Ajit Singh

Herpes simplex keratitis-induced endophthalmitis in a patient with AIDS with disseminated tuberculosis

We present the case of a 42-year-old man with AIDS who had lost complete vision of his left eye for the past 15u2005days. MRI and brightness scan ultrasonography were performed on his eyes that suggested of endophthalmitis with dendritic involvement in the left eye. Viral DNA PCR was performed in aqueous humour sample that confirmed the presence of herpes simplex virus and showed a negative result for cytomegalovirus. The patient was treated with a high dose of oral acyclovir for 10u2005days and long-term topical acyclovir. Neodymium-doped yttrium aluminum garnet procedure was performed to clear up the cornea, and intraocular pressure was controlled with brimonidine and timolol maleate. The patient was diagnosed to have disseminated tuberculosis (tuberculoma of the brain) and was started with antituberculosis therapy. His condition improved significantly after the treatment, and keratitis in cornea started to clean up.

Descriptive Analysis of Mortality Predictors in H1n1 Influenza in South Indian Patients

BACKGROUNDnH1N1 (hemagglutinin-H-neuroaminidase-N) influenza infection is associated with high morbidity and mortality because of associated complications and related factors. Predictors of mortality in H1N1 patients are studied with very few without seasonal/pandemic declaration. This study was carried out to describe the clinical features, complications and different risk factors that affect the outcome in the patients with confirmed H1N1influenza infection.nnnMETHODSnA retrospective study was done in Kasturba Medical College Hospital, Manipal, India by analyzing the medical records of 141 patients admitted from January, 2011 to June, 2015.nnnRESULTSnOf the 141 patients in the study, 51.1% of the patients were female with a mean age of 32±16.2 years. Fever with headache was observed in 92.9% patients while cough in 78.7% patients and breathlessness in 54.6% patients. On the basis of disease severity, 53.2% of the patients were put on mechanical ventilation. For all the patients, treatment for influenza management began with oseltemivir. Diuretics, antianxiety and corticosteroids were given as supportive and symptomatic care which contributed to high mortality in hospitalized patients. Mean hospitalization period was 8.5 days. During the hospitalization, patients developed different complications i.e. 31.20% patients developed respiratory tract infections, while 17.7% patients developed ARDS and 14.4% patients developed sepsis. The mortality rate of this study population was found to be 29.1 %.nnnCONCLUSIONnIt was observed that low oxygen saturation during admission, high blood urea level, use of diuretics, corticosteroids, anti-anxiety drugs and complications like ARDS, sepsis influence the mortality rate of patients with H1N1 infection.

Multiple Drugs Causing Severe Anemia in Infective Endocarditis

Ceftriaxone and linezolid are commonly used antibiotics in infective endocarditis. Here we present a rare case of severe anemia caused by both the drugs via different mechanisms. Drugs have shown significant contribution in inducing anemia via hemolysis and bone marrow suppression in an infective endocarditis patient.

Body image and sexual problem in young breast cancer patients in South Indian population

Results: Body image and sexual problems were experienced by a substantial proportion of women after diagnosis or treatment. Different type of treatment patterns were used as 59 (81.94%) women underwent surgery, 39 (54.1%) were treated with CMF chemotherapy, 54 (72.2%) women underwent hormonal therapy and remaining with radiotherapy. The Hopwood Body Image Scale was used for the assessment of the body image perception which shown less physically attraction in most of the patients with self-consciousness, seeing themselves naked in mirror and dissatisfied with scars on their body. The Female Sexual Distress Scale (FSDS) was used to assess the sexual distress in women with breast cancer. The mean score was 24.4 (47%) which relatively shows higher sexual distress with the major sexual problem; distress about sex life, frustration by the sexual problems, dissatisfaction with sex life and inferiority because of sexual problem among the women.

Job's syndrome in a pediatric patient: Case report and the clinical review

Job′s syndrome or hyper-immunoglobulin E syndrome (HIES) is a heterogeneous complex of immunodeficiencies distinguishes by skin abscesses, recurrent pneumatoceles or staphylococcal infections, high serum immunoglobulin E levels and eczematous dermatitis. It has two types depends on type of gene involved; autosomal-dominant HIES (AD-HIES), which develops due to signal transducer and activator of transcription 3 gene and autosomal recessive HIES caused by DOCK8 gene mutation. Hereby we present a case of 13-month-old male child who admitted to our hospital with pustular lesions on the neck, face and upper chest associated with itching; some of these were hemorrhaged and crusted. The complete clinical presentation and lab investigations have confirmed AD-HIES syndrome. The therapeutic strategy was directed mainly toward the prevention and management of infections and symptoms. This case presents the clinical features, investigational procedures and management strategy for that particular condition in pediatrics.

Seizure relapse based upon withdrawal period of antiepileptic drugs in pediatric epilepsy patients

Aim: This study was carried out to quantify risk of seizure recurrence after discontinuation of antiepileptic drugs (AEDs) after varying duration of seizure remission in children with epilepsy and to assess the variables modifying the risk of seizure recurrence. Materials and Methods: Randomized controlled trials that evaluate withdrawal of AEDs after varying periods of seizure remission in pediatric epilepsy patients, which could be unblinded, single-blind, or double-blind. The database searching included Cochrane Epilepsy Group Specialized Register, MEDLINE, EMBASE, CINAHL, WHO Clinical trial register, and the Cochrane Central Register of Controlled Trials. Two independent authors extracted the data and assessed trials for quality. Results: The pooled relative risk ratio (RR) for early AEDs withdrawal and late AEDs withdrawal was assessed as 1.22 (95% confidence intervals [CI]: 0.94-1.57), for type of epilepsy pooled relative risk was 1.52 (95% CI: 0.96-2.41), electroencephalogram (EEG) relative risk was assessed as 1.65 (95% CI: 1.08-2.51) and the underlying etiology relative RR was assessed as 1.65 (95% CI: 1.08-2.51). Conclusion: The high-grade evidence of this study supports that discontinuing AED medication prior to at least 2 seizure free years is associated with higher seizure recurrence risk than waiting for two or more seizure free years in children.