Malaria, the most important of the parasitic diseases of humans, is transmitted in 108 countries containing 3 billion people and causes nearly 1 million deaths each year. With the re-emergence of malaria various life-threatening complications of malaria have been observed. Unarousable coma/cerebral malaria, severe normochromic, normocytic anemia, renal failure, pulmonary edema/adult respiratory distress syndrome, hypoglycemia, hypotension/shock, bleeding/disseminated intravascular coagulation (DIC), hemoglobinuria and jaundice are few of the common complications of severe malaria. Symmetrical peripheral gangrene (SPG) has been reported as a rare complication of malaria. We report a rare and unique case of Plasmodium falciparum malaria complicated by DIC, severe normocytic normochromic anemia, and SPG.

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Despite advancements, severe Sepsis and septic shock are increasing and contributing significantly to mortality. Acute Physiology and Chronic Health Evaluation (APACHE) II scoring is used as an index of illness severity and for outcome prediction. However, calculating it is cumbersome. Recent studies reported that Red Cell Distribution Width (RDW) is associated with prognosis in Critical Illness and as a part of Complete Blood Count, it is tested in all patients of sepsis. Hence, this study is being done to see correlation between RDW and sepsis. Materials and methods: A hospital-based prospective observational study done for a year on 50 patients admitted with sepsis and septic shock in the intensive care units of RNT Medical College & MBGH, Udaipur after taking consent. The necessary details were taken in Proforma and data was analyzed in MS excel and the results were interpreted & significance was attributed to P <0.05 Results: Out of 50 patients-21 were non-survivors, 15(71.43%) were males & most of the patients in the age group of 41-60 years (47.62%) in non-survivors. Amongst survivors, 19 (65.52%) were males & most of the patients in the age group of 61-80 years (37.93%) Mean APACHE II score among non-survivors was 30.43±6.14 and 16.14±6.50 among survivors. Mean RDW among non-survivors was 16.09±2.24 and among survivors was 14.45±1.45. Conclusion: There was a statistically significant positive correlation between APACHE II & RDW among survivors and non-survivors. In developing countries like India, RDW levels measured on admission can be used as a prognostic marker in severe sepsis and septic shock.

Background: Vitamin D is a hormone with known effect on calcium homeostasis, but recently there is increasing recognition that it also is involved in cell proliferation and differentiation, has immunomodulatory and anti-inflammatory properties. These effect may explain its importance in the liver diseases. Vitamin D deficiency has been reported highly prevalent in Chronic liver disease (CLD) and there is an emerging interest to explore the relationship of vitamin D deficiency and severity of CLD. The aim of the study was to evaluate the correlation of serum vitamin D levels to the Child Pugh and MELD-Na scoring system in liver cirrhosis and to establish its relationship with the severity of the disease.Methods: Serum vitamin D levels were measured in 100 patients of CLD and 100 healthy controls. The degree of liver dysfunction was estimated by Child-Pugh and MELD-Na scores.Results: 91% of the CLD patients had subnormal vitamin-D levels. The mean vitamin D level in CLD patients was lower (15.97±7.45) than controls (30.12±6.60) with statistical significance (p= 0.0001). On linear regression vitamin D level showed significant negative correlation with Child Pugh score (r= –0.446, p<0.001) and MELD score (r= –0.395, p<0.001). Low vitamin D level was associated with poor outcome (mean vitamin D level 9.61±3.01 who died versus 16.52±7.47 who survived and discharged).Conclusions: CLD is associated with a significantly low level of vitamin D. The lower level of vitamin D is associated with severity of CLD, mortality and increased risk for complications. Awareness of serum vitamin D level in CLD patients is important to improve outcome.