Severe jejunitis masquerading as intussusception in a case of Henoch-Schönlein purpura.

SUMMARY: Intussusception is a well-known complication of Henoch-Schönlein purpura (HSP).1 Diagnosis of intussusception is based on well-defined clinical and radiological features, but certain conditions can mimic intussusception, both clinically and radiologically, so closely as to result in unnecessary invasive procedures. Authors here present a case of HSP complicated by severe acute jejunitis, masquerading as jejuno-jejunal intussusception on ultrasound.

Effect of aspirin in vascular surgery in patients from a randomized clinical trial (POISE-2).

BACKGROUND: In the POISE-2 (PeriOperative ISchemic Evaluation 2) trial, perioperative aspirin did not reduce cardiovascular events, but increased major bleeding. There remains uncertainty regarding the effect of perioperative aspirin in patients undergoing vascular surgery. The aim of this substudy was to determine whether there is a subgroup effect of initiating or continuing aspirin in patients undergoing vascular surgery. METHODS: POISE-2 was a blinded, randomized trial of patients having non-cardiac surgery. Patients were assigned to perioperative aspirin or placebo. The primary outcome was a composite of death or myocardial infarction at 30 days. Secondary outcomes included: vascular occlusive complications (a composite of amputation and peripheral arterial thrombosis) and major or life-threatening bleeding. RESULTS: Of 10 010 patients in POISE-2, 603 underwent vascular surgery, 319 in the continuation and 284 in the initiation stratum. Some 272 patients had vascular surgery for occlusive disease and 265 had aneurysm surgery. The primary outcome occurred in 13·7 per cent of patients having aneurysm repair allocated to aspirin and 9·0 per cent who had placebo (hazard ratio (HR) 1·48, 95 per cent c.i. 0·71 to 3·09). Among patients who had surgery for occlusive vascular disease, 15·8 per cent allocated to aspirin and 13·6 per cent on placebo had the primary outcome (HR 1·16, 0·62 to 2·17). There was no interaction with the primary outcome for type of surgery (P = 0·294) or aspirin stratum (P = 0·623). There was no interaction for vascular occlusive complications (P = 0·413) or bleeding (P = 0·900) for vascular compared with non-vascular surgery. CONCLUSION: This study suggests that the overall POISE-2 results apply to vascular surgery. Perioperative withdrawal of chronic aspirin therapy did not increase cardiovascular or vascular occlusive complications. Registration number: NCT01082874 ( http://www.clinicaltrials.gov).

Co-infection of Central Nervous System by M. Tuberculosis, Cryptococcus and possibly Naegleria fowleri.

Co-infection due to Mycobacterium tuberculosis, Cryptococcus and Naegleria fowleri has not been reported till now in literature, to the best of our knowledge. Here we report a curious case of co-infection of the central nervous system due to these three pathogens in an apparently immune-competent, HIV negative boy. The 15 year old boy was a diagnosed case of tubercular meningitis and was on anti-tubercular and anti-epileptic treatment. However, two months later he presented again in the emergency department with sudden loss of consciousness. His CSF showed presence of capsulated budding yeast cells (suggestive of Cryptococcus) and flagellated parasites (resembling the flagellated stage of Naegleria fowleri). CSF was also positive for Cryptococcal antigens by Latex Agglutination test. The boy was HIV negative and apparently immuno-competent. He was subsequently put on amphotericin B therapy for six weeks. Repeat microscopy, done towards the end of amphotericin B course, showed clearing of CSF. However, the patient's condition improved only slightly, owing to neurological damage caused by the pathogens as suggested by brain CT and MRI scans. Thus infection caused by the members of three different kingdoms in an apparently immunocompetent boy highlights the importance of thinking beyond the ordinary causative pathogens, and actively searching for rarer etiologies to ensure timely intervention; especially in nonresponsive cases.

Co-infection of Central Nervous System by M. Tuberculosis, Cryptococcus and possibly Naegleria fowleri

Co-infection due to Mycobacterium tuberculosis, Cryptococcus and Naegleria fowleri has not been reported till now in literature, to the best of our knowledge. Here we report a curious case of co-infection of the central nervous system due to these three pathogens in an apparently immune-competent, HIV negative boy. The 15 year old boy was a diagnosed case of tubercular meningitis and was on anti-tubercular and anti-epileptic treatment. However, two months later he presented again in the emergency department with sudden loss of consciousness. His CSF showed presence of capsulated budding yeast cells (suggestive of Cryptococcus) and flagellated parasites (resembling the flagellated stage of Naegleria fowleri). CSF was also positive for Cryptococcal antigens by Latex Agglutination test. The boy was HIV negative and apparently immuno-competent. He was subsequently put on amphotericin B therapy for six weeks. Repeat microscopy, done towards the end of amphotericin B course, showed clearing of CSF. However, the patient’s condition improved only slightly, owing to neurological damage caused by the pathogens as suggested by brain CT and MRI scans. Thus infection caused by the members of three different kingdoms in an apparently immunocompetent boy highlights the importance of thinking beyond the ordinary causative pathogens, and actively searching for rarer etiologies to ensure timely intervention; especially in nonresponsive cases.

Primary cutaneous tuberculosis of the pinna: an unusual presentation.

Cutaneous tuberculosis is an uncommon form of extra-pulmonary tuberculosis. A young female presented with chronic, non-healing ulceration involving the left pinna. Serology and skin biopsy suggested tuberculosis. Anti-tubercular therapy resulted in complete resolution of lesions. The recent increase in tuberculosis has led to myriad forms of the disease which often mimic non-specific dermatitis in morphology. The diagnostic dilemma encountered in such clinical settings has prompted us to present this unusual case. On review of literature, we could find only three case reports of ulcerative form of primary tuberculosis of pinna.

Physico-chemical study of Vaikranta bhasma.

BACKGROUND: Vaikranta has very important place in Rasa sastra and is placed under Maharasa and Upratna group. It has been mentioned that vaikranta can be used in the place of diamond, which is a very precious stone and whose use is beyond the limit of the common man. Vaikranta possesses pharmacological and therapeutic properties similar to diamond, but still very few researchers have worked on it. AIMS AND OBJECTIVES: The main aim of the present study is to analyze vaikranta bhasma by employing various organoleptic methods mentioned in Ayurvedic science along with analysis as per tools available today. SETTINGS AND DESIGN: In the present study, vaikranta bhasma was prepared according to method mentioned in Rasa Ratna Samuccaya. Final product is prepared according to classical parameters described in Ayurvedic science. MATERIALS AND METHODS: Ayurvedic scholars have described various parameters for the qualitative evaluation of vaikranta bhasma, but all those are subjective in nature and cannot be evaluated numerically for reproducibility of the result. With this in mind, in the present study, tests as per Ayurvedic science and analytical parameters such as scanning electron microscopy, energy dispersive X-ray analysis, Fourier transform infrared spectrometry and inductively coupled plasma spectrometry were adopted to analyze the final product. RESULTS AND CONCLUSIONS: Data suggests that vaikranta bhasma is a multi-mineral compound, which contains iron and silica as major constituents and others are present as trace elements. The data obtained in this study suggest that quality specifications for vaikranta bhasma can be developed using tests described in Ayurvedic science along with analytical tools available today.

Efficacy of Vasadi Syrup and Shwasaghna Dhuma in the patients of COPD (Shwasa Roga).

Chronic Obstructive Pulmonary Disease (COPD) threatens as emerging public health crisis. The two major drivers for this are the ageing of the world's population and the impressive, if deplorable, success of the multinational tobacco companies at forcing open world markets. One of the most striking aspect of COPD is that it is heterogenous. There are many different presentations with differing intensities of symptoms and even differing responses to the medication. Sorting out, what accounts for this phenomenon and how treatments can be best individualised, is of concern to both basic and clinical scientists. COPD is a leading cause of morbidity and mortality worldwide and results in a substantial economic and social burden to society. It is the sixth most common cause of death worldwide and expected to rise to third position by 2020. Several national and international agencies like WHO, GOLD, ATS, ERS etc. are working in a direction of finding some solution of this wicked problem. In Ayurvedic texts Shwasa Roga has been described having symptomatology close to COPD. A study was carried out in P.G.Deptt. of Kayachikitsa in R.G.G.P.G.Ayu.College Paprola, H. P. where the role and efficacy of two Ayurvedic formulations -Vasadi Syrup and Shwasaghna Dhuma was evaluated on 30 patients of COPD selected on the basis of fixed inclusion and exclusion criteria in two different groups. In both the groups drugs provided significant results based on subjective symptomatological criteria and objective spirometric criteria.

Adenocarcinoma of the rete testis with uncommon presentation as haematocele.

Adenocarcinoma of the rete testis was encountered in a 62-year-old man. The tumour was localised in the region of the testicular hilum as a greyish-white nodule that showed no involvement of the adjacent testicular parenchyma or the epididymis. On microscopical examination, there was a well-differentiated adenocarcinoma separated by fibrovascular stroma, entirely confined to the testicular hilum. This primary carcinoma of the rete testis presented as a haematocele.

Giant abdominal hydatid cyst masquerading as ovarian malignancy.

Hydatid disease, caused by Echinococcus granulosus, is a common parasitic infection of the liver. Disseminated intra-abdominal hydatid disease may occur with the rupture of the hydatid cyst into the peritoneal cavity, producing secondary echinococcosis. Occasionally, the cyst may not rupture, and instead, enlarge, thus mimicking gross ascites or huge ovarian tumours. We present a 30-year-old woman with a giant intra-abdominal hydatid cyst communicating with the liver, and discuss the management of her case.