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2013| May-June | Volume 6 | Issue 3
Online since
November 7, 2013
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CASE REPORTS
Viral myositis as a close mimicker of polymyositis
Harpreet Singh, Paulomi Talapatra, Suvrat Arya, Vikas Gupta
May-June 2013, 6(3):324-326
DOI
:10.4103/1755-6783.120997
Viruses can induce myositis through persistent infections, molecular mimicry, production of immune complexes, immune dysregulation, or other mechanisms. Self limited viral myositis is more common among children and has been seen to be mostly associated with influenza A and B. We report a case of 15-year-old boy who presented with proximal muscle weakness following 3 weeks after an episode of fever. Muscle necrosis was evident from the raised creatine kinase levels and myoglobinuria. The patient improved slowly over a period of weeks without any treatment except for adequate hydration.
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ORIGINAL ARTICLES
Investigation of plasmid profile, antibiotic susceptibility pattern multiple antibiotic resistance index calculation of
Escherichia coli
isolates obtained from different human clinical specimens at tertiary care hospital in Bareilly-India
Ajay Francis Christopher, Sandhya Hora, Ziledar Ali
May-June 2013, 6(3):285-289
DOI
:10.4103/1755-6783.120985
Background:
Escherichia coli
is well known as noninvasive commensal and has been established as etiological agent of various human infections.
E. coli
also contributes to high rate of resistance to several antibiotics due to multiresistant antibiotic plasmid genes e.g., extended spectrum β-lactamases (ESBL).
Material and Methods:
To analyse the situation of antibiotic resistance, a total of 77
E.coli
isolates from urine, pus, sputum and endotracheal aspirate were screened for their antibiograms for antibiotic resistance, multiple antibiotic resistance (MAR) index for evaluating the spread of resistance and plasmid profiles for the presence and characterization of plasmids.
Results:
Very high resistance level (> 90%) was detected against ampicillin, amoxycillin, ceftazidime, norfloxacin, tetracycline while imipenem and amikacin recorded the least resistance levels of 2.3% and 13.9%, respectively, among the isolates. An increased resistance to amoxycillin, tetracycline, cotrimoxazole and norfloxacin were observed in this geographical area which however displayed a lower resistance in other countries. The MAR index varied considerably, the lowest was 0.18 and the highest was 0.89. Plasmids of 10 size ranges were detected in the isolates. Some isolates possessed single-sized plasmid while other possessed multiple plasmids. Isolates with high MAR profiles were found to possess multiple plasmids.
Conclusion:
Regular antimicrobial sensitivity surveillance is necessary and acquisition of plasmid could greatly contribute in the antibiotic resistance and poses a significant risk of the spread of microbial resistance in this community. Also, it was observed that route of administration of antibiotics perhaps reduced its misuse and hence led to the reduction in the emergence of resistant bacterial strains.
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PROSPECTIVE CLINICAL STUDY
A study of patients with type II respiratory failure put on non-invasive positive pressure ventilation
Vishal Vanani, Monila Patel
May-June 2013, 6(3):369-377
DOI
:10.4103/1755-6783.121015
Non-invasive ventilation as an alternative to the endotracheal intubation is associated with less infectious complications and injury to the airways. In a study cohort that included 50 patients with type II respiratory failure with the commonest diagnosis of chronic obstructive pulmonary disease (COPD) exacerbation with or without associated co-morbidities, mechanical ventilation with non-invasive positive pressure ventilation (NIPPV) was applied and the response was observed in terms of change in various clinical and laboratory parameters after 1 hour, at the time of weaning, and 6 hours after weaning. There was significant improvement with NIPPV in form of increase in pH and PaO
2
and decrease in PaCO2 and HCO3 after 1 hour of NIPPV application, which also persisted after successful weaning. The patients who failed NIPPV had significantly high respiratory rate, low pH value, and high PaCO
2
on admission.
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CASE REPORTS
Tropical pulmonary eosinophilia presenting as severe pulmonary arterial hypertension
Shikha Jindal, Alok Nath, Jeetender Kumar Patra, Sudeep Kumar
May-June 2013, 6(3):339-342
DOI
:10.4103/1755-6783.121001
Tropical pulmonary eosinophilia (TPE) is an easily diagnosed and treatable disease. Patients with TPE usually present with respiratory symptoms that include paroxysmal cough, breathlessness, wheeze and chest pain, often misdiagnosed as bronchial asthma. This case highlights one of the unusual presentations of TPE and discusses the association between TPE and pulmonary hypertension.
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LETTERS TO THE EDITOR
Change of platelet count after receiving of garlic supplementation: An observation in cancerous patient
Kamon Chaiyasit, Viroj Wiwanitkit
May-June 2013, 6(3):378-378
DOI
:10.4103/1755-6783.121016
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ORIGINAL ARTICLES
HIV-tuberculosis interface: a comparison of collateral prevalence of HIV and tuberculosis in an urban health centre
Saurabh R Shrivastava, Prateek S Shrivastava
May-June 2013, 6(3):290-296
DOI
:10.4103/1755-6783.120986
Background:
The Human Immunodeficiency Virus (HIV) epidemic has posed major challenges to tuberculosis (TB) control efforts globally. The combined TB-HIV epidemic demands effective and urgent action.
Aim:
To estimate the prevalence of HIV infection among patients reporting at TB clinic and prevalence of TB infection among patients reporting at the Integrated Counseling and Treatment Center (ICTC).
Setting and Design:
Longitudinal study of 6 months duration from August 2010 to January 2011 at Urban Health Center located in an urban slum of Malwani, Mumbai.
Materials and Methods:
All patients attending ICTC who were diagnosed as seropositive and those with HIVnegative status but considered as TB suspects based on symptoms of TB were referred to TB clinic for ruling out TB. Similarly, all patients attending TB clinic who were diagnosed with TB (sputum positive TB/sputum negative TB/extra-pulmonary TB [EPTB]) were referred to ICTC for their HIV status. Both categories of patients were followed up till initiation of their treatment.
Statistical Analysis:
SPSS version 16 using Chi-square test and percentages.
Results:
Out of the 305 patients referred from ICTC to TB clinic, 61 (20%) were diagnosed with TB. Out of 264 TB patients referred from TB clinic to ICTC, 27 (10.2%) were diagnosed as seropositive. Married subjects and subjects staying with their family were having less chances of TB or HIV than unmarried subjects or those who were staying away from their family.
Conclusion:
Referral of seronegative TB suspects from ICTC to TB clinic should be strengthened as it was found in the study that prevalence of seronegative TB was higher in TB suspects than in HIVpositive patients.
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CASE REPORTS
Cysticercosis involving muscles and liver only: A yet unknown entity
Kaushik Sen, Parthasarathi Karmakar, Arghya Bandyopadhyay, Tuhin Santra, Mukti Sarkar
May-June 2013, 6(3):350-352
DOI
:10.4103/1755-6783.121006
Cysticercosis is a very common disease in tropical countries like India. Cysticerci can be found anywhere in the body, but are most commonly detected in the brain, cerebrospinal fluid (CSF), skeletal muscle, subcutaneous tissue, or eye. Neurologic manifestations are the most common clinical feature. Isolated extra-central nervous system (CNS) involvement in cysticercosis is extremely rare. Herein, we have presented an interesting case of a young boy with a combination of hepatic and muscular cysticercosis without any evidence of CNS involvement.
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LETTERS TO THE EDITOR
Safe motherhood: Implementation of risk approach in developing nations
Saurabh Ram Bihari Lal Shrivastava, Prateek Saurabh Shrivastava, Jegadeesh Ramasamy
May-June 2013, 6(3):386-387
DOI
:10.4103/1755-6783.121021
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CASE REPORTS
Disseminated cysticercosis: Uncommon presentation of a common disease
Minakshi Dhar, Sohaib Ahmad, Saurabh Srivastava, Nadia Shirazi
May-June 2013, 6(3):317-320
DOI
:10.4103/1755-6783.120994
Cysticercosis is an important disease of the developing world and is a common cause of seizures and neurological morbidity. Neurocysticercosis (NCC) is the most common manifestation of the disease involving the central nervous system (CNS). Disseminated cysticercosis (DCC) is an uncommon manifestation of this disease and less than 50 cases have been reported; the majority being from India. Here we report a case with extensive dissemination of
C cellulosae,
involving all possible sites, namely, the brain, eyes (extra- and intraocular), muscles, tongue, and subcutaneous tissues. She had innumerable cerebral cysts giving a starry sky appearance on imaging, and subcutaneous nodules, as yet unreported in the existing literature, to the best of our knowledge. The patient developed an anaphylactic reaction on receiving albendazole, despite being properly preconditioned with steroids. Presently she is in follow-up and is asymptomatic.
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EDITORIAL COMMENTARY
Do West Bengal and other provinces in India need reforming for a poor-friendly, safe, quality, and effective healthcare system instead of a health industry, public-private partnership, or health tourism for the rich and middle class society of the state or country?
Pranab Kr. Bhattacharya
May-June 2013, 6(3):269-273
DOI
:10.4103/1755-6783.120981
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LETTERS TO THE EDITOR
Natto supplementation and decreased platelet count in a case with rheumatoid arthritis
Kamon Chaiyasit, Viroj Wiwanitkit
May-June 2013, 6(3):387-387
DOI
:10.4103/1755-6783.121022
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CASE REPORTS
Conjunctival Myiais caused by
Oestrus ovis
in a medical college student which responded to Ivermectin
M Ashok Kumar, Noyal Mariya Joseph, Krisnagopal Srikanth, Selvaraj Stephen
May-June 2013, 6(3):315-316
DOI
:10.4103/1755-6783.121027
Ophthalmomyiasis can present as external, internal or orbital infestation.
Oestrus ovis
is the commonest cause of conjunctival myiasis. Myiasis is a disease usually caused due to poor hygiene and responds to removal of the larvae. We are reporting a case of conjunctival myiasis caused by
Oestrus larvae
in a medical college student with persistent symptoms after removal of the larvae. The symptoms resolved with ivermectin.
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REVIEW ARTICLE
Malaria vaccine: A myth or a reality
Sarita Mohapatra
May-June 2013, 6(3):274-279
DOI
:10.4103/1755-6783.120982
Malaria is a common parasitic disease caused by
Plasmodium
spp
.
and transmitted by anopheles mosquito. Every year several million people are affected and killed due to this infection in the endemic regions of the world. Recently, drug resistance to the common antimalarial drugs has pressurized upon the development of an effective vaccine for the elimination of malaria along with other control measures. A number of vaccine trials are in the pipeline. Indeed, some were proven to have potential efficacy as therapeutic vaccine. We searched all the articles in heading malaria vaccine, recent advances in malaria vaccine, review on malaria vaccine, efficacy trials on malaria vaccine published in pubmed and google website and, review the current status and the unresolved challenges regarding malaria vaccine.
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CASE REPORTS
Amoebic cecal perforation following fulminant colitis with amoebic appendicitis and ruptured liver abscess: A rare presentation
Raman Tanwar, Sudhir Kumar Jain
May-June 2013, 6(3):367-368
DOI
:10.4103/1755-6783.121014
Amoebiasis is a common infection in the tropical areas, which commonly presents to the physician as colitis or liver abscess. Invasive amoebiasis is associated with high morbidity, and its presentation in the form of cecal perforation following fulminant colitis with appendicitis and a ruptured liver abscess is an extremely rare entity. We would like to report one such rare case where the patient presented with all these three amoebic manifestations together. Their concomitant presentation is an indicator towards invasive amoebiasis and is associated with a dismal outcome despite aggressive management.
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ORIGINAL ARTICLES
Malarial acute kidney injury: Prognostic markers
Ruhi Khan, Saif Quaiser, Shahzad Faizul Haque
May-June 2013, 6(3):280-284
DOI
:10.4103/1755-6783.120983
Background:
Malaria has protean clinical manifestations and acute kidney injury (AKI) is one of its serious and life threatening complications. This study was carried out to describe the clinical characteristics, and factors associated with adverse outcomes, in patients with malarial AKI.
Materials and Methods:
Data of 100 patients with AKI and smear positive malaria was retrospectively analyzed to evaluate the incidence, clinical profile, outcome and predictors of mortality among all cases presented to us at the Nephrology unit of Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh between November 2010 to October 2011. Results were expressed as mean, standard deviation (SD) and range.
Results:
One hundred (22.1%) (68 males, 32 females) cases of malaria induced AKI, amongst 452 total cases of AKI, were evaluated. The mean age (± SD) was 30 ± 11.23 years. Male to female ratio was 3.3:1.
Plasmodium falciparum
was reported in 76%,
P. vivax
in 11%, and both in 13% patients. The mean serum creatinine was 8.7 ± 3.7 mg%, and oligo/anuria was present in 84% of the patients. 78% of the patients required hemodialysis. 67% of the patients recovered completely, 12% did not show full recovery, and 6% developed chronic kidney failure. Mortality occurred in 15% of the patients.
Conclusion
: Malarial AKI most commonly occurs in patients infected by
Plasmodium Falciparum
. Falciparum malaria associated with AKI is a life threatening condition. Prolonged disease duration, low hemoglobin, oligo/anuria on admission, hyperbilirubinemia, cerebral malaria, disseminated intravascular coagulation, and high serum creatinine were the main predictors of mortality in our study.
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CASE REPORTS
Autoimmune hemolytic anemia secondary to chicken pox
Abraham M Ittyachen, Mohan B Jose, Varghese Abraham
May-June 2013, 6(3):353-354
DOI
:10.4103/1755-6783.121007
Autoimmune hemolytic anemia (AIHA) is a rare complication of chicken pox. It is described mainly in children. Even in children it is a rare complication and the long-term prognosis remains to be elucidated. Herein we report an adult, a 23-year-old male who developed AIHA secondary to chicken pox.
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LETTERS TO THE EDITOR
Malaria in renal transplant recipients: an interesting problem in tropical medicine
Wiwanitkit Somsri, Wiwanitkit Viroj
May-June 2013, 6(3):388-389
DOI
:10.4103/1755-6783.121023
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CASE REPORTS
Pulmonary aspergillosis: Atypical presentation in immunocompetent individuals
Ramakrishna Pai Jakribettu, Rekha Boloor, Shreevidya Kinila, Thomas S Kuruvilla
May-June 2013, 6(3):327-330
DOI
:10.4103/1755-6783.120998
Aspergillosis, an opportunistic infection, is a major cause of morbidity and mortality in immunocompromised patients. But, Aspergillus is also known to cause Pulmonary aspergillosis in immunocompetent host too. Only few cases have been reported in literature of Aspergillosis in Immunocompetent individuals so far. Here, we report 4 different cases of Pulmonary Aspergillosis , who have presented with acute symptoms.The possibility of pulmonary mycosis needs to be considered in patients with acute pulmonary symptoms like breathlessness , hemoptysis, etc with signs of infection even in immunocompetent individuals, without underlying pulmonary disease.
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Lupus nephritis in a Nigerian child: A first documented case report in South-East Nigeria
Odetunde O Israel, Ezeonwu B Uzoma, Okafor H Uche, Uwaezuoke S Nkachukwu, Adiele K Daberchi, Daberchi O Charles
May-June 2013, 6(3):335-338
DOI
:10.4103/1755-6783.121000
Systemic lupus erythematosus (SLE) is reportedly becoming a common condition among Black Africans in the sub-Saharan countries like Nigeria. Generally, clinical evidence of renal disease occurs in approximately half of the cases of SLE at presentation. The severity of the renal involvement determines the morbidity and mortality of the disease. We report the first documented case of lupus nephritis in an 11-year-old boy in South-East Nigeria. The diagnosis was based on the clinical presentation of a malar rash, photosensitivity rash, discoid skin lesion, oral ulcer, hematuria and massive proteinuria with anasarca; renal biopsy histology revealed lupus nephritis class IIB and constitutional symptoms. He is responding slowly and steadily to corticosteroids and oral cyclophosphamide. SLE with renal involvement is not an unusual disease and accessibility to diagnostic facilities may bring a major change in the approach of the disease in the sub-region.
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Kala-azar-A case series from nonendemic area, Uttarakhand
Ashok Kumar, Vinita Rawat, Naveen Thapliyal, Sanjeep R Saxena
May-June 2013, 6(3):355-357
DOI
:10.4103/1755-6783.121008
Resurgence of kala-azar in India has posed many problems. Apart from endemic areas, cases are being reported from nonendemic area. Other than diagnostic difficulties, resistance to stibogluconateand relapses are common problem in sporadic visceral leishmaniasis (VL). We present one case in detail and give brief description of nine other cases, hailing from nonendemicarea, Uttarakhand, during the period from December 2005 to September 2011, diagnosed in our teaching hospital. The patients in our study were diagnosed as VL by clinical findings and confirmed by demonstration of LD bodies in splenic or bone marrow smears. Six cases were treated successfully with amphotericin. One case died during treatment and three cases lost to follow up.Clinician should suspect and investigate for VL in patients with pyrexia of unknown origin even when the disease is not endemic in a specific region for early diagnosis.
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Ocular cysticercosis causing isolated ptosis: A rare presentation
Nasib Iqbal Kamali, Mohammad Fakhrul Huda, Vinod Kumar Srivastava
May-June 2013, 6(3):303-305
DOI
:10.4103/1755-6783.120989
Cysticercosis is the most common parasitic disease of the central nervous system. Although seizure is the most common presenting feature, the presentation depends upon the location of the cysts. Orbital cysticercosis presents with limitations of ocular motility in 75% of patients. We describe a case of orbital cysticercosis where the patient presented with isolated unilateral painless progressive ptosis and showed complete resolution after 1 month of treatment with Albendazole.
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A case report of toxic shock syndrome in a patient with underlying chronic liver disease associated with multiple satellite abscesses in elbow, perinephric region, psoas, and neck
Shafali Nandwani, Apurva Pande, Mahip Saluja
May-June 2013, 6(3):358-360
DOI
:10.4103/1755-6783.121009
Toxic shock syndrome is an acute febrile illness, which leads to multi-organ dysfunction and has a high mortality and morbidity. We report a case of toxic shock syndrome in a patient with underlying chronic liver disease associated with multiple satellite abscesses in elbow, peri-nephric region, psoas and neck.
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Acute respiratory distress syndrome: A rare clinical presentation of pulmonary involvement in Plasmodium vivax infection
Sachin Gupta, Sukhminder Jit Singh Bajwa, Amarjit Singh, Surjit Singh Parmar
May-June 2013, 6(3):361-364
DOI
:10.4103/1755-6783.121012
The common perception and belief among general medical fraternity about vivax malaria is its benign nature and rare association with any known complications. Even, the literary evidence is scarce regarding the devastating complications of malaria due to vivax but is abundant with complicated reports of falciparum malaria. Therefore, any such complicated case of vivax malaria throws diagnostic challenges to the attending physician and is very difficult to exclude the presence of other type of infections and falciparum infestation. Among various complications associated with malaria, pulmonary complications are rare and the possibility of acute respiratory distress syndrome (ARDS) is even rarest with vivax infection. The present case is a description of rare pulmonary complication of vivax malaria resulting in ARDS and its successful management.
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Hypokalemic Quadriparesis in a female-The marker for Sjogren's syndrome
Muzafar Naik, Mohammed Saleem Najar, Tariq Bhat, Younis Shah
May-June 2013, 6(3):312-314
DOI
:10.4103/1755-6783.120992
Sjogren's syndrome (SS) is a multi-systemic autoimmune disorder characterized especially by lymphocytic infiltration of exocrine glands. Renal involvement in SS is commonly manifested by tubular dysfunction. A 35 years old female presented to the emergency department with weakness of all four limbs. The baseline investigations in Emergency Department (ED) revealed hypokalemic normal anion gap metabolic acidosis. On further questioning there was history of dryness of mouth, eyes and multiple dental extractions for the last two years. Clinical and biochemical assessment confirmed a diagnosis of SS with type 1 Renal Tubular Acidosis (RTA). Hypokalemic quadriparesis associated with SS is mainly due to type 1 RTA and it can precede the sicca symptoms. We hereby report a case of primary SS with long standing sicca symptoms in which the diagnosis of SS was suspected only after the hypokalemic paralysis. The case highlights the significance of presentation of acute hypokalemia in the ED as it can unmask SS even if it is associated with sicca symptoms. Hypokalemic paralysis if associated with normal anion gap metabolic acidosis should prompt towards diagnosis of SS.
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Rhinoentomophthoromycosis caused by
Conidiobolous coronatus
in a diabetic patient: the importance of species identification
Anil Kumar, Vineeth Viswam, Sukhmani Regi, Kavitha R Dinesh, Madhumita Kumar, Shamsul Karim
May-June 2013, 6(3):331-334
DOI
:10.4103/1755-6783.120999
Rhinoentomopthoromycosis usually presents as a chronic inflammatory or granulomatous disease characterized by swelling of nose, paranasal sinuses, and mouth. We present a case of a 43-year-old male who presented with right nasal blockade and paranasal sinus pain since two months. The clinical picture was further complicated by the fact that neither the patient could tolerate plain amphoterecin B nor could he afford its liposomal derivative. Species identification enabled us to successfully treat the patient with cheaper and less toxic alternative like itraconazole and potassium iodide. Our case highlights the importance of species identification in making appropriate choice of therapy in resource poor settings in developing countries.
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Acute hypokalemic quadriparesis in dengue fever
Shyam Chand Chaudhary, Deepali Mohanty, Satyendra Kumar Sonkar, Abhinav Gupta, Preeti Singla, Rajesh Kumar Arya
May-June 2013, 6(3):365-366
DOI
:10.4103/1755-6783.121013
Dengue fever is an acute mosquito-borne infection caused by dengue viruses belonging to the family Flaviviridae. It is an important public health problem in tropical and subtropical climates. Acute motor quadriparesis during the course of dengue infection is quite unusual and uncommonly reported. We hereby report two cases of acute motor quadriparesis during the course of dengue infection due to hypokalemia.
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LETTERS TO THE EDITOR
Study of knowledge and attitude regarding ill effects of smoking among current male smokers at Cochin, Kerala
Samal Rabindra Kumar, Sagar Borker
May-June 2013, 6(3):389-391
DOI
:10.4103/1755-6783.121024
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EDITORIAL COMMENTARY
A cross-sectional study on patient satisfaction toward services received at a rural health center, Chandigarh, North India
Tanmay Mahapatra
May-June 2013, 6(3):267-268
DOI
:10.4103/1755-6783.120980
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ORIGINAL ARTICLES
Entomo-epidemiological investigations of chikungunya outbreak in Delhi, India
Ruchi Jain, Anita S Acharya, Jyoti Khandekar, Manoj Jais
May-June 2013, 6(3):297-300
DOI
:10.4103/1755-6783.120987
Context:
An outbreak of fever with severe joint pain started in the Palam area of Delhi in August 2010. An entomological and epidemiological investigation of this outbreak was conducted to ascertain the nature and cause of the outbreak.
Aim:
Aim of the study was to investigate the nature and cause of the outbreak and to contain its further spread.
Settings and Design:
It was a cross-sectional study conducted in the Palam area of south-west Delhi, situated at a distance of about 20 km from Medical College. It is one of the field practice areas for training of undergraduate and postgraduate students of Department of Community Medicine of Medical College of Delhi.
Materials and Methods:
All patients attending OPD of Primary Health Center (PHC) Palam, complaining of ever with incapacitating joint pain, were screened for chikungunya fever. Of the 750 suspected chikungunya patients, 130 blood samples were randomly drawn amongst these patients. Out of the 130 tested, 97 (70.8%) were positive for the IgM antibodies against chikungunya virus. House-to-house survey was conducted in the affected area for more cases and to find out the vector-breeding sites.
Statistical Analysis:
Frequency distributions were calculated for age and sex.
Results:
The main breeding sites of the mosquitoes were the desert coolers of houses, water stored in metal and plastic containers, and water collections at construction sites. Aedes mosquito was present in almost all the houses surveyed in the area.
Conclusions:
It was concluded that the routine campaigns need to be organized regularly within the community highlighting the potential breeding grounds of mosquitoes and the possible control methods. Source reduction strategies like cleaning of desert coolers on weekly basis, emptying of water containers, and close monitoring of construction sites for potential breeding of the vector needs to be done on a regular basis to avoid future outbreaks.
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CASE REPORTS
Calvarial Tuberculosis: A rare localisation of a common disease
Rana Safia, Jairajpuri Zeeba, Jetley Sujata
May-June 2013, 6(3):309-311
DOI
:10.4103/1755-6783.120991
Calvarial tuberculosis (TB) is a rare manifestation of extra-pulmonary TB, scantily reported in literature and accounting for 0.2% -1.3% of all cases of skeletal TB. The incidence of calvarial TB is rare, even in developing countries where TB is endemic. We describe a case of skull TB in a 16 year old male presenting as scalp swelling with a sinus in the occipital region. The diagnosis was established on histo-pathological examination with demonstration of Acid Fast Bacilli.
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Unusual presentation of calvarial tuberculosis masquerading as a cutaneous neoplasm: diagnosis by fine needle aspiration cytology
Prem Singh, Ankita Goyal, Aparna Tanwar, Sanjeev Sharma
May-June 2013, 6(3):347-349
DOI
:10.4103/1755-6783.121005
Calvarial tuberculosis is a rare entity forming 0.2-1.3% of skeletal tuberculosis. Primary calvarial tuberculosis without evidence of tuberculous lesion elsewhere in the body is still rarer and sometimes clinically mimics cutaneous neoplasm. We describe a case of young girl who presented with swelling on the scalp in the region of the left frontal bone. She was suspected to be case of cutaneous neoplasm. Diagnosis was confirmed by Fine Needle Aspiration Cytology supplemented by radiological and microbiological investigations. The patient responded well to Anti-tubercular therapy without any surgical intervention.
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A pelvic mass with obstructive uropathy in a 4-year old boy
Majid Malaki, Masood Jamshidi
May-June 2013, 6(3):306-308
DOI
:10.4103/1755-6783.120990
Cystic Echinococcosis is endemic in middle- East it may present in different sites mostly liver, but children show atypical signs in uncommon sites. A 4 years old boy presents with urinary retention, his imaging demonstrates a 6cm cystic mass displaced and compressed bladder outlet during survey another asymptomatic cyst found in chest but his liver was not involved. Retroperitoneal Cystic Echinococcosis is a rare event especially in children if present with urinary obstruction it may be due to rectum penetration and dislodged to lymphatic drainage head to chest. Cyst growth rapidity rate is 2-3 cm/year as our study.
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Rhinosporidiosis of distal radius: A case report with review of literature
Dilip K Pal, Anowar A Mallick, Ranadeb Bandyopadhyay
May-June 2013, 6(3):321-323
DOI
:10.4103/1755-6783.120996
Rhinosporidiosis is a chronic granulomatous disease caused by
Rhinosporidium seeberi
, mainly affecting the mucous membrane of nose, nasopharynx, and eyes. Involvement of bone though rare has been reported along with other mucocutaneous lesions. But bony involvement without any mucocutaneous lesion is very rare and only few cases are documented. Here we report a case of rhinosporidiosis of distal radius without any other lesion, which has not been reported in English language-peer reviewed literature, to the best of our knowledge.
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Actinomycetoma-recurrence after amputation
Kalidas Rit, Rajdeep Saha
May-June 2013, 6(3):301-302
DOI
:10.4103/1755-6783.120988
Actinomycetoma is a chronic granulomatous infection of the subcutaneous tissue caused by fungus-like bacteria, that is,
Nocardia sp, Actinomyces sp
. This infection is common in tropical countries like India, though the disease is worldwide in distribution. A 22-year-old female who presented with multiple fistulas, sinus tracts, and pain and swelling over left foot following trauma 6 years back. A diagnosis of actinomycetoma was made based on clinical and microbiological ground. Two years after amputation there was recurrence and finally took multiple antibiotic therapies but was left without cure. Another case was that of a 37- year-old male who presented with multiple fistulas, sinus tracts, and pain and swelling on the right sole 6 months after prick of bamboo stick. There was a recurrence after amputation. Both the patients were treated with a Wallace regimen
(Amikacin with Cotrimoxazole/Minocycline/Ciprofloxacin)
. Patient showed excellent response with healing of all sinuses after 2 months of therapy.
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2,192
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Isolated immunoglobulin A (IgA) deficiency presenting with cytomegalo virus pneumonia
Girish Chandra Bhatt, Jhuma Sankar, NK Dubey
May-June 2013, 6(3):343-344
DOI
:10.4103/1755-6783.121003
A 5-month-old infant with an uneventful perinatal period was presented with lower respiratory tract symptoms and abnormal X-ray findings of 1-month duration. At admission, the baby was in respiratory distress requiring oxygen therapy and supportive care. Despite optimal supportive care and antibiotic therapy, he continued to be symptomatic necessitating further investigations for nonresolving pneumonia. His bronchoalveolar lavage and urine were positive for cytomegalovirus (CMV) and workup for immunodeficiency showed undetectable immunoglobulin A(IgA) levels. Rest of the workup was inconclusive. We investigated the mother for a carrier status, but the workup was negative for CMV and/or other intrauterine infections. In view of severe CMV-associated lung disease, the baby was started on ganciclovir therapy for 6 weeks on which he recovered completely. Although the associated isolated IgA deficiency may be an incidental finding in this case, it is indeed intriguing and requires further research.
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Aspergilloma
Ramesh Aggarwal, Shridhar Dwivedi, Meenakshi Aggarwal
May-June 2013, 6(3):345-346
DOI
:10.4103/1755-6783.121004
Aspergilloma represents one of the many manifestations of fungus Aspergillus and usually occurs in preexisting lung cavities. It may be asymptomatic or presents sometimes with massive hemoptysis requiring urgent intervention. This patient was not suffering from any predisposing factors for acquiring fungal ball except chronic tobacco use and possible development of COPD. His symptoms and radiological features were suggestive of pulmonary tuberculosis. However as his tuberculin test and sputum were negative, a possibility of fungal ball was kept which was later confirmed by CT scan of chest. The case highlights the role of tobacco in compromising immune status of patient giving way for acquisition of fungal ball in lungs and the role of imaging in early diagnosis of these disorders.
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LETTERS TO THE EDITOR
A rare case of giant cell myocarditis with aortic involvement
Samarth Shukla, Sourya Acharya, Anil Wanjari, Anand Sancheti, SN Mahajan
May-June 2013, 6(3):378-382
DOI
:10.4103/1755-6783.121017
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Tuberculosis treatment default among TB-HIV co-infected patients in Nigeria
Kingsley N Ukwaja
May-June 2013, 6(3):382-383
DOI
:10.4103/1755-6783.121018
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1,883
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Noninfectious complications in HIV disease: Need for rational changes in HIV disease management in the highly active antiretroviral therapy era
KV Ramana, Ratna Rao
May-June 2013, 6(3):383-385
DOI
:10.4103/1755-6783.121019
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2012 hand food and mouth syndrome epidemic in Thailand: Geographical and virolological source
Buey Joob, Viroj Wiwanitkit
May-June 2013, 6(3):385-385
DOI
:10.4103/1755-6783.121020
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Coagulation defect in the fifth species of human malaria: A topic that has never beensystematically addressed
Viroj Wiwanitkit
May-June 2013, 6(3):391-391
DOI
:10.4103/1755-6783.121025
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© Annals of Tropical Medicine and Public Health
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