Arvind Anand

Unilateral RS3PE in a Patient of Seronegative Rheumatoid Arthritis.

Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) is a rare but well-reported clinical entity. It is classically described as symmetrical involvement of both upper extremities. Asymmetrical involvement had also been reported, but unilateral presentation is very rare. We hereby report a case of unilateral RS3PE in a patient of seronegative rheumatoid arthritis which was initially misdiagnosed as cellulitis and was given high dose antibiotics without any significant improvement. Later a rheumatologic consultation leads to a prompt diagnosis, and treatment with steroids leads to dramatic reversal of symptoms. This case demonstrates the rare presentation of this rare clinical entity and highlights the necessity of awareness regarding unilateral disease to clinicians.

Clinicomicrobiological profile of the Indian elderly with sepsis

The study included 400 elderly patients (≥60 years of age) with clinically suspected sepsis. The maximum number of patients was in the age group of 60-69. Diabetes was the most prevalent comorbid condition. The most common site of infection was the urinary tract followed by the lungs atypical manifestations were quite prevalent with delirium being present in majority of patients. The most common organism isolated was Staphylococcus aureus followed by Escherichia coli. Introduction: Sepsis is one of the leading causes of morbidity and mortality in the elderly; despite great progress in antimicrobial treatment and intensive care medicine, the incidence of sepsis remains high while severe sepsis still has high mortality. Materials and Methods: The study included 400 consecutive elderly patients (≥60 years of age) with clinically suspected sepsis. Sepsis definition was based on the presence of infection and two or more of the systemic inflammatory response syndrome (SIRS) criteria. Blood and other site cultures were obtained on admission and during hospitalization when needed. Result: The total number of elderly patients with suspected septicemia who were enrolled in the study was 400. The maximum number of patients (68%) were in the age group of 60-69 years, whereas 32 patients (8%) were in the age group of >80 years. The age of the study population ranges from 60 years to a maximum of 95 years. The mean age of our study population was 67.52 ± 6.65 years with a male: female ratio of 1.68. The prevalence of SIRS criterion in the study population shows that tachycardia (89%) was the most common criteria followed by fever (84%) and leukocytosis (82.5%). All the four SIRS criteria were present in 42% of the patients, three in 37.5% of the patients and only two in 20.5% of the patients. The most common site of infection was the urinary tract (30.5%) followed by the lungs (21.25%) and skin infection (14%). Atypical manifestations were quite prevalent in the study population with delirium being the most common presentation. Conclusion: The present study was undertaken to study the clinicomicrobiological profile in Indian elderly patients presenting with sepsis. The mean age of the study population was 67.52 ± 6.65 years. Out of 400 cases, there were 115 (28.75%) blood culture positive cases. Gram-negative organisms (51.7%) were more commonly grown than gram-positive ones (48.30%). The most common organism isolated was Staphylococcus aureus (49 patients) followed by E. coli (36 patients). Diabetes was the most prevalent comorbid condition in our study population that was present in 28% of the population followed by BPH (17.75%) and hypertension (16%). Delirium was present in 112 (28%) patients not having CNS infection. In our study, 324 patients improved, whereas 76 died and the mortality was positively correlated with the stage of sepsis and it was statistically significant (P = 0.032).