Varicella zoster usually manifests as maculopapular rash (MPR), which later progresses to vesicle. It can also manifest as MPR without progression to the vesicle stage. This atypical manifestation is more common in adults and immunocompromised patients. A 30-year-old female presented with high-grade fever and rash over face and body for 5 days. She was diagnosed to have Varicella zoster virus (VZV) infection by positive VZV immunoglobulin M enzyme-linked immunosorbent assay and polymerase chain reaction. We present this case to increase awareness among clinicians on the atypical manifestations of VZV and prevent complications by early diagnosis.
BACKGROUND:The nephrotic syndrome is recognized as an independent entity of renal disease for over half a century. 1 Causes of nephrotic syndrome varies with age, time period, geographical location and race. In children, minimal change nephrotic syndrome is the commonest 2 ; however, membranous nephropathy is most frequent in adults. 3 As it commonly affects the younger age group and is associated with high morbidity and mortality, there is a need to understand and diagnose the disease at an early stage. Hence, this study has been done to identify the clinical presentation, biochemical parameters and histopathology associated with nephrotic syndrome in adults and its subtypes. OBJECTIVE: To study the clinical, biochemical and histopathological profile of patients with Adult Nephrotic Syndrome admitted in our tertiary care hospital. METHODS: Prospective study of 100 patients with Adult Nephrotic Syndrome admitted in our tertiary care hospital were screened with facial puffiness and pedal edema. They were tested for urine proteinuria, urine protein creatinine ratio or 24 hour urine protein estimation. Later renal biopsy was done for all patients to stratify the subtypes. RESULTS: In this study, males were predominantly affected. Most common presenting complaints were facial puffiness and pedal edema. Systolic BP was increased in 96% of patients and diastolic BP was elevated in 50% of patients. Serum LDL and TGL were elevated in nephrotic syndrome. In young patients less than 40 years Focal Segmental Glomerulosclerosis (FSGS) is the commonest type, then Membrano Proliferative Glomerulo Nephritis (MPGN) and Minimal Change Disease (MCD). In individuals more than 40 years, membranous nephropathy was predominantly seen followed by FSGS. CONCLUSION: There is a changing trend in primary nephrotic syndrome and FSGS was found to be the commonest subtype. Male preponderance was noticed and also FSGS was found to be more common in younger adults. Most patients in this study were found to have high BP at presentation. Serum creatinine was markedly elevated in patients with IgA Nephropathy and FSGS subtype. Most patients with FSGS who had elevated creatinine were found to have significant protein loss in urine. Lipids were observed to be elevated in all the subtypes, most significantly in the IGA nephropathy type.
BACKGROUND: Individuals admitted with non ST elevation MI have a wide variation in their disease severity, which ranges according to clinical and laboratory characteristics 1. Thus risk stratification is essential for adequate clinical decision and identifying individuals who benefit from more aggressive therapy. TIMI risk score is the most widely used scoring system for risk stratification because of ease of using this system over others and is much more powerful comparing to other systems. 2 OBJECTIVE: To prognostically correlate TIMI risk score with angiographic severity and extent of coronary artery disease in 100 Patients with non ST elevation acute coronary syndrome. MATERIALS AND METHODS: Individuals meeting the objective criteria for NSTEMI who are undergoing coronary angiography were assessed by TIMI score for risk stratification and quantification of severity of coronary artery disease. RESULTS AND DISCUSSION: Out of 100 NSTEMI patients assessed, significant three vessel disease was found in patients with TIMI score of 5-7 (p value < 0.01) and significant two vessel disease was found with p value of < 0.05 for the same TIMI score of 5-7. CONCLUSION: There is a positive correlation between TIMI score and extent of coronary artery disease. TIMI risk stratification is safe and easy method for rapid assessment of mortality and MI risk.
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