Listeria monocytogenes brain abscess in an immunocompromised patient: a case report

Listeria monocytogenes is a facultative intracellular gram-positive bacillus which usually infects immunocompromised patients, though it can infrequently infect immunocompetent individuals, neonates and pregnant women as well. Neurological manifestations include meningitis and cerebritis. Brain Abscess is an extremely rare presentation with approximately 80 reported cases. Authors report a patient with a brain abscess identified on an MRI scan with positive blood culture for Listeria monocytogenes. Patient was managed conservatively with intravenous followed by oral antibiotics with resolution of the abscess.

Prevalence and predictors of pulmonary artery hypertension in systemic sclerosis.

INTRODUCTION: Development of pulmonary artery hypertension (PAH) worsens the prognosis of systemic sclerosis (SSc). There is paucity of data on PAH in patients with SSc in India. We have attempted to determine the prevalence and predictors of pulmonary artery hypertension in systemic sclerosis using noninvasive cardiopulmonary evaluation. OBJECTIVES: (1) To study the prevalence of PAH in SSc (2) To study the predictors of PAH in SSc (gender, age of onset of disease, duration of disease, extent of skin involvement, digital infarcts/ulcer, interstitial lung disease. MATERIAL AND METHODS: Clinical and functional characteristics of 100 patients of systemic sclerosis who had undergone screening echocardiography to detect pulmonary artery hypertension were studied. RESULTS: PAH was found in 32% patients on 2D-echocardiography. Prevalence of PAH did not differ between patients with limited cutaneous SSc (lcSSc) and patients with diffuse cutaneous SSc (dcSSc). On multiple logistic regression analysis, none of the studied variables was found to be independent predictor of PAH in SSc. CONCLUSION: PAH in SSc occurs in significant proportion of patients without any "red flag signs" in early stages. Non-invasive screening of patients with SSc for PAH will help in early diagnosis and appropriate timely therapeutic intervention before significant end-organ damage occurs.

Complementary and alternative medicine use in rheumatoid arthritis: an audit of patients visiting a tertiary care centre.

BACKGROUND: Complementary and alternative medicine (CAM) enjoys widespread popularity in chronic illnesses such as rheumatic diseases. Rheumatoid arthritis (RA) is the commonest inflammatory joint disease seen in clinical practice. No systematic study on the use of CAM by patients with RA is available from northern India. METHODS: We evaluated the prevalence and usage characteristics of CAM in Indian patients with RA using a questionnaire at a tertiary care centre in northern India. RESULTS: Of the 102 patients with RA included in the study, 39% reported current CAM use. As many as 84 respondents (82%) reported having tried CAM during the course of their disease. A total of 215 CAM courses were used, out of which 77 were being continued. Ayurveda was the commonest (28% courses) followed by homoeopathy (20%), yoga asana (17%) and pranayama (12%). Pain control was the primary reason for using CAM (69% of users). Most CAM therapies (78%) were started on the advice of friends and relatives. Discontinuation of CAM was attributed to lack of clinical benefit (78%) and adverse effects (10%). Of the patients using CAM, 87% did not reveal its use to their physicians, primarily because the physician did not enquire about it. CONCLUSION: Patients with RA frequently use CAM for pain control. These practices are often not revealed to the treating physician. Knowledge of the concurrent use of CAM may serve to alert the physician about potential side-effects or drug interactions.