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

This study shows that AKI in scrub typhus is common and a severe disease. Age, a shorter hospital stay, severities of leukocytosis, thrombocytopenia, azotemia, hypoalbuminemia, hepatic dysfunction and the complications of ARDS, encephalopathy, MOF and need for ICU support are the factors associated with mortality.

Encephalocraniocutaneous lipomatosis (ECCL), also known as Haberland syndrome, is a rare syndrome with unknown etiology. The syndrome is characterized by a triad of unique cutaneous, ocular, and central nervous system (CNS) manifestations. The cutaneous hallmark, nevus psiloliparus (NP), along with overlying alopecia is a constant feature. Choristoma of the eyelid is the most common ocular manifestation, while intracranial lipoma is the predominant CNS finding. Genetic counseling is required to emphasize that the disorder, although congenital, is not inheritable. We present a 21-year-old female with cutaneous, ocular, and CNS features satisfying the diagnostic criteria for ECCL. To our knowledge, this is the first case of ECCL having a large temporal exostosis. The objective of this article is to better understand the phenotypic spectrum of this syndrome whose molecular basis is still unknown.

E-strips are not quite feasible as a replacement for LJ-proportion method on a large scale due to high risk of cross contamination, laboratory infection, expense associated with it and high false positive resistance observed to all first line drugs. However, the good correlation observed for RIF between the two methods indicates that E-test could contribute to the role in rapid screening of MDR TB isolates as rifampicin mutations are invariably observed in MDR TB isolates.

Introduction:Chronic obstructive pulmonary disease (COPD) is an important non-communicable disease worldwide with a rising global incidence. COPD is associated with multiple co-morbidities. Patients with COPD are at increased risk of atherosclerosis and other cardiovascular events. Cardiovascular diseases are an important cause of morbidity and mortality in COPD. The present case-control study was designed to assess the relationship between sub-clinical atherosclerotic vascular diseases with COPD.Methods:It was a prospective case-control blinded observational study. There were 142 COPD patients and 124 age-and sex-matched controls without COPD and cardiovascular diseases. Frequency of sub-clinical atherosclerosis was assessed by the carotid B-mode duplex ultrasonography assessment of carotid wall intima medial thickness (IMT). Plaque was defined as IMT of more than 1.2 mm.Results:Prevalence of carotid plaqing was significantly higher amongst patients of COPD (38.7%) compared to controls (13.7%, odds ratio 3.9, P < 0.0001). Multinomial logistic regression analysis revealed COPD as an independent predictor of carotid plaqing (r = 0.85, P < 0.023).Conclusion:The frequency of carotid plaqing is high in COPD patients. Carotid plaqing may be due to shared risk factors or the presence of low-grade systemic inflammation. Presence of increased CIMT and carotid plaqing in COPD patients identifies early atherosclerotic changes and future cardiovascular risk. Hence screening of CIMT should be a part of cardiovascular assessment in patients with COPD.

No abstract

Subcutaneous emphysema is a common condition occurring after chest injury. It may also be observed in association with pneumothorax or pneumomediastinum as a result of pathological changes in the respiratory tract. Spontaneous subcutaneous emphysema in absence of pneumothorax or pneumomediastinum is rare. We report a case of spontaneous subcutaneous emphysema in isolation secondary to fibrocavitatory lesion in the chest along with review of the literature.

Background Lower gastrointestinal bleeding (LGIB) is fairly a common presentation in gastroenterology and medicine departments, and presents major diagnostic and therapeutic challenges. This study aimed to explore the varied clinical spectrum of LGIB in our region. Methods A total of 138 patients presented with chronic LGIB and were investigated using colonoscopy and relevant investigations. Results The majority of patients were in the age group of 40 to 59 years, with a mean age of 49.5 years, slight male predominance, and male-to-female ratio of 1.19:1. The most common clinical presentation was hematochezia (97.8%). Overall, 15% patients had more than one comorbidity, and 39.13% patients were anemic, of which 7.24% received blood transfusions. Diagnostic yield of colonoscopy was 92.75%. Major causes of LGIB were anorectal causes (19.56%), inflammatory bowel disease (19.56%), colorectal carcinoma (17.39%), radiation proctitis (9.42%), infective causes (11.59%), nonspecific colitis (7.24%), and benign growths (5.07%). However, in the elderly (age > 60 years), carcinoma colon, radiation proctitis, and hemorrhoids predominated the clinical picture. Conclusion Colonoscopy is very useful in the evaluation of patients with LGIB. The predominant causes of LGIB vary according to age as well as geographical location, and mortality of LGIB is negligible as compared with upper gastrointestinal bleeding. Abstract, Keywords ► lower gastrointestinal bleeding ► inflammatory bowel disease ► solitary rectal ulcer syndrome ► colonoscopy