An interesting case of chronic myeloid leukemia with twists and turns.

Additional cytogenetic abnormalities (ACA) are known to crop up in Ph+ cells of chronic myeloid leukemia (CML) patients due to cytogenetic evolution. But the frequency of molecular evolution and ACA is much less in Ph- cells of CML patients and is poorly understood. We report an interesting and rare case of Ph+ CML, who progressed to B lymphoblastic crisis, achieved remission, and later developed Ph- acute myeloid leukemia (AML) with KMT2A gene rearrangement and no detectable BCR- ABL transcripts.

Spectrum of bacteremia in posthematopoietic stem cell transplant patients from an Indian center.

BACKGROUND: Despite the relatively low prevalence of Gram-positive bacteremic infections in Indian oncology patients, glycopeptides are extensively used for empirical management of febrile neutropenia. Our aim was to analyze the spectrum of bacteremia in posthematopoietic stem cell transplant (HSCT) recipients in our center and make a recommendation on glycopeptide use in this patient population. MATERIALS AND METHODS: Retrospective analysis of bacteremic data from HSCT recipients in a tertiary care oncology and transplant center from South India, between 2011 and 2013. RESULTS: In 217 patients, 52 bacteremic episodes were identified. The majority of the isolates were Gram-negatives (88.4%) with very few Gram-positives (7.69%). CONCLUSION: Glycopeptides need not be included in the empirical antibiotic regimen in post-HSCT settings with very low Gram-positive infection rates.

Monotherapy versus combination therapy against carbapenem-resistant Gram-negative bacteria: A retrospective observational study.

BACKGROUND: Colistin-based combination therapy (CCT) is extensively used to treat infections due to carbapenem-resistant Gram-negative bacteria (CRGNB). There are no data available from India on the usefulness of combination therapy, especially in the oncology setup. The aim of this study was to analyze the clinical effectiveness of CCT over monotherapy in patients with CRGNB. MATERIALS AND METHODS: We conducted a retrospective, observational study of patients with CRGNB bloodstream infections in our oncology and bone marrow transplant center. RESULTS: Over a 3-year study period (2011-2014), we could identify 91 patients satisfying study criteria. There was no statistically significant difference in the 28-day mortality between monotherapy and combination therapy arms (mono n = 26, mortality 10 (38.5%); combination n = 65, mortality 28 (40%); P = 0.886). Neutropenic patients with Enterobacteriaceae bloodstream infections performed better with combination therapy (mono n = 7, mortality 6 (85.7%); combination therapy n = 22, mortality 8 (36.4%); P = 0.035). There was no significant difference in the 28-day mortality between the two treatment arms in other subgroups. CONCLUSION: Our study did not find CCT superior to colistin monotherapy in patients with CRGNB blood stream infections; except in the subgroup of neutropenic patients with Enterobacteriaceae bloodstream infections, where combination therapy performed better.

Preferential publication of editorial board members in medical specialty journals.

BACKGROUND: Publication bias and discrimination are increasingly recognised in medicine. A survey was conducted to determine if medical journals were more likely to publish research reports from members of their own than a rival journal's editorial board. METHODS: A retrospective review was conducted of all research reports published in 2006 in the four competing medical journals within five medical specialties. Only three journals were willing to divulge the authorship of reports that had been rejected. RESULTS: Overall, 4460 research reports were published in 2006 by the 20 journals from five subspecialties (mean 223 (SD = 164) reports per journal; median 176; interquartile range 108-238). On average, 17.2 (7.7%) reports were from a journal's own editorial board (SD = 10.7; median 15; interquartile range 10-23; n = 20), and 6.3 (2.8%) reports were from a member of the editorial board of one of the three rival journals within the specialty (SD = 7.3; median 3.5; interquartile range 1-8; n = 60). There was a statistically significant excess of publications from the journal's own editorial board in 14 of the 20 journals (p<0.05). Journals were almost three times more likely to publish reports from their own editorial board than from one of the three rivals within their subspecialty (p<0.0001; median difference 11; Mann-Whitney U test; power for 5% significance >99.99%). CONCLUSIONS: There was a significant excess of publications from medical journals' own editorial boards, although it is not possible to determine whether this is due to bias in the peer review process or selective submission by editors.

Opportunistic infection among HIV seropositive cases in Manipal Teaching Hospital, Pokhara, Nepal.

BACKGROUND: Human Immunodeficiency Virus (HIV)/ Acquired Immunodeficiency Syndrome (AIDS) claimed more than 22 million deaths in the past two decades. About 10,000-15,000 Nepalese are expected to die of AIDS related deaths every year in the absence of effective treatment and care. Major cause of mortality and morbidity in HIV infected people is opportunistic infection (OI). Type of pathogen(s) responsible for OI varies from region to region. OBJECTIVE: This study attempts to find out OI among HIV seropositive patients visiting MTH, Pokhara. RESULTS: Tuberculosis (30%) was found to be most common OI followed by candidiasis (14%). Pulmonary tuberculosis (21.14%) was more common than extra pulmonary tuberculosis (8.92%). Oral candidiasis (8.92%) was more common than oesophageal candidiasis (5.35%). CONCLUSION: The study findings indicate that immediate and strong action needs to be taken and guidelines and strategies to tackle the HIV AIDS problems are required and should be equally implemented to achieve a decline in the rate of prevalence of HIV.

Aeromonas hydrophila wound infection following a tiger bite in Nepal.

Aeromonas hydrophila is a rare human pathogen. Reports of zoonotic infection developing after large feline bites are even rarer. We are documenting the first case of human wound infection with A. hydrophila following a tiger bite. The patient responded well following wound debridement, secondary suturing and combination antibiotic therapy.

Ciprofloxacin-resistant Salmonella enterica serotype typhi in a patient with osteomyelitis of the rib.

Salmonella osteomyelitis of the rib is a rare clinical entity. In our case, a muhidrug resistant Salmonella enterica serotype Typhi was isolated from an immuno-competent patient with osteomyclitis of the ribs, who was treated earlier with ciprotloxacin for typhoid fever. The patient was successfully treated for osteomyclitis with intravenous ceftriaxone.

East African sleeping sickness in Chennai.

A traveler to East Africa developed fever, an eschar on his forearm and thrombocytopenia shortly after returning home to Chennai, India. Trypanosoma brucei rhodesiense infection was diagnosed on examination of his peripheral smear. He made a full recovery after receiving a course of suramin.