Kikuchi-Fujimoto disease in a tertiary care teaching hospital in Coastal South India: A 8-year retrospective study.

Background: Kikuchi-Fujimoto disease (KFD) is a rare, benign condition of unknown etiology, presenting as cervical lymphadenitis. Lymphadenopathy is usually tender and maybe associated with systemic symptoms. Despite the extensive literature on this disease, it continues to be misdiagnosed owing to its misleading clinical presentation. METHODS: A retrospective hospital-based descriptive cross-sectional study was conducted in tertiary care hospitals from 2011 to 2019. All patients with confirmed KFD diagnosis were included and after ethics committee approval the clinical details and histopathological data was retrieved from the medical records department and analyzed. RESULTS: A total of 67 cases were included. The mean age was 26.9±11.3 years with a female: male ratio of 1.9:1. There were 50 patients with tender cervical lymphadenopathy which was the most common clinical presentation. The mean length and width of palpable lymph nodes were 2.3±1.0 cm and 2.2±0.7 cm respectively. Histology revealed proliferative stage in majority of patients ( n=40, 59.7%). Lymphadenopathy resolved in 83.6% within 2 months. There were 42 patients who had complete recovery with symptomatic treatment within a period of 9 months. CONCLUSIONS: KFD is prevalent in young, female patients of Asian descent and often presents as tender cervical lymphadenopathy. Early diagnosis with excisional lymph node biopsy is crucial to avoid unnecessary investigations and treatment. Treatment is symptomatic unless complicated, where steroid therapy is considered. KFD has an excellent prognosis with almost no risk of fatality.

Does Azithromycin and Cetirizine Combination Given for Upper Respiratory Tract Infections has any Significant Effect on QTc?

INTRODUCTION: Azithromycin usage in patients with baseline cardiovascular risk is associated with increased risk of cardiovascular mortality, following which Food and Drug Administration (FDA) issued a black box warning regarding safety of azithromycin in patients with cardiovascular morbidity particularly with prolonged QTc. Cetirizine is a second generation anti histaminic and is found to be commonly used for Upper Respiratory Tract Infections (URIs) along with azithromycin on outpatient basis. Whether, usage of these two drugs in combination confers a similar risk, is unknown. AIM: To assess the effect on QTc among patients treated with azithromycin and cetirizine combination for upper respiratory tract infection. MATERIALS AND METHODS: We conducted a prospective longitudinal study from August 2014 to July 2016. The study was done on 45 patients above 18 years of age without any cardiovascular morbidity in whom azithromycin and cetirizine were prescribed for upper respiratory tract infections. We compared the QTc on day 1 and day 4. Data was analysed using Student's paired t-test. RESULTS: During three days of azithromycin and cetirizine for upper respiratory tract infections, we observed that on day 4 there was significant increase in QTc in 43 patients (95.6%) as compared with the QTc on day 1. We also observed that in 8 (17.8%) out of 45 patients, QTc on day 4 crossed the upper limit of normal {430 milliseconds (ms)}, but this was not statistically significant. However, analysing these eight patients, we obtained the baseline QTc of 377.50 ms above which if prescribed, this combination of drugs have a chance of prolonging the QTc above 430 ms with a sensitivity of 87.5% and specificity of 40.5%. CONCLUSION: During three days treatment with azithromycin and cetirizine, there was significant change in QTc between day 1 and day 4. Patients with baseline QTc greater than 377.5 ms were at risk of QTc prolongation above 430 ms on day 4.

Atypical Manifestations of Dengue Fever (DF) - Where Do We Stand Today?

BACKGROUND AND OBJECTIVES: Dengue fever (DF) is transmitted by Aedes aegypti mosquitoes. With growing population, rapid urbanization and lack of appropriate sanitary measures, proliferation of mosquitoes and subsequent dengue infections have increased rampantly with an estimated 30-fold increase in incidence over last five decades. With rising disease burden, atypical manifestations have increased as well, which are missed most often due to lack of awareness. Our aim was to look for the atypical manifestations of dengue fever. MATERIALS AND METHODS: A prospective hospital based observational study was conducted at hospitals of Kasturba Medical College in Mangalore over a period of two years (June-2010 to May-2012). One-hundred fifty ELISA confirmed IgM-dengue sero-positive cases satisfying WHO criteria were examined clinically and laboratory data assessed till they got discharged from hospital after ruling out other causes of fever. Atypical manifestations in dengue fever were noted and analyzed. RESULTS: Most common symptoms noticed were myalgia, headache, rash, arthralgia, pain in abdomen and nausea. More than half of the study group had one or the other atypical manifestation. Liver function test derangement was most often seen. Most common atypical manifestation was hepatitis found in 40.6% patients. Febrile diarrhea, renal failure, Acalculous cholecystitis and conduction abnormalities of heart were among other common manifestations. Three patients died of multi-organ dysfunction, disseminated intravascular coagulation and shock. Platelet count did not correlate well with severity of bleeding. Overall recovery rate was good. CONCLUSION: Some of the atypical manifestations of dengue fever are no more a rare entity. Clinical vigilance for these manifestations is important for timely detection and management as some of them could be fatal.