22 Sep 2023
30 Sep 2023
Thrombotic thrombocytopenic purpura (TTP) is a rare disorder with an estimated incidence of 3 - 7/1,000,000. It is an autoimmune disorder characterized by fever, neurological signs, microangiopathic hemolytic anemia, thrombocytopenia and renal failure. This case report will describe a young lady who presented with acute middle cerebral artery infarct and was subsequently diagnosed to have TTP. Therapeutic plasma exchange (TPE) did not improve the neurological deficit. This case highlights the importance of recognizing TTP as a possible differential diagnosis in young onset stroke.
We present a simple and validated HPLC method for measuring Vitamin B6 urinary metabolite 4-pyridoxic acid (4-PA). Urine samples were treated with 6% per chloric acid. HPLC separation was achieved using Waters column (Symmetry® C18 250 mm × 4.6 mm i.d (5 µM). The mobile phase was a mixture of methanol and 35 mM sodium phosphate buffer containing 2.5 mM sodium heptane polysulfonate at pH=3.5 with 85% O-phosphoric acid. Retention times were 8.0 min for 4-pyridoxic acid. Detection (UV at 302 nm) of analyte was linear in a range from 0.0125 to 0.8 µM. This method is stable, reproducible and has practical advantages such as ease and low cost.
Takayasu arteritis is one of the large vessel vasculitis with variable clinical features in Indian patients. It is common in males and may be associated with tuberculosis and often presents with large vessel wall inflammation, obstruction and aneurysm. A 23-year-old female presented with features of acute psychosis and during evaluation and following electroconvulsive therapy she was found to be tachycardic and pulse less in one arm. Further CT angiogram proved features of aortoarteritis with raised inflammatory markers and her infective screen including TB came back as negative. She was treated with steroids, losartan and corticosteroids and Methotrexate was added as steroid sparing immune suppression. She remains disease free and doing well. Literature review suggests increasing incidence of this vasculitis and early effective treatment helps to reduce morbidity and prolong disease free remission.
Obsessive-Compulsive Disorder (OCD) is psychological disorder that leads to many other psychological problems such as tic disorder, anxiety disorder, depression disorder and so on. The symptoms of Obsessive-Compulsive Disorder can be managed by medication and various psychological strategies such as distraction techniques, thought stopping and response prevention.
When initial treatment and rehabilitation are inappropriate, it may leave severe dysfunction in hand infection. We experienced rehabilitation with postoperative hand based splint therapy and obtained good results. Case 1 A 59-year- old male stuck chopsticks in the right-hand metacarpus, the middle of the left volar hand was painful. The post- operative rehabilitation conducted blocking exercise and adductor stretching. There are not the pain and excursion restrictions. Case 2 A 64-year old male was operated for purulent flexor tendon tenosynovitis. The postoperative rehabilitation was done in the same method and there are not the pain and excursion as Case 1. Enforcement of careful exercise therapy depending on an episode of care is important.