Antibiotic-Resistant Pyrexia of Unknown Origin: An Unusual Presentation of Myelodysplastic Syndrome.

A 74-year-old male presented to the emergency department (ED) with complaints of high-grade fever, productive cough, and difficulty breathing for three weeks, and a significant weight loss in the past six months. Despite a detailed investigation, diagnosis could not be achieved. Multiple empiric regimens were tried but no response was observed. Bone marrow biopsy was conducted after suspicious peripheral film result, which concluded that the patient was having myelodysplastic syndrome. Although pyrexia of unknown origin has a diverse group of diseases to evaluate for, and rare entities are difficult to diagnose, meticulous evaluation may give significant evidence for targeted diagnostic workup.

Impact of Fasting Lipid Profile on Chronic Kidney Disease Patients Having Fatty Liver Disease.

Background and objectives Chronic kidney disease (CKD) share a common pathophysiology with non-alcoholic fatty liver disease (NAFLD). This study aims to identify the lipid derangements in patients of CKD and to associate them with radiological evidence of NAFLD. Material and methods A cross-sectional observational study was performed in a tertiary care hospital, to include all chronic kidney disease patients (n=238) through non-probability consecutive sampling. The criteria for inclusion were baseline estimated Glomerular filtration rate (eGFR) below 60 ml/min/1.73m2 for at least three months and chronic renal parenchymal changes on ultrasound. Two study groups were identified based on ongoing hemodialysis, while two further study groups were identified based on radiological evidence of fatty liver disease. Results The mean age of the study population was 48.52 ± 9.44 years with no difference amongst hemodialysis status, females elder than males (p= 0.027), those with fatty liver were much younger (p=0.014), and the most common age group below 50 years (p=0.005) among the fatty liver group. Radiological evidence of NAFLD was found amongst two-third of the study group with the status of hemodialysis indifferent among the study population (p=0.436). The mean values amongst fatty liver versus non-fatty liver groups revealed high creatinine, alanine transaminase (ALT), high-density lipoprotein (HDL), triglycerides (TG), and very-low-density lipoprotein (VLDL) in the fatty liver group, low-density lipoprotein (LDL) and total cholesterol (TC) were indifferent amongst the groups, while LDL/HDL ratio was higher in the non-fatty liver group. Conclusion A significantly higher HDL was found in fatty liver associated with CKD as compared to the non-fatty liver group.

Thiolated sodium alginate conjugates for mucoadhesive and controlled release behavior of metformin microspheres.

The absorption of BCS III drugs can be improved by inhibiting the P-glycoprotein (P-gp) efflux and by increasing the mucoadhesion of natural polymers. In the present study, an esterification of sodium alginate (SA) with thioglycolic acid (TGA) was applied for the preparation of thiolated sodium alginate (TSA). The Ellman's test was applied to quantify the thiol group and a di-sulphide bond test was performed to confirm any SS linkages. The FTIR, DSC, XRD, 1H NMR and charring point determinations were confirmed the thiol group of TSA. The gel like rheological properties with porcine mucous was confirmed by viscoelasticity properties and the mucoadhesion with the rabbit intestine was carried out after compression of 30 mg tablets of TSA. The content of thiol group was in the range of 320-730 µmoL/g of the polymer. The FTIR spectrum showed a characteristic peak of sulfhydryl group at 2557 cm-1 in TSA and the reduction of the charring point from 220 °C to 178 °C was confirmed the thiolation of TSA. A direct relationship of mucoadhesion and swelling was observed with the concentration of TGA and SA, respectively. The prepared microspheres were 2-7 µm in size, excellent rheological properties and non-fickian drug release behavior was observed.

Microscopic polyangiitis: an incidental finding in a patient with stroke.

Microscopic polyangiitis (MPA) is a primary systemic vasculitis characterized by inflammation of small-sized vessels associated with the presence of anti-neutrophilic cytoplasmic antibodies. We report a case of a 39-year-old female diagnosed with microscopic polyangiitis as an incidental finding who presented with signs and symptoms of a stroke at a young age. Usually, it presents with fever, malaise, skin rash, weight loss, mononeuritis multiplex, and arthralgia/myalgia. Very rarely, it can involve meninges to cause meningeal vasculitis which can present as a febrile seizure. The most frequent neurological manifestation is peripheral neuropathy. Cerebral infarction or hemorrhage as an isolated finding is very rarely observed in the patient with MPA as was seen in our patient.