Erythema nodosum with oral and genital ulcers: A case of behçet's disease

Behçet's disease (BD) is a chronic, relapsing, multisystemic disorder characterized by mucocutaneous, ocular, vascular, and central nervous system manifestations. The clinical spectrum includes oral and genital ulcerations, uveitis, and vascular, neurological, articular, renal, and gastrointestinal manifestations. The etiopathogenesis of the disease remains unknown although genetic predisposition, environmental factors, and immunological abnormalities have been implicated. It usually affects young adults. The case of a 22-year-old female who presented with fever, recurrent oral ulcers, genital ulcers, arthralgia, and erythema nodosum is presented here. A diagnosis of BD based on clinical criteria was made. The patient was treated with colchicine 1 mg/day which had beneficial effects on the reduction in size and recurrence of mucocutaneous ulcers

Intraoperative low tidal volume ventilation strategy has no benefits during laparoscopic cholecystectomy

Background and Aims: Benefits of intraoperative low tidal volume ventilation during laparoscopic surgery are not conclusively proven, even though its advantages were seen in other situations with intraoperative respiratory compromise such as one-lung ventilation. The present study compared the efficacy of intraoperative low tidal volume ventilatory strategy (6 ml/kg along with positive end-expiratory pressure [PEEP] of 10 cmH2O) versus one with higher tidal volume (10 ml/kg with no PEEP) on various clinical parameters and plasma levels of interleukin (IL)-6 in patients undergoing laparoscopic cholecystectomy. Material and Methods: A total of 58 adult patients with American Society of Anesthesiologists physical status I or II, undergoing laparoscopic cholecystectomy were randomized to receive the low or higher tidal volume strategy as above (n = 29 each). The primary outcome measure was postoperative PaO2. Systemic levels of IL-6 along with clinical indices of intraoperative gas exchange, pulmonary mechanics, and hemodynamic consequences were measured as secondary outcome measures. Results: There was no statistically significant difference in oxygenation; intraoperative dynamic compliance, peak airway pressures, or hemodynamic parameters, or the IL-6 levels between the two groups (P > 0.05). Low tidal volume strategy was associated with significantly higher mean airway pressure, lower airway resistance, greater respiratory rates, and albeit clinically similar, higher PaCO2and lower pH (P < 0.05). Conclusion: Strategy using 6 ml/kg tidal volume along with 10 cmH2O of PEEP was not associated with any significant improvement in gas exchange, hemodynamic parameters, or systemic inflammatory response over ventilation with 10 ml/kg volume without PEEP during laparoscopic cholecystectomy

Metronidazole induced neurotoxicity in a case of liver abscess Article ID: 100061IJHPDRZ2016 *********

ABSTRACT Metronidazole is a commonly used drug and considered relatively safe. But it may present with neurotoxicity, commonly peripheral and rarely central. We report here a case of a young patient with amoebic liver abscess who continued taking metronidazole longer than the prescribed duration of the drug and developed peripheral neuropathy and cerebellar neurotoxicity which was reversible after discontinuation of the drug

Hemorrhagic stroke and cerebral venous thrombosis: rare neurological sequelae of chickenpox infection

Chickenpox (varicella) is primarily a disease of childhood which occurs due to infection with varicella-zoster virus (VZV). Primary VZV infection is rare in adults due to exposure in early childhood in our country. In adults, it is associated with some serious systemic and neurological complications which can follow both primary infection and reactivation of VZV. Neurological sequelae caused by primary VZV infection are rare and include encephalitis, aseptic meningitis, myelitis, acute cerebellar ataxia, Reye syndrome, Ramsay Hunt syndrome, and rarely stroke and cerebral venous thrombosis (CVT). VZV infection of cerebral vessels produces vasculopathy and hypercoagulable state, leading to complications such as stroke and CVT. We hereby report cases of two immunocompetent young adults who developed acute hemorrhagic infarction in the brain and CVT following chickenpox infection