Sudhir Kumar Verma

Effect of vitamin E on thrombocytopenia in dengue fever

Context: Dengue fever frequently causes thrombocytopenia for which there is no satisfactory treatment. Aim: To evaluate the effect of vitamin E on thrombocytopenia in dengue fever. Settings and Design: A tertiary teaching hospital during a recent outbreak of dengue fever in the area. Materials and Methods: Patients of dengue fever (as per WHO criteria) with thrombocytopenia and platelet counts between 10 × 10 3 /mm 3 and 100 × 10 3 /mm 3 seen during September 1, 2010 to November 30, 2010 were enrolled. After detailed history and clinical evaluation, the patients were randomized to two groups - group I which received vitamin E 400 mg (Evion, Merck) once daily along with standard treatment and group II which received standard treatment only. The platelet counts, bleeding manifestations, requirement for platelet transfusion were serially monitored for up to 1 week in these cases. Statistical Analysis Used: Percentage, mean, standard error of mean, Mann-Whitney U test, and Chi-square test. Results: We enrolled 66 cases (group I - 33 and group II - 33). Mean platelet count at baseline in both the groups was similar (group I - 28.39 ± 1.61 × 10 3 /mm 3 and group II - 27.64 ± 1.65 × 10 3 /mm 3 ) ( P > 0.05). We observed that the mean platelet count on day 4 in group I (vitamin E) was significantly higher (Mean - 122.19 ± 9.98 × 10 3 /mm 3 ; CI 95% -102.63 × 10 3 /mm 3 - 141.76 × 10 3 /mm 3 ) than in group II (Mean - 92.57 ± 7.93 × 10 3 /mm 3 ; CI 95% - 77.03 × 10 3 /mm 3 - 108.11 × 10 3 /mm 3 ) ( P = 0.0436). Similar findings were also observed on day 7 in the two groups. Platelet transfusion was required in less cases in group I [2 out of 33 (6.06%)] as compared to group II [5 out of 33 (15.15%)]. Conclusion: We conclude that vitamin E is beneficial in thrombocytopenia in dengue fever and results in faster increase in the platelet counts.

Atypical rabies with MRI findings: clue to the diagnosis

Rabies is known for most as a fatal infectious disease, mainly transmitted to both humans and animals through bites by rabid animals. In its classical form, rabies is well recognised, but when it presents atypically in paralytic form, it may become difficult to distinguish from Guillain–Barré syndrome (GBS) or myelitis, particularly where history is not forthcoming or concealed. The authors report here an atypical case of paralytic rabies presenting with descending paralysis followed by furious form where clue to suspicion was MRI findings. Imaging in rabies is seldom done. MRI findings of rabies encephalitis are well known, but in myelitis these need to be further characterised. The authors present MRI findings in a confirmed case of rabies myelitis. The differential diagnosis of the imaging findings as well as the role and the relevance of imaging in the diagnosis of this disease are discussed.

An epidemiological study of Protein Energy Malnutrition (PEM) among 1-6 years children in rural Lucknow, Uttar Pradesh, India

Background: Under-nutrition continues to be a major public health problem in developing countries and various factors are involved in determining the nutritional status of the children. Objectives: To study the prevalence of protein energy malnutrition (PEM) and various socio-demographic factors influencing it, among children (1-6 years) in rural community. Methods: A cross-sectional study was undertaken by house to house visit covering 400 children (1-6 years) from the six villages around the Rural Health Training Centre (RHTC), under department of Community medicine of Carrier Institute of Medical Science, Lucknow, U.P., India. Results: According to Indian Academy of Pediatrics (IAP), the prevalence of PEM was 54.8% with the proportion of grade I, II and III being 33%, 18.3% and 3.5%, respectively and none of the children was in grade IV under nutrition.The prevalence of underweight was significantly (p<0.001) higher in 1-3 years children (71.2%) as compared to 3-6 years children (46.6%). Girls (61.8%) were significantly (p=0.008) more malnourished than boys (48.6%) in all grade of underweight. PEM was significantly (p=<0.05) higher in children belonging to Hindu religion, schedule caste, nuclear family, among ≥3 siblings, illiterate father, lower socioeconomic status, poor housing & environmental sanitation.Conclusion: The burden of PEM was very high and some important risk factors for it were age, girls, schedule caste, lower socio-economic status, poor condition of housing and environmental sanitation. Therefore, any intervention to prevent and solve the problem

Pyopneumothorax following suicidal kerosene ingestion

Liquid hydrocarbons derived from petroleum are widely used in household and industry. Many hydrocarbons in kerosene, such as hexane, naphthalene, octane and phenanthrene, are toxic to humans. Pulmonary toxicity is the major cause of morbidity and mortality followed by central nervous-system and cardiovascular complications. 1 As kerosene is a mixture of chemicals, there is no definitive absorption, distribution, metabolism and excretion. The major route of exposure is by inhalation of liquid (aspiration). Kerosene vapours may be mildly irritating to the respiratory system and spray applications of kerosene may provoke signs of pulmonary irritation such as coughing and dyspnoea. Kerosene aspiration leads to inflammation and loss of surfactant. Secondary effects in the lungs include pneumothorax, pneumatocele or bronchopleural fistula. Here, we are presenting a case of pyopneumothorax after kerosene consumption.

Schwannoma in anterior mediastinum with massive pericardial effusion.

Schwannoma is a benign nerve sheath neoplasm of schwann cell origin. Mediastinum is the second most common site of schwannoma with majority originating in the posterior medistinum. Mediastinal schwannoma is slow growing and mostly asymptomatic in presentation. We present a case of schwannoma arising in the anterior mediastinum, an unusual location, complicated by massive haemorrhagic pericardial effusion. We recommend an aggressive approach in such cases with pericardiectomy to prevent reaccumulation of the pericardial fluid.

An unusual case of DRESS syndrome due to leflunomide.

The DRESS (drug rash, eosinophilia and systemic symptoms) syndrome, is a type of drug hypersensitivity syndrome, is a severe idiosyncratic reaction to several drugs, mainly antiepileptics and antibiotics, which can occasionally produce acute hepatic failure. In this article, the authors report a case of DRESS syndrome with severe exfoliative dermatitis with acute hepatitis associated with intake of leflunomide. Rapid diagnosis with withdrawal of offending agent is crucial for survival of these cases.

Correlation of severity of chronic obstructive pulmonary disease with potential biomarkers.

BACKGROUND Chronic obstructive pulmonary disease (COPD) is a non-specific inflammation, which involves the airways, lung parenchyma and pulmonary vessels. The inflammation causes the activation of inflammatory cells and the release of various inflammatory mediators such as interleukin-1 beta, interleukin-6 and tumor necrosis factor alpha (TNF-a). The present study was designed to assess the serum cytokines [Interleukin-1β (IL-1β), Interleukin-6 (IL-6), Tumor necrosis factor-α (TNF-α)] levels in chronic obstructive pulmonary disease (COPD) patients and they were correlated with severity of disease by spirometric measurements. MATERIALS AND METHODS A total of 384 COPD patients and 50 healthy controls were enrolled in this study. The COPD patients were divided according to gold stages ie: mild, moderate, severe and very severe. 5 ml of venous blood samples were taken from all participants and it was collected in a test tube containing anticoagulant and then centrifuged at 3000 rpm for 10 min. Serum was separated and used to measure the amount of TNF-alpha, il-1beta, and IL-6. Spirometry was performed according to the criteria set by the Gold 2012 RESULTS: Tnf-α (pg/ml), IL-6 (pg/ml), IL-1β (pg/ml) serum levels in COPD patients and healthy controls subjects were measured. Tnf-α and IL-6 serum levels were significantly (<0.001) higher in COPD patients compared to healthy control subjects. Likewise, IL-1 beta levels were also significantly (p-value = 0.022) higher in COPD patients compared to healthy control subjects. The distribution of Tnf-α, IL-6, IL-1β (pg/ml) serum levels in COPD patients in relation to GOLD grading. There was a significant (p < 0.001) difference in the level of TNF-α, IL-6 and IL-1β (pg/ml) among the severity of COPD. The posthoc analysis revealed that the TNF-α was significantly (p < 0.05) higher among the than mild, moderate, severe and very severe COPD patients. A similar observation was also found for IL-6. However, IL-6 was significantly (p < 0.05) higher among mild, moderate, severe and very severe COPD patients. There was significant (p = < 0.0001) difference in the level of IL-1β in the different severity of COPD. The posthoc comparison test showed that IL-1β levels were significantly (p < 0.05) higher among the mild, moderate, severe and very severe COPD patients. CONCLUSION The present study signifies that the levels of TNF-α, IL-1β, and IL-6 are directly proportional to the post-bronchodilator FEV1 percentage. Results provide population-based evidence that COPD is independently associated with low-grade systemic inflammation, with a different inflammatory pattern than that observed in healthy subjects. Overall, these results identify a novel systemic inflammatory COPD phenotype that may be the target of specific research and treatment.

Tuberculosis of gallbladder neck: a cause of cholecystitis with cholelithiasis

Tuberculosis of gallbladder neck is not a very common problem reported in the literature. Here, we report a case of gallbladder neck tuberculosis complicated with chronic cholecystitis with cholelithiasis in a 55-year-old woman. Diagnosis was made postoperatively on surgical biopsy.

Takayasu's arteritis presenting as digital gangrene of right hand

Takayasus arteritis (TA) is a chronic inflammatory disease of medium and large vessels, mainly involving the aorta and its major branches. TA may have diverse clinical presentation including claudication, stroke, asymmetric pulse or blood pressure. However, the association of TA with digital gangrene is a rare entity. Here, we report a case of a 40-year-old woman who presented with digital gangrene of the right hand, which on workup was diagnosed as a case of TA.

Leflunomide-induced chronic cough in a rheumatoid arthritis patient with pulmonary tuberculosis

A 40-year-old lady presented with clinicoradiological features suggestive of pulmonary tuberculosis, which was confirmed on sputum smear examination, and was started on four-drug antitubercular treatment. On subsequent visits, she complained of persistent cough, despite improvement in other symptoms. A careful anamnesis revealed that the patient had been taking leflunomide for rheumatoid arthritis for the last 10 years, and this was suspected to be the cause of the cough. The patient became asymptomatic upon stopping the drug, thereby confirming the hypothesis.