Life-Threatening Thrombo-embolic Events in a Case of Dengue Hemorrhagic Fever.

In Dengue Hemorrhagic Fever (DHF), hemorrhagic manifestations are common but thrombotic events are uncommonly reported, despite the wide range of increased procoagulant activity during Dengue Fever illness. We report a case of a 55-year-old man of Asian Indian ethnicity who developed large vein thrombotic event -Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE) in the acute phase of DHF. His condition was further complicated by associated thrombocytopenia. The etiological connections between dengue viral infection with thrombocytopenia, DVT/PE and abnormal thrombophilia profile as well as the treatment dilemmas posed in treating a patient of DF with hemorrhagic manifestations and associated DVT/PE, and the role of eltrombopag are discussed.

Symptomatic Primary Selective IgM Immunodeficiency - B Lymphoid Cell Defect in Adult Man with Secondary HLH Syndrome.

Selective immunoglobulin M deficiency(sIgMD) is a rare form of dysgammaglobulinaemia characterized by an isolated low level of serum immunoglobulin M (IgM). It was an incidence of less than 0.03% in the general population and 1% in hospitalized patients. sIgMD may occur as a primary or secondary condition. sIgMD is much more common than primary .Hemophagocytic lymphohistiocytosis (HLH) is also a rare but potentially fatal disease of normal but overactive histiocytes and lymphocytes and can be primary or secondary, characterized by the overwhelming activation of normal T lymphocytes and macrophages, invariably leading to clinical and hematologic alterations. We report an adult case of primary sIgMD with absent B lymphoid cells and secondary HLH syndrome who presented with recurrent infections, fever and pancytopenia.

Near Fatal Poisoning by Isoniazid and Rifampicin.

Since six decades, Isoniazid and Rifampicin are used as first line drugs for treatment of tuberculosis. The minimum acute lethal or toxic dose of Rifampicin is not well established. However, non-fatal acute overdoses in adults have been reported with doses ranging from 9 to 12 gm and fatal acute overdoses with doses ranging from 14 to 60 gm. Isoniazid, if acutely ingested, even 1.5 to 2 gram may cause toxicity in adults. We report a case of Pott's spine on ATT, who took massive overdose of Rifampicin (>18 gm) and Isoniazid (>12 gm) and reported late (almost 36 hours) after ingestion. He was treated successfully with pyridoxine, hemodialysis and supportive care.

Pericardial Effusion with Cardiac Tamponade as a form of presentation of Primary Hypothyroidism.

Hypothyroidism is a rare cause of pericardial effusion (PE). Pericardial effusion secondary to hypothyroidism remains a diagnostic challenge for clinicians because of its inconsistency between symptoms and amount of pericardial effusion. We report an atypical case that presented with ascites and was diagnosed to have cardiac tamponade secondary to primary hypothyroidism. Besides repeated pericardiocentesis she eventually required surgical management and optimization of medical therapy to manage the massive pericardial effusion.

Patient with Recurrent Polyserositis (Familial Mediterranean Fever).

Familial Mediterranean fever (FMF) is a hereditary autosomal recessive ,systemic, auto-inflammatory disorder characterized by sporadic, unpredictable attacks of fever and serosal inflammation. FMF is caused by mutations in MEFV, a gene located on the short arm of chromosome 16 (16p13) which encodes a protein 'Pyrin'. The disorder has been given various names including familial paroxysmal polyserositis, periodic peritonitis, recurrent polyserositis, benign paroxysmal peritonitis, and periodic disease or periodic fever, As the name indicates, FMF occurs within families and is much more common in individuals of Mediterranean descent than in persons of any other ethnicity. It has been described in several ethnic groups including Sephardic Jews, Armenians, Turks, North Africans, Arabs, Greeks, and Italians. However, the disease is not restricted to these groups and sporadic cases have been reported. Diagnosis is usually clinical and it classically presents with unprovoked, recurrent attacks of fever and painful polyserositis mainly affecting the peritoneum (most common), synovium, and pleura that usually (but not always) begin in childhood. We present a atypical case of FMF with type 1 Diabetes Mellitus and FMF who had no fever, Mediterranean ancestory or family history and discuss his clinical features,diagnosis and management.

Process Standardization of Functionally Enriched Millet-Based Nutri-Cereal Mix Using D-Optimal Design Approach for Enhancing Food and Nutritional Security.

Millets are currently employed in a variety of ways, including direct consumption and usage in the manufacture of certain cuisines or snacks. The present investigation was aimed at optimizing functionally enriched millet-based nutri-cereal mix comprising chicken and vegetable for a nutrition-deficient population. A total of 16 experiments were carried out by using optimal (custom) design model of mixture design with 60% major ingredients, including malted sorghum flour (20-30%), malted green gram flour (15-25%), and boiled chicken powder (5-15%). To make 100% of the total nutri-cereal mixture, other ingredients such as malted pearl millet (10%), finger millet flour (10%), beetroot powder (2.5%), pumpkin powder (7.5%), skimmed milk powder (9.5%), and stevia powder (0.5%) were added. Numerical optimization was done using Design Expert software, version 13. The optimized ratio was 30% malted sorghum flour, 15% malted green gram flour, and 15% chicken powder. The predicted values of responses 5.101%, 3.616%, 1.963%, 11.165%, 28.005%, 50.149%, 330.282 kcal, and 0.373 were in accordance with experimental values 6.426%, 3.455%, 1.714%, 11.432%, 29.12%, 47.853%, 323.318 kcal, and 0.385 for moisture, ash, fat, fiber, protein, carbohydrates, energy, and water activity, respectively, with a small error percentage. The results of mineral content, phenolic content, and amino acid profiling revealed that the optimized Nutri-cereal mix have higher amounts of these components. The results also suggested that the optimized Nutri-cereal mix of these malted millet flours can potentially enhance the nutritional deficiency as well as improve food and nutritional security.