Mixed connective tissue disease is a distinct complex overlap disorder characterised by combination of clinical features of systemic lupus erythematosus, systemic sclerosis, polymyositis and rheumatoid arthritis. Higher levels of anti-U1-ribonucleoprotein (anti-U1RNP) antibody has been found in these patients. 39 year old female, known case of hypothyroidism, came with complaints of multiple joint pains with swelling associated with morning stiffness of fingers since last 2 years. She also had dryness of skin, loss of appetite, constipation, difficulty in swallowing and dyspnea on exertion since last 2 months. Considering the joint pains an antinuclear antibody (ANA) was sent. She turned out to be RNP, Sm, Ro 52, Mi-2 positive. Anti-CCP, rheumatoid factors (RA), Raynaud’s phenomenon all were positive. Rheumatologist opinion was taken and she was diagnosed as mixed connective tissue disorder with hypothyroidism. Patient was successfully treated with immunosuppressants and supportive measures and responded well to tablet methotrexate, prednisone, nifedipine and hydroxychloroquine. Our patient had one major and 3 minor criteria: anti RNP antibody positive, Raynaud’s phenomenon, swollen fingers and synovitis. Thus, diagnosed as mixed connective tissue disease.

Anti-synthetase syndrome is an autoimmune disease associated with interstitial lung disease (ILD), dermatomyositis and polymyositis. It has been recognized as an important cause of autoimmune inflammatory myopathy in a subset of patients with dermatomyositis. 37-year-old male, known case of type 1 diabetes mellitus, came with complaints of: generalized anasarca, pain in both knees, ankles, wrist and small joints of fingers. He also had dyspnoea on exertion, chronic non-productive cough, and fever off and on, all for 1 month. Initially all involvement was attributed to diabetes. For joint pain an antinuclear antibodies (ANA) was sent. He turned out to be anti-Jo1, antibody positive. Rash on hands was diagnosed by dermatologist as, mechanic’s hand, hence diagnosed as an inflammatory myopathy with dermatomyositis anti-synthetase syndrome. Patient was successfully treated with immunosuppressants and supportive treatment and responded to tablet Prednisolone and Mycophenolate mofetil. The patient had one major and 2 minor criteria-ILD, arthritis and Mechanic’s hand and anti-Jo 1 antibody positive. Thus, diagnosed as anti-synthetase syndrome with type 1 diabetes mellitus.

Acute respiratory distress syndrome (ARDS) is a life threatening complication of many infectious diseases like malaria, H1N1, bacterial pneumonia, and leptospira. Malaria is an important treatable cause of ARDS. ARDS can develop either at initial presentation or after initiation of treatment when the parasitaemia is falling and patient is improving. 58 year old female presented with high grade fever and breathlessness since 5 days. Arterial blood gas (ABG) on admission showed type 1 respiratory failure and chest X-ray was suggestive of ARDS. Thus patient was shifted to intensive care unit and was put on non-invasive ventilation. PBS was positive for Plasmodium vivax malaria and patient was started on antimalarial drugs. Considering the epidemic of H1N1 swab was sent for polymerase chain reaction (PCR) which turned out to be negative. Thus antimalarial and supportive treatment for ARDS was continued. Patient was discharged on day 11 and started on tablet primaquine to prevent relapse. ARDS is a hard to predict late complication of severe malaria. ARDS in malaria is a disease with high mortality. Early diagnosis and institution of specific antimalarial treatment along with assisted ventilation can be life-saving.

Background: Electrocardiography (ECG) is an accessible, low cost diagnostic and prognostic tool. Recent studies have shown increased risk of deaths associated with cardiomyopathy and to study the patients with symptoms of cardiomyopathy on basis of ECG.Methods: A total of 50 patients were explained the procedure and the purpose of the study, informed consent was taken from the patient or the relative in a language they can understand. Required physical examination and necessary investigations were carried out. In our study, maximum subjects had normal voltage (80%) low voltage ECG findings were in 20%, normal QRS complex in 78%, wide QRS complex in 20% LBBB/RBBB in 24%. Evidence of ischemia like T wave changes in 34%, ST wave changes in 24% and tachycardia (26%). Thus ECG can give a clue for diagnosing cardiomyopathy and guide us for further managements but it is not a diagnostic marker for it since most of the patients had normal ECG findings.Results: In our study, electrocardiogram findings among patients are: Maximum subjects had normal voltage (80%). Low voltage ECG findings were in 20%. Normal QRS complex in 78%, wide QRS complex in 20% LBBB/RBBB in 24%. Evidence of ischemia in 58% and tachycardia (26%).Conclusions: ECG is an accessible, low cost diagnostic and prognostic tool. Most common findings in cardiomyopathy is biventricular hypertrophy and left bundle branch block with wide QRS complex, low voltage ECG and ST changes as also seen in present study. Thus, ECG can be initial investigation for cardiomyopathy and can give us clue for further investigations and management.