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symptoms of kidney dysfunction. I find kidney dysfunction in my patients very frequently. Lower back pain is a common indicator that the kidneys are starting to become irritated. Yes, lower back pain can come from many different areas, but one of the areas I always rule out is kidney congestion.

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Homan’s sign test also called dorsiflexon sign test is a physical examination procedure that is used to test for Deep Vein Thrombosis (DVT). A positive Homan’s sign in the presence of other clinical signs may be a quick indicator of DVT. Clinical evaluation alone cannot be relied on for patient management, but when carefully performed, it remains useful in determining the need for additional testing (like D-dimer test, ultrasonography, multidetector helical computed axial tomography (CT), and pulmonary angiography) [1][2].

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Ascites, the collection of fluid within the peritoneal space is caused due to a variety of causes including cirrhosis, cardiac causes, sinusoidal obstruction syndrome, tubercular peritonitis and pancreatitis, amongst others. Most commonly, the cause of ascots may be cirrhosis , which in turn, is most frequently causes by alcohol use, hepatitis C and non-alcoholic steatohepatitis. At the heart of the ascitic fluid analysis is the serum albumin ascitic gradient, the differential diagnosis of which has been discussed in detail in this presentation. Both low SAAG and high SAAG ascites have been dealt with in some depth, with a brief overview of the management of these conditions

Systemic lupus erythematous is an autoimmune condition characterised by damage to organ systems due to autoantibodies and immune complex deposition. Genes, epigenetic changes and environment play a role in its pathogenesis. SLE is a truly multi system disease causing widespread clinical manifestations in almost all organ systems. Autoantibodies in SLE are numerous and mainly include ANA, dsDNA, Sm and others.

Hemophagocytic lymphohistiocytosis is a rare but life threatening condition characterised by activation of macrophages which result in phagocytosis of RBCs and cytokine mediated tissue damage. This presentation aims to discuss the genetic basis, clinical features, diagnostic criteria and management options in this serious condition. The management options in HLH include Etoposide, Dexamethasone, Cyclosorine, Tacrolimus, Alemtuzumab and stem cell transplant.