Vikas Suri

Pathology and virology findings in cases of fatal influenza A H1N1 virus infection in 2009-2010.

Bal A, Suri V, Mishra B, Bhalla A, Agarwal R, Abrol A, Ratho R K & Joshi K 
(2012) Histopathology 60, 326–335 
Pathology and virology findings in cases of fatal influenza A H1N1 virus infection in 2009–2010

Lupus myocarditis: marked improvement in cardiac function after intravenous immunoglobulin therapy

Intravenous immunoglobulin (IVIg) is emerging as the mainstay in the treatment of many autoimmune diseases, including systemic lupus erythematosus. IVIg has been found to be beneficial in myocarditis due to dermatomyositis/polymyositis, Kawasaki disease, and viral myocarditis in children. We report an 18-year-old man of active lupus with worsening cardiac systolic function who did not respond to pulse methylprednisolone and cyclophosphamide, but subsequently showed an improvement in his cardiac function after IVIg administration.

Prevalence of peripheral neuropathy in multiple myeloma at initial diagnosis

Abstract To evaluate the presence of peripheral neuropathy (PN) in newly diagnosed treatment-naive patients with multiple myeloma (MM), 29 patients and 25 age and sex matched controls underwent electrophysiological studies. Patients with associated diabetes, alcoholism, peripheral vascular disease and POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, M component and skin changes) were excluded from the study. The median age of patients was 56 years (range 28–82) and the sex ratio was 2.6:1. Eighteen (62.1%) patients were found to have evidence of PN by history and clinical examination alone (two patients), both clinical and electrophysiological evidence (five patients) and only electrophysiological evidence (11 patients). Out of 25 healthy controls, only two patients had evidence of PN by electrophysiological studies (cases vs. controls, p < 0.002). The commonest nerve involvement was in the form of sensory-motor axonal neuropathy followed by sensory-motor demyelinating neuropathy. This information may impact therapeutic and prognostic decision-making in newly diagnosed patients with MM.

Institutional outbreak of rubella in a healthcare center in Chandigarh, North India.

Rubella is traditionally considered a childhood disease but it has the potential to cause outbreaks in closed communities when a susceptible population accumulates. The present study reports an outbreak of rubella among healthcare workers in the pediatric center of a tertiary care North Indian hospital. The cases of rubella were identified by clinical features and confirmed by the detection of anti‐rubella IgM antibodies in blood by enzyme linked immunosorbent assay. A total of 23 cases of rubella occurred over a period of one and a half month, out of which 9 (39%) were males. All the patients were in the age group of 21–35 years. None of the patients gave a history of rubella vaccination. This outbreak of rubella occurred due to the accumulation of a susceptible population in a closed hospital environment. There is need for the introduction of rubella vaccination in healthcare workers to prevent outbreaks at work place. J. Med. Virol. 82:341–344, 2010.

Chronic necrotising pulmonary aspergillosis in a marijuana addict: a new cause of amyloidosis.

of 4 mg/L tazobactam). Molecular investigation was undertaken to determine the type of cephalosporinase produced by the organism. A positive result was obtained with an identified DHA-1 enzyme from Morganella morganii described previously. Therefore, the gene coding for this enzyme was likely to be plasmid-encoded with a regulator gene located on the same plasmid. A further analysis of this DHA-1 positive strain indicated that conjugation of the DHA-1 marker was not possible. However, using Kieser technique for extracting large size plasmid, a transformant was obtained after selection with amoxicillin 50 mg/L. This E. coli transformant had an AmpC inducible phenotype and was also resistant to trimethoprim. The plasmid had a 140 kb size. This is the first report of an E. coli carrying a plasmidencoded gene with a regulator situated on the same plasmid. The positioning of an imipenem 10 mg disc adjacent to a cefotaxime 5 mg or a ceftazidime 10 mg disc, as described in the CDS method, enabled the recognition of this strain in routine testing in a busy diagnostic laboratory. One important lesson that can be drawn from this experience is that, given the low MIC of cefotaxime, in the circumstances where a strain such as EC 259 is isolated from a blood culture, the organism probably would be reported as susceptible to oxyimino-cephalosporins if antibiotic susceptibility testing was performed by any other method. With the high mutation rate of 10 to hyperproduction of AmpC b-lactamase, failure of treatment with cefotaxime or ceftriaxone would be inevitable.

First and second trimester induced abortions in women with cardiac disorders: A 12-year analysis from a developing country

Summary This was a retrospective analysis of induced abortions (1st and 2nd trimester) in women with cardiac disease over a 12-year period (September 1994–December 2006). Of the 3,096 women who underwent an induced abortion during this period, 65 (2.1%) had an associated cardiac disease (NYHA class I or II = 58, class III or IV = 7). Their mean age was 29.6 years and 48/65 (73.9%) had opted for concurrent sterilisation. Nearly all 1st trimester abortions (52/53) were performed by suction evacuation. Among the 12 women undergoing 2nd trimester abortions, seven received vaginal misoprostol with or without oral mifepristone, four received varying combinations of intracervical dinoprostone, extra-amniotic saline (EAS) and oxytocin and elective hysterotomy was performed in one. Complications observed among the 1st trimester terminations were incomplete abortion in 1/53 (1.8%) and prolonged bleeding in 3/53 (5.6%). Method failure was the only complication seen in 2/12 (16.6%) 2nd trimester abortions. There was no major morbidity or mortality. Mifepristone and misoprostol used for 2nd trimester induced abortions were found to be safe in the few women so treated.

Factors Affecting Early Molecular Response in Chronic Myeloid Leukemia

OBJECTIVES There is controversy about whether 3- or 6-month molecular assessment predicts progression-free and overall survival in those with chronic myeloid leukemia (CML). The factors predicting molecular response at 3, 6, and 12 months have not been studied extensively. The study objective was to study the factors affecting molecular response at 3 and 6 months in patients with CML who are receiving imatinib mesylate. METHODS We prospectively enrolled patients with newly diagnosed CML who were receiving imatinib mesylate as the initial therapy for CML. The diagnosis of CML was based on clinical examination, bone marrow, and demonstration of BCR ABL(IS) transcripts by polymerase chain reaction. The molecular response(IS) was assessed at 3, 6, and 12 months by GeneXpert (Cepheid, Sunnyvale, CA) and co-related with various baseline characteristics of patients. We also looked at whether early achievement of a complete hematologic response within 6 weeks predicts molecular response at 3 or 6 months. The study took place at a tertiary care hospital in Northwest India catering to patients belonging to low-middle socioeconomic status. RESULTS We enrolled 131 patients with CML in the chronic phase from July 1, 2013, to August 31, 2014. The median age of the patients was 40 years (range, 13-67) with a male preponderance (61% were male). Most patients presented with symptoms of low-grade fever (52.7%) and abdominal fullness (26.7%). Spleen was palpable in 84.7% of patients. The median hemoglobin at presentation was 10.8 g/dL (range, 4.8-18.4 g/dL), white cell count was 138.3 × 10(9)/L (4.1-697 × 10(9)/L), and platelet count was 326 × 10(9)/L (85-1819 × 10(9)/L). The median number of peripheral blood basophils was 3% (range, 0%-20%), and blasts were 3% (range, 0%-10%). Myelofibrosis of more than grade 1 was present in 30% of patients. Most patients belonged to intermediate Sokal (45.8%) and Hasford (55%) scores and low EUropean Treatment Outcome Study (78.6%) score. Of 128 evaluable patients at 3 months, 96.9% achieved complete hematologic remission (CHR) and 82.3% achieved BCR ABL(IS) of less than 10%. None of the patients who had BCR ABL(IS) > 10% at 3 months achieved BCR ABL(IS) < 1% at 6 months or < 0.1% at 12 months. Early achievement of CHR (< 6 weeks), peripheral blood blast count of < 5%, and lactate dehydrogenase < 851 U/L were significantly associated with achievement of BCR ABL(IS) < 10% at 3 months and BCR ABL(IS) < 1% at 6 months. CONCLUSIONS We found that BCR ABL(IS) assessment at 3 months is superior to assessment at 6 months. Patients with CML in the chronic phase who achieve CHR within 6 weeks are more likely to achieve BCR ABL(IS) < 10% at 3 months and < 1% at 6 months than patients who achieve CHR between 7 and 12 weeks.

Cerebrospinal fluid infiltration in Hodgkin lymphoma: a case report.

BACKGROUND Central nervous system (CNS) involvement by Hodgkin lympboma is a rare event. Involvement of the cerebrospinal fluid (CSF) in such cases is even more uncommon. We report a case of Hodgkin lymphoma in which the patient developed infiltration of the CSF while on chemotherapy. CASE A 45-year-old woman was diagnosed with Hodgkin lymphoma by fine needle aspiration and subsequent biopsy of the cervical lymph node. She complained of headache during the course of chemotherapy, for which CSF examination was undertaken. Cytocentrifuge sediment of the CSF revealed marked eosinophilic pleocytosis, accompanied by scattered monocytes, polymorpbs, lymphocytes, plasma cells and histiocytes. An occasional large mononudlear cell with a large, round nucleus and prominent irregular nucleolus with a moderate amount of basophilic cytoplasm conformning to the morphology of Hodgkins cells was noted. Binucleated Reed-Sternberg cells were not seen. Following intratbecal methotrexate, a reduction in the cellular infiltrate was observed. CONCLUSION CSF cytology is important for the diagnosis of CNS involvement by Hodgkin lymphoma and may be positive before lesions can be visualized by magnetic resonance imaging or computed tomograpby scans.

Epstein–Barr Virus Infection Masquerading as Acute Leukemia: A Report of Two Cases and Review of Literature

Epstein–Barr virus (EBV) is the first herpes virus to be completely sequenced. It is implicated in diseases from the benign infectious mononucleosis to malignant nasopharyngeal carcinoma, Burkitt’s lymphoma and primary CNS lymphoma in AIDS patients. It has also been found to be associated with some miscellaneous diseases like chronic fatigue syndrome, multiple sclerosis etc. however causality still remains an issue of debate. As the virus mainly targets the lymphomonuclear cells and the reticuloendothelial system of the body, it’s various manifestations are often mistaken as leukemic malignancies. We report two such cases of young adults who had been diagnosed as having acute leukemia on the basis of atypical cells in the peripheral blood. One patient later turned out to be a classical infectious mononucleosis and second patient had EBV associated hemophagocytic lymphohistiocytosis syndrome.

Leptospirosis as a cause of intrauterine fetal demise: short report of rare presentation

We present a rare severe leptospirosis in a patient who presented with fever, jaundice, coagulopathy and intrauterine fetal demise. Possibility of leptospirosis should be kept in an obstetric patient with such clinical profile particularly in endemic areas or if there is recent outbreak of disease.