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Purpose: Diabetic kidney disease (DKD) represents a unique subset of patients with chronic kidney disease (CKD). Acute kidney injury (AKI) is implicated in DKD progression; however, their interplay is not studied well. We studied risk factors for AKI and the effect of AKI on disease progression in a homogeneous group of patients with DKD. Patients and Methods: We conducted a retrospective open cohort study of patients with DKD at a single tertiary care centre between August 2016 – August 2019. Patients with a minimum follow-up of 2 years were included in the study. The incidence, etiology and risk factors for AKI were studied. The primary outcome studied was the effect of AKI on reduction in estimated glomerular filtration rate (eGFR) in DKD. Loss in eGFR by 50% and need for renal replacement therapy or reaching CKD stage V were studied as secondary outcomes. Results: Two hundred and ninety-two DKD patients meeting the study criteria with a follow-up of 29.57 (± 4.3) months were included. The incidence of AKI was 31.1%. Sepsis was the most common etiology (61%). Proteinuria was an independent risk factor for AKI after adjusting for covariates (adjusted OR - 1.158; 95% CI (1.018– 1.316); p=0.025). In patients with AKI, median decline in eGFR was 10.29 mL/min/1.73m2/year (IQR-5.58– 13.84) which was significantly higher compared to patients with no AKI [eGFR 7.25 (IQR 5.06– 11.38); p-0.014]. On subgroup analysis, sepsis-induced AKI (versus non-sepsis AKI; p< 0.001) and higher AKI stage (stage 2/3 versus stage 1; p=0.019) were associated with a faster decline in eGFR. Conclusion: AKI is common in patients with DKD with sepsis being the most common etiology. AKI in diabetic kidney disease is associated with a faster decline in eGFR. Baseline proteinuria is an independent risk factor for AKI. [ABSTRACT FROM AUTHOR]

Primary urinary Bladder Adenocarcinoma (PBA) is an uncommon neoplasm and can cause diagnostic difficulties due to histologic similarities with adenocarcinomas of adjacent structures like Gastrointestinal Tract (GIT) and prostate, since involvement of the bladder by metastasis or direct spread can occur. Seven cases of bladder adenocarcinomas were diagnosed during a period of four years in a tertiary care hospital. Patient's age ranged from 26-78 years with a male predilection. Three cases were signet ring type adenocarcinomas, two cases were subtyped as enteric variant, one as mucinous variant and one as adenocarcinoma Not Otherwise Specified (NOS) variant. One case showed urachal involvement. Common site of involvement was the base and posterior wall of the bladder. Three cases had prior history of GIT malignancy. No morphologic difference was identified to differentiate primary from secondary adenocarcinomas. Bladder adenocarcinoma is rare tumours. Primary and secondary adenocarcinomas cannot be distinguished from each other on morphologic grounds. Ancillary studies may have limited role in distinguishing between the two. Hence, clinical correlation has a major role in their evaluation. [ABSTRACT FROM AUTHOR]

Dressler's syndrome is pericarditis which develops 2-10 weeks after myocardial infarction or due to a traumatic etiology. Dressler's syndrome is an immune system response that damages the heart tissues or pericardium secondary to events like myocardial infarction, heart surgery, or traumatic injury with incidence of 3-4 %. This is usually diagnosed in autopsy due to the narrow treatment window which makes clinical diagnosis difficult. This case highlights the rare condition called Dressler's syndrome. [ABSTRACT FROM AUTHOR]

Sudden deaths of cardiac origin are usually caused by unexpected loss of heart function. One of the causes may be Infective endocarditis (IE) which refers to the microbial infection of the heart valves or mural endocardium that leads to the formation of thrombotic vegetations that cause calcification and destruction of underlying cardiac tissue. The vegetations are typically friable and embolize easily causing abscesses (Ring abscess), septic infarcts and mycotic aneurysms. Left untreated, IE may lead to congestive heart failure (CHF). Hence, it is important to discuss cases where IE was the main cause for death. Case suggested of a 67-year-old female who developed breathlessness, was taken to a local hospital and later brought to a multi-speciality hospital on the advice of doctors where she was declared brought dead. Internal Examination revealed the brain to be soft, congested and oedematous. There was coning of the orbital part of the frontal lobe, uncal part of the hippocampal gyrus of the temporal lobe and the cerebellar tonsil bilaterally. Tracheal lumen contained blood stained mucoid fluid. White patch was present on the anterior surface of the right ventricle 4 cm above apex. Right coronary artery showed 50% occlusion in its entire course. Left anterior descending artery showed 75% occlusion for 4cm from its origin. Multiple atheromatous streaks and plaques were present over the aortic intima at several places. Histopathology suggested chronic myocardial infarct with left coronary artery atherosclerosis. Pseudo hyphae were noticed in the vegetation's on the heart valve which were confirmed to be belonging to the genus Candida. Final opinion as to the cause of death after hospital records, autopsy findings, histopathology report and RFSL reports-due to sequelae of fungal infective endocarditis. [ABSTRACT FROM AUTHOR]

Amniotic fluid embolism (AFE) is one of the most catastrophic complications of pregnancy in which it is postulated that amniotic fluid, fetal cells, hair, or other debris enters the maternal pulmonary circulation, causing cardiovascular collapse and other complications which are a cause of high case fatality. It was first reported by Meyer in 1926. The incidence of Amniotic fluid embolism is rare, and the exact pathophysiology is still unknown. The process is similar to anaphylaxis than to embolism, so also termed as anaphylactoid syndrome of pregnancy because foetal tissue or amniotic fluid components are not universally found in women who present with signs and symptoms attributable to AFE. This is a case of a 27-year old female who developed severe bleeding after delivery of a male child and died 3 hours later to it. The post mortem report showed 50 ml of straw-coloured fluid in both the right and left pleura. Section from lung shows dilated and preserved alveolar air spaces with luminal secretions; surrounded by congested and inflamed interstitium, with congested blood vessels as per the histopathological report. Vessels showed luminal lamellated keratin flakes and squamous cells. The cause of death on examination was found to be amniotic fluid embolism. Since there was no indication of any sort of abdominal trauma therefore in such cases it becomes important to figure out the possible reasons behind the development of amniotic fluid embolism in an apparently normal individual. Though it is a rare condition, an early diagnosis of amniotic fluid embolism is necessary to prevent fatality. [ABSTRACT FROM AUTHOR]