Background Scrub typhus is rare in pregnancy, but it has now become an important cause of febrile illness in pregnancy in sub-Himalayan region of India. Only a few case reports have been published so far, and they show adverse maternal and fetal outcomes. No consensus has been reached till now regarding treatment. Methodology All the pregnant patients irrespective of period of gestation admitted with febrile illness with positive IgM ELISA for scrub typhus with or without eschar were included. The clinical profile was observed using a detailed history of symptoms, travel, recreation, agricultural activities, treatment record prior to admission, and a detailed examination, and the treatment outcome was noted. Fever workup including cultures, CXR, CSF analysis, serology for scrub was done. IgM scrub typhus was done by kit method manufactured by InBios Intertational, Inc.Results We observed in total 14 pregnant patients out of which eight were in the the second trimester and six were in the third trimester. The clinical features of the disease observed for pregnant females were the same as for

Objectives: The purpose of the present study was to study the clinical profile and aetiology of anaemia in elderly more than 60 years of age at a tertiary care centre. Methods:147 elderly patients were studied during one year period, who fulfilled the inclusion criteria of age more than 60 years with anaemia, as per World health organisation. A detailed history, thorough clinical examination and symptom analysis, was done in all the patients. Haematological investigations including peripheral smear and biochemical investigations were done in all patients. Morphological pattern of anaemia was classified based on red cell indices and peripheral smear. From preliminary investigation, further studies were planned according to the probable cause of anaemia. The severity of anaemia was assessed according to the WHO Classification. Results: Elderly patients ranged from 60 years to 98 years, with a mean age of 68.29 ± 6.25 years. The number of males in the study group was 88 (59.9%), and females were 59 (40.7%), which was statistically significant (p-value <0.05). The most common type of morphological anaemia among elderly patients was found to be normocytic anaemia followed by microcytic anaemia. Anaemia of chronic disease was found to be the most common etiological type of anaemia followed by iron deficiency anaemia, vitamin B12 deficiency and anaemia due to acute blood loss. Conclusion: Hospitalised patients have more severe anaemia compared to populationbased studies where mild anaemia predominates. The morphological and etiological type of anaemia proportions is identical in both population and hospital-based studies.

No abstract

Pneumatosis Intestinalis is commonly seen in the infants and the cause being necrotizing enterocolitis. Being an uncommon entity among the adults sometimes the physician may be unaware of the benign causes of the Pneumatosis Intestinalis and pneumoperitoneum for which the patient may be exposed to the unnecessary surgical intervention. Computed Tomography scan is the investigation of choice to diagnose Pneumatosis Intestinalis.

No abstract

Background: The aim of the study was to study the clinical profile of patients presenting with adverse drug reaction.Methods: The study was conducted in the Department of Medicine, IGMC Shimla from 01 July 2015 to 30 June 2016. A total of 129 patients were included in this study. A detailed history was taken followed by examination of patients. The routine investigations were done and special investigations as per need. For analysis patients detail, suspected drugs and the adverse drug reactions caused by them were used.Results: Bleeding from various sites was the most common event (39.5%), followed by symptomatic hypoglycemia 22.5% of events and symptomatic hyponatremia in 16.3% events. Amongst various drug classes anticoagulants were the most commonly involved drug class followed by oral hypoglycaemic agents, diuretics and antiplatelets. Type A was predominant ADR constituting (97.7%) of total ADRs and only (2.3%) of ADRs were of type B. After causality assessment, majority 86 (66.6%) were probable related and large number 127 (98.3%) of ADRs were serious which recovered after hospitalization.Conclusions: Our study revealed that ADRs are frequent and are easily recognized in clinical practice and are mostly preventable. Most ADRs are due to the use of drugs with high toxicity for example, warfarin often results in bleeding. It also shows that careful drug monitoring in hospitals  may lead to reduction of many such ADRs, suggesting that some type A, ADRs may be due to inadequate monitoring of therapies and doses. This study will aid the development of interventions to reduce the impact of ADRs in hospital in-patients.

Methyl alcohol poisoning is an extremely hazardous poisoning commonly occurs via oral ingestion of illicit or adulterated liquors or as ethanol substitution. Toxicity results in gastrointestinal manifestations, metabolic acidosis, neurologic squeal and even death. Rapid recognition, early and aggressive management have been emphasized to prevent hazardous outcome. We hereby present a case series of 16 cases who presented to our hospital as methyl alcohol poisoning. Demographic, clinical and biochemical data were collected retrospectively from the hospital record section of the tertiary care hospital in the state of Himachal Pradesh. Out of 16 patients admitted, 12 patients had metabolic acidosis and treated with sodium bicarbonate. Four patients underwent hemodialysis for the improvement of symptoms. Five patients with severe metabolic acidosis, hypotension and altered sensorium did not be recover and succumbed.

COVID -19 is not just a respiratory illness; it is a great masquerader with clinical manifestations from pneumonia, acute respiratory distress syndrome to endothelial dysfunction, hypercoagulability and multiorgan failure. Thrombotic complications due to Covid related coagulopathy is of concern as it further leads to poor clinical outcome in severe cases of Covid 19. Acute limb ischemia (ALI) is a rare manifestation of Covid related coagulopathy. Key words: COVID, coagulopathy, acute limb ischemia (ALI).