Acute liver failure in an Immunocompetent host:A Diagnostic Dilemma

Acute liver failure(ALF) is defined as acute onset of hepatic dysfunction with timing of 8-28 days between onset of jaundice and hepatic encephalopathy .It is a medical emergency which needs prompt diagnosis and appropriate management with identification of the aetiological factors. I present an interesting case of acute liver failure due to cytomegalovirus(CMV) hepatitis in an immunocompetent, non addict patient without any co morbidities .The patient recovered with supportive treatment and did not require anti viral therapy as he was not immune compromised. The importance of the case lies in the fact that viral hepatitis by CMV can present in immune competent patients also and other treatable causes of acute liver failure should also be identified as several patients of ALF may need liver transplantation

Benign familial polycythaemia in a young male

Polycythaemia has been reported rarely as a familial condition. There is evidence to suggest transmission as a Mendelian dominant trait, but recessive inheritance has also been described. We present here a case of benign familial polycythaemia in a 25-year-old male with similar presentation in his family members. Our patient presented with reddish discolouration of the eyes, early satiety , weight loss and itching at intervals, for four years. An additional examination revealed red beefy tongue and Grade III clubbing. The importance of presenting this case lies in the fact that the prognosis appears to be good in these patients, but regular observation is necessary as Kiladjian and colleagues have mentioned that there is a risk of leukaemia, thrombosis and myelofibrosis in these patients later on, as the idiopathic erythrocytosis group contains a certain number of polycythaemia patients

Enteric Encephalopathy associated with reversible ECG changes: A Diagnostic Dilemma

Enteric fever is common in India. It presents with various clinical manifestations. Encephalopathyand ECG changes are indicators of prognosis. Persistent ECG changes indicate a poor prognosis. Thepathogenesis of encephalopathy is unclear though prostaglandins and free oxygen species may beimplicated in the prognosis and justifies the use of steroids in enteric encephalopathy withantibiotics. The case presented here presented with encephalopathy and ECG changes whichreversed following antibiotic and steroid therapy. The importance of the case lies in the fact thattyphoid should not be missed in the diagnosis of encephalopathy and ECG should be done in allcases of enteric fever to determine the prognosis

Parasitic Hypoproteinemia :A Diagnostic Dilemma in an Immuno competent Patient

Strongyloidiasis is caused by a nematode helminth which causes multisystem involvement with signs and symptoms related to gastrointestinal,pulmonary, dermatological and nervous system.The  index case discussed here presented with edema, hypoalbuminemia, malnutrition and anemia with urease positive duodenal ulcer.Duodenal biopsy suggested malabsorption and strongyloidiasis was detected in biopsy which clinched the diagnosis and treatment was given with ivermectin after which patient improved and responded to treatment.The importance lies in the fact that parasitic infections may cause malabsorption even in immunocompetent patients which is a rare entity, but must not be missed as it responds to treatment promptly which is cheap and effective

Variable Presentations of Enteric Fever, beyond Fever and Pain Abdomen: A Case Series

Enteric Fever (Typhoid and Paratyphoid fever) is an illness that presents with marked pyrexia, abdominal pain and other gastrointestinal symptoms. Symptoms and complications primarily involve gut. But sometimes it involves other organ systems like heart, and brain. It thus poses a great diagnostic challenge in diagnosing these extraintestinal manifestations. The three cases depicted in this case series had unusual presentations in the form of dilated cardiomyopathy, non haemophagocytic lymphohistiocytosis (HLH) dyslipidaemia and encephalopathy. The first case is a case of reversible cardiomyopathy in a 26-year-old male presenting with fever for seven days with headache, loose motions and vomiting with audible S3 and bibasal crepitations without oedema. The patient responded to ceftriaxone and azithromycin. On echocardiography dilated cardiomyopathy was diagnosed after which treatment with ramipril and metoprolol was started. The second case was of a 30-year-old female presenting with fever, vomiting, and abdominal pain. There was hypertriglyceridaemia with normal ferritin levels. The patient responded to ceftriaxone. High Density Lipoprotein (HDL) level was low. Statin and fenofibrates were added after which the triglyceride levels came down. This was an interesting case of non-HLH dyslipidaemia which responded to therapy. The third case was of a 40-year-old female presenting with fever for six days with impairment of consciousness. Bilateral plantar responses were extensor and there was no papilledema or any cranial nerve palsy. Magnetic Resonance Imaging (MRI) Brain and Cerebrospinal Fluid (CSF) study were normal. The patient responded to ceftriaxone and dexamethasone proving beneficial effects of steroids in enteric encephalopathy. The purpose of the case series was to make clinicians aware of these uncommon presentations of a common disease so that early diagnosis and treatment with Anti Salmonella antibiotics can be initiated quickly to prevent complications

Variable presentations of dengue fever with diagnostic dilemma: A case series

Dengue is a viral fever in humans which is caused by 4 serotypes of the flavivirus. It is spread by the bite of the infected Aedes mosquitoes. The acute febrile illness is often associated with multisystem involvement with complications. The case series presented here depicts atypical manifestations of dengue which may present with hypoplastic anemia, hepatitis, pancreatitis, and encephalopathy. The cases were diagnosed based on history of dengue with subsequent persistence of pancytopenia, presence of hepatitis, pancreatitis, and encephalopathy with serological evidence of dengue and after ruling out other possible etiologies supported by laboratory evidence of investigations. The bone marrow revealed pancytopenia with hypocellular marrow causing hypoplastic anemia, transaminitis and rise of lipase and amylase with symptoms diagnosed hepatitis, pancreatitis, and finally impairment of consciousness with electroencephalogram proved encephalopathy. The importance of the case series lies in the fact that atypical manifestations may occur in dengue patients challenging the physicians and early detection may avoid unnecessary treatment and complications

A Rare Presentation of a Common Disease: A Diagnostic Dilemma

Malaria affects millions of people across the globe .The classical clinical features may be absent, but the rapid diagnosis helps in early treatment and thus avoids complications .We present a case of co infection of Plasmodium  vivax and Plasmodium falciparum malaria in a female patient presenting with fever and pain abdomen and incidental detection of splenic infarct .The co infection  is uncommon and treatment should target both to avoid complications . Also,  the exact pathogenesis is un known and though splenic infarct is uncommon and missed due to lack of symptoms , it should be followed up. &nbsp

'Bhavishya Shakti: Empowering the Future': establishing and evaluating a pilot community mobile teaching kitchen as an innovative model, training marginalised women to become nutrition champions and culinary health educators in Kolkata, India.

BACKGROUND: Malnutrition is a global emergency, creating an overlapping burden on individual, public and economic health. The double burden of malnutrition affects approximately 2.3 billion adults worldwide. Following 3 years of capacity building work in Kolkata, with assistance of local volunteers and organisations, we established an empowering nutrition education model in the form of a 'mobile teaching kitchen (MTK)' with the aim of creating culinary health educators from lay slum-dwelling women. AIMS: To evaluate the piloting of a novel MTK nutrition education platform and its effects on the participants, alongside data collection feasibility. METHODS: Over 6 months, marginalised (RG Kar and Chetla slums) women underwent nutrition training using the MTK supported by dietitians, doctors and volunteers. Preintervention and postintervention assessments of knowledge, attitudes and practices (KAP), as well as anthropometric and clinical nutritional status of both the women and their children were recorded. The education was delivered by a 'See One, Do One, Teach One' approach with a final assessment of teaching delivery performed in the final session. RESULTS: Twelve women were trained in total, six from each slum. Statistically significant improvements were noted in sections of KAP, with improvements in nutrition knowledge (+4.8) and practices (+0.8). In addition, statistically significant positive changes were seen in 'understanding of healthy nutrition for their children' (p=0.02), 'sources of protein rich food' (p=0.02) and 'not skipping meals if a child is ill' (p≤0.001). CONCLUSION: The MTK as a public health intervention managed to educate, empower and upskill two groups of lay marginalised women into MTK Champions from the urban slums of Kolkata, India. Improvements in their nutrition KAP demonstrate just some of the effects of this programme. By the provision of healthy meals and nutritional messages, the MTK Champions are key drivers nudging improvements in nutrition and health related awareness with a ripple effect across the communities that they serve. There is potential to upscale and adapt this programme to other settings, or developing into a microenterprise model, that can help future MTK Champions earn a stable income

Three-year review of a capacity building pilot for a sustainable regional network on food, nutrition and health systems education in India.

BACKGROUND: In Kolkata (India), there are high rates of malnourished children (45.9%) under the age of three, impacting growth, organ development, function, and cognition. Mothers have a major role to play during this crucial development stage, with research showing nutrition knowledge, attitudes and practices (KAP) of mothers are important determinants of childhood malnutrition. AIMS: To document 3 years of capacity building towards a sustainable nutrition education network in Kolkata, India, while assessing the ability to perform data collection in the form of needs assessments, impact assessments and capacity reviews. METHODS: Descriptive review and analysis of engagement and impact from 3 years of work by the NNEdPro Global Centre for Nutrition and Health, initiating locally led nutrition education interventions. Mapping to the Indian National Nutrition Strategy was also performed to review adherence to nationwide priorities surrounding nutrition and determine the wider application potential of the network. RESULTS: Two simultaneous projects were taken forward by a team of local healthcare professionals and student champions. Project 1-medical college workshops for medical student nutrition education with added focus on underserved populations, Project 2-preparation for a 'Mobile Teaching Kitchen' (MTK) in marginalised communities to empower local women as nutrition educators.Data collection methods used for analysing markers of impact and sustainability were semi-structured interviews of the community members, and KAP questionnaires to assess response to educational sessions. CONCLUSION: With local support it is possible to create and sustain fieldwork for an extended period with meaningful outputs and impact. This initiative demonstrates that it is possible to use healthcare professionals, students and volunteers with low-intensity training and a low-cost approach to produce action research with considerable impact and results in rapid, reliable and robust manner