Background:C-reactive protein (CRP) is useful as marker of severity in malaria. African studies have shown that serum CRP levels correlate with parasite burden and complications in malaria, especially falciparum. However, there are very few data on CRP levels in Indian malaria patients.Materials and Methods:We assessed CRP levels in malaria patients at presentation and studied for any relation of CRP levels with subsequent prognosis. Statistical tests included student's t-test, Mann Whitney U test, and chi square test, all with 2-tailed analyzes.Results:Of 71 patients in our study, 42 (59.1%) were infected with P. falciparum. 23 (32.4%) patients needed admission and 10 (14.1%) died. Average CRP levels were quite high in malaria patients (31.29 ± 20.4 mg/L). There was no significant difference in CRP between vivax and falciparum cases. Admitted patients had significantly higher CRP levels compared to those treated on outdoor basis (47.11 ± 19.13 vs. 23.71 ± 16.35 mg/L; P < 0.0001). 8 patients were admitted with multiple complications. They had significantly high CRP level compared to those with 1 complication (P = 0.015). Also, patients who died had higher CRP levels compared to survivors (P = 0.000346). CRP levels at presentation showed positive correlation with duration of hospital stay (r = 0.59; P < 0.05). CRP levels >35 mg/L was highly sensitive in predicting mortality.Conclusion:Our study in Indian population corroborates the findings in African studies regarding prognostic role of CRP in malaria. CRP is an effective biomarker in assessing malaria severity and also for follow-up.

IV.

Background: Resistance to antibiotics is an extremely common phenomenon in bacteria isolated from clinical material. This is a serious threat to patient care all over the world. In India, antibiotic resistance has far reaching public health consequences. In this observational study, we aimed to generate data on the prevailing pattern of antibiotic resistance from Eastern India. Methods: This was a hospital based study involving both indoor and outdoor patients. Patients with history of antibiotic use in the past 3 months were excluded. The clinical specimens (blood, urine, pus etc.) were incubated for up to 7 days under aerobic conditions before declaring them as negative. Antibiotic sensitivity was tested by modified Kirby-Bauer disc diffusion method according to CLSI guidelines. Results: There were a total of 93 specimens with the majority being blood culture (n=43) and urine (n=33). Majority (n=57; 61.3%) of isolated organisms were gram negative with E. coli predominating (n=36). Of the gram-positive isolates, Staphylococcus predominated (32 out of 36). 100% of isolates from urine were gram negative while for blood, 60% of the isolates were gram positive. Resistance to penicillin group and cotrimoxazole was up to 100% in certain species. For carbapenem group, resistance varied from 17 to 75%. Resistance to aminoglycosides was 75% in Pseudomonas and 85% in Klebsiella. Conclusions: Our study has demonstrated very high levels of resistance to different common antibiotics in different classes of bacteria. Such data can be used for antibiotic stewardship and also to formulate antibiotic use protocols.

No abstract

Hydatid disease is a parasitic tapeworm infection caused by the Echinococcus species. Involvement of the long tubular bones is rare in hydatid bone disease. Patients are initially asymptomatic and usually present at a later stage of the disease when the bony lesions are extensive. Diagnosing bone hydatid disease is challenging, even in endemic regions, and a high index of suspicion is required because the radiologic findings often mimic other bone pathologies. Recurrence following treatment can occur after a long period of quiescence.This article describes a case of hydatid disease in a 62-year-old woman with extensive diaphyseal tibial involvement. She was treated with initial chemotherapy followed by extended curettage, polymethylmethacrylate cementation, and intramedullary fixation. Functional outcome was excellent, with no recurrence at 60-month follow-up. She was fully weight bearing with no pain or discomfort and had full hip, knee, and ankle range of motion.This case was important due to its rarity, the diagnostic challenge it presented, and the composite nature of the treatment used to avoid recurrence. Diaphyseal bone hydatidosis can be initially treated like a low-grade malignant tumor with curettage and high-speed burring, followed by filling the defect with polymethylmethacrylate cement. The composite treatment of chemotherapy with the surgical protocol described offers a reasonable chance of long-term disease suppression. Recurrent disease can be treated with repeat curettage and cementation. Wide excision with reconstruction of the resulting defect should only be considered for recalcitrant diaphyseal hydatid disease.