Scrub Typhus Presenting as Subdural Hemorrhage with Normal Platelet Counts: A Rare Case Presentation

Scrub typhus is a common zoonotic disease with high case fatality rate. The clinical presentation of this disease may vary from acute febrile illness, thrombocytopenia, gastrointestinal manifestations, coagulopathy to neurological manifestations. The common neurological manifestations are meningitis and meningoencephalitis, whereas subdural hemorrhage, cerebrovascular accident, i.e., intracerebral hemorrhage, infarct, subarachnoid hemorrhage, etc. are among rare neurological presentations. Scrub typhus-induced neurological disease should be investigated to provide a timely and appropriate diagnosis and to reduce the mortality in complicated scrub typhus infection. Here we report a case of scrub typhus complicated with subdural hemorrhage admitted in our hospital.

Pattern of dermatoses in the elderly population attending the dermatology clinic at a Tertiary Care Center in South-East Rajasthan

Introduction: The skin acts as the first line of defense for the body against external injuries. With aging, the architecture of the skin undergoes intrinsic changes that impair its capacity for repair. In addition, the aging skin is more susceptible to injury by external stimuli, including ultraviolet rays and environmental pollutants. The combination of these factors predisposes the elderly to a variety of dermatological disorders, including xerosis, pruritus, photoaging, eczematous disorders, and tumors. The elderly (>60 years of age) population in India accounted for 8.6% (104 million) in 2011, and the figure has been projected to increase to 19% by the year 2050. It is imperative to identify the pattern of cutaneous disorders in this population as skin care regimens aimed to improve epidermal function have been shown to be effective inthe prevention and treatment of some of these aging-associated cutaneous disorders. Objectives: The objective of the study was to identify the pattern of dermatoses among the elderly population attending the dermatology clinic at a tertiary care hospital in South?east Rajasthan. Materials and Methods: We conducted a cross-sectional descriptive study of patients above the age of 60 years who attended the dermatology clinic at a tertiary care hospital in South?east Rajasthan from May 2018 to May 2020. A combination of history, physical examination, and clinical investigations (when appropriate) were used to establish the diagnosis. Results: A total of 210 patients were included in this study. Most patients were between the age group of 60–65 years (40.47%). One hundred and thirty?eight were male (65.71%) and 72 were female (34.28%), with a male to female ratio of 1.9:1. Our study demonstrated that xerosis was one of the most common diagnoses seen in 126 cases (60%), followed by eczematous skin conditions seen in 82 cases (39%). Conclusion: The elderly constitute an important part of the population. Cutaneous disorders in the elderly range from mild disorders such as cherry angiomas to dermatological malignancies. Therefore, it is important to recognize the pattern of dermatosis in this population so that appropriate therapeutic and preventive strategies could be implemented.

Antimicrobial resistance pattern of microorganisms isolated and identified from Godavari River across the mass gathering event

The Kumbh Mela is considered the world’s largest mass gathering event (MGE). It represents a unique anthropogenicburden on the river ecosystem and may confer antimicrobial resistance among microbial communities. The present studyexplains the characterization of microbial isolates associated with Godavari River under the advent of the mass bathingevent using culture dependent approach. The isolates were identified by sequencing of 16S rRNA gene and ITS region.Further, the isolates were screened for antibiotic susceptibility against 22 antibiotics using disc diffusion method. A total of63 bacterial and 21 fungal isolates were isolated under the temporal variation of the event. Kocuria and Staphylococcuswere the most prevalent bacterial genera in the samples collected before and during the event, while Meyerozyma andCandida predominate among fungal communities. A group of antibiotics impeding the bacterial protein synthesis werefound to be most effective against C67% of bacterial isolates. However, C37–67% of isolates could escape the action ofinhibitors of bacterial cell wall synthesis. Moreover, bacterial isolates belonging to genera Acinetobacter, Corynebacteriumand Brevibacterium showed higher resistance towards the antibiotics. Observations from the current study suggest likelymicrobial taxa as targets to mitigate the waterborne infections during the MGE.

Assessment Of Clinical Profile And Outcome Of Cervical Spinal Cord Injuries With Or Without Bony Injuries

Objective: The present study was design to investigate the clinical profile and outcome in patients of cervical spinal cord injury with or without bony injury. Material and Method: All patients of cervical spinal cord injury with or without evidence of bony injury on X–ray were included in this study. In addition to X–ray finding, patient age, sex and MRI cervical spine were also recorded at the time of admission. Clinical profile and outcome was assess with Benzel–Larson Grade included one to seven grades. Results: Total 87 patients of cervical spine injury were included in study, 25 patients were included in SCIWORA group while 62 patients were having associated with bony injuries. Both SCIWORA and SCI with bony injury ware more commonly due to fall from height and more common in males. Neurological recovery was more in SCIWORA than bony injury patients. Conclusion: cervical spine cord injury is commonly seen in children, while associated bony injury is common in adult population. Early diagnosis and proper management for SCIWORA can improve neurological outcome in selected group of patients.

Comparison of the Diagnostic Accuracy of FNAC and Biopsy in the Diagnosis of a Palpable Breast Lump

Background: Mammary gland carcinoma is the most common malignant tumor. Annually worldwide more than1,000,000 cases of breast carcinoma occur, which is the leading cause of carcinoma death in women. The most relevant and important method to diagnose breast cancer is Fine Needle Aspiration Cytology (FNAC). The use of core needle biopsy (CNB) has been increasing because of various limitations. Advantages of core needle biopsy over FNAC is, that core needle biopsy provide sufficient tissue for definitive histological diagnosis, differentiate between invasive cancer and carcinoma. The purpose of this study was to determine if there is a difference in diagnostic accuracy in using CNB and FNAC in patients with palpable breast lumps undergoing breast surgery. Methods: This was cross sectional type of study conducted in the Department of General Surgery at Muzaffarnagar Medical College, Muzaffarnagar. The study was carried out from July 2016 to March 2018. The study population was recruited from the patients presenting with suspicious palpable breast lump clinically and/or radiologically, attending at General Surgery Outpatient Department (OPD), Muzaffarnagar Medical College, Muzaffarnagar. Hundred (100) patients suffering from breast lumps were included in this study. Results: Total 58 patients (58% of total patients with breast lump) were found with malignancy having C5 category of FNAC. All of them confirmed malignancy after the surgery. FNAC showed malignancy in 58% cases of breast lump. There was no false positive case in FNAC findings. Rest of 42 patients showed non-malignant breast lumps which showed C2, C3 and C4 category of FNAC. Findings after excision biopsy showed that there were 26 patients (26%) were false negative. Conclusion: Findings of the present study suggest that FNAC is almost equally effective technique for the diagnosis of malignancy in patients suffering carcinoma of mammies. FNAC is considered as an economical, less complicated, rapid and reliable method for the pathological diagnosis of breast carcinoma in a developing country like India. Malignant tumour can be exactly diagnosed by FNAC as it is highly sensitive for malignancy. CNB should be put after FNAC If initial FNAC fails to determine the type of tumour, CNB can be a useful second line method of pathological diagnosis in order to minimize the chance of missed diagnosis of breast cancer. Excision biopsy should be considered as last option for pathological diagnosis.

An Adolescent with Kawasaki Disease.

Kawasaki disease is an acute vasculitis of unknown etiology that predominantly affects children <5 years of age. The incidence and the severity of myocarditis in this disease is variable and depends upon the stage of the disease, acute or chronic. Acute-stage Kawasaki disease shows relatively high incidence of myocarditis, but almost all cases are clinically mild. We describe teenage boy presenting with atypical/incomplete manifestations of Kawasaki disease and developing fulminant myocarditis within a week of illness resulting in death. The case underscores the importance of suspecting Kawasaki disease in a young child presenting with features of myocardial ischemia.

Prevalence of Hypertension Among Schoolchildren in Shimla.

This cross-sectional study was done to find the prevalence of sustained hypertension and prehypertension among school children aged 11-17 years. A total of 1085 apparently healthy students from rural and urban schools in hills of northern India were examined using standard methods. Students with blood pressures above the 90th centile were re-examined after four weeks. The mean BMI of the students was 17.5±2.7 kg/m2, 5 (0.4%) were obese, and 39 (3.5%) overweight. After two evaluations, hypertension was identified in 62 (5.9%) children and prehypertension in 130 (12.3%). Urban and rural children had comparable rates of elevated BP (hypertension and prehypertension). Rates of elevated BP were significantly higher (46.5% vs 17%, P<0.001) among those with high BMI (overweight and obese) compared to those with normal BMI. In conclusion, nearly 20% of the school children had elevated blood pressures.