Systemic lupus erythematosus presenting as acute lupus pneumonitis in a young female.

Acute lupus pneumonitis is a rare initial presentation of systemic lupus erythematosus (SLE). We report a 19-year-old female presenting with fever and recurrent hemoptysis with radiological evidence of parenchymal lung involvement with mild pleural effusion. Subsequent development of malar and discoid rash with anti-nuclear antibodies (ANA) and anti-dsDNA positivity clinched the diagnosis. Her clinical signs and symptoms resolved with a course of intravenous pulse methyl-prednisolone along with radiological resolution.

Bacterial incidence and antibiotic sensitivity pattern in moderate and severe infections in hospitalised patients.

Infectious diseases are among the leading causes of death and sometimes curable. Bacteria are the most common aetiology in hospitalised patients. Objectives of this study were to evaluate the incidence of bacterial infections and their pattern of susceptibility to antibiotics in moderate and severe infections in hospitalised patients. The study was performed in the apical teaching hospital of West Bengal in the first half of 2005. Patients admitted in medical wards and medical ICU, suffering from moderate and severe infections having APACHE-II score > 5 were studied. Clinical evaluation, routine and specific investigations were done in each case. Microbiological samplings were tried on day 1, after completion of antibiotic therapy and in between as required. Aerobic BACTEC bacterial culture and sensitivity tests were done. Pending initial culture and sensitivity report empiric antibiotic therapy was started, which was modified on getting the culture and sensitivity report. Outcome was observed as no response, cured, resolved, inconclusive, died and left against medical advice. Out of 40 patients total number of samples were 54 and that of sites of infections were 48. Primary site could not be detected in 11 infections (22.9%). Commonest form was urinary tract infection and abdominal infection in community acquired infection (n=18) and pneumonia in hospital acquired infection (n = 15). Culture was positive in 33 (61.11%), Gram-negative infection was more common in general, but incidence of Gram-positive infection was also quite high and Gram-positive infection was more common in community acquired infection. In general S aureus was most common bacteria -8 (24.24%). In community acquired infection S aureus 4 (22.22%) predominated followed by E coli and in hospital acquired infection S aureus -4 (26.66%) followed by E coli and P aeruginosa. Incidence of methicillin resistant Staph aureus was low. But it constituted 50% of S aureus. No methicillin resistant Staph aureus was found in community acquired infection. Two isolates of vancomycin intermediate sensitive Staph aureus were observed. Methicillin resistant Staph aureus showed maximum sensitivity to linezolid (100%) and all methicillin resistant Staph aureus but one vancomycin intermediate sensitive Staph aureus were sensitive to vancomycin. Coagulase negative Staph aureus were all sensitive to vancomycin and linezolid. Gram-negatives were mostly resistant to aminoglycosides and P aeruginosa were all sensitive to aztreonam. Single strain of S typhi as isolated was resistant to ceftriaxone and ciprofloxacin. P miribalis, P aeruginosa and coagulase negative Staph aureus were notoriously multidrug resistant; 82.5% of cases responded to treatment of which 35% were cured microbiologically. Gram-negative infection was more common overall, but incidence of Gram-positive infection was also very high. Gram-negative infections were responsible for more severe infections and case fatality. Multidrug resistant Gram-positive infections are rising.

Opportunistic infections of central nervous system in AIDS.

HIV/AIDS is a new epidemic in current century. Predominant route of transmission is sexual. Virtually all systems are affected either directly by virus or by oppurtunistic infections or by malignancy. Neurological complications may occur at any stage of disease. Clinical manifestations may be acute, subacute or chronic. Presentation and diagnosis are often confusing. Central nervous system toxoplasmosis and tuberculous meningitis are commonest opportunistic infections in advanced HIV patients. Patients frequently present with focal neurodeficit. Mortality is high i.e., 13 (54%) out of 24 cases of opportunistic infectious in the study carried out at the SSKM Hospital during the period January 2005 to December 2006.

Heart failure and acquired immune deficiency syndrome: report of 2 cases.

Acquired immune deficiency syndrome (AIDS) patients usually present with prolonged fever, chronic diarrhoea, weight loss and other opportunistic infections. Congestive heart failure is not a usual presentation of AIDS. Here two cases, one a female of 38 years and another a male of 22 years presented with fever and breathlessness. On examination they were found to have features of congestive heart failure. Echocardiography revealed dilated cardiomyopathy. Laboratory investigations suggested human immunodeficiency virus was reactive in both cases with immune deficiencies of different degrees. The first patient expired during hospital stay, but the second one is progressing well with antiretroviral therapy.

A study of bone mineral density in diabetes mellitus in eastern India.

To measure bone mineral density in diabetic patients at the time of clinical diagnosis of diabetes mellitus and to find out correlation, if any, with microvascular complication of diabetes mellitus and glycosylated haemoglobin, a study was conducted at Medical College and Hospital, Kolkata among 138 cases of diabetes and 212 controls. All patients were screened for ophthalmoscopy, routine blood and urine examinations. Bone ultrasound attenuation study of the calcaneus was performed in all cases. The bone ultrasound attenuation result was compared to a mean normal population result and expressed as Z score and T score. The age of diabetic patients varied from 11 years to 70 years. Of 138 diabetics, 32 (23.18%) had type 1 diabetes and rest type 2 diabetes. Forty-two diabetic patients had retinopathy, 42 nephropathy and 48 had neuropathy. Glycosylated haemoglobin was above 7% in 124 patients. The broadband ultrasound attenuation of type 1 diabetics ranged from 38 to 95 dB/MHz and in type 2 it was 35 to 104 dB/MHz. There was no statistically significant correlation between neuropathy, nephropathy, retinopathy and bone mineral density status. It was also found no correlation between glycosylated haemoglobin values and ultrasound attenuation.

Multiple myeloma presenting as acute pancreatitis.

Acute pancreatitis is a very uncommon presenting feature of multiple myeloma. We report an elderly non-alcoholic man presenting with acute abdominal pain and rapidly progressing renal failure. Investigations revealed lytic lesions in the vertebrae and skull, M band on urine electrophoresis, and radiological and biochemical evidence of acute pancreatitis. The patient died despite conservative management of the pancreatitis.

Risk stratification by treadmill testing in acute myocardial infarction following thrombolytic therapy.

Survivors of acute myocardial infarction (AMI) should have risk stratification for assessment of their future risk of cardiovascular events. One of the important means of risk stratification is by treadmill test (TMT). Most of the algorithms for assessment were done in the prethrombolytic era. But in the post-thrombolytic era, risk stratification by TMT should be properly evaluated. Fifty males with confirmed AMI with age ranging from 38-62 years (mean 48 years) were tested with a symptom limited (Modified Bruce Protocol) TMT. The patients were followed up for a minimum of 6 months (range 6-10 months). Out of 50 patients, 38 reported for follow up. Among them 22 (Group A) had cardiac events and 16 (Group B) had no events. Among the patients (Group A), 6 had unstable angina, 7 had reinfarction, 2 had sudden death, 4 had coronary artery bypass grafting (CABG) and 3 had angioplasty. Comparison between the two groups, A and B in TMT parameters like ST segment depression > 2.5 mm (12 vs 9), no. of leads where ST depression occurred (66 vs 48) during exercise, mean work capacity (8.1 vs 7.9 mets), mean systolic blood pressure response were all statistically insignificant. Though TMT was believed to be a good prognostic indicator to assess further cardiac events after AMI, its efficacy in risk stratification after thrombolysis is yet to be determined. This study does not show its worth in post MI risk assessment.

Smoking habits and respiratory symptoms: observations among college students and professionals.

The study comprising smoking habits among educationally and socially forward class, its impact on respiratory system and response of the said class of people to a questionnaire was undertaken among a random sample of 1188 subjects consisting of students and professionals aged between 15 and 65 years. Results showed that smoking habit was alarmingly high (48.8%) among the students and a little higher (53%) among the professionals. The exact nature and extent of the problem of smoking was not very much clear to all the subjects.