Rare association of leukocytoclastic vasculitis in visceral leishmaniaisis

A 30-year-old man presented with fever, hepatosplenomegaly, and a rash over his lower limbs [palpable purpura]. Evaluation revealed pancytopenia and hypergammaglobulinemia. A subsequent bone marrow examination and serology confirmed visceral leishmaniasis [kala-azar], while the biopsy of skin lesion suggested leukocytoclastic vasculitis. No alternate cause of vasculitis was forthcoming, and the patient was treated with conventional amphotericin B for 14 days after which resolution of symptoms [including the rash] was noted. Cutaneous vasculitis is an extremely rare complication following visceral leishmaniasis with no known cases reported thus far. Hence, a high index of suspicion is warranted in achieving timely diagnosis and initiation of appropriate therapy

Status of multidrug resistant tuberculosis [MDR-TB] among the Sahariya tribe of North Central India

Background: The incidence/prevalence of tuberculosis [TB] is reported to be high in the Sahariya tribe of North Central India. The outbreaks of different drug-resistant isolates of Mycobacterium tuberculosis emphasized the need for continuous monitoring of resistance to anti-tuberculosis drugs. This study aimed to assess the profile of multidrug resistant TB among the Sahariya tribe and their non-tribal neighbors for first line drugs through field-based investigations.

Methodology: A total of 274 sputum positive pulmonary TB individuals were enrolled and studied for their drug susceptibility profile by the proportion method. Results: A total of 21 cases from Sahariya and 6 from non-tribes were identified with MDR-TB. Thus Sahariya tribe showed a 1.95-fold increased risk of developing drug resistance than non-tribes. Significant differences were observed for developing drug sensitivity between Sahariya males and females when analyzed for resistance developed to any drug and overall drug resistance vs. sensitive isolates, respectively

A 4.46-fold risk was found for MDR-TB among the smokers of Sahariya tribe, whereas, the non-tribes did not show any significant association

Conclusion: The drug susceptibility profile developed in the present study indicates that drug-resistant tuberculosis is emerging as a serious public health concern in Sahariya tribe. Urgent and effective control measures and better management policies are needed for the prevention of MDR-TB in the tribe

prospective, randomized, double-blind, comparative study of the efficacy of intravenous ondansetron and palonosetron for prevention of postoperative nausea and vomiting

Palonosetron is a second generation 5-Hydroxytryptamine-3 receptor antagonist with longer half life and higher receptor binding affinity than Ondansetron. To assess the efficacy and safety profile of intravenous palonosetron compared to the ondansetron for prevention of post-operative nausea and vomiting [PONV] under general anesthesia. A prospective, randomized, placebo-controlled, double-blind study was conducted in 90 patients aged 20-60 years, undergoing major surgeries. Group I [n=30] received placebo injection; Group II [n=30] received inj. ondansetron 8 mg and Group III [n=30] received inj. palonosetron 0.075 mg IV. In the operating room, the study drugs were given IV in equal volume of 4ml, before inducing the patients. In postoperative period each patient was observed for retching, nausea and/or vomiting at 30 min; and then at 1, 2, 6, 12 and 24 hours. Any side effects intra-operatively and post-operatively were recorded. The number of patients, who remained vomiting free in the first 24 hours after surgery was 56.6%, 80% and 86% in the placebo, Ondansetron and Palonosetron groups respectively. The difference with placebo was highly significant for ondansetron [p < 0.05], and highly significant for palonosetron [p=0.009]. The difference in vomiting between Ondansetron and Palaonosetron was not significant but the incidence of nausea was significantly less common in the Palonosetron group than the Ondansetron group [16.7% vs. 43.4%, p=0.006]. We conclude that the second generation 5-HT3 antagonist, palonosetron is significantly more effective against PONV than ondansetron. It has a particularly more pronounced and prolonged effect on postoperative nausea

Seroprevalence and trend of dengue cases admitted to a government hospital, Delhi - 5-year study [2006-2010]: a look into the age shift

Diagnosis of dengue infection is easily and best accomplished by demonstration of specific IgM antibodies in blood. We analyzed retrospectively the dengue IgM seropositivity available for samples obtained over a period of 5 years [2006-2010] from patients with suspected dengue fever [DF]-like illness to investigate whether there was an overall increase in the dengue IgM prevalence over this period. Blood samples were collected from patients with DF-like febrile illnesses attending the Pediatric, Medicine, and Fever clinics of a Government hospital, Delhi. A total of 8138 individuals [suspected dengue cases] obtained over 5 years were tested for dengue specific IgM antibodies. Year wise, month wise, and age wise data on geographic distribution and clinical manifestations were analyzed. Of the 8138 samples, 1600 [19.66%] were positive for dengue specific IgM. The year 2006 had the highest number of reported cases, 761 [46.23%]. In our study, the age group most commonly affected of all 5 years was 11-20 years. Out of the total 1600 cases admitted to the hospital between 2006 and 2010, 279 [58.9%] had DF, 178 [37.6%] had dengue hemorrhagic fever, and 16 [3.38%] had dengue shock syndrome. We found a high burden of dengue in young children and late adolescents in both rural and urban communities at a magnitude greater than previously described. We observed an increase in the dengue positive cases every alternate year, thereby indicating a possible role of herd immunity in northern India. We did not find a steady increase in the number of cases over 5 years. We found an increase in the number of positive cases in children and young adolescents