Bacterial and fungal causes of hemoptysis in patients of a tertiary care center in Western Uttar Pradesh.

Objective: To study the various bacterial, fungal and neoplastic causes of hemoptysis in patients of different age groups in a teaching hospital in western Uttar Pradesh (U.P) Materials & Methods: One hundred & Eighty patients who were admitted to the Department of Chest & T.B and in the Department of Medicine from Jan 2010 to Jan 2012 were included in this study. The patients were characterized on the basis of Clinical signs & symptoms, physical examination, complete blood count with platelets, bleeding time, clotting time, prothrombin time [clotting profile] chest radiography, CT scan, bronchoscopy, histopathological examination and microbial examination including culture of sputum & Bronchoalveolar Lavage. Results: Out of 180 patients admitted, 114 were males & 66 were females. The cause has been identified in 55 patients (32 males & 23 females) while in remaining cases the cause was undiscovered. Pulmonary tuberculosis was identified as the most leading cause of hemoptysis (38.16%) [Mycobacterium tuberculosis alone and M. tuberculosis with other bacteria in case of coinfection], followed by bacterial agents [Staphylococcus aureus (9.09%), Klebsiella spp (9.09%), Pseudomonas aeruginosa (5.45%) and Streptococcus pneumoniae (1.81%). Among the fungal agent we have found Aspergillus spp (10.9%) and Mucor in 1 case (1.81%). The other group of patients include the neoplasms (20.0%). Coinfection was seen among (14.54%) patients and the agents were [Mycobacterium tuberculosis & Pseudomonas aeruginosa] (5.45%), [M. tuberculosis & S. aureus] (3.63%), [M.tuberculosis & klebsiella spp] (1.81%), [Klebsiella & S.aureus] (3.63 %) Conclusion: In developing countries like India with such an increasing population, hemoptysis is one of the potentially life threatening symptom of underlying respiratory tract infection. An adequate & efficient evaluation of the etiological agents causing hemoptysis plays a pivotal role in management of such patients. The purpose of this study was to identify the different etiological agents along with the other causes of hemoptysis.

Symmetrical peripheral gangrene due to viral gastroenteritis.

A case of multifactorial symmetrical peripheral gangrene due to viral gastroenteritis, shock, dopamine infusion, exposure to low temperature and nonlactose fermenters septicaemia is presented for its rarity and devastating consequences.

Baclofen in the treatment of intractable hiccups.

Availability of a large number of drugs/remedies for the management of hiccups suggests that all the available drugs are not effective in all the patients. Baclofen was successful in relieving the intractable hiccups where all other known drugs of hiccup were unable to provide relief.

Mountain desert silicosis.

OBJECTIVES: To evaluate the radiological miliary shadows in the high landers of a Himalayan desert for the presence of silicosis. METHODS: Seventeen high landers attending the Medicine OPD of a multi-speciality medical camp at Kaza in Himalayas (height 12,500 feet above sea level) having radiological miliary shadows were included in the study. A detailed life time work place history was taken. In the laboratory workup their hemogram, repeat chest skiagram, peak expiratory flow rate, urinalysis and electrocardiogram were undertaken. Their localities were looked for the presence of industries particularly for silicosis prone work place. The silica contents of upper strata of soil were estimated. RESULTS: Silicosis--chronic simple variety was present in nine males and eight females. The youngest person was 43 years of age and oldest person was of 65 years of age. There was no silicosis prone industry in their locality. Four had taken repeated courses of anti-tubercular treatment in adequate doses for these miliary shadows without any change in the radiological shadows. Three had silicosis prone work history. Seven were smokers and two had hypertension. The miliary shadows were 2-4 mm in size and hilar lymphadenopathy was in 11 and fine calcification of lymph nodes in two. Peak expiratory flow rate was reduced. Upper strata of soil had a silica content of 36.8 percent. CONCLUSION: Silicosis developed in high landers of the Himalayas even without working in silicosis prone work place. They were exposed to silica from the non-work place silica rich environment.

High altitude koilonychia.

OBJECTIVE: To study the incidence of koilonychia in the residents of high altitude. METHODS: Nails of all the patients attending the Medical Outpatient Department (MOPD) of a multispeciality medical camp at Kaza in Himalayas (height 12,500 feet above sea level) were looked for the presence of koilonychia and were included for the study. Those residing below 10,000 feet were excluded from the study. A detailed history was taken and a thorough physical examination was made in each. Routine laboratory investigations were undertaken. Serum ferritin levels were estimated in seven. RESULTS: Koilonychia was present in 6.99% of the patients (67 out of the 986). There were 29 males and 37 females within the age range of 37 to 78 years. Sixty four were high landers since generations and three were high landers from 2nd generation onward. All were right handed. Koilonychia was in the nails of both upper and lower limbs in 14, in the nails of upper limbs in 49 and in the nails of lower limbs in 18. In the upper limbs it was in all the fingers in 42, in thumb, index and middle fingers of right hand in 12 and of left hand in nine. In the lower limbs it was bilateral in the first three toes in nine. Chronic obstructive pulmonary disease was in 29, ulcer like dyspepsia in 24, osteoarthritis of knee in 17, hypertension in 14, pulmonary tuberculosis in eight, anxiety neurosis in five, pneumoconiosis in two and squamous cell carcinoma of lung in one. The haemoglobin in all was normal and serum ferritin level of the seven patients estimated was also normal. CONCLUSIONS: Koilonychia at high altitude is present in 6.99%. It is due to retardation of nail plate growth and is more common in upper limbs.

Cerebral dysfunction in vivax malaria: a case report.

A case of vivax malaria with neurological symptoms is described.