Shailendra Prasad Verma

Acute hypokalaemic quadriparesis in dengue fever.

The authors report acute hypokalaemic quadriparesis in two young patients that occurred during dengue epidemic in 2010 in India. Both patients developed flexic type of pure motor weakness in all four limbs without bladder bowel involvement, following 2 to 3 days of fever and malaise. Higher mental functions were normal. Serum potassium level was very low; 2–2.5 m mol/l. Non-structural protein (NS1)-antigen and immunoglobulin M-antibody for dengue were positive in both patients. Both patients improved with potassium supplementation. In follow-up, they are doing well.

Cardiac abnormalities in HIV-positive patients: results from an observational study in India.

Background: The clinical presentation of cardiac abnormalities in HIV-infected patients may be atypical or masked by concurrent illnesses that lead to misdiagnosis or they remain undiagnosed; therefore, this study was aimed to determine the frequency of cardiac abnormalities in HIV-infected patients. Material and Methods: Consecutive HIV-infected patients of age >13 years were studied for 3 months, after obtaining their consent. After clinical assessment, chest x-ray, electrocardiogram, 2-dimensional echocardiography and serum Troponin T levels were done. Results: A total of 100 patients were studied, cardiomegaly was observed in the x-ray of 15% of them, abnormal electrocardiogram was seen in 18%, 2-dimensional echocardiography was abnormal in 67%; and diastolic dysfunction (42.8%) was the commonest abnormality followed by dilated cardiomyopathy (17.6%). Serum troponin T was elevated in 8%. The variables, opportunistic infections (OIs), antiretroviral therapy (ART), stage of HIV disease, and CD4 counts, did not affect the frequency of diastolic dysfunction. Conclusion: The diastolic dysfunction is the most common cardiac abnormality observed in HIV-infected patients.

A Rare Case of Adult Acute Lymphoblastic Leukemia Presenting with Paraparesis and Multiple Osteolytic Lesions

Acute lymphoblastic leukemia presenting with bone involvement and multiple osteolytic lesions has been commonly reported in pediatric population. Various myeloid and lymphoid malignancies can rarely present with bony lesions. We are reporting an adult female patient with acute lymphoblastic leukemia who presented with paraparesis and multiple osteolytic lesions in skull initially giving false impression of multiple myeloma.

Corticosteroid responsive prolonged thrombocytopenia in a case of dengue fever.

Thrombocytopenia and bleeding manifestations are consistent features of dengue fever. Usually thrombocytopenia resolves and platelet count normalises by day 10 of fever. Persistent thrombocytopenia is not a feature of dengue fever. Proposed mechanisms behind thrombocytopenia are many. Direct platelet destruction by dengue virus, immune-mediated platelet destruction and even megakaryocytic immune injury have been proposed as underlying mechanisms. We are reporting a case of an old man who presented in dengue season in 2012 with fever and bleeding and was diagnosed as a case of dengue fever. He developed persistent thrombocytopenia requiring treatment on the lines of immune thrombocytopenia and responded to steroids. Other causes of thrombocytopenia were ruled out.

Rational Use of Recombinant Factor VIIa in Clinical Practice

In the United States, the FDA-approved indications for recombinant factor VIIa is for bypassing inhibitors to factors VIII and IX in patients with hemophilia A and B respectively and for treatment of congenital factor VII deficiency. In European countries, rFVIIa is licensed for the above indications as well as for Glanzmann’s thrombasthenia. In absence of high-quality data favoring off-label use of this agent and laboratory test to predict response to this agent, and in view of high cost of rFVIIa, off-label use of recombinant factor VIIa should be restricted to only when hemorrhage has not responded to transfusion or other conventional therapy. It appears, two such conditions where recombinant factor VIIa may be beneficial are traumatic and postpartum hemorrhages.

Bleomycin-induced skin toxicity: is it always flagellate erythema?

Bleomycin-induced skin toxicity is a rare and unique complication. We report a 35-year-old man with nodular lymphocytic predominant Hodgkins lymphoma, stage IVB, who was started on adriamycin, bleomycin, vinblastin and dacarbazine (ABVD) chemotherapy. He developed pruritic hyperpigmented, patchy skin lesions on the neck, back, chest and thighs after IA cycle of ABVD chemotherapy. Lesions were not typical flagellate rash but hyperpigmented, patchy and mildly pruritic lesions over the trunk and proximal extremities. Lesions increased with continuation of bleomycin and improved gradually after removing the drug from chemotherapy schedule. The patient was in complete remission after VI cycles of chemotherapy (AVD Regimen) and skin lesions healed with minimal residual hyperpigmentation.

Cerebral infarction leading to hemiplegia: A rare complication of acute pancreatitis

Peripancreatic vascular thrombosis is a known complication of acute pancreatitis (AP) and chronic pancreatitis. However, hemiplegia resulting from cerebral infarction due to cerebral arterial thrombosis is a rare complication of AP. Here, we report a case of alcohol related severe AP with multi-organ dysfunction, which was complicated by large left sided middle cerebral artery territory infarct - leading to right sided hemiplegia in a 48-year-old male patient. The neurological and vascular thrombotic complications of pancreatitis, their pathogenesis and management are discussed in brief.

An observational study on the prevalence of dyslipidemia and dysglycemia in human immunodeficiency virus patients

Context: Dyslipidemia and dysglycemia are prevalent among patients with human immunodeficiency virus (HIV) infection. Besides antiretroviral therapy, other factors like opportunistic infections may contribute to the development of these disorders. Aims: The objective of this study was to determine the prevalence and pattern of dysglycemia and dyslipidemia in HIV patients. Settings and Design: An observational cross-sectional study was done over a period of six months at the Gandhi Memorial and Associated Hospital, Lucknow, India (a tertiary care centre in north India). Materials and Methods: A total of 85 consecutive HIV patients, >15 years of age attending the outdoor clinic were enrolled. A single fasting blood sample was taken to estimate the sugar and lipid parameters. Acutely ill and previously diagnosed patients of diabetes mellitus were excluded. Statistical Analysis Used: Data were presented in percentage and mean values. Statistical analysis was done by using software Stata Version 11 Texas. Results: The mean (SD) age of the studied patients was 34.34 (8.3) years. The prevalence of dysglycemia was 30.9%; 10.9% patients were diagnosed to have frank diabetes mellitus while 20% patients had their blood sugars in the range of glucose intolerance. Prevalence rates of low high density lipoprotein (HDL), hypertriglyceridemia, raised low density lipoprotein (LDL) and total cholesterol were 69.41%, 29.41%, 10.58%, and 9.41% respectively. Conclusions: Dysglycemia and dyslipidemia are more prevalent among HIV patients. Advanced disease and antiretroviral therapy (ART)-naive patients have higher rates of dysglycemia and dyslipidemia. High prevalence of low HDL, hypertriglyceridemia and impaired glucose intolerance comprising three components of metabolic syndrome are found in HIV patients. Hence, HIV disease itself is a major risk factor for cardiovascular disease.

Cardiac Abnormalities in HIV-Positive Patients

Background: The clinical presentation of cardiac abnormalities in HIV-infected patients may be atypical or masked by concurrent illnesses that lead to misdiagnosis or they remain undiagnosed; therefore, this study was aimed to determine the frequency of cardiac abnormalities in HIV-infected patients. Material and Methods: Consecutive HIV-infected patients of age >13 years were studied for 3 months, after obtaining their consent. After clinical assessment, chest x-ray, electrocardiogram, 2-dimensional echocardiography and serum Troponin T levels were done. Results: A total of 100 patients were studied, cardiomegaly was observed in the x-ray of 15% of them, abnormal electrocardiogram was seen in 18%, 2-dimensional echocardiography was abnormal in 67%; and diastolic dysfunction (42.8%) was the commonest abnormality followed by dilated cardiomyopathy (17.6%). Serum troponin T was elevated in 8%. The variables, opportunistic infections (OIs), antiretroviral therapy (ART), stage of HIV disease, and CD4 counts, did not affect the frequency of diastolic dysfunction. Conclusion: The diastolic dysfunction is the most common cardiac abnormality observed in HIV-infected patients.

Cardiac Abnormalities in HIV-Positive Patients: Results from an Observational Study in India

Background: The clinical presentation of cardiac abnormalities in HIV-infected patients may be atypical or masked by concurrent illnesses that lead to misdiagnosis or they remain undiagnosed; therefore, this study was aimed to determine the frequency of cardiac abnormalities in HIV-infected patients. Material and Methods: Consecutive HIV-infected patients of age >13 years were studied for 3 months, after obtaining their consent. After clinical assessment, chest x-ray, electrocardiogram, 2-dimensional echocardiography and serum Troponin T levels were done. Results: A total of 100 patients were studied, cardiomegaly was observed in the x-ray of 15% of them, abnormal electrocardiogram was seen in 18%, 2-dimensional echocardiography was abnormal in 67%; and diastolic dysfunction (42.8%) was the commonest abnormality followed by dilated cardiomyopathy (17.6%). Serum troponin T was elevated in 8%. The variables, opportunistic infections (OIs), antiretroviral therapy (ART), stage of HIV disease, and CD4 counts, did not affect the frequency of diastolic dysfunction. Conclusion: The diastolic dysfunction is the most common cardiac abnormality observed in HIV-infected patients.