Babu Lal Meena

Paraquat Poisoning: A Case Report

Paraquat is commonly used herbicide by farmers in North West Rajasthan. Despite its easy availability, poisoning of its not common. Fatal dose of paraquat is so small that >10 ml poison can damage lungs permanently. Diagnosis is often difficult without proper history, absence of specific clinical feature and lack of diagnostic test. Inhalation exposures represent one of the most important routes of poisoning. We are reporting a case of inhaled paraquat poisoning with complication of irreversible acute kidney, liver and lung injury.

Pulmonary cryptosporidiosis in an immunocompetent host treated successfully with nitazoxanide.

Cryptosporidium parvum is an intracellular spore-forming protozoa which predominantly causes intestinal diseases. It causes severe and life-threatening diarrheal diseases in immunocompromised hosts and usually self-limiting disease in immunocompetent hosts. Extra-intestinal manifestations of cryptosporidium infection are very rare. Herein, we report a case of pulmonary cryptosporidiosis in a 35-yrs-old immunocompetent host, who presented with fever, cough and breathlessness which was soon followed by diarrhea and vomiting, had lung consolidation, and treated successfully with nitazoxanide.

Clinical profile of thyroid dysfunction in elderly: An overview

Aim and Objective: To study the presentation and clinical profile of thyroid disorder in elders in the North-West Rajasthan. Subjects and Methods: This study was carried out on 553 elderly patients in the Department of Medicine, S P Medical College, Bikaner, North-Western Rajasthan. All patients above 60 years were included. Clinical examination was done for detection of thyroid disorders and, keep in mind, the sign and symptoms of hypothyroidism and hyperthyroidism. Recently, a new immunoassay methodology has been applied to the measurement of thyroid stimulating hormone (TSH)/T3/T4 level. The analysis was undertaken using SPSS (version 10). Chi-square test was used to examine the association and trends for categorical. Results: There were 456 cases in the age group 60-71 years. 71-80 and >80 years patients were in numbers of 57 and 20, respectively. Prevalence of hyperthyroidism, euthyroidism, and hypothyroidism according to age was 5.9%, 80.9%, and 13.2%, respectively. When we compared TSH with age, no statistically difference was found (χ2 = 9.366, df = 4; P = 0.05). Of 456 cases, 27 (5.9%) were in decrease level, 359 (80.9%) were within normal range, and 60 (13.2%) cases were having increasing pattern of TSH. Around 8 (4.8%) females having decrease level, 135 (81.8%) were having within normal range of TSH, 22 (13.3%) females having increase level. Around 24 (6.5%) male having decrease level while 40 (10.9%) were having increase level of TSH. Weakness is the most common symptoms of thyroid dysfunction. A highly significant difference was found in weakness, feeling cold, constipation, palpitation, and diarrhea (P < 0.001) while significant difference was found in menstrual irregularity, hoarseness of voice, and irritability (P < 0.01). Conclusion: The current study aimed at spectrum of various clinical aspects in the elderly population that differs from typical presentation. As the age advances, the incidence of thyroid disorders increases. Hypothyroidism was more common than hyperthyroidism. Hence, we recommended that more study required knowing clinical presentation of thyroid disorder in elderly populations.

Neuropsychiatric Profile in Malaria: An Overview.

INTRODUCTION Malaria is the most important parasitic disease of humans causes clinical illness over 300-500 million people globally and over one million death every year globally. The involvement of the nervous system in malaria is studied in this paper, to help formulate a strategy for better malaria management. AIM To study the Neuropsychiatric manifestation in malaria. MATERIALS AND METHODS This was a prospective observational study in 170 patients with a clinical diagnosis of malaria admitted in various medical wards of medicine department of PBM Hospital, Bikaner during epidemic of malaria. It included both sexes of all age groups except the paediatric range. The diagnosis of malaria was confirmed by examination of thick and thin smear/optimal test/strip test. Only those cases that had asexual form of parasite of malaria in the blood by smear examination or optimal test were included in the study. RESULTS Out of total 170 patients 104 (62%) reported Plasmodium falciparum (PF), Plasmodium vivax (PV) were 57 (33.5%) followed by mixed (PF+PV) 9 (5.3%) cases. The total PBF-MP test positivity was 84.5%. Maximum patients were belonging to the age range of 21-40 year with male predominance. Neuropsychiatric manifestation seen in falciparum malaria (n=111) as follow: altered consciousness 20 (18.01%), headache 17 (15.32%), neck rigidity 5 (4.5%), convulsion 5 (4.55%), extra pyramidal rigidity 2 (1.8%), decorticate rigidity 1 (0.90%), decerebrate rigidity 1 (0.90%), cerebellar ataxia 3 (2.7%), subarachnoid haemorrhage 1 (0.90%), aphasia 2 (1.8%), subconjunctival haemorrhage 1 (0.90%), conjugate deviation of eye 1 (0.90%) and psychosis 6 (5.40%). Twenty one patients presented with cerebral malaria out of 111 patients. Most patients of cerebral malaria presented with altered level of consciousness followed by headache and psychosis. Acute confusional state with clouding of consciousness was the most common presentation of psychosis (50%). CONCLUSION Neuropsychiatric manifestations are not an uncommon presentation of malaria. Most commonly caused by PF malaria. Malaria should be thought as a differential diagnosis in pyrexia with neuropsychiatric manifestation. Observation obtained in the study will be highly useful for the diagnosis and management of patients suffering from malaria.

Multiple splenic infarctions with a rare etiology

Malaria is the most common parasitic infection in tropical countries such as India, and it causing a major economic burden on the Asian and African countries. Splenic complication is common in Plasmodium falciparum infection, but splenic infarction itself is a rare clinical entity in P. falciparum infection. Herein, we are presenting a case report of an 18-year-old male patient who presented to the department of medicine with a complaint of pain abdomen. On the next day of admission, the patient had complained of fever with chills and rigor. Routine blood investigations including peripheral smear examination for malarial parasites were sent. Contrast-enhanced computed tomography (CECT) of the abdomen was performed to diagnose the cause of abdominal pain after the findings of infarction in ultrasonography. CECT showed multiple infarctions of spleen and peripheral blood film showed ring forms of P. falciparum. Hence, we should always rule out splenic complication in cases of malaria which present with fever and left hypochondrium pain.

Asymptomatic HIV positive patient presenting with myelopathy

A wide variety of disorders of diverse pathogenic mechanisms can trigger spinal cord dysfunction in HIV-1-infected patients. The most common such condition is HIV-1-associated myelopathy (HAM) which characteristically seen during advanced HIV infection in patients with low CD4 cell counts and previous AIDS-defining diagnoses. Histologically seen in approximately 30% of AIDS patients, but only 10% have clinical symptoms related to the disease. We describe an unusual case of HAM in previously asymptomatic patient with relatively low CD4 cell count (78 cells/mm3). The patient unaware of her seropositive status presented with a clinically slowly progressive myelopathy with difficulty in walking without assistance. We discharged a patient on antiretroviral therapy. We also review the disorders reported to derange spinal cord function in previously asymptomatic HIV-1 infected patients with preserved counts.

Multiple splenic abscesses

Splenic abscess is a rare clinical entity with poor prognosis. But owing to imaging technique, diagnosis and prognosis have improved nowadays. Most patients who are presented with splenic abscess are immunocompromised due to predisposing risk factors like diabetes mellitus, intravenous drug abuse, trauma, bacterial endocarditis, human immunodeficiency virus (HIV), chemotherapy, or steroids. Here, we are presenting a rarer case of multiple splenic abscesses with its complication in an immunocompetent healthy adult male without any risk factor.

A study of serum lactate level in malaria and its correlation with severity of disease

Background: Since there is a high mortality due to malaria, there is a need of a parameter to identify patients at risk of developing complications, whereby intensive care is given to those patients who are at higher risk for complications and mortality. Aims: This study was undertaken to estimate serum lactate levels in patients with Plasmodium vivax, Plasmodium falciparum, and mixed malaria, and also to correlate it with various clinical and biochemical parameters and with the severity and prognosis of malaria. Methods: This was a cross-sectional, analytical, and observational study, which was conducted on 100 patients diagnosed with malaria and older than 14 years of age. Diagnosis of malaria was made by the gold standard method of peripheral blood smear examination and rapid tests. The blood sample for plasma lactate levels on admission was collected from a stasis free vein. The Student′s t-test for continuous normally distributed variables was used. For categorical data, the chi-square test was used and for the small numbers, Fisher′s exact test was used for small numbers. P < 0.05 was considered as a statistical significance at 95% confidence intervals. Results: In this study, there were 90% survivors and 10% of patients succumbed. Out of 90 survivors, 43 patients (47.7%) had some form of complicated malaria, whereas all patients who succumbed (10) had complicated malaria. All the patients who had jaundice, severe thrombocytopenia, renal failure, severe anemia, or hypotension (hypotension was confirmed clinically, but the remainder were confirmed by biochemical parameters such as liver functions, renal functions, platelet count, and hemogram) had hyperlactatemia in this study. All patients who died had a serum lactate level of >2 mmol/l. Conclusions: Hyperlactatemia had significant associations with complications of malaria. Raised serum lactate levels were significantly associated with mortality (P < 0.05).

Systemic lupus erythematosus with intracerebral hematoma due to decreased factor XIII activity: A rare association

Intracerebral hemorrhage is a dangerous occurrence in systemic lupus erythematosus (SLE). This may occur due to hypertension, anticoagulation, aneurysmal rupture, and catastrophic anti-phospholipid antibody syndrome. Factor XIII is required for stabilizing the fibrin clot. Decreased activity of factor XIII is a relatively rare coagulation abnormality, which may be due to congenital and acquired causes. Acquired causes of this condition are drugs such as isoniazid and phenytoin, liver disease, lymphoproliferative disorders, disseminated intravascular coagulation, sepsis and autoimmune disease, including SLE. The association of intra-cerebral hematoma in SLE due to decreased activity of factor XIII as its only detectable cause is a rarity in the medical literature. We report a case of SLE with intra-cerebral hemorrhage presenting as headache, found to be due to decreased activity of factor XIII. The activity of factor XIII increased after treatment with intravenous cyclophosphamide and there were no further bleeds reported.