BackgroundSevere cholestatic jaundice may complicate with bile cast nephropathy (BCN) causing severe acute kidney injury (AKI). In this study, we investigate BCN in severe falciparum malaria complicated with jaundice and AKI.MethodsThis prospective study was conducted in a tertiary health care institution with high prevalence of malaria. A cohort of 110 patients with falciparum malaria complicated with cerebral malaria, jaundice and AKI were enrolled. Species diagnosis was made from peripheral blood smear or rapid diagnostic test. Severe malaria was diagnosed from WHO criteria. BCN was diagnosed with the detection of bile casts in urine or in biopsy. The recovery pattern and outcome with and without BCN was assessed.ResultsOut of 110 patients, 20 (18.2%) patients had BCN and 15 (13.6%) patients had hepato-renal syndrome. Patients with BCN had high conjugated bilirubin (26.5 ± 4.1 mg/dL), urea (75.9 ± 10.3 mg/dL) and creatinine (7.2 ± 0.8 mg/dL), longer duration of illness (6.4 ± 1.1 days), higher mortality (25.0%) and prolonged recovery time of hepatic (9.6 ± 2.4 days) and renal dysfunction (15.1 ± 6.5 days) compared with patients without BCN.ConclusionsProlonged duration of illness and increased bilirubin cause BCN among patients with severe falciparum malaria with jaundice and AKI, which is associated with high mortality and morbidity.

Background: HIV destroys the CD4+T cells progressively thus making the HIV infected persons susceptible to a number of opportunistic infections (OIs).Methods: The study was conducted in the Medicine Department and ART Centre, VIMSAR. It is a prospective study from July 2016 to September 2017.Results: 86 patients register, detail history, clinical examination and investigation were done and then the data is complying in detail. Most of the patients were male (72%) male female ratio is 2.6:1. The majority of patients presented with fever, weight loss and anorexia seen in more than 73% of the study population.Conclusions: (42%) cases belonged to the CD4+T cell count range of 101-200/µl with aCD4+T cell count of 183/µl, so there is increased chance of hospitalization in patients having CD4+T cell count below 200/µl. The most common OI was tuberculosis (51%) with pleural effusion as its commonest manifestation. The second most common OI was candidiasis (43%) with most cases suffering from oral candidiasis was seen to occur at higher CD4+T cell counts than tuberculosis.

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BACKGROUND Malaria is a global health burden. About 300 - 500 million people suffer from the disease every year, out of whom, about 1 million succumb.1 This study was undertaken, as there has been no such study regarding the possible effect of - thalassemia and ABO blood group in Indian population on falciparum malarial infection. METHODS This is an observational study carried on in all malarial patients admitted in the Department of General Medicine, VSS Medical College & Hospital, Burla, between October 2008 - September 2010. Inclusion criteria: (i) Fever with positive asexual forms of falciparum malarial parasites [thick smear, thin smear, positive quantitative buffy coat (QBC), ICT test]. (ii) WHO criteria for severe falciparum malaria2 . “Controls”: Healthy persons of about same age, sex, ethnicity and locality. Exclusion Criteria: Blood transfusion within 3 months, cases of DM, CKD, hepatitis, SCD, tuberculosis, HIV, chronic liver disease, and COPD. RESULTS 128 cases of malaria, between 15 - 75 years, both sexes, pregnant / non-pregnant were included in the study. For control, the gene frequencies were  /  29 (45.3 %),  3.7 /  27 (42.2 %) and 3.7 / 3.7 8 (12.5 %). For cases, it was found 33 (51.56 %), 25 (39.1 %) and 6 (9.4 %) respectively. In HPLC, HbA0 values of 3.7 / 3.7 (81.83  10) were >  /  (77.11  21.6) >  3.7 / , (64.8 ± 32.42), HbA2 values of  /  (2.1  1.4) >  3.7 /  (1.8 ± 0.8) > 3.7 / 3.7 (1.43  0.27). In HbF, there were nearly same number of cases in all three variants and were negligible in HbS. Anaemia, jaundice, oliguria were the predominant causes of morbidity in alpha thalassaemic patients with severe falciparum malaria. Blood group A patients had significantly higher morbidity than blood group B, AB and O. CONCLUSIONS The percentage of anaemia, coma, convulsion and death was significantly less in homozygous alpha thalassemia cases in comparison to normal alpha thalassemia and heterozygous alpha thalassemia. Above features were also found to be significantly less in blood group O patients, and significantly high in blood group A patients, when compared to other blood groups. Prevalence of heterozygous and homozygous -thalassemia was lower in cases in comparison to controls. MCV was significantly lower in homozygous alpha thalassemia patients in comparison to other genotypes of alpha thalassemia. Anaemia, jaundice, coma, shock, oliguria, being the major co-morbidity conditions, should be detected and treated early. KEYWORDS Severe falciparum Malaria, ABO Blood Group, Homozygous & Heterozygous, -Thalassemia

Introduction: Acute Kidney Injury (AKI) occurs most commonly in Plasmodium falciparum infection. Next to cerebral malaria and anaemia, AKI is the third most common complication of falciparum malaria. N-Acetylcysteine (NAC) has been shown to decrease serum creatinine without affecting the Glomerular Filtration Rate (GFR) by activating creatinine kinase and possibly by increasing tubular secretion. Aim: To study the effect of NAC on improvement and deterioration of falciparum malarial AKI. Materials and Methods: This prospective observational study was undertaken on 100 patients of falciparum malaria with AKI who were admitted to the Department of General Medicine ward, VSSIMSAR, Burla, Odisha from November 2014 to October 2016. Patients who were treated with NAC were considered as NAC group (n=50) and those who were not given were considered as Non N-Acetylcysteine (NNAC) group (n=50). In both the groups serum creatinine level and urine output were compared on day 1, day 3 and on day 5 of the study. Graph pad instat version-3 for windows was used for various statistical analyses. The numerical value was compared by Chi-square test. The comparison of mean values among the NAC and NNAC groups was performed by student t-test. The p-value less than 0.05 was considered statistically significant. Results: A total of 63 males and 37 females were included in the study. Most of the cases were present in 15-34 years age group in both NAC and NNAC groups. The mean age of the patients for NAC group was 33.3±12.8 years and for NNAC group was 33.2±12.1 years with majority being males in both the groups. Out of 50 cases who were given NAC 600 mg twice daily for five days, 28 (56%) cases improved in AKI on day 5 as compared to day 1 of the study in NAC group. Similarly, out of 50 cases who were not given NAC, 26 (52%) cases improved in AKI on day 5 as compared to day 1 of the study in NNAC group. There was no difference in patients showing improvement in AKI after NAC therapy compared to patients with NNAC (χ2, 0.04; p=0.841). Conclusion: In NAC group, improvement of falciparum malarial AKI after five days was found to be little bit more as compared to the NNAC group, though it did not reach statistically significant difference.

Background: Intracerebral hemorrhage has an annual incidence of 10-30/100,000 population, accounting for 2 million (10-15%) of about 15 million strokes worldwide each year. The outcome of ICH depends on the clinical presentation and radiological parameters. The objective of current study was to study the etiology, clinical patterns and imaging profile in patients of intracerebral hemorrhage.Methods: All patients admitted in department of medicine, VIMSAR, Burla, with a diagnosis of ICH during a period of November 2017 to October 2019 were evaluated for their clinical presentation, etiology and radiological parameters.Results: A total of 105 patients with a diagnosis of ICH were included in the study. The sites of ICH were basal ganglia (49%) followed by lobar (19%), thalamus (14%), cerebellum (11%) and brain stem (8%). A pre-diagnosis of hypertension was present in 33% of the cases. Headache was the most common presenting symptom, present in 38.2% of patients followed by paralysis in 29.5%, vomiting in 27.6% and seizures in 20.9% of cases. Overall mortality rate was 39%. The mean GCS of patients who expired was 8.8 when compared to 11.28 of those patients who survived (p=0.00009). The mean hematoma size of patients who expired was 20.98 while that of those who survived was 17.41 (p=0.047). The presence of IVC was associated with mortality (p=0.006).Conclusions: A lower GCS at presentation and a mean hematoma volume >20 ml with intraventricular extension at presentation are associated with increased mortality in ICH.

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Background:Methemoglobinemia is found in patients with vivax and falciparum malaria. We study the relation between Methemoglobinemia and lipid peroxidation which is a marker of reactive oxygen species and its role as a biomarker in prognosis of patients with falciparum malaria. Material and Methods: 133 patients of falciparum malaria and 25 control subjects were enrolled for the study. Blood was collected for estimation of Methemoglobin, thiobarbituric acid reactive substances (TBARS) calorimetrically. TABRS reflected amount of lipid peroxidation that indirectly measures reactive oxygen substances(ROS). The correlation between Methemoglobinemia, TBARS, parasites, and outcome of falciparum malaria was analyzed. Results:The present study enrolled 133 patients of falciparum malaria of which 48 were with uncomplicated (UM) and 85 patients with severe falciparum malaria (SM) and 25 normal persons as controls. All were followed up to 7 days. Out of 85 patients 2, 3, 4, and 5 organ dysfunctions constituted 19 (22.3%), 38 (44.5%), 19 (22.1%), and 9 (12.0%) patients, respectively. The concentration of Met-Hb in UM was 4.1 ±1.2 % (p<0.001) and increased with SM to 11.1 ±7.2 % (Table-1). After 7 days of treatment it tends to return to normal (p<0.001). The level of TABRS was high in UM compared to controls and higher in SM than SM(p<0.001). There is a significant correlation between Met-Hb and TABRS and with parasitemia. A positive correlation exists between parasite count and Met-Hb level (r = 0.930, p < 0.0001), between parasite count and serum TBARS level (r = 0.948, p < 0.0001) and between Met-Hb and serum TBARS level (r = 0.917, p < 0.0001). In total 15 cases (17.6%) died during the study and the patients who died had a high Met-Hb (14.5 ±3.6%) compared to survivors 11.4 ±4.6% (p<0.001) and high TABRS (6.5 ±2.6 nmol/ml) compared to the survivors 5.9 ±3.6 nmol/ml (p<0.001). Conclusion:In the present study we found Methemoglobinemia is high among patients with UM and SM. Met-Hb also high among the patients