Comparative evaluation of antigen detection ELISA and reverse transcriptase PCR in acute stage of Japanese encephalitis prevalent in endemic areas of North-Eastern part of Uttar Pradesh, India.

Background: Objective of current study was to compare and evaluate different diagnostic tests to establish a reliable and less time consuming diagnostic test for prompt diagnosis of acute Japanese encephalitis cases mainly amongst children and young adults from North-Eastern part of Uttar Pradesh. Methods: A total of 100 subjects, including 50 suspected cases and 50 diseased controls were investigated to establish the diagnosis of JE in acute encephalitis patients. All CSF samples were subjected to MAC-ELISA, virus cultivation and RT-PCR. Results: Out of 50 cases, 6 showed negative results by all the three tests. 50% (22 out of 44), 47.5% (21 out of 44), and 66% (23 out of 44) were found positive by MAC-ELISA, Virus cultivation and RT-PCR respectively. The rate of detection by Virus cultivation and RT-PCR was higher in case of MAC-ELISA negative cases (57.1% and 78.5%) than that of MAC-ELISA positive cases (22.7% and 27.2%) respectively. Mean age of the patients was 12.5 years, which ranged from 1-24 years with male to female ratio of 3:1. Conclusions: The RT-PCR was found most reliable, sensitive and specific method amongst the three chosen methods for detection of JEV in suspected encephalitis patients.

Atrial fibrillation associated with high voltage electric shock in a young healthy female: a case report.

Atrial fibrillation is amongst the various arrhythmias resulting after electrical injury but its incidence has been reported to be extremely rare. Here we are reporting a case of 35 years old lady presenting to our Emergency department with atrial fibrillation with fast ventricular rate after accidentally being injured by high voltage electrical current. She was managed successfully with pharmacological cardioversion followed by a period of observation. The rhythm reverted back to normal sinus rhythm on 3rd day. This approach of management is amongst one of the few published cases where patient was managed conservatively.

Sphingobacterium multivorum causing fatal meningoencephalitis: a rare case report.

We report a case of fatal meningitis caused by bacteria, Sphingobacterium multivorum, probably first time being reported from India. S. mulivorum has been isolated from various clinical specimens but it is only rarely been associated with serious infections. Sphingobacterium species are generally resistant to aminoglycosides and polymyxin B. Susceptibility to β-lactam antibiotics is variable, requiring testing for individual drug. This 36 year male had two weeks history of high-grade fever with altered sensorium and occasional seizures. Patient admitted with septicemia and subsequently developed meningitis and succumbed to his illness after being discharged against medical advice. His CSF culture yielded S. multivorum subsequently confirmed by mini API, bioMérieux Inc. Marcy-l’Etoile France. Due to its rare association with common clinical conditions, it requires a high degree of suspicion and expertise to prove its presence in clinical specimens. Since this bacterium is inherently resistant to many classes of antibiotics, a vigilant and efficient microbiological work up is needed to establish its diagnosis and prompt treatment.

Myxoedemic coma: an uncommon presentation of Sheehan syndrome.

This is a rare case of a 35 year old multiparous female who presented with electrolyte abnormality, hyponatremia in a setting of seizure and moderate pallor. She had a significant past history of childbirth complicated with post-partum haemorrhage after which she developed secondary amenorrhoea and lactation failure. Workup showed suppressed levels of all pituitary hormones and was treated as myxoedemic coma. A diagnosis of Sheehan’s syndrome presenting as myxoedemic coma - a rare but emergency presentation was made.

Echocardiographic assessment of the impact of cardiovascular risk factors on left ventricular systolic function in patients with acute myocardial infarction.

Background: Objectives of current study were to determine the magnitude of left ventricular systolic dysfunction in patients with acute myocardial infarction in the rural sub-population of Uttar Pradesh in India and to evaluate the impact of cardiovascular risk factors on the risk of impairment of left ventricular systolic function. Methods: One hundred and fifty seven consecutive patients with first acute myocardial infarction were enrolled into the study. Most patients were male (73.2%) and the mean age of presentation was 52.7 years. Two dimensional echocardiography was utilized to assess conventional parameters such as Left Ventricular End-Diastolic Diameter (LVEDD), Left Ventricular End-Systolic Diameter (LVESD), LV End-Diastolic Volume (LVEDV), LV End-Systolic Volume (LVESV) and Left Ventricular Ejection Fraction (LVEF). The LV volumes (end-systolic and end-diastolic) and LVEF were calculated from the conventional apical two-and four-chamber images using the biplane Simpson’s technique. LV systolic function was considered depressed when LVEF was less than 45%. The chi-square test was used in the statistical analysis to compare proportions and a logistic regression model was used to assess the independent effect of the each variable. Results: The study projects a high proportion (42.7% of the patient population) of left ventricular systolic dysfunction in patients with Acute Myocardial Infarction (AMI). No association was found between gender or age and LV systolic dysfunction. The proportion of patients with diabetes mellitus was higher in the sub-group of patients with impaired LV systolic function (45.2% vs. 30.2%, P = 0.01); the proportion of patients with history of current or past smoking was also higher in the sub-group of patients with impaired LV systolic function (48.9% vs. 34.2%, P = 0.03). On the other hand, hypertension and dyslipidemia were not associated with impaired LVEF. After adjustment of other variables, diabetes and smoking were associated with a significantly higher risk of LV systolic dysfunction (diabetes: OR = 3.73; 95% CI = 1.25-11.16; smoking: OR = 3.8; 95% CI = 1.37-11.05). Conclusion: Since the proportion of patients with LV systolic dysfunction in patients with AMI remains relatively high, LV systolic function variables such as LVEF and LVESV should be echocardiographically evaluated in all patients with AMI. Since the post-infarction LV systolic function remains the single most important determinant of survival, treatment of AMI patients should be aimed at limitation of infarct size and prevention of ventricular dilation. Moreover, cardiovascular risk factors such as diabetes mellitus and smoking have a significant impact on the likelihood of impairment of LV systolic function in patients with AMI and hence could influence long-term prognosis.

Pattern of macrovascular disease phenotypes amongst newly diagnosed type 2 diabetic patients in a rural institute in Uttar Pradesh, India.

Background: The objective of current study was to determine the proportion of Macrovascular Disease (MVD) phenotypes amongst newly diagnosed type 2 diabetic patients in our institute by dividing the cases into sub-groups according to the MVD sites involved (NMVD - no macrovascular disease; NSCS - non-significant carotid stenosis; CBVD - cerebrovascular disease; CAD - coronary artery disease; PAD - peripheral artery disease; PVD - polyvascular disease) and studying the anthropometric, clinical and laboratory parameters in each group. Methods: The study included a cohort of 136 newly diagnosed patients with T2 DM. Demographic, clinical and laboratory parameters were included in analyses. Standardized procedures were used to assess the risk factors of associated metabolic syndrome (MetS). Results: The proportion of patients with MVD was 27.94% amongst the participants in the study. The majority of patients with MVD were in the CAD group (15.44%). Age, male sex and smoking history were independent risk factors in the CAD and PAD groups (P <0.01). A low HDL-C value was an independent risk factor in the CAD and PVD group P = 0.03). Very high frequencies of MetS were observed in the PAD and PVD groups (90% and 91.7% respectively). Prevalence of PVD was three times more common in males as compared to that in females. All patients with PAD had associated CAD also. Conclusion: This study projects a high proportion of MVD amongst newly diagnosed Type 2 diabetics in rural sub-population in Uttar Pradesh. High rates of mortality and morbidity in these patients due to macroangiopathy warrant early screening of MVD to ensure timely preventive and therapeutic measures.

Acute intermittent porphyria with syndrome of inappropriate antidiuretic hormone secretion (SIADH) and neurological crisis, successfully treated with haemodialysis.

We report a 35 years old male, a case of Acute Intermittent Porphyria (AIP) with Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH) and neurological crisis for its rarity. Since specific parenteral medication (hemin) was not available, patient was empirically treated with haemodialysis with satisfactory outcome.