Pleural fluid cytology in prompt diagnosis of pleuro-pulmonary nocardiosis masquerading as COVID-19.

Introduction: There are few reports of nocardial infections among the Indian population. We report this case because of its rarity and unique presentation and to highlight the role of cytology in diagnosis. Case Details: A 74-year-old woman presented with fever and chest pain of a duration of 15 days. In view of the coronavirus disease (COVID) pandemic, she was given steroids. She developed breathlessness and was referred to a tertiary care hospital. Her pleural fluid cytology showed filamentous bacteria. A diagnosis of nocardia was confirmed by culture. Discussion: Nocardiosis refers to the localized or disseminated infection caused by filamentous aerobic bacteria of the genus Nocardia. The clinical presentation of nocardiosis is highly variable. In our case, clinical misdiagnosis as COVID-19 and steroid treatment would have caused deterioration of nocardiosis. Conclusion: All patients with pulmonary symptoms should be thoroughly evaluated before considering a diagnosis of COVID-19. Pleural fluid cytology can be of help in the diagnosis of nocardiosis.

Clinico-Epidemiological Profile of Dialysis Services in Karnataka, India - A Multicentric Exploratory Study.

Introduction: New challenges in dialysis care delivery confront caregivers with the rise in dialysis numbers. There are significant lacunae in the knowledge and efficient application of dialysis therapy in the absence of a dialysis registry. This multicentric study was conducted by the Nephrology Association of Karnataka to systematically study patient demographics and dialysis characteristics in Karnataka state, India, as a basis for a statewide dialysis registry. Material and Methods: Data were collected from the consenting dialysis centers after institutional ethics board clearances. Residents of Karnataka state, who were confirmed prevalent patients with end-stage renal disease, on either maintenance hemodialysis (HD) or peritoneal dialysis were included. Demographic data of patients and details of dialysis as well as dialysis facilities were collected on an online platform. Statistical analysis was done using SPSS software Version 16. Results: Thirty-two centers contributed to the data of 2,050 patients (males 70.3%, mean age 53.49 ± 14.09 years). Most patients were on HD (95.3%). Diabetes was the commonest cause of chronic kidney disease. About 72% of patients had temporary venous catheters as initial vascular access. In all, 1,156 patients (59.9%) were on thrice weekly HD. Around 65% of the centers were in private hospitals. The majority (90%) of the centers reused dialyzers, 56% reprocessed dialyzers mechanically, and 66% tested viral serology quarterly. Conclusions: This study was one of the initial attempts to capture dialysis data across Karnataka, and it offers useful insight into the existing dialysis demographics and care delivery. Participation of more centers and continued effort to form a dialysis registry for deriving meaningful clinico-epidemiological insight are desirable.

Clinico-epidemiological profile of children hospitalized with dengue.

OBJECTIVE: To study the clinico-epidemiological profile of children hospitalized with dengue illness. METHODS: Prospective study of children hospitalized with the diagnosis of dengue illness during from September through November 2006 at a tertiary care centre in Jaipur. RESULTS: A total of 948 children including 671 (70.8%) boys and 277 (29.2%) girls were diagnosed to have dengue illness during the outbreak. Two third of children were from urban areas while 6-12 years was the most commonly affected age group (45.8%). 58.3% cases had dengue fever (DF) while 41.7% had DHF (dengue hemorrhagic fever). Dengue fever with bleed (DFB) accounted for 32% of cases. Common constitutional symptoms were vomiting (35.2%), pain abdomen (22.1%) and myalgia (10.1%). Bleeding manifestations were observed in 44.5% of cases.. Positive tourniquet test was the most common manifestation which was seen in 300 cases (31.6%) while in 9.2% cases bleeding was the only manifestation. Epistaxis (25%) was the most common spontaneous bleeding manifestation. Thrombocytopenia was documented in 84% of total cases and bleeding occurred more often in patients with severe thrombocytopenia. Ten children expired with a case fatality rate of 1.1%. CONCLUSIONS: Children between 6 and 12 yrs were most affected by dengue with larger number of cases from urban areas. DFB cases accounted for almost one third cases of dengue. Epistaxis was the most common spontaneous bleeding manifestation. Bleeding occurs more often in patients with severe thrombocytopenia.