Same day sputum smear microscopy approach with modified ZN staining for the diagnosis of pulmonary tuberculosis in a microscopy centre at Rajahmundry.

Background: Sputum smear microscopy is the main‑stay in the diagnosis of pulmonary tuberculosis in many developing countries. To overcome the drop outs, same day diagnosis is ideal. Materials and Methods: In the current study, two spot sputum samples (SS2 approach) are collected within a gap of one hour (same day sputum smear microscopy) in addition to the standard spot morning (SM) approach. The smears were stained with standard Ziehl Neelsen (ZN) and modified ZN staining techniques. Results: Out of 1537 patients, sputum smear positivity (SSP) was 9.43% (146 patients) in SM approach with standard ZN staining. Smear positivity was increased to 9.8% (151 patients) with modified ZN staining. For SS2 approach, SSP was 9.37% (144 patients) and 9.8% (151 patients) with standard and modified ZN staining procedures, respectively. Conclusions: Diagnosis of lung tuberculosis is possible with two spot sputum samples with modified ZN staining.

Delayed syndrome in carbon monoxide poisoning.

Acute carbon monoxide poisoning can lead to delayed manifestations. This has been called post-interval syndrome, which can present after an apparent period of normalcy following acute poisoning. We are reporting a patient who had an accidental exposure to carbon monoxide and presented later with all the manifestations of delayed poisoning. The various clinical manifestations and imaging findings are discussed. A delay in recognition in the acute stage can predispose to development of the post-interval syndrome.

Late postpartum eclampsia without prodroma.

Late postpartum eclampsia is an increasingly recognized entity. We describe a patient who developed postpartum eclampsia on the 6th day of delivery without any preceding pre-eclampsia. A high index of suspicion and close follow-up will help in the early detection of this condition. Awareness of this condition will also save the patient from unnecessary investigations. This may be all the more relevant in developing countries where eclampsia contributes to one-third of maternal mortality and the resources for patient investigation and management are limited.

Primary plasma cell leukemia occuring in the young.

Plasma Cell Leukemia (PCL) is a rare form of plasma cell dyscrasia. Plasma cell leukemia has two variants: the primary form presents de novo in patients with no previous history of multiple myeloma (MM); the secondary form consists of a leukemic transformation in a previously recognized MM. In contrast to myeloma, PCL has an aggressive course. Median age at presentation is usually above 50 years. Here we report a case of primary PCL presenting at age of 21 years, which is extremely rare. She was treated with combination chemotherapy (VAD). Although she had a good response initially, later the disease progressed and she died 6 months after the diagnosis.