Indian Man Research Articles

A Rare Case Report on Definitive Radiotherapy in Sebaceous Carcinoma of the Eyelid

Introduction: Sebaceous carcinomas are rare but potentially aggressive cutaneous malignancies. Surgical excision, albeit the primary modality of treatment, is associated with functional as well as cosmetic impairments. Radiotherapy offers an alternative treatment modality for those in whom surgical excision is not an option either due to medical reasons or patient preferences. Materials and Methods: Here we present a rare case report of an elderly Indian man with sebaceous carcinoma of the eyelid, for whom definitive radiotherapy was delivered as the primary modality of treatment. Results: There was a near complete response of the tumour to the definitive radiotherapy with acceptable toxicity. Discussion: Radiotherapy is a non-invasive alternative to surgical excision that has the advantage of better functional and cosmetic outcomes.

The gendered dress of DALL-E 2: Exploring profession-based images in the Indian context

This study delves into the intricate realm of gender and artificial intelligence (AI) through an examination of DALL-E 2 generated images within the Indian context. The study takes a methodological approach that focuses on assessing images generated in response to prompts such as ‘a farmer cultivating crops in rural Punjab’ or ‘a nurse providing care in a hospital in Delhi’ to reveal the dynamics of gender performativity within profession-based visual content. The generated images were analysed using the dress as a phenomenon to visualise Indian man, Indian woman and ambiguous Indian. The study concludes that DALL-E 2’s algorithm reiterates the binary gender norms leaving no space for ambiguous Indian in its responses. Though the generated image is centred on female professions, it is largely employed by male surroundings. Hindu religious symbols are largely used among male professionals denoting its predominance. In its aesthetics, the individuals portrayed exhibit a brown complexion, echoing the demographic landscape irrespective of gender.

The Secret of the Writing: James Welch and the Drafting of Winter in the Blood

ABSTRACT Winter in the Blood has an extremely interesting archival back story. Buchanan discovered in James Welch’s archives at the Beinecke Library at Yale University that, as a student at the University of Montana, Welch had already formed the thematic core of the novel nearly ten years before its publication. In a folder with a sticky note on it that reads “In his box in closet. ORIGINAL stuff from writing class!” rests a number of short stories that Welch wrote for a 1964 creative writing course. One of these documents is a short snippet of a story that features a young Indian man named Moses First Raise discovering a dead man lying along a trail in a ravine near a pen of cows. This plot event points to a similar plot event in the opening pages of the novel, though the point of view shifts around and confuses the relationship between the narrator, Moses, and the dead man. Moreover, it is the first time that the brother Moses appears in any of Welch’s other papers or published work. The article explores this and other elements of the compositional history of Welch’s masterpiece, Winter in the Blood.

Pseudofilariasis, a Presenting Sign of Alkaptonuria.

To report the association of Pseudofilariasis as a presenting sign of Alkaptonuria. Case Report. A 49-year-old Indian man was referred because of wormlike objects in his left conjunctiva. Ocular and family history was non-contributory. He had not been to India in 15 years. Past medical history revealed hypertension, hypercholesterolemia, arthritis, and a myocardial infarct. He had undergone two stents, bilateral Achilles tendon repairs and bilateral knee replacements. ROS showed longstanding back stiffness and pain. On ocular examination the vision was 20/25 in each eye and positive findings were in the left eye bulbar conjunctival which showed stationary black vermiform (filarial in appearance) foreign bodies along with 2 small corneal limbal pigmented deposits. Conjunctival biopsy showed dilated lymph channels with interstitial proteinaceous material of a light brown color consistent with Ochronotic pigment; hence diagnostic of Alkaptonuria. Pseudofilariasis may be a presenting sign of Alkaptonuria and occur years before a clinical diagnosis is made. Filariasis is always involves white worms and never black. Knowing the ophthalmic signs of this rare disease may lead to an accurate diagnosis earlier thusly avoiding unnecessary tests and examinations.

Gentlemen, husbandmen, and industrious wives: The role of gender in imagining Indian agriculture

The Agricultural and Horticultural Society of India (AHSI), founded in 1820, remains the most important producer of English-language knowledge regarding the cultivation of plants in colonial India. Members included missionaries, colonial officials, tea and indigo planters, merchants and bankers, as well as the Bengali bhadralok elites of Calcutta and some Indian princes. The writings it produced were highly gendered. Often they focus on how “improving” the political economy and agricultural productivity would create masculine identities, such as gentlemen landowners and industrious peasant husbandman. Yet I also argue that women’s agricultural work was fundamental in imagining this path towards “improvement.” Using descriptions of Indian farming and labor practices from the Society’s meeting minutes and published transactions, as well as additional writings by its members and missionary founders, I show how many European members of the Society viewed women working outside of domestic pursuits as a sign of Indian inferiority. At the same time, many argued for the benefits of women’s work, which they viewed as fundamental in making Indian households more productive. Women and their labor were a lynchpin in creating the idea of the effeminate Indian man as well as the solution for improving him. It was this intersection of race with gender which helped to define agriculture as a discipline much closer to practical knowledge than abstract science. While some European women were able to participate in the Society’s production of scientific knowledge because of agriculture’s practical nature, Indian knowledge (whether from men or women) tended to be openly dismissed as tradition or habit rather than truly practical. The overlap of gender with race consequently helped to create a hierarchy between practical knowledge and tradition.

Lessons learned from a fatal case of Tuberculosis Meningitis: A case report

BACKGROUND In 2023, 10 million cases of Tuberculosis were reported by the WHO. Tuberculous meningitis (TBM) may be the sole manifestation of Tuberculosis (TB) and does not require prior pulmonary or extrapulmonary disease[1]. Approximately one-half of all TBM infections lead to severe neurological disability with a mortality rate of 30% with death in 6 months and 50% overall[2-4]. Despite being inarguably the most devastating clinical presentation of TB, frequent diagnostic delays are common due to low clinical suspicion or misdiagnosis as current diagnostic tests still have a limited yield[5]. The best way to reduce mortality and morbidity associated with TBM is by maintaining a high index of suspicion, timely diagnosis and initiation of treatment. This case report aims to highlight the clinical presentation, imaging findings, and diagnostic pitfalls in the diagnosis of TBM. CASE PRESENTATION A 36-year-old Indian man with no significant medical, social, or travel history initially sought treatment at a private hospital in Abu Dhabi for fever, intermittent headaches, and confusion. Investigations at the hospital included a negative QuantiFERON TB gold (QTF) test and a negative cerebrospinal fluid (CSF) culture, but the CSF analysis was not included in the provided reports. Consequently, he received acyclovir treatment for suspected viral encephalitis but was discharged without complete symptom resolution. Following discharge, he experienced worsening confusion over three days. Upon presentation to our Emergency Department (ED), he was febrile, disoriented, and difficult to rouse, with a GCS score of 11/15, displaying terminal neck stiffness. There were no signs of lateralization, cranial nerve deficits, or cerebellar abnormalities. A computerized tomography (CT) scan conducted in the ED revealed hydrocephalus with diffuse leptomeningeal enhancement. Laboratory results indicated significant hyponatremia at 121 mmol/L. He was started on broad-spectrum antibiotics and anti-tuberculosis medication empirically based on the clinical scenario and CT findings. During his Intensive Care Unit (ICU) stay, a CSF analysis suggested TB meningitis, and a positive Mycobacterium tuberculosis polymerase chain reaction (MTB-PCR) confirmed the diagnosis. An MRI of the brain showed meningoencephalitis with tuberculoma formation in the left cerebellar hemisphere. Unfortunately, despite treatment, his condition deteriorated, necessitating endotracheal intubation, multiple EVD revisions, and ventriculoperitoneal shunt placement. A follow-up MRI revealed worsening hydrocephalus and cerebral vessel thromboses, ultimately leading to his unfortunate demise in the ICU. CONCLUSION This case highlights that Tuberculous meningitis is a highly lethal, under-recognized disease with characteristic clinical and imaging features in which delay in diagnosis and subsequent treatment can lead to fatal consequences. Emergency Medicine physicians should maintain a high index of suspicion for TBM in patients with fever and vomiting and signs of altered mental status and keep in mind that a normal CXR, negative QuantiFERON test, and the absence of TB exposure history does not exclude TBM from the differential when clinical and Brain imaging findings raise concern. Prompt identification prevents delay in initiation of management and ultimately may lead to better long-term outcomes.

A case report on angioedema induced by ramipril in a patient treated in a tertiary care hospital in north India

Angioedema is non-pitting edema, or swelling, of the area beneath the deep dermis, subcutaneous, and/or mucosal layers of tissue resulting from fluid buildup, and it can be fatal if the larynx and pharynx are implicated. Drug-induced angioedema, like other cutaneous drug reactions, is most frequently elicited by non-steroidal anti-inflammatory drugs and beta-lactam antibiotics, while reliable information obtained from epidemiologic research is lacking. The latest studies have revealed that angiotensin-converting enzyme inhibitors have an increasing role in the development of life-threatening angioedema. Because of its safety and efficacy, ramipril is a commonly prescribed ACEI. This case report describes the clinical manifestations, management, and outcome of ramipril-induced facial angioedema in a 70-year-old Indian man.

Case Report on the Outcome of the Scheduled Exercise and Manual Physiotherapy on A Male Patient with Failed Neck Surgery Syndrome

Pain and discomfort after spinal surgery are known as "Failed Back Surgery Syndrome (FBSS)" and "Failed Neck Surgery Syndrome (FNSS)," respectively. Understanding what triggers FBSS/FNSS is essential for treating it. Outcomes can be affected by preoperative symptoms, patient expectations, and previous surgeries. Imaging techniques including X-rays, CT scans, and MRIs help doctors diagnose physical problems. After surgical attempts have failed, conservative treatment is often suggested. A 34-year-old Indian man after cervical surgery had neuropathic neck discomfort. Scheduled exercise and manual physiotherapy completed the treatment. Manual therapy addressed scar tissue adhesions and nerve mobility, while exercise improved neck strength, flexibility, and stability. Twelve weeks of three-times-a-week treatment. Manual physiotherapy uses soft tissue mobilisation, myofascial release, joint mobilisation, and nerve gliding to alleviate neck pain and restore function. The patient's neck pain, mobility, and neuropathic symptoms improved over twelve weeks after the intervention. The intervention also improved the group's flexibility, mobility, and pain management, as seen by a greater range of motion, decreased discomfort, and higher pressure pain threshold. Balance increased as well. NDI scores showed little improvement after the intervention. Moreover, the intervention improved physical performance, pain management, and balance, however further research could address neck impairment elements not addressed by the intervention (Table 1). A 34-year-old Indian guy with a history of cervical surgery was cured of chronic neuropathic neck pain after 12 weeks of exercise and manual physiotherapy. Manual treatment targeted scar tissue and nerve movement, while exercise relieved neck pain and mobility. Keywords: Failed Back Surgery Syndrome (FBSS)”, Cervical Surgery, Neuropathic Symptoms, Neck Pain

57 Clinical Utility of Neuropsychological Evaluation in the Differential Diagnosis Between Late-Onset Primary Progressive Aphasia Semantic Variant (PPA-SV) Versus Limbic Predominant Age-Related TDP-43 Encephalopathy (LATE): A Case Report

Objective:Primary progressive aphasia semantic variant (PPA-SV) is an atypical dementia subtype on the frontotemporal dementia (FTD) spectrum. PPA-SV is clinically defined by naming and semantic deficits, with progressive language decline that generalizes to other domains over time. Typically, it presents as an early-onset dementia with TDP-43 pathology, but 33-46% of PPA-SV cases display initial onset after age 65 with potentially different clinical features. Limbic Predominant Age-Related TDP-43 Encephalopathy (LATE), a more recently discovered neurodegenerative entity, is defined by an older age of onset, hippocampal sclerosis/atrophy, and TDP-43 pathology with a gradually progressive amnestic profile that expands to other cognitive deficits over time. The authors present a case report with overlapping features and suspected TDP-43 neuropathology ante-mortem for two reasons: first, to highlight the need for clinical criteria to formally diagnose LATE, and second, to address a gap in the literature on the possible clinical differences of late-onset PPA-SV.Participants and Methods:The authors present a case of a 78-year-old Indian bilingual man (English dominant) with 18 years of education, noncontributory medical history, and gradually progressive cognitive complaints reported over the past few years who was seen for outpatient neuropsychological evaluation. Prior workup was notable for negative amyloid PET scan, negative p-tau 217 blood test, and abnormal brain MRI revealing marked bilateral hippocampal atrophy with ex vacuo ventriculomegaly and minimal cerebrovascular disease. He scored 23/30 on prior MMSE, was diagnosed with amnestic MCI, prescribed Namenda and Exelon, and complained of minor memory and word-finding difficulties with reportedly intact IADLs and no signs of NPH.Results:Neuropsychological testing revealed a profound dysnomia (RBANS Naming raw score = 1/10), and he provided 0 words on two semantic fluency tasks but 15 words on letter fluency. Receptive vocabulary score was also impaired (PPVT-4, <1st %). Memory performance also demonstrated rapid forgetting of information (RBANS List Recall raw = 0/10, Story Recall raw = 0/12) with no benefit to recognition cues (RBANS List Recognition raw = 12/20), but slightly better visual memory recall, albeit still impaired (RBANS Figure Recall raw = 4/20). Grooved pegboard scores were significantly worse with right-hand than left-hand. Irregular word reading (NAART = 16th %ile) was significantly below expectations and thought to reflect more of a surface dyslexia rather than a cultural confounder given that he has lived in the US for over 50 years and his occupational and educational history was completed in English.Conclusions:Results support the clinical utility of neuropsychological evaluation in the differential diagnosis to support a predominant clinical syndrome of PPA-SV despite overlapping features with LATE and suspected TDP-43 pathology. This case report highlights the diagnostic issue with the lack of literature describing the typical clinical progression or suggested diagnostic criteria of LATE. These findings also indicate that late-onset PPA-SV may include greater memory deficits earlier in the course, but this may also be a clinical masquerade that is more reflective of the extent of language deficits. Further research on late-onset manifestations of PPA-SV and LATE consensus clinical guidelines is advised.

Approach to lymphadenopathy: how to diagnose tuberculosis lymphadenitis

lymphadenopathy is considered as abnormal finding local or generalized that can becaused by neoplasm or infection, as tuberculosis lymphadenitis. Cervical localization has prevalence
 in the variety of disorders, can has a similar kind of clinical presentation and to differentiate them be-comes extremely difficult. We provided a case report of the new onset of extrapulmonary tuberculosis
 lymphadenitis in 42-year-old Indian man. The patient complained of multiply enlarged painful lymphnodes on left anterior neck and was also concerned about sore throat persistent for a year. Objectiveexamination and analysis were without evident inflammatory signs. Previous ultrasound, pulmonaryand abdominal CT-scan investigations also revealed conglomerate of left mediastinal lymph nodes,moderate splenomegaly. The preliminary diagnosis of lymphoma was excluded due to confirmationof typical tuberculosis lymphadenitis with specific testing and morphological changes of the resected
 lymphatic node. Sputum microscopy was found to be negative, which meant that the patient was neg-ative for social transmission of tuberculosis. Affected lymph nodes resolved completely after appro-priate therapy during one-year treatment. This case report of extrapulmonary tuberculosis highlights
 the importance of tissue diagnosis in unclear situations. We used clinical protocol for unspecifiedlymph node enlargement as complete history taking and physical examination that is preliminary fordiagnosis, while laboratory tests, imaging diagnostic methods and tissue samplings are gold standardevaluation for definite lymphadenopathy. Tuberculosis lymphadenitis is popularly known as collarstud abscess and is the most common benign cause of cervical lymphadenopathy in endemic areas.This observation determined the details of the immunocompromised state of the patient, conclusionwas supported by the evidence of Pseudomonas putida associated pharyngitis. The main differentialsigns between lymphoma as immunoproliferative disorder and infectious tuberculosis lymphadenitiswere provided.

Shapiro syndrome: a cause of episodic hyperhidrosis, hypothermia and altered mental status.

Shapiro syndrome is characterized by recurrent episodes of hypothermia and hyperhidrosis, with agenesis of the corpus callosum. This is a rare condition with only approximately 60 cases described worldwide. We describe a case of Shapiro syndrome. A 50-year-old Indian man with diabetes and hypertension presented with a 3-month history of frequent episodic profuse hyperhidrosis, accompanied by postural giddiness and confusion. He had episodes of isolated hyperhidrosis 20 years ago which had spontaneously resolved. These episodes re-emerged 3 years prior to presentation, with increasing frequency over the last 3 months. Previous extensive investigations, including a positron emission tomography (PET) scan were normal and he was treated for anxiety. During his inpatient stay, he was observed to have recurrent episodes of hypothermia (lowest temperature recorded 31.3 degrees Celsius), labile blood pressure (systolic ranging from 71mmHg to 175mmHg) and pulse rate (38/min to 214/min). Apart from slow responses to routine questioning, the rest of his neurological examination was normal. Extensive investigations looking for malignancy, autoimmune diseases and infections were unremarkable. CSF studies were negative for inflammation or infection. Magnetic resonance imaging of the brain demonstrated agenesis of the corpus callosum and schizencephaly. Based on his symptoms of hyperhidrosis, hypothermia and imaging findings, a diagnosis of Shapiro syndrome was made. He was treated with clonidine and levetiracetam with good response. Shapiro syndrome is characterized by a triad of episodic hyperhidrosis, hypothermia and agenesis of the corpus callosum. Recognition of this rare condition is important to direct effective treatment.

IN THE ANGST OF THE INVISIBLE EXISTENCE: MIRRORING THE EXISTENTIAL DILEMMA USING BODILY METAPHORS IN THE SELECTED POEMS OF JAYANTA MAHAPATRA AND KEKI N DARUWALLA

Indian English poetry since the culmination of the colonial phase took a decisive and deliberately marked shift from the slavish imitation of the romantic writers like Keats, Byron, Shelly, and Wordsworth to a more progressive and experimental style with methodical and thematic innovativeness. It was known as post-independence poetry which heralded the arrival of a new way of composing poems with an indigenous ‘Indianness’ essence, sabotaging the strong clutches of its colonizer’s English mother tongue. Some of the greatest contributors include Nissim Ezekiel, Dom Moraes, P. Lal, Adil Jussawalla, A. K. Ramanujan, R. Parthasarathy, Gieve Patel, Arvind Mehrotra, Pritish Nandy, Kamala Das, K. N. Daruwalla, Shiv Kumar, Jayanta Mahapatra, Meena Alexander, Agha Shahid Ali, Vikram Seth, Manohar Shetty, etc. A large section of poetry produced by these avant-garde writers was based on raw human experiences and expressions with overtones of psychoanalysis, existentialism, surrealism, etc. Another major experimentation conducted by the modern Indian poets was the incorporation of symbols and metaphors, which made an allusive reference to the unvoiced pathos of the survival guilt of the modern Indian man. With the emergent uncertainties and disillusionment of the post-independence scenario, themes like an identity crisis, alienation, feminist concerns, Marxism, etc were projected as close allies with the existential concerns of the era. Using Foucault’s discourse of society on ‘subject’ and ‘power’ in the molding of the individual’s self, the present study marks an attempt to demonstrate how the two selected poets Jayanta Mahapatra and Keki N Daruwalla try to reflect their existential concerns and post-colonial ‘angst’ by meticulously employing differently disabled bodily metaphors.

Rare case of double seronegative ocular myasthenia gravis and non-functional pituitary macroadenoma

Chronic autoimmune neuromuscular disorder known as Myasthenia Gravis (MG). The relationship of myasthenia gravis with pituitary adenomas is relatively uncommon, despite the fact that it is widely known that people with the condition have a higher prevalence of other autoimmune diseases. Here, we describe the case of a 45-year-old Indian man who had complained of severe cephalgia, associated with ocular pain, dizziness, diplopia, ptosis of the unilateral right eye. Although he has a history of severe headaches that started prior to 3 months, his complaints became more obvious at the end of the day. An MRI of the brain revealed an increased pituitary gland that measured 13.7 × 15.5 x 16. 9 mm. Furthermore, post admission histological examinations supported the diagnosis of a double seronegative ocular myasthenia gravis and non-functional pituitary macroadenoma. Following treatment, it was discovered that Pyridostigmin and Prednisolone considerably reduced his myasthenia symptoms. Finally, it should be noted that pituitary tumours are one potential underlying cause of headache in myasthenic patients.

Vitamin E-induced coagulopathy in a young patient: a case report

BackgroundHigh-dose vitamin E intake is known to inhibit vitamin K-derived coagulation factor synthesis, which can cause serious bleeding events such as gastrointestinal bleeding and intracranial hemorrhage. We report a case of coagulopathy induced by marginally increased levels of vitamin E.Case presentationA 31-year-old Indian man presented with oral bleeding, black tarry stools, and bruising over his back. He had been taking non-steroidal anti-inflammatory drugs for low backache and vitamin E for hair loss. He had mild anemia with normal platelet count, thrombin time, and prolonged bleeding time, activated partial thromboplastin time, and prothrombin time. Serum fibrinogen was slightly raised. Mixing studies with pooled normal plasma, aged plasma, and adsorbed plasma were suggestive of deficiency of multiple coagulation factors due to acquired vitamin K deficiency. Serum phylloquinone was normal, while prothrombin induced by vitamin K absence-II level was increased. Serum alpha-tocopherol was slightly raised. Upper gastrointestinal endoscopy showed multiple gastroduodenal erosions. A final diagnosis of vitamin E toxicity-related coagulopathy was made. The patient responded well to pantoprazole, vitamin K supplementation, multiple fresh frozen plasma transfusions, and other supportive treatments besides the discontinuation of vitamin E supplementation. The coagulation parameters normalized, and the patient was discharged with complete resolution of symptoms and remained asymptomatic during the follow-up for 6 months.ConclusionsVitamin E-related inhibition of vitamin K-dependent factors with coagulopathy may occur even at marginally increased levels of serum vitamin E. This risk becomes significant in patients receiving other drugs that may increase the risk of bleeding.

Politics of gender: challenges of being a feminist male women human rights defender in the north-eastern periphery of India

ABSTRACT Masculinity and manhood are prerequisite characteristics desired and demanded from every male individual born in Indian society. They are taught to become an ‘Ideal Indian Man’ from the time they are born. Critical reading of masculine attributes is an important facet of feminist discourse. Men who become a part of this quest and movement as ‘women rights activists’, fighting against gender inequality, are often ridiculed and discouraged. In this context, this paper brings out the narratives and struggles of being a male ‘women human rights defender’ in India. According to the information published on the official website of the Office of the United Nations High Commissioner for Human Rights (OHCHR), women human rights defenders (WHRDs) are people of all genders who work, promote, defend, advance, and advocate for gender equality, and stand for the cause of human rights of women. Hence, going by the definition mentioned above, I argue that a feminist man working relentlessly on women’s issues will surely fall under the category of ‘women human rights defenders’. Their personal experiences and struggles as WHRDs working in their local areas voice varied forms of challenges, stigma, ostracisation, and life risks that otherwise go unnoticed, unspoken, and at times trivialised because of their gender. With an objective to bring out a broader conversation between masculinity studies and feminist scholarship, this paper analyses the challenges of being feminist male WHRDs. To examine this position as a WHRD, the paper will look into the questions of (1) being a man who is always looked upon with suspicion as a person occupying a privileged gender position; (2) a man working on gender-sensitive issues such as human/sex trafficking, child abuse, violence, conflict, and displacement; and (3) his regional location and social class. This paper will structure details of different forms of gender-based lived experiences of selected male WHRDs working in various districts of Assam and West Bengal, through personal interview methods.

Unusual infections and diabetes: dangerous fungi

Unusual infections and diabetes: dangerous fungi

S2729 Failed Tofacitinib Rescue Therapy in Acute Severe Ulcerative Colitis Refractory to Steroids and Anti-TNF Therapy

Introduction: Acute severe ulcerative colitis (ASUC) is a life-threatening condition that may lead to complications such as toxic megacolon, infection, perforation, or hemorrhage. Current medical therapy has a high failure rate with approximately a third of patients requiring colectomy. Case Description/Methods: A 60-year-old Indian man with a three-year history of ulcerative proctitis on mesalamine therapy was admitted to the hospital for diarrhea, abdominal pain, and hematochezia after failing outpatient oral prednisone and rectal budesonide foam. His vital signs on admission were normal. Labs showed WBC of 12.5, Hgb of 10.6, platelet count of 530, albumin of 2.7, CRP of 143.2, ESR of 75, and fecal calprotectin of 1860. C. difficile testing was negative. CT scan showed mild colonic wall thickening. The patient was started on IV methylprednisolone 60 mg/daily. Colonoscopy which showed severe (Mayo Score 3) pancolitis with negative CMV on biopsies. Surgery was consulted after his symptoms did not improve after five days of steroid therapy and he required several blood transfusions. Due to the unavailability of inpatient Infliximab use in our hospital at the time, he was started on Adalimumab and received 160 mg dose, followed by another 160 mg injection in 9 days due to the lack of significant improvement after first dose. The patient refused to undergo colectomy until all medical therapies failed. Given some data on the treatment of ASUC with Tofacitinib, he was started on a 10 mg dose three times daily. CRP declined initially but quickly worsened. Patient decided to transfer care to another tertiary center for colectomy. While awaiting transfer, he developed brisk lower GI bleeding and became hypotensive. He was moved to the ICU and required emergent exploratory laparotomy with colectomy and an end ileostomy, three weeks after his admission to the hospital. Discussion: Despite recent data demonstrating some efficacy of tofacitinib as a rescue therapy with concomitant IV steroids, our case failed to respond to this treatment. Further delay in surgical intervention likely resulted in the need for emergent surgery. Data to support rescue tofacitinib is based on observational and retrospective case-control data with several limitations. Clinicians should be cautious delaying a definitive surgical intervention until more robust data supports tofacitinib rescue therapy for this sick population. Fortunately, this patient had an uncomplicated post-op course and was discharged to rehab in ten days.

Porphyria cutanea tarda: A case report

The porphyria's are a rare group of metabolic disorders produced by acquired or hereditary deficiency of the enzyme UROD, fifth enzyme in the chain of production of the heme group, which results in an accumulation of photosensitive by products, such as uroporphyrinogen, which leads to the fragility and blistering of sun-exposed skin. Porphyria can manifest with neurovisceral and/or cutaneous symptoms, depending on the defective enzyme. Prevalence of porphyria's varies, from 1 in 500 to 1 in 50,000 people worldwide. PCT, the most common. A 59-year-old Indian man presented with multiple non healing ulcers on dorsum of right hand and scalp associated with photosensitivity and reddish discoloration of urine, and surrounding depigmentation with scarring. He was diagnosed as having PCT after clinical investigation and was treated symptomatically. PCT is the most common of the seven porphyrin metabolism disorders. The misdiagnosis and mismanagement of this disease can have a significant impact on a patient's life and does management of PCT in our case is focused on the signs and symptoms and findings.

Seropositive Neuromyelitis Optica in a Case of Undiagnosed Ankylosing Spondylitis: A Neuro-Rheumatological Conundrum

Seropositive Neuromyelitis Optica in a Case of Undiagnosed Ankylosing Spondylitis: A Neuro-Rheumatological Conundrum

Paso a paso se va muy lejos: Traveling the Path with AFS

<i>Paso a paso se va muy lejos</i>: Traveling the Path with AFS