Search

Introduction: Systemic lupus erythematosus (SLE) is a systemic autoimmune disease with increased prevalence in recent years. One of the extra skeletal functions of vitamin D is involved in regulation of immune response. Objectives: This study was to determine vitamin D status in SLE patients and the relationship with disease activity. Methods: This prospective observational study was conducted at Medicine department in Dhaka Medical College and Hospital. Data regarding disease activity of SLE was taken from 50 SLE patients fulfilling ACR criteria and disease activity was calculated by SLEDAI score. Vitamin D level was quantified by ELISA. Results: Out of 50 patients, 46(92%) were female and 4(8%) were male. Age range was 15 to 65 years and mean age was 28.00 ± 13.34 SD. Most of the population reside in rural areas (n=32, 64%) and rest from urban areas (n=18,36%). Common presentations were fever (62%), proteinuria (50%), rash (40%), vasculitis (36%) and hematuria (34%). Overall mean SLEDAI score was 18.24 ± 9.67. Among the study population, 21(42%) patients had very highly active disease, 12(24%) patients had highly active disease, 11(22%) patients had moderately active disease and 6(12%) patients had mildly active disease. Mean vitamin D level was 16.70 ± 8.83 ng/ml. In this study, majority were found to be vitamin D deficient 37(74%), out of rest 7(14%) patients had insufficient vitamin D level and 6(12%) patients had sufficient vitamin D. This study showed that there is negative linear correlation between SLEDAI score and vitamin D level which is statistically significant (p value <0.001 and r=-0.577). Conclusion: Low vitamin D level in SLE patients correlated with increased disease activity. [ABSTRACT FROM AUTHOR]

Hyperpigmentation as primary symptom is rare in vitamin B12 deficiency. This adolescent non vegetarian girl presented with hyperpigmentation, anaemia, glossitis and weight loss. She was worked up to find out the cause of anemia and hyperpigmentation. Addison disease was a strong provisional diagnosis. Her cortisol level was normal and megaloblastic anemia due to vitamin B12 deficiency was found. All of her symptoms were dramatically improved by injectable cobalamin. As vitamin B12 deficiency is a treatable condition so it should be ruled out in patient presenting with hyperpigmentation. Early replacement therapy also prevents multisystem involvement like bone marrow failure and demyelinating neurological disease. [ABSTRACT FROM AUTHOR]

A heterotopic pregnancy is a rare complication of pregnancy in which both extra-uterine (ectopic pregnancy) and intrauterine pregnancy occur simultaneously. The prevalence of heterotopic pregnancy is estimated at 0.6-2.5: 10,000 pregnancy. It is a challenge for obstetrician to manage the tubal pregnancy without interruption of intrauterine pregnancy. Here we describe a case who had left tubal alive ectopic pregnancy & also intrauterine alive pregnancy simultaneously after a natural conception. This patient was managed successfully with laparoscopic left salpingectomy, and intrauterine pregnancy has been continuing. There are some precautions during laparoscopic procedure & post operative period which can help for continuation of intrauterine pregnancy. In our clinical experience, this is an extreme rare disorder and we feel interest to report this case. A heterotopic pregnancy can result from a natural conception; it requires a high index of suspicious for early and timely diagnosis; a timely intervention can result in a successful outcome of the intrauterine fetus. [ABSTRACT FROM AUTHOR]

Raised intracranial pressure in the absence of an intracranial mass or hydrocephalus (BIH or pseudotumor cerebri) has been described in association with many conditions including SLE. Several pathogenic pathways tie BIH with SLE as thrombotic obliteration of cerebral arteriolar and venous systems and immune complex deposition within the arachnoid villi that are responsible for cerebrospinal fluid (CSF) absorption. The diagnosis of BIH was confirmed by increased intracranial pressure in the absence of any abnormal radiological findings of the brain. We report a young woman with SLE complicated by BIH which resolved with corticosteroid therapy and osmotic diuretics. [ABSTRACT FROM AUTHOR]

When supplementation of oxygen is inappropriate there is chance of development of either hypoxia or hyperoxia. During oxygen therapy, oxygen level should be maintained within a target-able range through proper monitoring. Pulse oximetry is a useful convenient and reliable monitoring system. The principle of working of pulse oximeter is based on the fact that oxyhaemoglobin and deoxyhaemoglobin absorb light at the red end of the spectrum differently; Deoxyhaemoglobin absorbs more red than infrared and oxyhaemoglobin more infrared than red. The 'emitter' of the probe of pulse oximeter sends equal intensities of red and infrared light into the tissue. The 'sensor' detects the ratio of red to infrared that emerges. From this information the proportion of oxyhaemoglobin to deoxyhaemoglobinthat is, the percentage saturation of hemoglobin with oxygen is calculated and displayed to the monitor of the instrument. The main advantage of pulse oximeter is that it is noninvasive, less complex, does not require calibration, provides continuous measurement of hemoglobin-oxygen saturation (SpO2), fast response time and high accuracy. Limitations of accuracy of pulse oximetry lie on poor perfusion, hypoxic events, hyperemia, severe anemia, dyshemoglobinemias, high oxygen partial pressures (PaO2), superficial pigments, black skin of infant, motion artifact, pressure on sensor, presence of abnormal dye, light and electrical interference. It is essential to remember the limitations of this instrument before going to pulse oximetry. [ABSTRACT FROM AUTHOR]