Amyloidosis is a group of heterogeneous diseases characterized by pathological deposition of proteinaceous substance extracellularly in various tissues. The clinical presentation depends on the site of amyloid deposition, with predominant involvement of mesenchymal elements and cutaneous findings in 30–40% of patients in case of primary systemic amyloidosis. We present a case of idiopathic primary systemic amyloidosis presenting with an unusual finding of nodulo-ulcerative lesion over tongue along with multiple skin-colored nodules, mimicking squamous cell carcinoma of tongue with secondary cutaneous metastasis, as well as lacking the classical presentation of purpura, macroglossia, waxy papules, and plaques.

No abstract

Introduction:Raised intracranial pressure (ICP)is important to determine in traumatic & non-traumatic neurological and neurosurgical patients as it may cause signicant neurological deterioration due to secondary brain damage. Intra cranial pressure means exerted by uids such as cerebrospinal uid (CSF) inside the skull and on the brain tissue. So, a quick evaluation of increased ICP is important for the management of patients with traumatic brain injury (TBI) to allow timely intervention to decrease the ICP and maintain adequate cerebral perfusion. Aims: The aim was to evaluate use of bedside sonographic measurement of optic nerve sheath diameter (ONSD) to detect ndings of increased intracranial pressure in adult head injury patients in Emergency department. Methods: This prospective study was conducted at Emergency Medicine department of Mahatma Gandhi medical college & Hospital, Jaipur. Total 108 adult head injury patientswith suspected raised ICPwere included in this study. Bedside ultrasound was done for ONSD measurement, followed by a computed tomography (CT) of brain. Mechanism of injury, GCS, TBI classication, clinical featuresof increased ICP, mean ONSD of both eyes by USG and brain CT ndings of increased ICP were recorded.A mean bipolar ONSD > 5mm was considered abnormal. Result: Present study found Moderate head injury (57.4 %) as most common head injury. Mean ONSD in right eye was 5.964 with SD 0.822 and mean ONSD in left eye was 5.957 with SD 0.822.Total mean ONSD was >5mm was found in 84.25 % patients. Raised ICP features was present in 82.4 % CT brain.GCS score was inversely correlated with mean ONSD. Conclusion: We concluded that thesonographic measurement of optic nerve sheath diameter has excellent diagnostic accuracy to predict increased intracranial pressure in adult head injury patients in Emergency department

No abstract

Background: Management of chronic spontaneous urticaria (CSU) is challenging because of its unpredictable course and negative influence on the quality of life. Second-generation antihistaminics are the first-line treatment. Levocetirizine, a time-tested antihistaminic, has proven efficacy in CSU. Bepotastine, which was previously used for allergic rhinitis and conjunctivitis, has recently been tried in urticaria. It may be a better alternative to levocetirizine because of its long-term safety. Objectives: The aim of this study was to compare the efficacy and safety of levocetirizine and bepotastine in CSU. Materials and Methods: A randomized, active-controlled, open-label, prospective, interventional study was conducted on 70 patients of CSU. After initial clinical assessment and baseline investigations, bepotastine and levocetirizine were prescribed to separate groups of 35 patients for a period of 12 weeks. Urticaria Activity Score (UAS) and Dermatology Life Quality Index (DLQI) were used for assessing the severity of disease. Follow-up visits were planned for evaluating clinical improvement and adverse effects. Results were compared using Mann–Whitney U test and Fisher’s exact test. P < 0.05 was considered statistically significant. Results: The reduction in UAS and DLQI score in levocetirizine group was better than bepotastine group, and the results were statistically significant at 12 weeks (P = 0.0001). Incidence of adverse effects such as sedation and weight gain was higher in levocetirizine group at 12th week (P = 0.0003). Conclusion: The result of the study reveals the superiority of levocetirizine in terms of efficacy, i.e., reduction of UAS and DLQI scores. Bepotastine although slightly lower in efficacy shows better safety profile.