Acquired Bartter-Like Phenotype.

We present a case of middle-aged man who presented with sudden onset of weakness of both upper and lower limbs with hypotension and polyuria without any antecedent illness. Investigations showed severe hypokalemia, hypocalcemia, hyponatremia, mild hypomagnesemia, hypercalciuria, metabolic alkalosis and increased renin and aldosterone levels in the blood suggesting Bartter syndrome. Thus a diagnosis of acquired Bartter-like phenotype was made.

Judicious use of antisnake venom in the present period of scarcity.

CONTEXT: Although antisnake venom (ASV) has been used for many years, selection of an optimal dose is a debated issue due to acute shortage of ASV in India. Despite evidence for smaller doses, most centers still use conventional doses. AIMS: This study aimed to evaluate the effects of two different dosage regimens on the outcome of patients with snake envenomation, using a retrospective descriptive analysis of patient records admitted in our hospital. SETTINGS AND DESIGN: A retrospective descriptive case series study was conducted from hospital records consisting 155 snakebite patients from June 2013 to January 2014. MATERIALS AND METHODS: PATIENTS WERE DIVIDED INTO TWO GROUPS: Low dose ASV group (received <10 vials) and high dose ASV group (received ≥10 vials). Various complications were compared among these two groups. RESULTS: The mean dose of ASV used in high dose, and low-dose group was 14.7 ± 5.3 and 4.2 ± 2.3, respectively. In low dose group, 20.5% of patients had acute kidney injury, whereas it was 10.9% in high dose group. In low dose group, 12.3% patients had neuroparalysis severe enough to require ventilator support and mortality rate was 5.5% which was comparable to the high-dose group (15.8% had neuroparalysis requiring ventilator support and a mortality rate of 8.5%). CONCLUSION: This study demonstrated that the low dose ASV regimen in poisonous snake bites along with supportive treatment as necessary is as efficacious as high dose regimen and has comparable complications.

Primary human parvovirus B19 infection in an HIV infected patient on antiretroviral therapy.

INTRODUCTION: Persons with HIV infection frequently present with anaemia from different causes, including use of antiretroviral therapy (typically zidovudine), iron deficiency, vitamin B12 deficiency, opportunistic infections (such as mycobacterial and fungal infections), chronic disease, AIDS-associated malignancies, autoimmune haemolysis, and direct effects of HIV infection itself. Persistent infection with Parvovirus B19 (B19) is an important treatable cause of anaemia in HIV-infected patients. CASE PRESENTATION: We present a case of anaemia in HIV positive patient who did not respond to change of drug therapy and nutritional supplements. Bone marrow biopsy suggested parvo virus infection. CONCLUSIONS: Chronic anaemia due to Parvo virus B19 infection is a treatable cause. Human Parvo virus B19 infection is a diagnosis of exclusion in patients who are started on antiretroviral therapy develop anaemia and later not responding to empirical management. Chronic anaemia requiring recurrent transfusions in HIV positive patient Parvo virus infection should be suspected and evaluated.