Khalid Hamid Changal

Differentiating secondary from primary dengue using IgG to IgM ratio in early dengue: an observational hospital based clinico-serological study from North India

BackgroundSecondary dengue causes more severe disease than the primary. Early on, it is important to differentiate the two. We tried to find important clinical and laboratory differences between the two for the purpose of early differentiation.MethodsOne hundred fourteen patients confirmed on reverse transcriptase-polymerase chain reaction (RT PCR) were studied. On day 2 of illness IgM and IgG indices were studied for calculation of IgG/IgM ratio. A one-step immunochromatographic assay was used for classification of patients into primary and secondary dengue. Patient characteristics were also studied.ResultsDengue serotype 1 was the most common found in 60.5% patients. 66.7% (76 patients) had secondary dengue. Secondary dengue cases had a higher mean temperature (101.56 ± 1.55 vs. 100.79 ± 1.25,°F, p 0.015), lower platelet counts (50.51 ± 38.91 vs. 100.45 ± 38.66, x 103/micl, p <0.0001) and a significantly higher percentage of Dengue hemorrhagic fever/Dengue shock syndrome (38.2% vs. 2.6%, p <0.0001). In early phase of dengue NS1 and PCR were found to be better tests for diagnosis and later IgM is better. The IgG/IgM ratio of ≥ 1.10 had a sensitivity of 100%, specificity of 97.4% and accuracy of 67.5% in differentiating secondary from primary dengue.ConclusionEarly on in the clinical course, IgG/ IgM ratio can play an important role to differentiate the two. We found the ratio of ≥ 1.10 to be the best cut off for the same.

Bleomycin-induced Flagellate Erythema: A Rare and Unique Drug Rash.

Bleomycin-induced flagellate erythema is a rare rash associated with the use of the drug. The rash has a characteristic and intermingled lacy appearance as if it has been whipped. Lack of detoxifying enzymes for bleomycin in the skin makes it a vulnerable site for the adverse effects of bleomycin, along with the lungs. We report the case of young girl with germ cell tumour who developed bleomycin-induced flagellate erythema.

Central Nervous System Manifestations of Tuberculosis: A Review Article

Tuberculosis can involve almost any organ of the body. In the central nervous system (CNS) it can cause meningitis, tuberculoma, abscess, or other manifestations. Around 10% of all patients with tuberculosis have CNS involvement. Tuberculosis is rampant in the developing world and has reemerged as a major public health menace with the HIV pandemic. Compared with HIV-negative individuals, HIV-positive individuals with TB are 5 times more likely to have CNS involvement. We review the CNS manifestations of tuberculosis here in this article.

Association of low levels of vitamin D with chronic stable angina: A prospective case-control study

Background: Coronary artery disease (CAD) is a major cause of death and disability in developed countries. Chronic stable angina is the initial manifestation of CAD in approximately 50% of the patients. Recent evidence suggests that vitamin D is crucial for cardiovascular health. The prevalence of vitamin D deficiency in our region is 83%. A low level of vitamin D is associated with chronic stable angina. Aim: This study was aimed at supporting or refuting this hypothesis in our population. Materials and Methods: The study was a prospective case-control study. We studied 100 cases of chronic stable angina and compared them with 100 matched controls. Vitamin D deficiency was defined as <20 ng/mL, vitamin D insufficiency as 20-30 ng/mL and normal vitamin D level as 31-150 ng/mL. Results: The prevalence of vitamin D deficiency among cases and controls was 75% and 10%, respectively. 75% of the cases were vitamin D-deficient (<20 ng/mL); 12% were vitamin D-insufficient (20-30 ng/mL), and 13% had normal vitamin D levels (31-150 ng/mL). None had a toxic level of vitamin D. Among the controls, 10% were vitamin D-deficient, 33% were vitamin D-insufficient, and 57% had normal vitamin D levels. The mean vitamin level among cases and controls was 15.53 ng/mL and 40.95 ng/mL, respectively, with the difference being statistically significant (P ≤ 0.0001). There was no statistically significant relation between the disease severities, i.e., on coronary angiography (CAG) with vitamin D level. Among the cases, we found that an increasing age was inversely related to vitamin D levels (P = 0.027). Conclusion: Our study indicates a correlation between vitamin D deficiency and chronic stable angina. Low levels may be an independent, potentially modifiable cardiovascular risk factor.

Aluminium phosphide poisoning with severe cardiac dysfunction and the role of digoxin

Aluminium phosphide (ALP) is a common cause of suicidal poisoning in India where it is easily available and commonly known as ‘rice tablet’. In rural areas of India, it is still used to protect rice and stored grains from rodents and pests. 1 There is no specific antidote for phosphide poisoning and treatment involves meticulous supportive care. Ingestion can lead to severe cardiac suppression and cardiogenic shock. For patients poisoned with ALP who continue to have refractory shock with persistent myocardial suppression despite the use of adrenergic inotropic agents, the addition of digoxin may be beneficial. We present a case where digoxin was utilised with beneficial patient outcomes.

ANA Negative Systemic Lupus Erythematosus Leading to CTEPH, TTP-Like Thrombocytopenia, and Skin Ulcers.

SLE affects almost every organ system, with differing degrees of severity. During its clinical course periods of flares may alternate with periods of remission culminating in disease and therapy related damage. We describe a case of ANA negative SLE with severe thrombocytopenia, cutaneous vasculitis, antiphospholipid antibody syndrome, and pulmonary artery hypertension. As there is no definitive cure for SLE the treatment lies in caring for the individual organ systems involved and simultaneously taking care of the patient as a whole.

Neisseria lactamica Causing a Lung Cavity and Skin Rash in a Renal Transplant Patient: First Report from India

Neisseria lactamica, a commensal, has been very rarely reported to cause diseases in immunocompromised hosts. In medical literature, there is only one report of a cavitatory lung lesion caused by it. The patient was a kidney transplant recipient. Neisseria lactamica was found to be the cause of his pulmonary cavity and a desquamating rash on feet. With the rapidly spreading medical advance, more and more patients are getting organ transplants, so the population of immunocompromised people is on the rise. We expect more sinister and less expected organisms to cause diseases in patients who have organ transplants.

Rectus sheath haematoma: a rare masquerader for abdominal pain

Rectus sheath haematoma is a rare cause of abdominal pain. It can be easily confused for other causes of acute abdomen and may even lead to unnecessary laparotomies. Our patient has the rectus sheath haematoma because of violent coughing and on presentation had no obvious clinical sign pointing to the same. Diagnosis was made by a CT scan of the abdomen, and patient was treated conservatively. Rectus sheath haematomas are usually present on the posterior aspect of the rectus muscles and thus may not be clinically appreciable.

Lamotrigine induced Stevens-Johnson syndrome: a case report

This case is about a young girl who had lamotrigine induced Stevens Johnson syndrome which is known to occur but is rare. Lamotrigine was started when the patient was also receiving valproate for several years; no adverse effects, including any minor skin rash, were recorded while on valproate monotherapy. Valproate is known to augment lamotrigine availability via reduced glucuronidation, which increases the risk of serious rash if patients are concomitantly given lamotrigine. This suggests that a drug-drug interaction between lamotrigine and valproate did contribute to the development of Stevens-Johnson syndrome. Stevens-Johnson syndrome was linked in this case with a higher dose of lamotrigine, suggesting a dose-dependent toxicity. We emphasize that a rapid dose escalation of lamotrigine, even a single higher dose, could expose to an unacceptable risk of Stevens-Johnson syndrome, particularly in patients taking valproate.