Peri-operative euglycaemic diabetic ketoacidosis is under-recognized and difficult to diagnose due to variable triggers and absence of hyperglycaemia. We report a case of a 58 years old type -2 diabetic female who developed refractory post-operative metabolic acidosis caused by starvation and euglycaemic diabetic ketoacidosis. Recent surgery, major illness, carbohydrate restriction, and a relative insulin deficiency were the contributing factors leading to it. This report highlights the importance of nutrition and appropriate insulin usage in sick peri-operative diabetic patients presenting with unexplained keto acidosis.
Mucormycosis is a rare life-threatening fungal infection. It occurs usually in immunocompromized patients. We present a case of pulmonary mucormycosis in patient with poorly controlled diabetes. The diagnosis was suspected on radiological finding showing a right upper lobe cavitating consolidation and confirmated by isolating typical aspect of the pathogene within histological exam. Patient was treated by liposomal amphotericin B and had significant improvement.
Aims: To illustrate abdominal migraine as a possible and often unrecognized cause of recurrent abdominal pain in children.
Study design: Case report.
Place and duration of study: Department of Propaedeutics of internal diseases, “Heratsi” N1 University Hospital Complex, Yerevan, Armenia, August 2017.
Methodology: The differential diagnosis of abdominal pain in children can be difficult. We present a case of a 12 years old girl who was complaining of recurrent abdominal pain and nausea during the last year, which was affecting her regular activity. After many diagnostic procedures, every possible somatic disease was ruled out, and a diagnosis of abdominal migraine was made. As of now, four years after the initial diagnosis, the abdominal migraine transitioned into migraine headaches, as often occurs in patients with this diagnosis.
Clonal eosinophilia with FIP1L1-PDGFRA rearrangement is a rare disorder which is almost exclusively seen in males. Targeted therapy with Imatinib has led to successful achievement of molecular remission of this disorder but no evidence exists for continuous or maintenance therapy or treatment free remission yet. This is a case of clonal eosinophilia with FIP1L1-PDGFRA rearrangement in a young man, who presented with very high eosinophil and neutrophil counts, moderate thrombocytopenia, hepatosplenomegaly and skin and lung involvement. Imatinib at 100mg daily was started after initial treatment with cytoreductive therapy and steroids. He responded well to low dose Imatinib with complete absence of symptoms and normalization of counts within 3 months and disappearance of molecular evidence of the disease following 2 years of therapy. Imatinib was then tailed off and he remains asymptomatic on a weekly dose of 100mg Imatinib. Workup towards a diagnosis of eosinophilia has been made easy with the new classification and inclusion of molecular evaluation. The high eosinophil count, presence of organomegaly and thrombocytopenia favoured a clonal aetiology .Low dose Imatinib gives excellent clinical, haematological and molecular remission and can be safely reduced thereafter to weekly maintenance.
The word yoga originates from the Sanskrit for union and aims to harmonize mind, body, and spirit. Patanjali, the father of philosophy of Yoga, wrote a Yoga Sutras in which he formalized this discipline. Traditional yoga incorporates the eight limbs. Physical health is the well-being of the body and the proper functioning of the organism of individuals. The mental status examination is a structured assessment of the patient's behavioral and cognitive functioning. Physical Health is correlated with Mental Health because good physical health leaves a better personal feeling in the long term. Objective of this study was to find out the descriptive analysis of Practice of yoga with physical state and Mental state. This study was retrospective survey was conducted on 165 in Ayurvedic Internal Medical Officers under the Bachelor of Ayurveda Medicine and Surgery(BAMS) .They were between the age group of 20-50 years, both male and female were included in the training program at the National Institute of Education. We have used the closed ended “Self-assessment questionnaire”. Results of this study ,majority were included to the age group between 20-30years(95.8%)females were high in proportion (85.5%). Buddhist (89.1%) and Sinhalese (93.3%) were also high. Most of them are unmarried (63%) and monthly income was Sri Lankan Rupees below 60000(95.2%). Majority are living in suburban area (60,6%) and education level was graduate (100%). Most of not having children (89.7%) According to the Physical state in this study most of them were Normal body weight (76.4%)In thus study according to the mental state most of them were normal mental state (79.4%).but 15.1% in mild mental status Impairment as well as 5.5% in moderate Mental status Impairment. There were no severe Mental status impairment. Most of them were not practicing yoga (75.8%). Conclusion of the study was mentioned according to the results Practicing of yoga was not significantly associated with Mental and Physical status of this study group. Although in this study15.1% in mild mental status impairment as well as 5.5% in moderate mental status impairment and Underweight 9.1%, Over weight 12.1%, Obesity 1.8% and Obesity II 6%. It is necessary to commence the programs to improve physical state, mental state and the Quality of life in internal medical doctors.