Muzamil Latief

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.

Prevalence of dyslipidemia in school children of Kashmir valley

AIM Increased incidence of CVD has been observed in recent years in the Kashmir valley (North India). Since the risk factor development of the cardiovascular diseases (CVD) takes place during childhood, we undertook an epidemiological survey to assess the prevalence of dyslipidemia in the school children of Kashmir valley. MATERIALS AND METHODS 1131 children of 5-19 years of age were selected and evaluated for BMI, cholesterol, TGs, LDL and HDL levels from different areas of Srinagar city (urban) region of the Kashmir valley from June 2011-June 2014. RESULTS The frequency of dyslipidemia in Kashmiri children varied along the subjects. Hypertriglyceridemia was seen in 82.6% of the males and 47.6% of females in the age group of 5-9 years, 38.5% of males and 51.1% of females in the age group of 10-14 years and 24.7% of males and 35.9% of the females in the age group of 15-19 years. Low levels of HDL than normal were seen in 34.7% of males and 19% of females in the age group of 5-9 years. Similarly low HDL levels were seen in 17.9% of males and 15.5% of females in the age group of 10-14 years. The incidence of low HDL was also seen in 4.9% of males and 10.8% of females in the age group of 15-19 years. CONCLUSIONS In the present study dyslipidemia was more common in centrally obese children and the most common component was high triglycerides and low HDLs. Female school children were at higher risk of developing CVD than males.

Poncet’s Disease in Tubercular Cervical Lymphadenitis.

Introduction: Poncet’s disease (PD) is a type of reactive arthritis that accompanies tuberculosis (TB) infection. The joint involvement varies both in number and in severity of involvement. Treatment usually involves anti-inflammatory drugs and antituberculosis treatment (ATT). Case report: We report a female patient who presented with fever with joint swelling and pain, who, on further evaluation, turned out to be harboring tubercular cervical lymphadenitis as confirmed by histopathology of lymph node and tuberculin skin test. Her joint X-rays, joint aspirate, and negative serological markers established diagnosis of PD. She was treated with ATT and nonsteroidal anti-inflammatory drugs (NSAIDs). Patient responded to this treatment and joint signs and symptoms subsided in 3 weeks after institution of treatment. She went on to complete ATT and is doing well on follow-up. Conclusion: Diseases like PD, though being rare entities, still have very much clinical importance given the possibility of misdiagnosis and wrong treatment which otherwise is very much treatable with ATT and NSAIDs. Hence, clinical suspicion is very important in this disease state.

Novel risk factors and early detection of anti tubercular treatment induced liver injury—Looking beyond American Thoracic Society Guidelines

INTRODUCTION ATT remains the standard treatment for tuberculosis. Drug-induced liver injury (DILI) has been a long-standing concern in the treatment of tuberculosis (TB) infection. AIMS AND OBJECTIVES To study the occurrence and risk factors of DILI in patients on ATT by regular clinical and biochemical monitoring. MATERIALS AND METHODS 200 patients, in whom ATT was started, were enrolled in the study. None of the patients with established risk factor for DILI as recognized by ATS guidelines was included in our study population. Regular clinical and liver function test monitoring was done at the commencement of ATT and then at 2, 4, and 8 weeks in the intensive phase subsequently at 4 and 6 months. RESULTS DILI developed in 16 patients. Among those, 10 patients (62.5%) developed early DILI and 6 patients (37.5%) developed late DILI. Female gender and extrapulmonary tuberculosis were found to be associated with increased risk of ATT-induced DILI, whereas age, BMI, and serum albumin were not found to significantly increase DILI risk. CONCLUSION DILI is a common problem among patients on ATT in our population. Early detection not only reduces the risk of developing Hepatic Failure but also prevents mortality.

Vitamin D Deficiency in Rheumatoid Arthritis and Vitamin D Levels that vary with Rheumatoid Arthritis Severity: An Indian Study

ABSTRACT Aim To evaluate the long-term safety and efficacy of ab-interno trabeculectomy with trabectome for the treatment of glaucoma. Materials and methods Data collected for 339 eyes which included demographics, intraocular pressure (IOP) measurements using Goldmann applanation tonometry, best-corrected visual acuity (BCVA), visual field results, optic nerve status, gonioscopic findings, prior glaucoma procedures, number of glaucoma medications and pain level. The main data points of interest were preoperative IOP vs. postoperative IOP and BCVA, medication use, pain status, and complications. Results Of the 339 eyes that underwent trabectome, we found a statistically significant reduction in IOP (p < 0.01) at final follow-up (average = 18.35 months) of nearly 23%, with a complication rate of 5.86%. Furthermore, this reduction was maintained up to 8 years post procedure. LogMAR visual acuity was significantly improved in 69% of eyes at the final visit (p < 0.05), while only 1.77% of cases saw a significant reduction. Based on these findings, we determined a success rate of around 80% to 100 months following trabectome. Conclusion Trabectome is a safe and effective long term for most forms and severities of glaucoma. How to cite this article Bendel RE, Patterson MT. Long-term Effectiveness of Trabectome (Ab-interno Trabeculectomy) Surgery. J Curr Glaucoma Pract 2018;12(3):119-124.

Uncommon adverse effects of commonly used chemotherapeutic agents in medical oncology practice: A series of two cases of hand-foot syndrome

Chemotherapy has an increasing potential for cure and palliation of most forms of cancer in different stages. However, its use is associated with a multitude of side effects some very common and few very rare. We present two patients of metastatic nonsmall lung cancer who had severe forms of hand-foot syndrome with two different classes of antineoplastic drugs and have to discontinue chemotherapy.

Early onset symptomatic neuropathy in a child with Type 1 Diabetes mellitus

Diabetic neuropathy (DN) is a major complication of Type 1 Diabetes Mellitus (T1DM). It is usually subclinical in childhood, but can cause significant impairment with its progression through to adulthood. Current guidelines vary in their recommendation regarding screening for DN in children with T1DM, with some advocating starting screening 5 years after the diagnosis of T1DM. Clinical assessment comprising of history and neurological examination is the most commonly used method for screening, though Nerve Conduction Studies (NCS) provide better sensitivity in picking up early subclinical diabetic neuropathy. We describe an adolescent female with poorly controlled T1DM, presenting with symptomatic diabetic neuropathy within 2 years of disease onset and as the initial long term complication. Thus, guidelines regarding screening for DN may need revision, to start screening earlier than presently recommended, and NCS could play a prominent role in screening children with significant risk factors for developing DN.

An Unusual Presentation of Pancreatic Cancer

Pancreatic cancer is the fourth leading cause of cancer deaths, being responsible for 7% of all cancer-related deaths in both men and women. Patients usually present with weight loss, epigastric pain, obstructive jaundice or development of diabetes mellitus. Unusual presentations include pancreatic rupture, depression, icthyosis etc. Presentation as upper gastrointestinal bleed is very rare in pancreatic cancer and usually occurs due to sinistral portal hypertension. We present here a case of pancreatic cancer that presented to us as upper GI bleed.

Gastrointestinal Stromal Tumors: A Review

Introduction: Gastrointestinal tumors are rarest of the gastrointestinal tumors. They arise from interstitial cells of Cajal. Objective: To review the current diagnosis and management of gastrointestinal tumors. Material and methods: Pubmed was searched for ‘gastrointestinal tumors’ and relevant studies used for this review. Conclusion: GISTs are one of the rarest tumors of GI tract. They are more common in middle aged males. Diagnosis involves radiology, histopathology and immunohistochemistry. Treatment is surgical and chemotherapy.

Epidermal growth factor receptor mutation in adenocarcinoma lung in a North Indian population: Prevalence and relation with different clinical variables.

Introduction: Lung cancer is one of the most common causes of cancer deaths worldwide. Adenocarcinoma is taking over squamous cell lung cancer as the predominant histological subtype. Several cytotoxic drugs are available for the treatment of lung cancer, but side effects limit their use. Recently, targeted therapies for cancers have come into clinical practice. Aims and Objectives: To determine the prevalence of epidermal growth factor receptor (EGFR) mutation in adenocarcinoma lung in a North Indian population and its relation with different clinical variables. Materials and Methods: A total of 57 patients who met inclusion criteria were recruited into the study. Relevant history, clinical examination and investigations were done. EGFR mutation was done in all patients. Results: A total of twenty patients tested positive for EGFR mutation. EGFR was more frequently detected in female patients (53.8%), while as only 19.4% of the male patients expressed EGFR mutation, which was statistically very significant (P = 0.007). EGFR mutation was more frequently detected in nonsmokers (52%) as compared to smokers (21.9%) which also was statistically significant (P value of 0.018). EGFR mutation was more common in Stage III and IV adenocarcinomas (48%) as compared to Stage I and II (21.4%) which was statistically significant (P value 0.034). Conclusion: EGFR mutation should be routinely done in all patients of adenocarcinoma lung particularly non-smoker females with Stage III and IV disease.