Antiphospholipid antibody syndrome complicating infective endocarditis - case report.

A 37-year-old lady with infective endocarditis of the mitral valve presented in congestive cardiac failure. However, the clinical scenario became complicated when she was also found to have antiphospholipid antibody syndrome. Meticulous optimization and timely surgical intervention by a multidisciplinary team helped mitigate this not so common situation and lead to successful outcome.

Patient Satisfaction with Physicians and Nurse Practitioners in Multiple Sclerosis Centers.

BACKGROUND: With the predicted shortage of neurologists, care of patients with multiple sclerosis (MS) may be affected. Nurse practitioners (NPs) have successfully filled the provider gaps in a variety of care settings, with positive effects on care outcomes, including patient satisfaction. The purpose of this study was to determine patient satisfaction with physicians (MDs) and NPs in MS centers. METHODS: This is a cross-sectional pilot study wherein a convenience sample was recruited from two MS centers. Demographic data were collected previsit, and satisfaction surveys were completed postvisit using the Patient Satisfaction Questionnaire Short Form (PSQ-18) and the Visit-Specific Satisfaction Instrument (VSQ-9). Different attributes of satisfaction and visit times were analyzed. RESULTS: Patient satisfaction with both types of providers was high. All attributes of satisfaction were comparable for NPs and MDs, and they spent similar amounts of time with their patients, often exceeding the scheduled office visit duration. Encounter length was a strong determinant of patient satisfaction: VSQ-9 scores were significantly lower (P = .01) when duration was less than 20 minutes. Satisfaction was higher (P = .011) in patients who were diagnosed as having MS for 10 years or longer or had progressive MS, irrespective of provider type. CONCLUSIONS: This pilot study showed that use of standardized questionnaires to determine patient satisfaction with NPs and MDs was feasible. With the impending neurologist shortage and the increased MS prevalence, a collaborative team approach between NPs and MDs may improve access to care in MS centers without compromising patient satisfaction.

Successful Right Atrium-Pulmonary Artery ECMO in an Infant With Severe Necrotizing Pneumonia and Bilateral Bronchopleural Fistula.

We report an infant with necrotizing pnuemonia and bilateral broncho pleural fistula, who failed on conventional and high frequency ventilation and was managed successfully on Veno-venous Extra Corporeal Membrane Oxygenator (V-V ECMO) with a unique configuration for 12 days, and weaned off successfully.

HIV infection associated neuromyelitis optica spectrum disorder: Clinical features, imaging findings, management and outcomes.

INTRODUCTION: HIV Infection associated NMOSD (HIV-NMOSD) is a recently recognized entity. Management of patients with HIV-NMOSD is a challenge. Here we report our own experience of HIV-NMOSD along with a complete review of all the cases of HIV-NMOSD reported in literature. OBJECTIVE: Describe the clinical features, radiological findings, treatment patterns and outcomes in patients with HIV-NMOSD. METHODS: The details of all cases of HIV- NMOSD were searched from our NMOSD registry. A literature search was also done using the terms NMO, NMOSD and HIV infection in PUBMED, Google Scholar and EMBASE. The details of all the reported cases and cases from our registry were collected and analyzed. RESULTS: Six cases of HIV-NMOSD were identified from the literature and one from our registry. There were four males and three females with age ranging from 8 years to 49 years. Duration of HIV infection ranged from newly detected to 15 years. Optic neuritis followed by myelitis was the commonest presentation, occurring in 5 out of 7 patients. 3 patients were anti-aquaporin 4 antibody positive while 3 were negative and in one anti- aquaporin 4 antibody assay was not done. All patients received immunomodulatory treatment. 5/7 patients had poor recovery from acute attacks but no patient had further relapses while on immunomodulatory treatment and antiretroviral therapy. CONCLUSION: HIV associated NMOSD is a recently recognized entity. A high index of suspicion is needed to diagnose these patients. In all patients with HIV infection presenting with optic neuritis or/and myelitis, anti aquaporin 4 antibody status should be checked and in all patients of NMOSD, HIV infection should be ruled out.

Post herpes zoster infection neuromyelitis optica spectrum disorder.

Neuromyelitis optica is a severe autoimmune demyelinating disease; however, the trigger for autoimmunity in an individual patient is unclear. Here, we report the case of a 48 year old female presenting with longitudinally extensive transverse myelitis in the cervical region of the spinal cord two weeks post herpes zoster infection in right C6 dermatome. Though post herpetic myelitis was provisionally diagnosed, serological evaluation revealed aquaporin-4 antibody positivity, confirming the diagnosis of neuromyelitis optica spectrum disorder. Herpes zoster infection appears to have triggered the onset of autoimmunity, leading to the development of neuromyelitis optica spectrum disorder in this patient.

Multi-drug-resistant tuberculosis: the experience of an urban tertiary care hospital in South India using automated BACTEC 460 TB.

The emergence of multi-drug-resistant (MDR) strains has been a major obstacle in the tuberculosis (TB) control programme. In the present study we looked into the prevalence of MDR-TB in an urban tertiary care hospital in South India over four years (2007-2010). During this period, 641 clinical specimens (317 respiratory specimens and 324 non-respiratory specimens) were received for mycobacteriological culture and drug susceptibility testing for first-line drugs, using the BACTEC 460 TB system. Mycobacterium tuberculosis (MTB) was isolated in 34.8% (n = 223) specimens. Of the total 223 MTB isolates 83 (37.2%) were MDR. Forty-two percent of the pulmonary MTB isolates (n = 72) and 20.4% of the extra-pulmonary isolates (n = 10) were MDR. Although we observed a high percentage of drug resistance, the prevalence of MDR was not observed to vary significantly within the four years which suggested good management.