Browsing by Author "Uday Prabhakar"

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Atypical Presentation Of Rickettsial Spotted Fever
(2017) Uday Prabhakar; Anup Singh
Acute febrile illness is a common entity in tropics and often is challenging due a host of pathogenic bacteria, viruses and fungi. Extensive work up is required for better management. Rickettsiosis is uncommon and hence comes lower down in the differentials of multiorgan failure being superseded by the more common diseases as malaria, enteric fever and Dengue. We document a case of young male presenting with high grade fever, multiorgan dysfunction (hepatic, renal, neurological and respiratory involvement), conjunctival suffusion, retiform rash and without lymphadenopathy. The diagnosis was further challenging because the rashes appeared late at 8th day in the course of illness, unlike the typical disease where rashes come on early in day 3-6 of the disease. Patient responded to timely treatment with doxycycline. Thus, a high index of suspicion is needed to diagnose Rickettsiosis in geographical areas apparently free of the disease.
Comparison of patients with ankylosing spondylitis and non-radiographic axial spondyloarthritis-a cross sectional study
(Journal of Clinical and Diagnostic Research, 2018) Uday Prabhakar; Anup Singh
Introduction: The Assessment of Spondylo Arthritis International Society (ASAS) classification criteria for Axial Spondyloarthropathy (axSpA) published in 2009 aimed to achieve a greater sensitivity in diagnosing patients of axial spondyloarthritis. Whether the radiographic form Ankylosing Spondylitis (AS) and the Non Radiographic Axial Spondyloarthritis (nr-axSpA) form, are subgroups or different phases of the same disease is a pertinent question because this could have affected the pharmacological management of the two subgroup. Whether a distinction between AS and nr-axSpA in clinical practice is useful, remains unknown. Therefore, the present study was undertaken with the following aim. Aim: To investigate the differences in clinical presentation and disease activity between nr-axSpA and AS. Materials and Methods: A cross sectional study was conducted in Division of Rheumatology, Banaras Hindu University, Varanasi, India from January 2016 to June 2017. All the patients presenting with history of chronic back pain for ≥3 months and age at onset ≤45 years after taking written informed consent were included in the study. Using the ASAS criteria, patients were then classified into two groups of 50 patients each, patients having AS (if there was sacroilitis on radiographs as defined in modified New York criteria) and nr-axSpA diagnosed using ASAS criteria. The various SpA related variables were then compared including gender, age, duration of illness, enthesitis, dactylitis, uveitis, peripheral arthritis, psoriasis, family history, Human Leucocyte Antigen (HLA) B27 positivity, baseline C-Reactive Protein (CRP), baseline Erythrocyte Sedimentation Rate (ESR), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI). Results: Patients with AS, as compared with nr-axSpA had a longer disease duration {4.5(1.875-8.250) vs. 2.0(1.000-4.000); p-value 0.023} and had a significantly higher levels of objective markers of inflammation i.e., CRP {4.7(2.325-6.525) vs. 2.20(0.588-4.125); p-value<0.001)} and ESR {(41.98±16.936 vs. 34.20±14.552; p-value 0.015)}. No statistically significant difference was found in age of onset, male: female ratio, enthesitis, dactylitis, uveitis, peripheral arthritis, psoriasis, family history and HLAB27 positivity. Neither any statistically significant difference was noted between the mean BASDAI and BASFI in the two groups. Conclusion: Other than elevated levels of markers of inflammation (CRP/ESR) and a longer disease duration in AS, most other features do not vary significantly between the two groups. Thus, the two groups might represent same disease in different phases. © 2018, Journal of Clinical and Diagnostic Research. All rights reserved.