Hyperinfection Syndrome Case report and review of Literature

After the introduction of the Antiretroviral Therapy (ART) very few case reports of Lymphocytic interstitial pneumonitis (LIP) with HIV are available till date, especially in adults. In children LIP is still considered as AIDS defining condition. LIP is a polyclonal proliferation of lymphocytes, which can be misdiagnosed as Pneumocystis carnii pneumonia (PCP) or Hypersensitivity pneumonitis (HP) if proper sampling is not done. The mainstay of treatment is ART. Here we are presenting a case of lymphocytic interstitial pneumonitis in a defaulter case of HIV-positive patient. The Video-Assisted Thoracoscopic lung biopsy was taken and diagnosis was made on the basis of histopathology examination. Hence, it is suggested to consider for LIP as a differential for cough and dyspnoea in all HIV positive cases, who are not on ART

Clinical study of carbapenem sensitive and resistant Gram‑negative bacteremia in neutropenic and nonneutropenic patients: The first series from India.

OBJECTIVE: Carbapenem resistance is a growing global concern. There is a lack of published clinical studies on the topic from Indian subcontinent. Aim of this study was to analyze clinical profile of patients with carbapenem sensitive and resistant bacteremia among neutropenic and nonneutropenic patients. MATERIALS AND METHODS: Retrospective analysis of 141 patients who had carbapenem resistant or sensitive Gram‑negative bacteremia, identified over a period of 1‑year was done by medical records review, in Apollo Specialty Hospital, a 300‑bedded tertiary care Oncology, neurosurgical and orthopedic center in South India. RESULTS: Of the total 141 patients with Gram‑negative bacteremia, 44 had carbapenem resistant ones. Of these 44 patients, 17 were neutropenics (resistant neutropenic group) and 27 nonneutropenic patients (resistant nonneutropenic group). Of the 97 patients with carbapenem sensitive bacteremia, 43 were neutropenic (sensitive neutropenic group) and 54 nonneutropenics (sensitive nonneutropenic group). The 28 days mortality was significantly higher in carbapenem resistant bacteremic group compared to the sensitive one (P = 0.008). CONCLUSION: This is the first study from India comparing clinical features of patients with carbapenem sensitive and resistant blood stream infections. Patients with carbapenem resistant bacteremia had higher mortality compared to patients with sensitive bacteremia.

Susceptibility profile of Gram‑negative bacteremic isolates to beta lactam‑beta lactamase inhibitor agents in comparison to other antibiotics.

BACKGROUND: Comprehensive understanding about the local antibiogram is an essential requirement for preparation of hospital or unit based antibiotic policy. Bacteremic isolates are the most useful ones for this purpose, representing invasive disease. OBJECTIVE: To analyze susceptibility pattern of bacteremic Gram‑negative isolates in our center, to various antibiotics, including beta lactam‑beta lactamase inhibitor (BL‑BLI) agents and carbapenem. MATERIALS AND METHODS: This is a retrospective study done in Apollo Specialty Hospital, a tertiary care oncology center in South India. The susceptibility of Escherichia coli, Klebsiella, Acinetobacter and Pseudomonas blood culture isolates, identified between January 2013 and June 2014 to various antibiotics were analyzed. RESULTS: A total of 231‑Gram‑negative bacteremic isolates were analyzed. ESBL rate among E. coli isolates was 82.7% (67 out of 81) and 74.3% (58 out of 78) in Klebsiella. Carbapenem (imipenem) susceptibility rate in E. coli was 76.5%, Klebsiella 58.9%, Acinetobacter 32% and Pseudomonas 77.2%. Colistin susceptibility in E. coli was 96.2%, Klebsiella 93.5%, Acinetobacter 92.8% and Pseudomonas 97.7%. Difference in the susceptibility of Enterobacteriaceae to BL‑BLI agents (especially cefepime‑tazobactam) and carbapenem were minimal. In nonfermenters, BL‑BLI susceptibility was better than that of carbapenem. CONCLUSION: Findings of the study make a strong argument for using BL‑BLI agents and sparing carbapenem to curtail the spiraling scenario of carbapenem resistance.

Antimicrobial susceptibility of Salmonella enterica serovars in a tertiary care hospital in southern India.

Background & objectives: Salmonella enterica serovars Typhi and Paratyphi are predominantly known to cause enteric fever. Multidrug resistance in S. Tphi and S. Paratyphi has emerged as a cause of concern. This study was done to evaluate status in antimicrobial susceptibility patterns of Salmonella enterica serovar Typhi (S. Typhi) and S. Paratyphi obtained from blood culture in a tertiary care hospital in south India. Methods: Blood isolates of Salmonella species over a two year period between May 2009 and June 2011 were studied. A total of 322 isolates of Salmonella species were tested for antimicrobial susceptibility by Kirby-Bauer disc diffusion method. The MIC of ciprofloxacin was obtained by E-test, and azithromycin MIC was confirmed by agar dilution method for a limited number of isolates. Results: Of the total of 322 isolates studied, 186 (57.8%) were S. Typhi, 134 (41.6%) were S. Paratyphi A, and two were S. Paratyphi B. Of these, 44(13.66%) were resistant to ciprofloxacin (MIC <0.50 μg/ml) and 296 (91.9%) were nalidixic acid resistant. Of these 296 nalidixic acid resistant isolates, 278 (94%) were susceptible to ciprofloxacin by MIC criteria (<0.5 μg/ml). Of the 262 isolates tested for azithromycin sensitivity, only 120 (46%) were susceptible, whereas 81 (31%) were resistant and 55 (21%) showed intermediate susceptibility. Of the isolates, 322 (90%) were susceptible to ampicillin and (95%) were susceptible to co-trimoxazole. However, all the isolates were susceptible to chloramphenicol and ceftriaxone. Interpretation & conclusions: Nalidixic acid resistance screening is not a reliable surrogate indicator of ciprofloxacin resistance. Ciprofloxacin MIC should to be routinely done. Azithromycin resistance appears to be emerging. However, isolates showed a high degree of susceptibility to ampicillin, co-trimoxazole and chloramphenicol. Thus, antibiotics like ampicillin and co-trimoxazole may once again be useful for the management of enteric fever in southern India.

"The Chennai declaration" Recommendations of "A roadmap- to tackle the challenge of antimicrobial resistance" - A join meeting of medical societies of India.

"A Roadmap to Tackle the Challenge of Antimicrobial Resistance - A Joint meeting of Medical Societies in India" was organized as a pre-conference symposium of the 2 nd annual conference of the Clinical Infectious Disease Society (CIDSCON 2012) at Chennai on 24 th August. This was the first ever meeting of medical societies in India on issue of tackling resistance, with a plan to formulate a road map to tackle the global challenge of antimicrobial resistance from the Indian perspective. We had representatives from most medical societies in India, eminent policy makers from both central and state governments, representatives of World Health Organization, National Accreditation Board of Hospitals, Medical Council of India, Drug Controller General of India, and Indian Council of Medical Research along with well-known dignitaries in the Indian medical field. The meeting was attended by a large gathering of health care professionals. The meeting consisted of plenary and interactive discussion sessions designed to seek experience and views from a large range of health care professionals and included six international experts who shared action plans in their respective regions. The intention was to gain a broad consensus and range of opinions to guide formation of the road map. The ethos of the meeting was very much not to look back but rather to look forward and make joint efforts to tackle the menace of antibiotic resistance. The Chennai Declaration will be submitted to all stake holders.

Prevention of more complications in patients with head trauma

Head trauma and brain injuries are common causes of emergency admission and usually predispose multiple psychiatric complications. In turn, the traumas often occur after some psychiatric disorders. Therefore, the complicated interaction of these factors often causes difficulties in diagnosis and management of the patients. The side effects of surgical and medical treatments may also complicate these processes more, as well. In this study, we present a case of a young patient with these complex factors and discuss the diagnosis and management

Efficacy of memoral herbal on prevention of electroconvulsive therapy-induced memory impairment in mood disorder patients [Isfahan-ÿIran 2011]

Electroconvulsive therapy [ECT] is one of the most efficacious treatment for major depressive disorder [MDD], it is also used as a rapid and efficacious treatment for other psychiatric disorders, especially treatment resistant ones. The cognitive impairment is one of the most important side effects of ECT. This study examined the Memoral herbal efficacy in prevention of ECT-induced memory impairment. In a randomized clinical trial, 70 patients with mood disorders who were candidates for ECT enrolled in either Memoral or Control group, and received either Memoral or placebo. The memory was assessed by Addenbrook Cognitive Examination [ACE], and the findings were analyzed by ANOVA under SPSS18. The Memoral group patients showed significantly higher total ACE scores than placebo group [P < 0.001]. The scores of attention and orientation, verbal fluency and memory subscales not only never decreased during the study in Memoral group, but also increased. There was no significant difference between these scores of Memoral and placebo groups for the subscales of language and visuospacial ability. The Memoral herbal is an efficacious and safe choice in prevention of ECT-induced cognitive impairment

Profile of Young Acute Myocardial Infarction in Chittagong Medical College Hospital, Chittagong.

Background: Coronary artery disease (CAD) is now an emerging epidemic in developing countries including Bangladesh. Younger people are being affected here more and more. Young individuals with acute myocardial infarction (AMI) may have unique presentation, risk factor, angiographic profile and outcome which may have an influence on the preventive strategies. This study is an attempt to investigate the same. Methods: Young patients (aged d” 40 yrs) with AMI admitted to the coronary care unit of Chittagong Medical College Hospital over a period of one year were included in the study. Assessments of the patients were done with clinical history, physical examination and systemic evaluation. Location and types (STEMI, NSTEMI) of myocardial infarction were determined by ECG and serum troponin- 1 assay. Blood for glucose and lipid profile was drawn within 24 hours of admission. High sensitivity testing for C-reactive protein (hs CRP) was done in all patients. Coronary angiography was done within 6 weeks of hospital discharge. Results: A total of 83 Patients with age d” 40 years were included .Age range were 21-40 years (34.21 ± 5.07 yrs). There were 71 male (85.5%). Male: female ratio was 5.9:1. Most of the young AMI patients presented lately to the hospital. Majority of these patients were thinly built, came from urban or semiurban areas, engaged in heavy physical activities and belonged to lower socioeconomic group. A positive family history of CAD was present in 18 patients (28.68 %). Smoking was the most prevalent risk factor followed by a raised serum triglyceride or low high density lipoprotein (HDL). A raised hs CRP was present in 47 patients (49.39%). The overall in hospital mortality was only 3.61 %. Coronary angiography done in 38 patients revealed single vessel disease in the majority. Conclusion: The study focuses our attention to the rising incidence of AMI in young individuals who are less prone to CAD. Early detection of AMI and timely intervention needs high index of suspicion in this age group. These young patients have got low BMI High TG, Low HDG High hs CRP & habit of smoking. Avoidance of smoking, controlling high TG and/or low HDL may reduce incidence of AMI among young patients. Use of high dose of statin at an early age in young persons with raised CRP may be considered.

Accidental five fold overdose of propofol for induction in a 38-days-old infant undergoing emergency bilateral inguinal hernia repair

The induction dose of propofol is higher in younger children [2.9 mg/kg for infants younger than 2 years] than in older children [2.2 mg/kg for children 6-12 years of age]. A modest reduction in systolic blood pressure often accompanies bolus administration. The major concern with propofol is the potential for propofol infusion syndrome [lactic acidosis, rhabdomyolysis, cardiac and renal failure], which is generally associated with high-dose infusion for an extended period. We report a 38-days-old male infant underwent emergency bilateral inguinal hernia repair who accidentally received a five-fold dose of propofol for induction of general anesthesia

Comparison of four different treatment options in the management of acute conversion disorder

Patients with conversion disorder may be seen by different specialists in various clinics and emergency situations. However, there are not sufficient studies on the most effective treatment for this disabling illness. In a clinical trial, we compared four treatment strategies; muscle relaxation, suggestion, hypnosis and intravenous diazepam infusion, in 80 patients with acute conversion disorder. Speed of recovery and number of the recurrences in a month following different treatment options were compared among groups. Recovery was significantly quicker with muscle relaxation compared to hypnosis and diazepam infusion. In patients with comorbidity of major depressive disorder, recovery was even faster. There was no statistically significant differences in the number of remissions or relapses among the four groups. All the four different treatment strategies brought about significant recovery. However, after treating patients with muscle relaxation, recovery was faster compared to other treatment methods

Add-on topiramate for the pharmacological management of schizophrenia: a double blind randomized clinical trial

Glutamate antagonists including anticonvulsant topiramate have been recommended for the pharmacological management of schizophrenia. A randomized, double-blind, placebo controlled clinical trial was performed on 32 patients diagnosed with schizophrenia [18-45 years old]. Baseline information was gathered on demographic characteristics, vital signs, height, weight, smoking habit, [past] psychiatric history, drug history and adverse effects to medication. Patients were randomly assigned to topiramate group [n=16] or placebo one [n=16]. Positive and negative syndrome scale [PANSS] was administered on each patient at baseline, on days 28 and 56. The mean total PANSS score in topiramate group was 96.87 [85.37-108.37] at baseline, 85.68 [74.67-96.70] on day 28 and 76.87[66.06-87.69] on day 56. These were 101.87 [90.37-113.37], 100.31 [89.29- 111.32] and 100.56 [89.74-111.37] respectively in placebo group. General linear model for repeated measure analysis showed that topiramate has lowered PANSS score significantly. Significant decline was also found in all three PANSS components [negative, positive and psychopathology symptoms]. Topiramate can therefore be used as an effective add-on medication in treating schizophrenia