Experience with Splenic Abscess from Southern India.

INTRODUCTION: Splenic abscess is a rare entity with potentially life threatening complications. Sparse recent published data are available documenting the aetiological profile and management of patients with splenic abscess from India. AIM: To study the clinical profile of splenic abscess. MATERIALS AND METHODS: We retrospectively collected data from case records of admitted patients with splenic abscesses, to Nizam's Institute of Medical Sciences and Hospital which is a multispecialty, tertiary care referral hospital over a period of 15 months (from March 2014 to May 2015) and parameters studied were age, sex, symptoms, signs, risk factors, investigations like Ultrasound, CT scan, blood & microbiological culture, treatment and outcome. RESULTS: Most common presenting symptom was fever (90%). Mean age was 33.5 years. Five patients (55%) had risk factors like HIV, leukaemia and diabetes. From pus culture Escherichia coli was the most common organism (22%) grown. Staphylococcus saureus, Enterococcus faecium were seen in one each, blood culture grown Cryptococcus neoformans, Pseudomonas aeroginosa in one each, Plasmodium falciparum was seen on peripheral smear in one. Three were empirically treated as disseminated koch's. Another was treated as possible infective endocarditis. All were given antimicrobials, five (55%) were treated with antimicrobials alone, three (33%) with PCD (Per Cutaneous Drainage) and one (11%) with sub-total splenectomy. All patients recovered. CONCLUSION: With early diagnosis and increased use of ultrasound guided procedures like aspiration or drainage, spleenectomy can be avoided. Optimal treatment for splenic abscess is yet to be defined and customized to each patient.

A Prospective Study on Prevalence and Causes of Anaemia in Patients with Acute Coronary Syndrome.

INTRODUCTION: Anaemia is a contributor for adverse prognosis in Acute Coronary Syndrome (ACS), but the epidemiology and causes of anaemia in such patients is not defined. AIM: To study the prevalence and aetiology of anaemia in hospitalized patients with ACS. MATERIALS AND METHODS: All consecutive patients admitted with ACS from January to March, 2010 were included. Their clinical information was recorded. RESULTS: Of 130 (87 males) consecutive admissions for ACS, 47.7% had unstable angina, 10% had Non ST-Elevation Myocardial Infarction (NSTEMI) and 42.3% had ST-Elevation Myocardial Infarction (STEMI). Overall prevalence of anaemia (haemoglobin <130 g/l in men and <120 g/l in women) was 51.5% (n=67) and was more prevalent in women (n=30, 69.8%) than men (n=37, 42.5%). Moderate to severe anaemia was more in women (34.9%) compared to men (20.8%). Anaemia was more common in unstable angina patients (58.2%) than in NSTEMI (11.9%) or STEMI (29.9%) patients (p=0.013). Aspirin (p<0.01) and/or clopidogrel intake (p<0.01) and raised serum creatinine (p<0.01) were more often in anaemic patients. Heart failure (p<0.01) and triple vessel disease (p<0.05) were associated with anaemia. Multivariate predictors of duration of hospital stay were haemoglobin (p<0.05) at admission and revascularisation procedure (p=0.01) during hospital stay. The most common cause of anaemia was iron deficiency (29.9%). CONCLUSION: Anaemia was common in our patients admitted with ACS. Female gender, antiplatelet drug intake and raised creatinine were associated with anaemia, which in turn was associated with adverse in-hospital outcomes. The impact of correcting anaemia on outcomes in ACS needs long term prospective study.

Study of Aplastic Anaemia with Cyclosporine in Resource Poor Setting.

INTRODUCTION: Aplastic Anaemia (AA) is a syndrome characterized by peripheral pancytopenia with hypo-cellular marrow. Acquired idiopathic AA is the most common variety, probably of an autoimmune aetiology. Bone Marrow Transplantation (BMT) is the treatment of choice but cost is the limiting factor. Antithymocyte Globulin and Cyclosporine-A is an alternative to BMT. Cyclosporine alone has been tried as a single agent in resource poor setting. AIM: The study was conducted with the aim to observe the treatment response in aplastic anaemia to Cycloserine-A. MATERIALS AND METHODS: Patients who were diagnosed as AA and opted for Cyclosporine with informed consent were included in the study. All the subjects were started on 5mg/kg of Cyclosporine and were followed up for three months to see the treatment response. This study had the approval from IEC. RESULTS: Twenty patients were enrolled in the study. Age of the patients ranged from 10 to 65 years. Maximum number (10/20) of patients was in the 2(nd) decade. Most of the patients presented with mucosal bleeds and breathlessness on exertion; the predominant sign was pallor. Eleven patients had severe AA, eight had non severe and one had very severe anaemia. Out of 20, three patients were lost to follow-up and one patient discontinued therapy due to renal dysfunction; finally sixteen patients' data was analysed. Out of 16 patients, 9 responded was and 7 did not respond. Complete response was observed in three patients, partial response in six patients. Seven patients had drug toxicity in the form of acute renal failure and gum hypertrophy. CONCLUSION: Cyclosporine seems to be a reasonable therapeutic option with good response rate and minimal side effects.

Kikuchi-Fujimoto disease associated with systemic lupus erythematosus.

A cervical lymph node biopsy from a 38-year-old woman initially revealed necrotising lymphadenitis. Her case is presented herein. An exhaustive examination that included renal biopsy did not suggest systemic lupus erythematosus (SLE). She was diagnosed with Kikuchi-Fujimoto Disease (KFD) and was treated with prednisone. One year later, a renal biopsy performed for renal failure revealed Class IV SLE. It was proposed that lymphadenitis in this KFD patient should be considered as SLE so that the SLE would be properly treated. In our patient, this hypothesis was partially correct, because even though SLE could not be verified at initial presentation, it evolved into full SLE after a year interval.

Bilateral renal vein thrombosis due to inapparent polycythaemia.

Thromboses at unusual sites are characteristic of polycythaemia. We present a patient of bilateral renal vein thromboses due to polycythaemia that was inapparent. The diagnosis was confirmed by trilineage hyperplasia in bone marrow and JAK 2 V617F mutation in blood.