Allergic angina and allergic myocardial infarction are ubiquitous diseases covering a wide spectrum of mast cell activation disorders, which are associated with acute coronary syndromes and are referred to as ''Kounis Syndrome''. Here, we report a case admitted with dyspnea and mild chest heaviness secondary to bee sting, later diagnosed as Kounis syndrome.Allopurinol is a xanthine oxidase inhibitor used in management of chronic gout. It acts by reducing the amount of uric acid by inhibiting purine metabolism. A middle-aged hypertensive female who was on allopurinol for 7 months presented with generalized weakness and exertional dyspnea. Investigations revealed pancytopenia normocytic normochromic anemia (Hb-3.2g/dL, TLC-3400/mm3) and severe thrombocytopenia (Platelets-1000/mm3) with mild hepatosplenomegaly and grade 2 medico renal disease with normal cardiac status. Nutritional, hemolytic and infective causes were ruled out. She was transfused with fresh whole blood, platelets, administered empirical antibiotics and started on steroids. Initially, she responded to treatment but later developed an episode of convulsions with anuria and succumbed to leukopenic sepsis secondary to hypo/aplastic anemia probably due to allopurinol. Allopurinol is used extensively in the management of chronic gout and is well tolerated due to its safety profile. But we here report a case of allopurinol induced aplastic anemia leading to the demise of a patient. Allopurinol though safe needs careful monitoring.The three Ds of geriatric psychiatry-delirium, dementia, and depression are common and challenging diagnoses among elderly. Delirium is often difficult to diagnose and is an independent risk factor for morbidity and mortality in older adults. Dementia also affects a significant number of older adults and is associated with delirium, depression, frailty, and failure to thrive. It is well known that depression too increases with increasing age. These three syndromes can exist simultaneously in the same patient, and often confer increased risk for each other, especially in the geriatric population. Early identification, classification, and differential diagnosis are important at the primary care level for the timely management of these common problems of old age. We present a case of concurrent findings and complexity in the medical literature.Dermatologic diseases are often associated with oral manifestations and sometimes the oral lesions are the sole presenting features of the disease. Diagnosing a dermatologic disease based on its oral manifestations is a challenge, especially in the absence of associated cutaneous lesions. Lichen planus is a common dermatologic disease that affects the oral mucosa in the adult population. While some patients have concomitant oral and cutaneous lesions, the oral lesions are persistent and seen for years together even after the cutaneous lesions have healed. Herein, we present two cases of oral lichen planus seen as an ulcerated lesion on the lower lip which is an uncommon manifestation of this otherwise common disease.We report a case of 55-year-old female with chief complaints of fever and deranged liver function tests, diagnosed as autoimmune hepatitis (AIH) and under immunosuppressive therapy for two years. Following the failure in clinical improvement, she was started on anti-tubercular therapy (ATT). While investigating the underlying etiology, virological markers for Hepatitis A to E were found to be negative with plasma Epstein-Barr virus (EBV) viral load of 5 log10 copies/ml. Additional investigation of the liver biopsy showed Hodgkin's lymphoma (HL). The patient was initiated on chemotherapy but eventually succumbed to the illness. This case report underlines the dilemma in the initial diagnosis of AIH and the importance of considering hepatic involvement of EBV as one of the differential diagnosis among clinically suspected AIH cases not responding to immunosuppressive medications.Epidermoid cysts are very common and therefore relevant to Family Medicine physicians in the primary care setting. Epidermoid cysts can undergo transformation if they become infected or ruptured, resulting in keratin granulomas. Importantly, these may be misdiagnosed or confused with malignancy and should be differentiated histologically after excision if a presumed epidermal cyst has an atypical presentation. In this article we are reporting a case of temporal keratin granuloma as a result of an epidermoid cyst rupture in a middle-aged man.Autoimmune polyendocrine syndrome (APS) is a constellation of multiple endocrine and various autoimmune diseases. The hallmark features of APS are gradual onset, circulating autoantibodies, and tissue or organ infiltration by lymphocytes. There are genetic basis and failure of the immune system to maintain self-tolerance to a variety of molecules, which manifest as autoimmunity over a period of time. Age of onset of the syndrome may range from early infancy to adulthood, new onset of autoimmunity of the given syndrome can manifest thoughout life. We report a case of an adolescent female with endocrine and non-endocrine manifestation of APS, starting at a very young age of 7 years with nephritis and hypertension as an unusual association.An adult male who never stood, ambulating on all four due to bilateral severe knee flexion contractures, since his childhood, was 21 years of age, and not deterred by his condition, was pursuing his higher education. He was coaxed by his friends to seek medical opinion and it was decided to give a trial and let the client have a feel of bipedal stance and ambulation. Although there is a paucity of recent evidence on the use of **** knee prosthesis, the trial successfully restored the dignity.Lynch syndrome (hereditary non-polyposis colorectal cancer) is an autosomal dominant condition and it is caused by germline mutations in the DNA mismatch repair genes. The present case report was conducted to evaluate the efficacy of Madhuyasti (Glycyrrhiza glabra) Ksheerpaka kalpa in Lynch syndrome. A 28-year-old male was diagnosed with Lynch syndrome in 2016. The patient was operated three times followed by chemotherapy. In 2019, he was diagnosed with adenocarcinoma and advised for surgery. https://www.selleckchem.com/products/hro761.html But despite getting surgery patient prefer to take Ayurvedic consultation considering his miserable condition after previous surgeries. It is decided to give the kalpa method of therapy prescribed in Ayurveda for rejuvenation and overall improvement of health. After the 15 days of treatment with Madhuyasti (Glycyrrhiza glabra) Ksheerpaka Kalpa chikitsa, the patient showed significant improvement in quality of life (P less then 0.001 for SPF) and CT abdomen showed a reduction in circumferential thickening from 2.8 to 1.
Allergic angina and allergic myocardial infarction are ubiquitous diseases covering a wide spectrum of mast cell activation disorders, which are associated with acute coronary syndromes and are referred to as ''Kounis Syndrome''. Here, we report a case admitted with dyspnea and mild chest heaviness secondary to bee sting, later diagnosed as Kounis syndrome.Allopurinol is a xanthine oxidase inhibitor used in management of chronic gout. It acts by reducing the amount of uric acid by inhibiting purine metabolism. A middle-aged hypertensive female who was on allopurinol for 7 months presented with generalized weakness and exertional dyspnea. Investigations revealed pancytopenia normocytic normochromic anemia (Hb-3.2g/dL, TLC-3400/mm3) and severe thrombocytopenia (Platelets-1000/mm3) with mild hepatosplenomegaly and grade 2 medico renal disease with normal cardiac status. Nutritional, hemolytic and infective causes were ruled out. She was transfused with fresh whole blood, platelets, administered empirical antibiotics and started on steroids. Initially, she responded to treatment but later developed an episode of convulsions with anuria and succumbed to leukopenic sepsis secondary to hypo/aplastic anemia probably due to allopurinol. Allopurinol is used extensively in the management of chronic gout and is well tolerated due to its safety profile. But we here report a case of allopurinol induced aplastic anemia leading to the demise of a patient. Allopurinol though safe needs careful monitoring.The three Ds of geriatric psychiatry-delirium, dementia, and depression are common and challenging diagnoses among elderly. Delirium is often difficult to diagnose and is an independent risk factor for morbidity and mortality in older adults. Dementia also affects a significant number of older adults and is associated with delirium, depression, frailty, and failure to thrive. It is well known that depression too increases with increasing age. These three syndromes can exist simultaneously in the same patient, and often confer increased risk for each other, especially in the geriatric population. Early identification, classification, and differential diagnosis are important at the primary care level for the timely management of these common problems of old age. We present a case of concurrent findings and complexity in the medical literature.Dermatologic diseases are often associated with oral manifestations and sometimes the oral lesions are the sole presenting features of the disease. Diagnosing a dermatologic disease based on its oral manifestations is a challenge, especially in the absence of associated cutaneous lesions. Lichen planus is a common dermatologic disease that affects the oral mucosa in the adult population. While some patients have concomitant oral and cutaneous lesions, the oral lesions are persistent and seen for years together even after the cutaneous lesions have healed. Herein, we present two cases of oral lichen planus seen as an ulcerated lesion on the lower lip which is an uncommon manifestation of this otherwise common disease.We report a case of 55-year-old female with chief complaints of fever and deranged liver function tests, diagnosed as autoimmune hepatitis (AIH) and under immunosuppressive therapy for two years. Following the failure in clinical improvement, she was started on anti-tubercular therapy (ATT). While investigating the underlying etiology, virological markers for Hepatitis A to E were found to be negative with plasma Epstein-Barr virus (EBV) viral load of 5 log10 copies/ml. Additional investigation of the liver biopsy showed Hodgkin's lymphoma (HL). The patient was initiated on chemotherapy but eventually succumbed to the illness. This case report underlines the dilemma in the initial diagnosis of AIH and the importance of considering hepatic involvement of EBV as one of the differential diagnosis among clinically suspected AIH cases not responding to immunosuppressive medications.Epidermoid cysts are very common and therefore relevant to Family Medicine physicians in the primary care setting. Epidermoid cysts can undergo transformation if they become infected or ruptured, resulting in keratin granulomas. Importantly, these may be misdiagnosed or confused with malignancy and should be differentiated histologically after excision if a presumed epidermal cyst has an atypical presentation. In this article we are reporting a case of temporal keratin granuloma as a result of an epidermoid cyst rupture in a middle-aged man.Autoimmune polyendocrine syndrome (APS) is a constellation of multiple endocrine and various autoimmune diseases. The hallmark features of APS are gradual onset, circulating autoantibodies, and tissue or organ infiltration by lymphocytes. There are genetic basis and failure of the immune system to maintain self-tolerance to a variety of molecules, which manifest as autoimmunity over a period of time. Age of onset of the syndrome may range from early infancy to adulthood, new onset of autoimmunity of the given syndrome can manifest thoughout life. We report a case of an adolescent female with endocrine and non-endocrine manifestation of APS, starting at a very young age of 7 years with nephritis and hypertension as an unusual association.An adult male who never stood, ambulating on all four due to bilateral severe knee flexion contractures, since his childhood, was 21 years of age, and not deterred by his condition, was pursuing his higher education. He was coaxed by his friends to seek medical opinion and it was decided to give a trial and let the client have a feel of bipedal stance and ambulation. Although there is a paucity of recent evidence on the use of bent knee prosthesis, the trial successfully restored the dignity.Lynch syndrome (hereditary non-polyposis colorectal cancer) is an autosomal dominant condition and it is caused by germline mutations in the DNA mismatch repair genes. The present case report was conducted to evaluate the efficacy of Madhuyasti (Glycyrrhiza glabra) Ksheerpaka kalpa in Lynch syndrome. A 28-year-old male was diagnosed with Lynch syndrome in 2016. The patient was operated three times followed by chemotherapy. In 2019, he was diagnosed with adenocarcinoma and advised for surgery. https://www.selleckchem.com/products/hro761.html But despite getting surgery patient prefer to take Ayurvedic consultation considering his miserable condition after previous surgeries. It is decided to give the kalpa method of therapy prescribed in Ayurveda for rejuvenation and overall improvement of health. After the 15 days of treatment with Madhuyasti (Glycyrrhiza glabra) Ksheerpaka Kalpa chikitsa, the patient showed significant improvement in quality of life (P less then 0.001 for SPF) and CT abdomen showed a reduction in circumferential thickening from 2.8 to 1.
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