Stevens Johnson syndrome following paraquat poisoning: a case report

Paraquat is a herbicidal agent used extensively, mainly in developing countries where there is a high incidence of its poisoning. It causes damage to kidneys, lungs and liver. Reports of mucocutaneous manifestations following paraquat ingestion are rare. Here we describe a case of Stevens-Johnson syndrome(SJS) presenting in a case of paraquat ingestion. A 22 year old male was admitted to our hospital for difficulty in swallowing and micturation since ingestion of 10-15 ml of paraquat 7 days before. He had multiple hemorrhagic crusted erosions over lips and left maxillary area with diffuse erythematous erosions over bilateral buccal mucosa, palate, labial mucosa and urethral mucosa with whitish slough over them. Upper GI endoscopy revealed oral, esophageal and fundal sloughing. Patient was treated with oral corticosteroids and antibiotics which caused complete resolution of skin lesions within 15 days.Paraquat dichloride exerts its toxicity by generation of reactive oxygen species. Skin lesions following topical application of paraquat are common, but very few cases have been reported of the same after oral ingestion. SJS is caused by a variety of drugs and commonly presents with muco-cutaneous tenderness, hemorrhagic erosions and erythematous macules with 90% developing oral, genital and gastrointestinal mucosal involvement. As the oral and genital manifestations in our patient developed the day after paraquat ingestion, possibility of SJS developing due to the same are the highest. Paraquat should not be ruled out as a drug causality if mucocutaneous manifestations of SJS/TEN appear in a patient of paraquat ingestion.

COVID-19 and Multiorgan Dysfunction Syndrome

Severe acute respiratory syndrome (SARS) is the leading cause of death in COVID-19 infection, however, multi-organ dysfunction due to COVID-19 and/or because of co-morbidities is a usual accompaniment causing unfavorable outcome. Early detection of organ failure and giving appropriate organ support may improve the chances of survival. Arterial Blood Gas (ABG) analysis; electrolytes coupled with clinical picture and with organ related laboratory investigations may help in diagnosis of MODS and sepsis in COVID-19 SEVERE SYNDROME. Acute kidney injury (AKI), myocarditis, thromboembolism, acute liver de-compensation, hospital acquired infections, cardiac arrest, glycemic variability, thyroid dysfunction and other organ failure may lead to MODS. As patients having multiple organ syndrome requires ICU admission and interventions like intubation, hemodialysis and other extracorporeal treatment support knowing holistically about “COVID-19 MODS” is important for treating physicians

Kumbhakarna : Did he suffer from the disorder of the hypothalamus?

Kumbhakarna was brother of the evil Raavana in the mythological tale of Ramayana. According the legend, Kumbhakarna had an insatiable appetite and thirst and used to sleep for great lengths of time. He also had an uncontrollable temper, which was feared by many. It is our assessment that Kumbhakarna possibly suffered from hypothalamic obesity. Hypothalamic obesity can be defined as significant polyphagia and weight gain that occurs because of structural or function involvement of the ventromedial nucleus of the hypothalamus bilaterally. The characteristic features are obesity associated with polyphagia. Somnolence is present in 40% of cases. Sham rage is a characteristic behavioral abnormality seen in these patients. All these symptoms are described in the mythological text while describing Kumbhakarna. The episodic nature of Kumbhakarna′s symptoms can also be explained by another hypothalamic syndrome called Klein-Levine syndrome. This syndrome is characterized by with periodic episodes of somnolence, hyperphagia and hypersexuality along with other behavioral and cognitive difficulties

Microbiological Profile of Nosocomial Infections Due to Gram Negative Lactose Non-fermentative Bacteria in A Teaching Hospital of Gujarat

Hospital acquired infections caused by Non-fermentative gram-negative bacteria (NFGNB) have features that are of specific concern, detection of which is helpful for prevention and for better quality of healthcare in hospital premises. Present study was conducted to find out the nosocomial infections caused by NFGNB and its sensitivity pattern. Present microbiological study was carried out at C. U. Shah Medical College. Clinical samples which were included in this study were in accordance with inclusion criteria laid down in the research protocol, which were obtained during January 2018 to June 2020.Samples were collected and processed with the help of automated identification and antimicrobial susceptibility testing instrument i.e. Vitek – 2 as per standard guidelines. Statistical analysis was done by Microsoft Excel. Total 385 were classified as NFGNB from 1000 confirmed isolates causing Hospital acquired infection (HAI). Respiratory site infection was most common type of HAI i.e. 48%. While most common isolate was Pseudomonas sp.i.e. 42% followed by Acinetobacter baumannii i.e. 31%. Medicine ward showed maximum isolates i.e. 33%, followed by Surgery ward i.e. 23%. Maximum NFGNB isolates encountered from sputum sample i.e. 25% while blood shows only 6%. Trimethoprim/sulfamethoxazole and ciprofloxacinwere disclosedmaximum resistant. This study reports 385NFGNB isolates causing HAI. Such alarming resistance among NFGNB spreading the threat in medical care and epidemiology as they act as nosocomial pathogen. These isolated pathogens being the major cause of illness particularly in hospitalized patients

Combined effect of yoga and naturopathy in uncomplicated varicose vein disease – a prospective randomized controlled trial

Background: Though the treatment of uncomplicated varicose vein (UVV) might prevent late complications such as skin change or ulceration, but, there are limited studies available to justify this concept. Yoga and Naturopathy being a proficient tool in managing non communicable diseases including many cardiovascular diseases; no attempt was made to study its potential effect in Varicose Vein diseases. Objective: The present study aims to study the combination of Yoga and Naturopathy in uncomplicated varicose vein patients. Materials and methods: 50 UVV participants were prospectively recruited and randomly divided into two groups, Experimental and Active control groups. Both the groups practiced their respective interventions, and follow up was done after 1 and 3 months of active intervention. Finally study was completed with 46 participants (2 dropouts in each groups). The sample size was calculated based on the previous study, considering power as 0.8 and ‘α’ as 0.05, using ‘G’ power software. The variables such as Body weight, BMI, Systolic blood pressure (SBP), Diastolic blood pressure (DBP), Heart rate (HR), high-sensitivity C-reactive protein (hs-CRP), homocysteine (HCy) were recorded before and after the intervention, but Aberdeen Varicose Vein Questionnaire (AVVQ) and Visual analogue heaviness scale (VAHS) were recorded on 60 and 120 days of the follow up in addition to active intervention period. Results: There was a significant decrease in hs-CRP (p < 0.05) in the experimental group as compared to the control group. Body weight, BMI, SBP, HR, hs-CRP, HCy (p < 0.001) and DBP (p < 0.05) significantly decreases following the Combined Yoga and Naturopathy (CYN) intervention for a month in the experimental group. Also, the AVVQ (p < 0.01) and VAHS (p < 0.05) decreases following active intervention and two consecutive follow up. No adverse event was noted during or after the trial. Conclusion: The combined effect of Yoga and Naturopathy reduced blood pressure and inflammatory markers suggestive of potential of recovery in inflammation in the endothelial tissue of the microvascular system in UVV patients. Trial Registry number: CTRI/2018/10/015895; Clinical Trials Registry- India; www.ctri.nic.in