Rajeev Saxena

Abstract

Sjogren’s syndrome (SS) is common autoimmune diseases manifesting with various glandular and extra glandular features which are difficult to evaluate and manage. Hypokalemic flaccid paralysis may be the rare extra glandular clinical manifestation of SS. We present a case of acute flaccid paralysis which on evaluation turned out to be primary sjogren’s syndrome (pSS). We present a case of 30 year old young woman with no known comorbidities presented with acute flaccid paralysis. Her evaluation reveals severe hypokalemia with K+-1.6 meq/l, metabolic acidosis with pH-7.28 and urinary pH ?6.5. An initial diagnosis of hypokalemic periodic paralysis (HPP) secondary to distal renal tubular acidosis (dRTA) was made. She was later found to have sjogren’s syndrome on the basis of positive ANA & Anti-Ro (SS-A) Antibody and salivary gland biopsy. She was managed with potassium supplements, sodium bicarbonate and immunomodulators. Primary Sjogren’s syndrome usually associated with distal renal tubular acidosis which may cause hypokalemia leading to HPP, rarely which may be the initial presenting symptom in young women as in our case. Early diagnosis and treatment of these patients would lead to less complication and better quality of life. Keywords: Hypokalemic periodic paralysis, Sjogrens syndrome, Distal renal tubular acidosis.

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Abstract

A study on waiting time of patients in outpatient department was conducted in this hospital of northern India, with an aim to assess the services of outpatient department & suggests new ways to improve the health care system through research. A 100 respondents were chosen randomly from a pool of patients who visit the various OPD. The data was collected through questionnaire and interview. Results: The study revealed 62 were male and 38 were female, 26 were below age 30 yrs & 40 were between age 30-50 yrs and 34 were above 51 yrs of age. The majority were married 76%. The 55% were local and 45% were from out station. The 37% were new registration and 63% were old patients. The majority (95) had spent less than 30 min at the registration and 49% has consultation time more than 30 min. The time spent in laboratory and radiodiagnosis for more than 30 min by 12% and 29% respectively. The various factors like overlaps of round & OPD time, transportation time of sample and preparation time in radiology has been pointed out as major problem area. Conclusion: Queuing method, advanced simulations & real time waiting system will be immensely helpful to provide efficient & appropriate health care. Keywords: OPD, Waiting time, Simulation, Screening, Queuing method.

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