Clinical Manifestations, Antimicrobial Drug Susceptibility Patterns, and Outcomes in Melioidosis Cases, India.

We studied the clinical manifestations and outcomes of 114 patients with culture-confirmed melioidosis treated at a tertiary hospital in southern India. Diabetes mellitus is the main risk factor, and chronic melioidosis mimicking tuberculosis was more common than acute disease. Septicemia and respiratory involvement were associated with poor outcomes.

High or low- a trial of low dose anti snake venom in the treatment of poisonous snakebites.

OBJECTIVE: To demonstrate that use of lower doses of anti-snake venom is as effective as high doses and is associated with less complications and lower mortality especially in the wake of rising cost of medical treatment, the people most affected by snakebites being the poor farmers. METHODOLOGY: A prospective descriptive study consisting of 54 snakebite patients fulfilling the inclusion criteria who were admitted to Bangalore Baptist Hospital, Bengaluru, between November 2006 and November 2008 and were treated with a low dose ASV regime. The patients were initially given 2 vials of ASV followed later with 1 vial at a time according to clotting time. Any other supportive measures were undertaken as necessary. RESULTS: In this study the average dose of ASV required was only 6.70 +/- 3.24 vials. The complications--12.9% patients had ARF, and another 12.9% patients had neuropraralysis severe enough to require ventilatory support. There were 2 deaths (mortality of 3.7%) in the study. CONCLUSION: Low dose ASV regime in poisonous snakebites along with supportive treatment as necessary is as good as high dose regime, and has lesser adverse effects while reducing the cost of treatment too. Hence low dose regime can be used with beneficial results in poisonous snakebites.

Randomised controlled trial for efficacy of unfractionated heparin (UFH) versus low molecular weight heparin (LMWH) in thrombo-prophylaxis.

OBJECTIVE: To study if low dose Unfractionated heparin (UFH) is as effective and safe as Low-molecular weight heparin (LMWH) and also economical as a prophylactic agent for venous thromboembolism in medically ill patients. METHODOLOGY: A prospective double blind randomised controlled trial consisting of 92 patients fulfilling the inclusion criteria who were admitted to Bangalore Baptist Hospital, Bengaluru, between March 2008 and July 2009 were randomised to receive Unfractionated heparin (UFH) or Low-molecular weight heparin (LMWH). RESULTS: The result based on intention to treat (ITT)analysis with best outcome scenario: in the UFH arm there were 47 (97.9%) patients who had not developed DVT/PE as compared to 42 (95.5%) in the LMWH arm. The difference in proportion of patients who had not developed DVT/PE between UFH and LMWH was 2.4% (-5.0, 9.8). The results based on per protocol analysis: In the UFH arm there were 44 (97.8%) patients who had not developed DVT/PE as compared to 39 (95.1%) in the LMWH arm. The difference in proportion of patients who had not developed DVT/PE between the UFH and LMWH arm was 2.7% (-5.2, 10.5). Patients on UFH had higher major bleeding complications 4 (8.9%) as compared to 0 in LMWH arm. But with respect to other complications like thrombocytopenia (HIT) and mild or minimal bleeding both arms were comparable. CONCLUSION: This study has demonstrated that low dose UFH is as effective as LMWH as a prophylactic agent for venous thromboembolism in medically ill patients and economical also.

Case Report: Failure of Therapeutic Coma in Rabies Encephalitis.

Rabies encephalitis is a fulminant, almost universally fatal infection involving the central nervous system. A unique treatment protocol, including anti-exicitotoxic therapy and induced coma was credited with the survival of a vaccinated teenager with bat rabies encephalitis in 2005. However, multiple efforts to replicate this expensive and intense protocol have not been successful. In this article, we report the failure of the protocol in Indian patients with canine-acquired rabies and elucidate the potential explanations for the failure of the protocol in our patients.

A rare presentation of plasmablastic lymphoma as cutaneous nodules in an immunocompromised patient.

Plasmablastic lymphoma is a rare entity accounting for around 2.7% of all AIDS-related lymphomas. The oral cavity and gastrointestinal tract are the most common sites involved. We report a case of a 34-year-old HIV-positive woman with a rare presentation of cutaneous nodules all over the body. Due to overwhelming tumour burden, she developed tumour lysis syndrome during her hospital stay and succumbed to the illness.

Clinical presentation, etiology, management, and outcomes of iliopsoas abscess from a tertiary care center in South India.

INTRODUCTION: Iliopsoas abscess (IPA) is the collection of pus in the iliopsoas compartment. The etiology of IPA is variable and depends on the geographical area and the antibiotic usage prevalence in that area. This study attempts to evaluate the etiology, clinical features, risk factors, management modalities, and outcomes in patients with IPA from a tertiary care center in South India. MATERIALS AND METHODS: This was a retrospective study done in a tertiary care center in South India. Patient details were obtained from electronic medical records. RESULTS: A total of 43 patients were enrolled in the study, the causative organism could be identified in 20 (46.5%) patients. The most common etiology was tuberculosis (TB). Most (23 [56.5%]) patients were treated conservatively, 20 (46.5%) patients were treated with percutaneous drainage (PCD), and 2 (4%) patients required surgery. CONCLUSION: The most common cause of IPA is TB. PCD was successful in 95% of the patients with complete resolution of symptoms.

Occupation-related chromium toxicity a rare cause of renal failure and rhabdomyolysis.

A 21-year-old gentleman, a worker in a mobile phone shop, was admitted with rhabdomyolysis, renal failure, and pulmonary edema requiring mechanical ventilation and hemodialysis. After extensive workup and ruling out other causes, heavy metal poisoning was considered. Investigations during the course of the hospital stay revealed chromium poisoning. With repeated hemodialysis, his parameters normalized and he was discharged home in a stable condition. Diagnosis of chromium toxicity needs high index of suspicion. A history of occupational exposure might offer a clue to diagnosis. With hemodialysis and supportive care, it is a potentially salvageable condition.

Splenic infarct due to scrub typhus.

Scrub typhus is a mite borne infectious disease that has the potential to involve multiple organs and can be fatal. Involvement of the abdomen in the form of hepatitis, gastric ulcerations and pancreatitis are well-documented, the pathology being disseminated vasculitis. However involvement of the spleen in scrub typhus is extremely rare and is reported only in a few autopsy studies. We report the case of a 50-year-old lady who presented with fever and left upper quadrant abdominal pain due to a splenic infarct due to scrub typhus.