechanism of neurologic involvement in sarcoidosis is not clear.