COLD ANTIBODY-MEDIATED AUTOIMMUNE HEMOLYTIC ANEMIA IN A PATIENT WITH OVERLAP SYNDROME OF SYSTEMIC LUPUS ERYTHEMATOSUS WITH SJOGREN’S SYNDROME

Systemic lupus erythematosus (SLE) is a systemic autoimmune disorder commonly seen in females characterized by multisystem inflammation with the production of an array of antibodies. Hematological disturbances are common in SLE specifically autoimmune hemolytic anemia (AIHA) which results from the development of autoantibodies directed against antigens on the surface of patient’s own red blood cells. Here, we present a rare case of a 50-year-old female patient presenting with cold antibody-mediated AIHA

Recurrent Jaundice in an Otherwise Healthy Male

A 41-year-old Asian-Indian male presented with recurrent episodes of jaundice over the past six months. Physical examination was normal, barring mild icterus. Laboratory parameters revealed indirect hyperbilirubinemia. Further evaluation yielded a diagnosis of severe nutritional vitamin B12 deficiency. Indirect hyperbilirubinemia was ascribed to ineffective erythropoiesis. Underlying Gilbert’s syndrome was ruled out by provocative testing with lipid-restricted diet. Presentation of severe vitamin B12 deficiency with isolated hyperbilirubinemia without concomitant major haematologic or neurologic dysfunction is unusual and potentially underdiagnosed. Awareness of this possibility can permit early diagnosis of vitamin B12 deficiency and forestall development of severe haematologic and neurologic sequelae

Tubercular Neuritis

A 25-year-old housewife presented with burning sensation over both legs since the past 15 months, and fever with weight loss since the past six months. She had noticed a lump in her left breast since the past one month. Examination revealed hyperaesthesia and allodynia over the lower limbs. Nerve conduction studies confirmed the presence of sensory neuropathy. Nerve biopsy was suggestive of a chronic axonopathy. Subsequently sputum as well as aspirate from the breast lump tested positive for acid fast bacilli. Treatment with anti-tubercular therapy resulted in full recovery. Peripheral neuropathy is a unique and unusual presentation of tuberculosis

Bilateral Upper Lobe Pneumonia with Acute Adrenal Insufficiency

Achromobacter xylosoxidans is an uncommon pathogen of low virulence known to cause serious nosocomial infection in the immunocompromised. Its inherent multi-drug resistance makes treatment difficult. Community-acquired infections are rare despite its ubiquitous existence. We present a 50-year-old immunocompetent woman who presented with one-month history of coughing with expectoration who was subsequently diagnosed with bilateral upper lobe pneumonia and acute adrenal insufficiency. Achromobacter xylosoxidans was isolated from sputum and bronchoalveolar lavage culture. The acute adrenal insufficiency recovered after appropriate antibiotic therapy. Amongst the myriad of presentations, we highlight the rarity of acute adrenal insufficiency triggered by the infection

Cranial Melioidosis with Extradural Extension

A 32-year-old diabetic male, with a past history of head injury and seizures, presented with a painful swelling over his forehead present for the past three months.  Cranial MRI demonstrated the presence of a scalp collection with extradural extension through a bony defect. Biopsy from the area showed caseating necrosis suggestive of tuberculosis. Although the patient failed to return for initiation of anti-tubercular therapy for the next 11 months, the swelling did not progress, and there were no constitutional symptoms. The indolent nature of the swelling prompted re-evaluation and delayed cultures of pus from the collection grew Burkholderia pseudomallei

Effect of Life-Style Modification Intervention Programme on Bone Mineral Density among Postmenopausal Women with Osteoporosis

Objectives: Osteoporosis is one of the major public health problems worldwide among postmenopausal osteoporotic women. Lifestyle modification interventions along with pharmacotherapy helps to revert the bone loss and prevent the complications. Methods: A randomized controlled trial was conducted at Kasturba Hospital, Manipal from January 2019 to December 2021 among postmenopausal women with osteoporosis. The postmenopausal women who attended the osteoporosis clinic and were within the age group of 45-65 years, could speak and understand English or Kannada, and whose Bone Mineral Density (BMD) score was between -1 and -3 were included for the study. The total sample size of the study was 120 with 60 in each of the experimental and control group. After obtaining the informed consent, stratified block randomization method was used to allocate the participants to intervention and control group. The BMD was monitored by the portable ultrasound densitometer by a technician at the outpatient departments. The baseline information was collected by a structured demographic questionnaire. Intervention group participants received Lifestyle Modification Intervention Program (LMIP) whereas control group received the standard regular care by the physician.  Follow up was done at three and six months. Results: The results revealed that the increase in the BMD median score among the experimental group was from -2.2 [(-2.5, -1.8)] to -1.5 [(-1.8, -0.65)] where as in the control group it was from -2.3 [(-2.6, -1.9)] to -2.0 [(-2.4, -1.5)].  The increase in the median score of the experimental group (0.7) was higher than in the control group (0.3). The results of Mann Whitey U test showed a statistical significance between the intervention and control groups in the post test after 6 months (U =.505.5, p<0.05). Wilcoxon signed rank test showed the significant change in both the intervention and control groups from pre-test to post-test I (3 months) and Post-test II (6 months) (p<0.001). Conclusion: The lifestyle modification intervention was found to be effective in improving the bone health status of postmenopausal women. Hence it is very important to integrate in regular therapy. Keywords: LMIP, postmenopausal women, bone health status, bone mineral density

Clinical profile of high-risk febrile neutropenia in a tertiary care hospital

BackgroundInfection in the immunocompromised host has been a reason of concern in the clinical setting and a topic of debate for decades. In this study, the aim was to analyse the clinical profile of high-risk febrile neutropenic patients.AimsTo study the clinical profile of high risk febrile neutropenia patients with the objective of identifying the most common associated malignancy, most common associated pathogen, the source of infection, to correlate the treatment and management with that of the Infectious Diseases Society of America (IDSA) 2010 guidelines and to assess the clinical outcome.MethodsA cross-sectional time bound study was carried out and a total of 80 episodes of high-risk febrile neutropenia were recorded among patients with malignancies from September 2011 to July 2013 with each episode being taken as a new case.ResultsNon-Hodgkin’s lymphoma (30 per cent) was the most common malignancy associated, commonest source of infection was due to central venous catheters, the commonest pathogens were gram negative (52 per cent) the treatment and management of each episode of high risk febrile neutropenia correlated with that of IDSA 2010 guidelines and the mortality rate was 13.75 per cent.ConclusionFebrile neutropenia is one of the major complications and cause of mortality in patients with malignancy and hence understanding its entire spectrum can help us reduce morbidity and mortality

BERBERINE HYDROCHLORIDE COULD PROVE TO BE A PROMISING BULLET AGAINST CLOSTRIDIUM DIFFICILE INFECTION: A PRELIMINARY STUDY FROM SOUTH INDIA

Objective: Recurrent Clostridium difficile infection (CDI) and the emergence of strains with reduced susceptibility to metronidazole and vancomycinwarrants alternative therapy. Hence, we tested the potential efficacy of the natural compound berberine hydrochloride (BBRHCl) against toxigenicC. difficile.Methods: Three representative polymerase chain reaction confirmed, toxin-positive strains were included in the study. Pulsed-field gel electrophoresis(PFGE) profile and antibiogram of the strains were analyzed along with 10 other toxin positive isolates. Efficacy of BBRHCl against toxigenic C. difficilewas determined using agar diffusion by punch well method.Results: PFGE grouped the test strains into three clusters with unique susceptibility pattern toward standard antibiotics. BBRHCl was efficaciousagainst the test strains at a concentration ranging between 6.25 μg/ml and 10 mg/ml. BBRHCl's breakpoint point inhibitory zone diameter wasequivalent (p<0.001) to the epidemiological cutoff values for teicoplanin, vancomycin and 2% black seed oil. Although the predicted concentration ofBBRHCl for breakpoint zone diameter equivalent to European Committee on Antimicrobial Susceptibility Testing's epidemiological cutoff value formetronidazole was observed to fall outside the tested concentration range; it was still within the safe dosage for humans.Conclusion: The present study is promising in considering BBRHCl as a potent substitute or adjunct not only for metronidazole, vancomycin andteicoplanin but also for natural compounds like 2% black seed oil for managing resistant cases of CDI. Owing to BBRHCl's direct antibacterial and antiinflammatoryaction, further investigations will aid in the proper characterization of the therapeutic effects of similar plant compounds, to developsafe and effective drugs against the epidemiological outbreak of CDI

Snake bite: An unusual cause of ischaemic stroke

Snake bite continues to be one of the major and potential contributors for morbidity and mortality in India. Intracranial haemorrhage causing neurological deficits is a known entity due to snake bite but presentation with infarction is rare. The authors report a case of a healthy middle aged female who presented within hours of envenomation with altered sensorium and evaluation revealed left hemiplegia with deranged coagulation profile and multiple ischaemic infarcts instead of haemorrhage as a consequence of vasculotoxic envenomation due to viper bite

Snake bite: An unusual cause of ischaemic stroke

Snake bite continues to be one of the major and potential contributors for morbidity and mortality in India. Intracranial haemorrhage causing neurological deficits is a known entity due to snake bite but presentation with infarction is rare. The authors report a case of a healthy middle aged female who presented within hours of envenomation with altered sensorium and evaluation revealed left hemiplegia with deranged coagulation profile and multiple ischaemic infarcts instead of haemorrhage as a consequence of vasculotoxic envenomation due to viper bite