A rare case of scrub typhus vasculitis presenting as acute coronary syndrome diagnosed by skin manifestations

A 48-year-old diabetic man presented with complaints of acute onset chest heaviness with palpitations, anxiety and headache. He had raised troponin-T level and electrocardiogram showed ST elevation myocardial infarction. There was a prior history of fever of 4 days duration with associated abdominal pain. He later developed skin rash and neurological symptoms following admission to the hospital. Dermatological examination revealed purpura and a livedo-like rash. Investigations revealed deranged liver and renal function tests and positive serological tests for scrub typhus. Coronary angiography revealed no evidence of atherosclerosis or any other pathology. He was therefore diagnosed as a case of scrub typhus-induced vasculitis with coronary manifestations and was managed with oral doxycycline. Scrub typhus presenting like an acute coronary syndrome has been reported very rarely previously. In addition, patient had gastrointestinal, central nervous system and hematological involvement which added to the rarity of the case.

Situs Inversus With Atrial Septal Defect And Pulmonary Stenosis Presenting As Cortical Blindness

Cortical blindness is a rare form of blindness characterized by the normal anterior visual afferent system. Cerebrovascular diseases, tumor involving bilateral occipital lobe, cardiac surgery or cerebral angiography are common causes for cortical blindness. Some cases may be associated with denial of blindness when it is called Anton syndrome. We came across a 9-year-old male child presenting to us for evaluation of blindness which turned out to be cortical blindness after the examination. EEG and VEP were consistent with cortical blindness with MRI showing parieto-occipital lobe signal intensity alterations. Evaluation for the cause of cortical blindness led to the diagnosis of situs inversus in the patient with an atrial septal defect. The patient had an episode of dehydration due to gastroenteritis which resulted in vascular compromise thereby leading to hypoxic damage to the brain and cortical blindness. Presentation of cortical blindness in a patient of situs inversus is unique and hence being reported

Focused Abdominal Sonography In Trauma (FAST) In Patients With Blunt Trauma Abdomen In Rural Area- A Prospective Study

Background: Unrecognized blunt abdominal injuries are often causing of the preventable death. Clinical examination is frequently inaccurate and therefore, the reliable, accurate and repeatable bed-side diagnostic test should be chosen such as Sonography. This study was under-taken to assess Focused Assessment Sonography in Trauma (FAST) examination for in rural area in the patients with Blunt Abdominal Trauma.Material and Methods:This was the prospective study including all the trauma team cases in a 24 months period between March 2016 to February 2018 in emergency department of a Uttarpradesh University of Medical Sciences& hospital,Saifai. The results of the FASTscans were analyzed and when the FASTwas positive or followed by the period of the clinical observation when FASTwas negative. Descriptive statistics & sensitivity, specicity, & predictive values were calculated.Results: Total of 100 patients were included in our study and the majority of them were males and the commonest cause of injury was a Road Trafc Accident. The sensitivity & specicity of FASTwere 92.68% and 98.31%, respectively, with an accuracy of 96.0%.Conclusion:Our study found that FASTis the highly sensitive, specic, accurate initial bedside and reliable investigation in the patients with blunt abdominal trauma, which may be done rapidly even in the haemodynamically unstable patients, making it a useful tool.

Seroprevalence of Hepatitis B at Tertiary Care Hospital

The burden of Hepatitis B caused by a hepatotropic virus, Hepatitis B Virus (HBV), is a significant public health problem in India, although a cost-effective vaccine is available at each corner of the world. It has been estimated that up to 10% of HBV global burden is shared by India alone. Each year approximately 0.1 million deaths occur due to HBV and its related illnesses in our country. The present study aims to determine actual prevalence of disease by active surveillance at tertiary care hospital. Methods: This is a prospective cross-sectional study conducted at tertiary care hospital western UP, from June 2018 to Dec 2018. 2-4 ml of blood sample from each patient was collected and sent to VRDL from different clinical OPDs and IPDs for routine screening of HVB and these all were included in this study. For this routine screening of HBV, Hepatitis B Surface Antigen (HBsAg) was used as a marker of infection. The technique used was Chemiluminescence ELISA method. The data was collected on a predesigned patient information sheet. Results: A total of 13613 samples were tested, and of these all, 653 were positive for HBsAg. Hence, the overall prevalence observed in this study was 4.8%. Among all seropositive cases, 341 (50.2%) were males and 312 (47.8%) females with P value of (P >0.05). The majority of cases 50.1% were in the age group of 16-30 years, and among these, females were dominant with 32.8% over 17.3% males. Conclusion: Thus, this study concludes that HBV infection is still a public health problem which should be among the prioritized health problem in our country.

Awareness Of Organ Donation Among Medical Students Of Jaipur City

Background and Objectives: Organ donation is the process of surgically removing an organ or tissue from donor and placing it into a recipient. The present study was conducted to assess the awareness, knowledge, and attitude regarding organ donation among medical students of Jaipur city, Rajasthan. Methods: A cross-sectional descriptive study was conducted among the second year undergraduates at tertiary centre to evaluate the awareness, knowledge, and attitude regarding Organ Donation. Results: Among the study population, 90% were aware of the term „Organ Donation,? 60% students were aware of the “organ transplantation act.” About 60 % students wanted to be a part of any Organ Donation group and also motivate others for organ donation. Interpretation and Conclusion: A well organized approach is required to raise awareness among the youth about various aspects of Organ Donation which is necessary to eliminate the setbacks that affect the rate of availability of donor organs. Motivating messages and facts are some of the means of intervention to bring about changes regarding perceptions and intentions about Organ Donation among the students. Shortage of donor organs can be resolved by raising awareness and educating the youth about various aspects of Organ Donation since they comprise of the majority of the population.

Comparative evaluation of extract of Bacopa monnieri and Mucuna pruriens as neuroprotectant in MPTP model of Parkinson’s disease.

Parkinson’s disease (PD) results primarily from the death of dopaminergic neurons in substantia nigra. Treatment of PD has been shifted recently towards herbal medicines.Bacopa monnieri (L.) Wettst. (BM) and Mucuna pruriens (L.) DC (MP) are traditional herbal plants known to have neuroprotective effects due to the presence of bacosides in whole plant extract of Bacopa monnieri (BME) and L-DOPA in MP seed extract (MPE). In this study, the comparative effect of BME and MPE in Parkinsonian mice induced by chronic exposure to 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) was evaluated. Twenty four Swiss albino mice (35-45 g) were grouped into Control, MPTP, MPTP+BME and MPTP+MPE (6 mice in each). Experimental mice were given 40 mg/kg body wt. BME, 48 mg/kg body wt. MPE treatment was given orally for one month with prior use of 15 mg/kg body wt. of MPTP for 2 wk. After the treatment period, behavioral study was performed and assessment of neuroprotective effect was done via neurochemical analysis, Immunohistochemical parameters studied included functional viability of dopaminergic neurons in substantia nigra by Tyrosine hydroxylase (TH) using monoclonal antibody against TH and apoptotic study through caspase-3 and m-RNA expression of neurogenic gene in substantia nigra region of brain. Treatment with BME or MPE for one month significantly decreased the elevated levels of oxidative stress found in Parkinsonian mice. In behavioral tests, comparative analysis of BME and MPE showed a significant increase in spontaneous locomotor activity and grip strength test. Moreover, it was found that the use of BME considerably improved the tyrosine hydroxylase activity, caspase-3 and expression of neurogenic gene in the substantia nigra region of the brain. The results suggest that BME may provide a better platform for future drug discoveries and novel treatment strategies for PD as compared to MPE.

Livedoid vasculopathy: A review of pathogenesis and principles of management.

Livedoid vasculopathy is a rare cutaneous disease manifesting as recurrent ulcers on the lower extremities. The ulceration results in atrophic, porcelain white scars termed as atrophie blanche. The pathogenesis is yet to be understood with the main mechanism being hypercoagulability and infl ammation playing a secondary role. The important procoagulant factors include protein C and S defi ciency, factor V Leiden mutation, antithrombin III defi ciency, prothrombin gene mutation and hyperhomocysteinemia. Histopathology of livedoid vasculopathy is characterized by intraluminal thrombosis, proliferation of the endothelium and segmental hyalinization of dermal vessels. The treatment is multipronged with anti-thrombotic measures such as anti-platelet drugs, systemic anticoagulants and fi brinolytic therapy taking precedence over anti-infl ammatory agents. Colchicine, hydroxychloroquine, vasodilators, intravenous immunoglobulin, folic acid, immunosuppressive therapy and supportive measures are also of some benefi t. A multidisciplinary approach would go a long way in the management of these patients resulting in relief from pain and physical as well as psychological scarring.

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.

A retrospective study of fungal corneal ulcer from the western part of Uttar Pradesh.

Background: Infectious keratitis is a major cause of avoidable blindness worldwide. Fungus is an important aetiological agent of infectious keratitis following corneal trauma with vegetative matter. This infection should be promptly treated to limit the morbidity and dangerous sequelae. The purpose of this study was to detect causative agents from corneal scrapings and to identify the predisposing factors of mycotic keratitis. Methods: Corneal scrapings were taken in full aseptic precautions in total 112 suspected patients for fungal etiology and were subjected to direct examination by 10% KOH mount, gram stain and culture. Results: A total 112 cases of suspected corneal ulcers were subjected to KOH mount to detect fungal elements in corneal scraping and culture to isolate aetiological agents. In our study 29 (25.8%) samples were found positive in KOH mount and fungus was isolated from the all KOH positive samples. Males were more commonly affected and were mostly in the age group of 30-50 years. Fusarium species was the most common fungus isolated followed by Aspergillus species. Conclusion: Mycotic keratitis is a serious problem usually following corneal trauma, it requires rapid detection and identification of fugal agents for treatment to prevent disastrous consequences.

Indian common krait envenomation presenting as fulminant myocarditis and coma: a case report.

Fulminant myocarditis is an unusual manifestation of cardiotoxicity with severe elapid snake envenoming and is meagrely reported with snake bite due to Indian common krait. We report a 12-year-old boy who was admitted in complete locked-in state and hemodynamic instability after severe neurotoxic snake envenoming by Bungarus caeruleus (Indian common krait). His hospital course was complicated with recurrent episodes of sustained ventricular tachycardia requiring defibrillation; and cardiogenic shock requiring inotropes, vasopressors and intraaortic balloon counterpulsation. Severe heart failure features secondary to fulminant toxic myocarditis persisted even after full neurological recovery requiring prolonged standard medical heart failure therapy. Patient subsequently achieved full clinical recovery and regained normal left ventricular systolic function. We also reviewed the literature on cardiac manifestations, possible mechanisms and treatment of patients with cardiotoxicity due to elapid snake bites. The importance of anticipating severe cardiovascular complications is highlighted to help formulate appropriate therapeutic strategy.

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.

Expression of tumor necrosis factor-α and nuclear factor-kappaB/RelA and the pathogenesis of psoriasis.

Context: Tumor necrosis factor-α (TNF-α) is an important mediator in the pathogenesis of psoriasis. Nuclear factor-kappaB (NF-κB) is a transcription factor that regulates the activity of the proinfl ammatory genes. Psoriasis is an infl ammatory disease and the role of TNF-α and NF-κB, should be considerable. Aims: We studied the role of TNF-α and NF-κB in psoriasis. Materials and Methods: A total of 61 cases of psoriatic skin biopsies were studies and the grade of TNF-α and NF-κB, staining was correlated with the histopathological indices of severity. Statistical Analysis Used: Pearson’s correlation coeffi cient and Chi-square test. Statistical Package for Social Sciences version 13 was used. Results: The TNF-α immunostain in the cytoplasm of the epidermal cells and basal cells showed a strong inverse correlation with the grade of epidermal hyperplasia (P –0.019 and P –0.009, respectively). The epidermal cytoplasmic positivity and lymphocyte positivity for TNF-α did not correlate with the grade of NF-κB immunostaining in the epidermal cell nuclei, basal cells or lymphocytes. The basal cell cytoplasmic positivity for TNF-α correlated with the grade of NF-κB immunostaining in the nucleus of basal cells at a P – 0.005. There was a strong correlation between the epidermal cytoplasmic TNF-α immunostaining with the lymphocyte immunostaining (P –0.08); however, there was no correlation between the TNF-α expression in the other two locations. Conclusions: The study outlines the relationship between NF-κB and TNF-α and their combined role in the development of the characteristic histopathological changes in psoriasis. We hypothesize that NF-κB is involved in stimulating the release of TNF-α which would account for the characteristic histopathological changes of psoriasis. However, it is likely that NF-κB can act independently of TNF-α also in the pathogenesis of psoriasis.

Pharmacognostic Study of Trigonella Foenum Graecum.

The present research article reveals the pharmacognostic study of Trigonella foenum graecum. Standardization in medicinal plants is complicated by the complex chemical makeup of plants and the difficulty in obtaining the pure materials needed to compare and measure the amounts of any one particular compound in a plant mixture. In this, study standardization parameters are performed to ensure the quality, safety and efficacy of given herbal drug according to Indian Ayurveda pharmacopoeia.