Haematological and Inflammatory Biomarkers Among Stable COPD and Acute Exacerbations of COPD Patients.

Objectives: This study aimed to assess the variation in the levels of the neutrophil lymphocyte ratio (NLR) and platelet indices in patients with stable chronic obstructive pulmonary disease (COPD) and acute exacerbation of COPD (AECOPD) patients and its association with GOLD stages. COPD is heterogeneous in nature. AECOPD is diagnosed clinically, which is subjective, and clinical judgement may vary from clinician to clinician. Since chronic inflammation underlies the pathogenesis of COPD, markers of inflammation have generated considerable interest in their potential to be used as biomarkers of COPD. Methods: This prospective analytical study was carried out at the Department of Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India, from December 2018 to July 2020. A total of 64 subjects (32 stable COPD, 32 AECOPD) who satisfied the study criteria were included. Blood samples were taken from stable and AECOPD patients and were compared. Results: It was observed that the NLR, the platelet distribution width, the erythrocyte sedimentation rate (ESR) and the C-reactive protein (CRP) increased in AECOPD patients compared to stable COPD patients (P <0.001). A positive correlation was observed between the neutrophil lymphocyte ratio, the platelet distribution width, the ESR and the CRP (P <0.001). Conclusion: The NLR and platelet distribution width values increased significantly in AECOPD patients compared to stable COPD patients.

Concurrent Presentation of Emphysematous Pyelonephritis, Emphysematous Osteomyelitis, and Psoas Abscesses.

Emphysematous pyelonephritis (EPN) is an uncommon necrotizing infection commonly seen in people with diabetes. Emphysematous osteomyelitis (EOM) is a rare form of pyogenic osteomyelitis characterized by the presence of air in the bones. A combination of both these infections has been reported only thrice in the literature. We present the case of a middle-aged diabetic woman who had both these rare infections along with psoas abscesses, a phenomenon that has been described only once previously. The patient required prolonged hospitalization, surgical debridement and drainage, a double-J stent, and meropenem, and she subsequently achieved full recovery.

Large fetal intra-abdominal umbilical vein varix: Antenatal sonographic diagnosis and follow-up.

Fetal intra-abdominal umbilical vein varix is an uncommon antenatal finding defined as focal dilatation of umbilical vein >9 mm or more than two standard deviations above the mean for the gestational age. We report the case of a 28-year-old gravida 2 diabetic lady, who presented at 35 weeks of gestation, whose antenatal ultrasonography showed a cystic lesion of size 4 × 3.8 cm showing turbulent venous flow in the fetal abdomen in continuity with the umbilical vein, diagnosed as umbilical vein varix without any other anomaly. Postnatal ultrasonography showed size reduction and thrombosis of varix. Isolated umbilical vein varix has a favorable outcome, whereas those associated with other structural anomalies have a variable prognosis. This case was reported because of the unusually large size of varix with a good outcome and also to stress the importance of detailed sonography and close fetal monitoring in the presence of umbilical vein varix.

Neurotuberculosis immune reconstitution inflammatory syndrome in the setting of HIV infection: A case report and review of literature.

Immune reconstitution inflammatory syndrome (IRIS) is an exaggerated immune response which can occur with various coinfections in human immunodeficiency virus (HIV) infected patients, of which the most commonly implicated in central nervous system (CNS)-IRIS are progressive multifocal leukoencephalopathy (PML), cryptococcosis, and tuberculosis (TB). TB-IRIS is a known complication of pulmonary TB or TB lymphadenitis coinfection in HIV infected patients who are on antituberculosis treatment (ATT) after the initiation of antiretroviral therapy (ART). However, development of IRIS in extrapulmonary TB such as CNS TB is very rare. Our case is that of an isolated CNS-TB-IRIS, presenting as increase in the size and perilesional edema of the ring enhancing lesions in the brain, which was observed in two sequential magnetic resonance imaging done over a period of 2 months in a retropositive patient who presented with clinical deterioration after commencement of ART. As prompt diagnosis was made and specific management aimed at IRIS was started without delay, the patient improved symptomatically.