Vitamin B12 Deficiency Presenting as Acute Psychosis.

Psychiatric symptoms attributable to vitamin B12 deficiency have been described for decades. Vitamin B12 deficiency is common in developing countries and its prevalence ranges up to 67% among Indian population.1 The earlier reports are for the most part in accordance with more recent ones, despite being diagnostically less specific in psychiatric and haematological terms. These symptoms seem to fall into several clinically separate categories like slow cerebration, confusion, memory changes, delirium, with or without hallucinations and/or delusions, depression, acute psychotic states, and (more rarely) reversible manic and schizophreniform states.2 Apart from these conditions, some cases of dementia, violent behaviour and fatigue have also been documented to be caused by vitamin B12 deficiency.3 Reports of patients initially presenting to psychiatric facilities without associated haematological manifestations are rare. There are a few case reports of acute psychosis attributed to vitamin B12 deficiency, but more evidence is required to substantiate and establish this association.4 We describe three patients who developed acute psychosis accompanied by features suggestive of organic aetiology. They were found to have cobalamin deficiency in the absence of typical neurological or haematological abnormalities.

Distal End Radius Fracture Treatment by Different Modalities: A Comparative Study at Tertiary Hospital In Western Maharashtra.

Background: A retrospective study was conducted in the department of orthopaedic surgery in a tertiary care hospital of western Maharashtra. Methods: Data of all the patients with fracture of distal end radius with or without ulna fracture who were admitted in our centre over a period of 4 years were recorded from case files, casuality admission register and operative records. A total of 204 patients were included in our study and mode of treatment was compared among the various available treatment modality such as cast/slab; percutation fixation with k-wire, external fixation & plate osteosynthesis. Results: Out of the total number of cases (n=204) for fracture distal end radius, nearly 10% case were managed with cast (n=21), 22% with percutaneous fixation with k-wire (n=45), 23.5% with external fixature (n=48), 19% with both external fixator and k-wire (n=38) and 25% with plate osteosynthesis (n=52). Hence when we assess the modality of treatment of distal end radius year wise from 2011 to 2014, the incidence of surgery by plate osteosynthesis has increased over a span of period. Conclusion: Retrospective study conducted at our tertiary care hospital concludes that incidence of plating for distal end radius fracture has increased over a period of time as compared to cast, percutaneous k -wire fixation and external fixator.

Intra-pulmonary teratoma: A rare case.

A 28-year-old female, home-maker presented to our department with a four-year history of intermittent episodes of cough and haemoptysis. She had no history of fever, weight loss or expectoration. Physical examination was unremarkable.

Use of different primer directed sequence amplification by polymerase chain reaction for identification of Pneumocystis jirovecii in clinical samples.

BACKGROUND: Pneumocystis carinii pneumonia (PCP), caused by opportunistic agent Pneumocystis jirovecii (formerly, Pneumocystis carinii is one of the most serious respiratory infection in immunocompromised patients. AIM: The present study was conducted to compare polymerase chain reaction (PCR) assays targetting three different genes of Pneumocystis to study their application in its diagnosis. METHODS: One hundred and eighty (n = 180) clinical samples from 145 immunocompromised patients with clinical suspicion of PCP and 35 samples from control group of 30 immunocompetent individuals with respiratory infections other than PCP were prospectively examined for the presence of Pneumocystis jirovecii (P. jirovecii). All the samples were subjected to microscopic examination, one single [major surface glycoprotein, (MSG)] and two nested [mitochondrial large subunit ribosomal ribonucelic acid, (mtLSU rRNA) and internal transcribed spacer (ITS) region], polymerase chain reaction assays. RESULTS: Microscopic examination was positive in only six (n = 6) patients, whereas single round MSG PCR detected P. jirovecii deoxyribonucleic acid (DNA) in 16 cases. When the clinical samples were tested by mtLSU rRNA and ITS nested PCR assays, it was possible to detect seven additional cases of PCP, making it to a total of 23 cases. None of the clinical specimens in control group (n = 30) were positive by any of the above-mentioned techniques. Amongst the 81 bronchoalveolar lavage (BAL) samples tested, 16 were positive by MSG PCR, while 20 were positive by both nested, i.e., mtLSU rRNA and ITS PCR assays. Similarly, out of 50 sputum samples, only three were positive by MSG, seven by mtLSU rRNA and six by ITS nested PCR assays. CONCLUSION: It has been observed that MSG is relatively more sensitive when single round PCR assay is used for detection of human Pneumocystosis compared to the first (single) rounds of either ITS or mtLSU rRNA nested PCRs. However, the two nested PCRs using ITS and mtLSU rRNA have been found to be more sensitive. On comparison of two nested PCR assays, the results have been more or less comparable.