Acute Hemolytic Anemia With Rare Etiology

Naphthalene is a widely used industrial and household chemical in the form of mothballs. But it has rarely been used as an agent of poisoning worldwide. Here, we describe the case of acute hemolytic anemia with methemoglobinemia following ingestion of naphthalene mothballs. A 26-year-old female ingested 6 mothballs and presented three days later with hemolysis and methemoglobinaemia. She was given intravenous methylene blue, N-acetylcysteine and ascorbic acid, besides supportive treatment. Renal replacement therapy in the form of hemodialysis was done on an alternate day basis. She was discharged after ten days on outpatient follow-up.

Evaluation of HbA1c and tuberculin test in wound complications of surgical patients with diabetes.

Background: Diabetes is a global epidemic and India is regarded as the “diabetes capital of world”. Wound healing deficit are often seen in patients with diabetes mellitus. Aims & Objective: The present study was undertaken to correlate HbA1c level and plasma glucose level with wound complications in postoperative wounds in diabetic patients, to find out relationship of HbA1c and tuberculin test with wound complications, to correlate the role of HbA1c and tuberculin test in prediction of wound complications. Materials and Methods: The study is a prospective analysis of 100 patients from June 2006 to June 2008, in University Hospital in North India. All known diabetic and recently diagnosed diabetic patients with surgical illness were included in the study. All patients were investigated for HbA1c (by micromatTM Hemoglobin A1c test), Mantoux test (intradermally injecting 0.1 ml Tuberculin PPD with tuberculin syringe), blood sugar F/PP, serum albumin. Wound complications have been noted in postoperative period along with co-morbid condition of patients. Selected patients are divided in four group (i) clean wound; (ii) clean contaminated; (iii) contaminated and (iv) diabetic foot / dirty wound. Results: Out of 100 diabetic patients, male to female ratio was 3:2. Maximum number of patients are in age group of 51-60 years, 51 out of 100 patients were associated with comorbid condition. HbA1c level in diabetic patients were < 6 in 13%, 6-8 in 43%, 8-10 in 30% and >10 percent in 14% patients. Mantoux test was positive in 31 out of 92 patients. Wound complication was present in 54 patients, mostly in uncontrolled diabetes. Out of 99 patients, 41 have clean wound, 31 have clean contaminated, 6 contaminated and 21 patients having dirty / diabetic foot. Conclusion: Study show a fair correlation between HbA1c, Mantoux test and wound complication. There is decrease in cell mediated immunity leading to decrease in mantoux test positivity and increase in wound complication.

Study of the association of metabolic syndrome with schizophrenia in north eastern part of India.

Background: During last several years there has been growing interest in metabolic abnormalities in Schizophrenia. Studies in this context are lacking in this part of India. Aims & Objective: To study the association of metabolic syndrome with schizophrenia in North eastern part of India. Material and Methods: 50 Adult schizophrenic patients diagnosed as per DSM-IV TR Criteria and age and sex matched 50 subjects of control group were included in for prevalence of MetS as per the criteria of the International Diabetes Federation (IDF). Informed consent was obtained. The study was approved by local ethical committee. Results: Maximum numbers of subjects were in the age group 21-30 years and males were more than female in schizophrenia group. 14 (28%) patients in schizophrenia group and 6 (12%) subjects in control group had MetS. The mean Serum triglyceride of schizophrenia (153.41 ± 57.26) was significantly higher (p<0.05). Mean BMI of schizophrenia (22.55 ± 4.19) was higher as compared to control group (22.30 ± 3.35). 38 patients (76%) were taking antipsychotics for more than 6 months of duration, in which 14 patients (28%) were found to be having MetS while 24 patients (48%) had no MetS. 2nd generation antipsychotics were taken by 35 patients (70%) in which 14 patients (28%) were found to have MetS while 21 patient (42%) had no MetS. Conclusion: This study showed that prevalence of MetS, risk factors, was more in schizophrenia than control group and it was present more commonly in patients taking second generation antipsychotics.

Evaluation of the incidence, nature of injury and clinical outcomes of head injuries in North Eastern part of India.

Background: Incidence of head injuries/ traumatic brain injuries (TBI) is increasing day by day, and this is the major cause of morbidity and mortality in developing countries. Aims & Objective: To evaluate the incidence, nature of injury and clinical outcomes of head injuries in North eastern part of India. Material and Methods: 1300 patients of head injury were included in the study. On presentation a patient’s clinical status was grossly assessed with the Glasgow Coma Scales (GCS). X-ray cervical spine in suspicious cases and Non contrast computed tomography scan was done of all head injury patients. Results: 21-40 years age group (40.0%) was most commonly affected and most of patients (74%) were male. Road traffic accident (47.07%) was most common cause of head injury followed by fall from height (32%). Overall mortality in total head injury patient was 13%. According to GCS al 368 (43.5%) patients of severe head injury patient expired while mortality in moderate grade injury was 5.6% and 100% of mild head injury patients were saved. A total of 532 (40.92%) patients had skull bone fracture and among bone fracture simple bone fracture was most common. Conclusion: Most of the injuries occur more commonly in certain age groups, at certain localities and mostly in male. So the knowledge about the causes and pattern of head injury may be extremely helpful in making preventive policies.

Study to assess the pathophysiological role of VEGF in patients with chronic myeloid leukemia(CML) .

Background: VEGF play a significant role in the pathogenesis of chronic myeloid leukemia. Aims & Objective: (1) Assess the pathophysiological role of VEGF in patients with chronic myeloid leukemia (CML). (2) Study the effect of Hydroxyurea and Imatinib on serum VEGF level. Material and Methods: A total of 40 cases of chronic myeloid leukemia (CML) and 20 age and sex matched healthy controls were included in this study. The patients were divided into 3 subcategories: Untreated cases (which did not receive any treatment); patients who were treated with Hydroxyurea and patients who were treated with Imatinib Mesylate. 5 ml of blood was collected, were centrifuged at 5000 rpm for 10 minutes and stored at - 20°C until assay. Results: On comparing the various subgroups with control, the value was 726.61 ± 199.67 pg/ml in untreated group. It was 573.53 ± 213.423 pg/ml in Hydroxyurea group and 530.00±180.96 pg/ml in Imatinib group. Fresh cases had significantly elevated VEGF value (P value < 0.001). VEGF level significantly elevated in Untreated cases when compared to treated groups either hydroxyurea (p=0.02) or Imatinib (p=0.019). There was no significant difference between Hydroxyurea and Imatinib groups. Conclusion: This study suggests that VEGF play a significant role in the pathogenesis of chronic myeloid leukemia. Understanding this may help in designing new therapeutic strategies (antiangiogenic agents) for this dreaded disease.

Knowledge, Attitude, and Practices (KAP) study on HIV / AIDS among HIV patients, care givers and general population in north-eastern part of India.

Background: HIV, the disease, whose mode of transmission is known and is largely preventable, but due to lack of knowledge and practices about HIV/AIDS in general population causes its rapid spread. Aims & Objective: To assess and compare the knowledge, attitude and practices about HIV in patients group, care giver and in general population. Material and Methods: A total of 102 HIV/AIDS patients, 60 care givers (35 attendant, 19 nurses, 6 doctors) and 40 general population (control) were included in the present study. The patients who were registered for study were followed up for three visits. The responses were recorded on a pre-designed and pre-tested, semi- structured questionnaire. Results: Illiteracy was more common in HIV patient group (27.5%) . A high proportion of HIV/AIDS cases were engaged in transport/ production industry (24.5%). Electronic media and print media are major source of information. 35.3% patients, 22.9% care givers and 47.5% general population group thought that with medication HIV is curable. Sexual contact (63.8%) was the commonest mode of transmission. 80.0% medical staff thought that a newly diagnosed HIV person, first to talk with doctor. After 6 month follow up: 82% patients write sexual contact as major mode of transmission, and Use of condom was most important preventive measure (68%). Conclusion: Understanding the KAP about HIV/AIDS of Patients, care givers and in general populations will help us in formulating strategy for prevention and treatment.