Massive splenomegaly as the presenting feature of multiple myeloma in an elderly man

A 70-year-old man presented with generalized weakness, easy fatigability, and early satiety of 2-month duration. On examination, he had severe pallor and massive splenomegaly. Hematological investigations revealed bicytopenia with hypergammaglobulinemia and acute kidney injury. Bone marrow aspiration cytology was suggestive of plasma cell dyscrasia. Monoclonal protein peak (due to heavy chain of IgG type) was found on serum protein electrophoresis, and lambda light chains and IgG heavy chains were elevated on immunofixation. The patient was diagnosed as a case of multiple myeloma and was started on bortezomib杔enalidomide杁examethasone regimen. After 7 months of chemotherapy, his spleen had regressed, and the patient had become asymptomatic. Presentation with massive splenomegaly is usually a feature of Waldenstrom抯 macroglobulinemia. However, rarely multiple myeloma may have extramedullary manifestations such as splenomegaly as the primary presenting feature.

Third generation cephalosporin-resistance in Klebsiella pneumoniae isolates: an emerging threat.

Background: Newer generation cephalosporin-resistance among Klebsiella pneumoniae organisms has increased recently. Present study is undertaken to find incidence, antimicrobial susceptibility and prevalence of extended spectrum beta-lactamase (ESBL) in K. pneumoniae isolates in a tertiary care hospital. Methods: Prospective study was carried out between June to December 2011. Samples of pus, blood, urine, cerebro-spinal fluid, stool, peritoneal, pleural and synovial fluid were collected from indoor and outdoor patients for isolation and antimicrobial susceptibility pattern of K. pneumoniae in the department of microbiology, G.R. Medical College Gwalior, M.P. Ceftazidime resistant K. pneumoniae were subjected to Phenotypic Confirmatory Disc Diffusion Test (PCDDT) and Double Disc Synergy Test (DDST) for detection of ESBL. Results: Out of 2480 samples collected a total of 530 K. pneumoniae were isolated and subjected to antimicrobial susceptibility. Antibiotic sensitivity to imipenem, cefoperazone, amikacin and ofloxacin were 82, 74, 73 and 72% respectively whereas sensitivity to ceftizoxime, ceftriaxone cefotaxime, ceftazidime ranged between 47-50%. K. pneumoniae were found to be resistant to ampicillin, co-trimoxazole, doxycycline and gentamicin, by 91, 82, 54 and 50% respectively. Among third generation cephalosporins K. pneumoniae were least sensitive (47%) to ceftazidime. About 33 and 32% of the ceftazidime resistant strains were found to be ESBL positive by PCDDT and DDST respectively. Conclusions: This study has shown that prevalence of ESBL producing K. pneumoniae is the most important reason for increased resistance to third generation cephalosporins. There is need to carry out tests for detection of ESBL producing bacteria routinely.

Anti-ulcer & antioxidant activities of Hedranthera barteri {(Hook F.) Pichon} with possible involvement of H+, K+ ATPase inhibitory activity.

Background & objective: Hedranthera barteri (HB) is used in folk medicine as a vermifuge, laxative and an anti-inflammatory agent. The aim of this study was to evaluate the anti-ulcer and antioxidant properties of the dichloromethane fraction of HB root (DMHBR). Methods: Anti-ulcerogenic activity was assessed in cold-restraint (CRU), aspirin (ASP), alcohol (AL), pyloric ligation (PL) induced gastric ulcer models in rats and histamine-induced duodenal ulcer (HST) in guinea pigs. The effect of DMHBR (100 mg/kg) on gastric juice for free and total acidity, peptic activity and mucin secretion, using the pylorus ligated model, were evaluated. The H+, K+-ATPase activity was assayed in gastric microsomes, spectrophotometrically. The in vitro anti-oxidant assays were explored through DPPH, nitric oxide, hydroxyl radical, superoxide anion scavenging assays. Results: DMHBR reduced the incidence of ulcers in CRU (63.3%), PL (58.5%), ASP (52.7%), HST (75.0%) and AL (53.87%). Also, reductions were observed in the free acidity (49.4%), total acidity (45.8%) and peptic activity (32.9%) with increase in the mucin secretion by 81.6 per cent. DMHBR (60-100 μg/ml) inhibited the H+,K+-ATPase activity with IC50 of 89.64 μg/ml compared with omeprazole (10-50 μg/ml ) with IC50 of 32.26 μg/ml. DMHBR showed antioxidant activity with IC50 values of DPPH (397.69 μg/ml), nitric oxide (475.88 μg/ml), hydroxyl radical (244.22 μg/ml) and superoxide anion radical (285.20 μg/ml). Interpretation & conclusion: DMHBR showed anti-ulcer activity against experimentally-induced peptic ulcer models and exhibited both cytoprotective and anti-secretory property. It exhibited a proton pump inhibition activity and its anti-ulcer properties may be partly ascribed to its antioxidant activities.