BackgroundPrevious studies have shown that microalbuminuria (MAU) is an independent risk factor for cardiovascular diseases in diabetics, hypertensive patients and in the general population. However, the correlation of MAU with the severity of coronary artery disease (CAD) in non-diabetic patients has not been addressed in detail. This study aimed to investigate the relationship between MAU and severity of angiographically confirmed CAD in non-diabetic patients.MethodsThis was a cross-sectional study, which included 90 non-diabetic patients with documented CAD by coronary angiography. The ratio of urine albumin to creatinine was used to define MAU and severity of CAD was estimated using SYNTAX score. Patients were divided into two groups: group I that included patients without MAU and group II that included patients with MAU.ResultsOut of 90 non-diabetic CAD patients, 62 (68.9%) were in group I (MAU negative) and 28 (31.1%) were in group II (MAU positive). There was statistically significant difference in the median SYNTAX score between the groups (21 vs. 28, P < 0.001). The prevalences of double vessel CAD and triple vessel CAD were significantly higher in MAU positive group. There was a strong relationship between the presence of MAU and the extent and complexity of CAD (r = 0.094; P < 0.001).ConclusionThus, we conclude that patients with MAU have more severe angiographically detected CAD than those without MAU, and MAU exhibits a significant association with the presence and severity of CAD.

Coeliac disease has a significant association with many autoimmune disorders. It shares many common genetic and immunological features with other autoimmune diseases. Gluten, a gut-derived antigen, is the driver of the autoimmunity seen in coeliac disease. The altered intestinal permeability found in coeliac patients, coupled with a genetic predisposition and altered immunological response, may result in a systemic immune response that is directed against sites other than the gut. Gut-derived antigens may have a role in the pathogenesis of other autoimmune disorders including rheumatoid arthritis. Here we report a case of adult coeliac disease associated with rheumatoid arthritis.

No abstract

A 22-year-old female, living in a village in northeast India presented with, high grade, continuous fever for five days, associated with headache and myalgia. Fever was followed by irrelevant talks and alteration in sensorium. There was no history of seizure or vomiting. She also developed yellowish discolouration of sclera. There was no past or contact history of tuberculosis. On examination, patient was febrile and had altered sensorium. Pulse rate was 100/ minute, regular, BP-110/70 mm Hg, respiratory rate-24/minute. The patient had a dark, hyperpigmented, raised, patch in left infraaxillary region suggestive of an eschar [Table/ Fig-1]. Respiratory system, cardiovascular system and per abdominal examination were non contributory. On neurological examination, higher mental function was impaired in the form of disorientation and clouding of consciousness. Plantar reflex was flexor bilaterally. Cranial nerve examination revealed bilateral lateral rectus palsy [Table/ Fig-2]. Investigations showed Hb-9.3 gm%, total leucocyte count-6000/cumm, platelets-1.9 lacs/cumm, PCV-28%, ESR-70mm/h. Peripheral blood smear showed normocytic normochromic anaemia with relative lymphocytosis. Malaria parasite slide and dual antigen were negative. Liver function test revealed total bilirubin-3.2mg/dl, direct bilirubin-1.5 mg/dl, SGOT-169 U/l, SGPT-91 U/l, albumin-2.4 gm/dl, globulin-4.9 gm/dl. Blood for HbsAg, anti HCV, HIV-1 and HIV-2 antibody were negative. Dengue NS-1 antigen and IgM, IgG anti-dengue antibody by ELISA were also negative. Urea-22 mg/ dl, creatinine-0.5 mg/dl. Widal test was negative. Chest X-ray was normal. Sonography of abdomen revealed mild hepatosplenomegaly with minimal right sided pleural effusion. Cerebrospinal fluid study showed cell count-3/cumm predominantly lymphocytes, glucose 54mg/dl, protein-117 mg/dl, Adenosine Deaminase (ADA) below 10 U/l. MRI of brain with contrast was normal. Considering patient's area of living, clinical presentation of fever and skin lesion, blood test to confirm scrub typhus (IgM) was sent which came out to be positive on immunofluorescence assay. Skin biopsy showed extensive dermal necrosis with small vessels of the upper and lower dermis showing necrotizing vasculitis with perivascular lymphocytic and neutrophilic infiltrate. There was extravasation of red blood cells and evidence of luminal thrombosis and also there were zones of infarction . Features were in favour of typical eschar (Doxycycline to be considered after confirmation of diagnosis). She responded on third day with improvement in sensorium however she developed diplopia and her lateral rectus palsy persisted. The patient was given a full course of doxycycline along with azithromycin with occular movement exercises and discharged with an advice to follow up in outpatient department. Scrub typhus, a rickettsial disease is endemic in several parts of India usually presenting with acute symptoms. Fever, maculopapular rash, eschar, history of tick exposure and supportive diagnostic tests usually leads to diagnosis...

No abstract