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Low back pain is very disabling and dispiriting because of the physical impediment it causes and its psychological effects. Innumerable factors have been implicated in its etiology. In spite of improvements in diagnostic modalities, a considerable number of such cases fall in the ambiguous zone of unknown etiology or ‘idiopathic.’Early diagnosis of low back pain will allow effective prevention and treatment to be offered. This study was conducted to assess the contribution of vitamin D levels and other biochemical factors to chronic low back pain in such cases. All patients attending the orthopedics OPD for low back pain in whom a precise anatomical cause could not be localized, were prospectively enrolled in this study. We measured serum levels of glucose, calcium, phosphorus, uric acid, rheumatoid factor, C reactive protein, alkaline phosphatase, total protein, albumin and 25 (OH) D concentrations in 200 cases and 200 control samples. The patients showed significantly lower vitamin D levels compared to controls with p value < 0.0001. The maximum number of low back pain patients were in the age group of 31–50 years (42 %).The average BMI was 23.27 ± 5.17 kg/sq m, 73 % of total patient population were females and 27 % were known case of type 2 diabetes mellitus. Calcium, alkaline phosphatase, was positively correlated with vitamin D and glucose showed a negative correlation with vitamin D in the patient population. The problem of low back pain provides a challenge to health care providers. The problem in developing countries is compounded by ignorance to report for early treatment and occupational compulsions in rural areas and sedentary lifestyle in urban youth. The authors strongly recommend early frequent screening for vitamin D along with glucose, protein, albumin, calcium, phosphorus, CRP as part of general health checkup for non-specific body pain, especially low back pain.  相似文献   
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Ovulation induction has been an important mode of treatment of infertility. Ovarian stimulation may result in a supraphysiologic response leading to an iatrogenic complication known as the ovarian hyperstimulation syndrome (OHSS). This syndrome is potentially a lethal condition, the pathophysiologic hallmark of which is the accumulation of massive extravascular exudate combined with profound intravascular volume depletion and hemoconcentration. We report a case of severe OHSS with very large ovaries in a 35 year old case of embryo transfer. The patient presented to the emergency department with abdominal pain, massive ascites, respiratory distress and amenorrhea. The patient was managed symptomatically with no complications. Although ovarian hyperstimulation is a rare entity, it is important that the physician recognizes this condition. Prompt diagnosis and successful management is likely to avoid serious and rapid development of complications.  相似文献   
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Hemoglobin is a tetramer formed of two alpha and two beta globin chains. On exposure to high levels of blood glucose, hemoglobin gets non-enzymatically glycated at different sites in the molecule. HbA1c is formed when glucose gets added on to the N-terminal valine residue of the beta chain of hemoglobin. The development of chronic vascular complications of diabetes such as retinopathy, nephropathy and cardiovascular disease is intimately linked to the level of glycemic control attained by the individual with diabetes. We report a case of convulsions and monoplegia admitted to emergency department, showing unusually high glycated hemoglobin but plasma glucose not as high. The patient was not a known diabetic and we could not find any of the other documented conditions that are known to elevate glycated hemoglobin to such disproportionately high levels. Screening for abnormal hemoglobins was negative in the patient. Oral hypoglycemic drug treatment over 3 months and withdrawal of other medications only marginally lowered glycated hemoglobin.  相似文献   
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We report an unusual presentation of primary biliary cirrhosis. We present the case of a 31-year-old Indian woman who presented to the hospital with non specific complaints of gastritis, reduced appetite and marked weight loss and no complaints of pruritus. Serum liver enzymes were elevated. Cytoplasmic pattern of antinuclear antibodies was found on immunofluorescence microscopy accompanied by positive anti smooth muscle antibody. Endoscopy revealed esophageal varices. Following a liver biopsy, the diagnosis of primary biliary cirrhosis was made. It is important to consider the diagnosis of hepatic cirrhosis when patient presents with gastritis, reduced appetite and marked weight loss in both the presence and absence of ascites.  相似文献   
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Multiple myeloma is a disseminated malignancy of monoclonal plasma cells that accounts for 15 % of all hematological cancers. The present study was conducted to evaluate the role of inflammation and oxidant-antioxidant dynamics in the etiology of this disease. The study population comprised of 20 cases of multiple myeloma and 20 healthy controls. The parameters evaluated were serum malondialdehyde (MDA), superoxide dismutase (SOD) and ferritin levels. The serum MDA levels were 1.9 ± 0.96 nmol/ml in cases as compared to 0.98 ± 0.55 nmol/ml in the controls. Similarly, a statistically significant difference was noted in the SOD and ferritin levels between the cases and controls (93.2 ± 23.8 vs. 210.1 ± 190.5 U/ml and 285.8 ± 216.4 vs. 131.8 ± 30.1 ng/ml respectively). Our study highlights the imbalance in the oxidant-anti oxidant mechanism and the role of smoldering inflammation in the etiology of multiple myeloma.  相似文献   
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We present three cases who presented to our Endocrinology OPD a few days apart with the common complaints of no or minimal development of secondary sexual characteristics. Although they had similar problems, investigations revealed a spectrum of different clinical, biochemical and genetic abnormalities. All the patients had otherwise normal anterior pituitary hormone secretion and sellar anatomy. One had a short Y chromosome, one was a Klinefelter syndrome and the other had no chromosomal abnormality. These findings along with absence of any detectable abnormality on pituitary imaging helped us diagnose these cases as Idiopathic hypogonadotropic hypogonadism. Treatment with testosterone showed marked improvement at 1 year follow up.  相似文献   
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