20 research outputs found
Acute tubulo-interstitial nephritis leading to acute renal failure following multiple hornet stings
BACKGROUND: Hornet stings are generally associated with local and occasionally anaphylactic reactions. Rarely systemic complications like acute renal failure can occur following multiple stings. Renal failure is usually due to development of acute tubular necrosis as a result of intravascular haemolysis, rhabdomyolysis or shock. Rarely it can be following development of acute tubulo-interstitial nephritis. CASE PRESENTATION: We describe a young male, who was stung on face, head, shoulders and upper limbs by multiple hornets (Vespa orientalis). He developed acute renal failure as a result of acute tubulo-interstitial nephritis and responded to steroids. CONCLUSION: Rare causes of acute renal failure like tubulo-interstitial nephritis should be considered in a patient with persistent oliguria and azotemia following multiple hornet stings. Renal biopsy should be undertaken early, as institution of steroid therapy may help in recovery of renal functio
HLA typing in Vogt-Koyanagi-Harada syndrome in north Indian patients
Purpose: To report the HLA profile of VKH patients from India. Method: Forty-one patients and 50 controls were studied. Phenotyping using a lymphocytotoxi city assay was done for HLA-A and -B. DNA-based sequence-specific low resolution typing was done for HLA-DR and -DQ-loci. Results: HLA-A9 was over-represented in the patient population (p = 0.01), whereas HLA-A11 (p = 0.03) and HLA-DRB1*13 (p = 0.007) were found to be underrepresented. The frequency of HLA-DRB 1* 04 was 14.6% and 10% in the patient population and controls, respectively. The HLA-DQ frequencies did not differ significantly between patients and controls. Conclusion: Unlike that reported in most populations, we did not find a significant association between HLA-DRB1*04 and our patient population
Ocular signs predictive of tubercular uveitis
PURPOSE: To determine ocular signs predictive of tubercular uveitis. DESIGN: Retrospective, nonrandomized, comparative interventional case study. METHODS: Three hundred eighty-six patients with active uveitis were treated at a tertiary care single-center uveitis practice. Uveitis was presumed to be tubercular in patients who showed evidence of latent or manifest tuberculosis without any other known cause and who did not show recurrence of uveitis after 12 months of antitubercular therapy. One hundred eighty-two patients who thus obtained clinical diagnoses of presumed tubercular uveitis were enrolled in group A. Two hundred four patients with uveitis resulting from a nontubercular cause were enrolled in group B. Patients were monitored for the presence of types of keratic precipitates (mutton fat or fine), posterior synechiae (broad based or filiform), iris nodules, snowballs, snow banking, vasculitis (with or without choroiditis), serpiginous-like choroiditis, and other types of posterior uveitis (choroidal abscess, retinochoroiditis, or exudative retinal detachment) which were compared between the 2 groups. Statistical analysis was carried out at a 5% level of significance. The main outcome measures were clinical signs significantly associated with tubercular uveitis. RESULTS: Broad-based posterior synechiae, retinal vasculitis with or without choroiditis, and serpiginous-like choroiditis were seen significantly more commonly in patients with tubercular uveitis. Filiform posterior synechiae were more frequent in eyes with nontubercular uveitis. CONCLUSIONS: Broad-based posterior synechiae, retinal vasculitis with or without choroiditis, and serpiginous- like choroiditis in patients with latent or manifest tuberculosis in tuberculosis-endemic areas are suggestive of a tubercular cause of uveitis and merit specific treatment
Simultaneous choroidal tuberculoma and epididymo-orchitis caused by Mycobacterium tuberculosis
PURPOSE: To report positive polymerase chain reaction (PCR) for Mycobacterium tuberculosis from the vitreous and epididymal fluid in a patient of choroidal tuberculoma and epididymitis
Causes of DMARD withdrawal following ADR within 6 months of initiation among Indian rheumatoid arthritis patients
The present study was conducted in Indian rheumatoid arthritis (RA) patients prescribed disease-modifying anti-rheumatic drugs (DMARDs) to determine the incidence and type of adverse drug reactions (ADRs) leading to their withdrawal in the initial 6 months of therapy. This was considered important as pharmacogenetic variations in the pattern of RA in different populations and genetic differences in efficacy and safety to drugs demand separate studies to be conducted in different populations. Hospital records were used to identify 1,000 consecutive patients with RA fulfilling the American College of Rheumatology criteria and having at least 6-month follow-up. Age, gender, duration of arthritis, drug usage and ADR-related drug withdrawal were recorded from the charts. Most of the patients were put on single DMARD. Combined use of DMARD was less frequent and non-use of DMARD was common; however, disease control was good. The commonest DMARD used in our hospital was hydroxychloroquine 444 (44%) and the commonest combination used was methotrexate with hydroxychloroquine by 55 (6%). Sulphasalazine use showed preference to young and males. Supportive drugs used were NSAIDs by 883 (88%), corticosteroids by 646 (65%), paracetamol by 594 (59%) and amitriptyline by 88 (9%). Incidence of ADR-related DMARD withdrawal was maximum with leflunomide 2/15 (13.33%) followed by methotrexate 9/116 (7.76%), sulphasalazine 6/185 (3.24%), chloroquine 3/131 (2.29%) and hydroxychloroquine 8/444 (1.8%). Severity and symptomatology of disease, genetic pattern of patients, financial status, previous experience of the clinicians and patients, availability of drugs, patient expectations and compliance were the main factors that lead to a difference in pattern of therapy in our patients compared to other population
Cryptococcal meningitis in HIV infected: Experience from a North Indian tertiary center
Background: Cryptococcal meningitis is a common opportunistic infection
in Human Immunodeficiency Virus (HIV)-infected individuals. There is
little information specifically addressing cryptococcal meningitis in
HIV-infected patients from North India. Aims: To determine clinical
presentation, hospital course, response to treatment, complications
developed, in-hospital mortality, any recurrence of cryptococcal
meningitis and reasons of recurrence during follow-up. Settings and
Design: A retrospective observational study undertaken in a large
tertiary care center. Materials and Methods: Patient′s
demographic data, presenting clinical symptomatology, physical
findings, laboratory parameters, cerebrospinal fluid (CSF) examination
findings, side-effects of treatment, development of any complications
and hospital outcome were analyzed. During follow-up any recurrence of
cryptococcal meningitis, possible reasons of recurrence, type of
treatment received, complications developed and outcome was recorded as
well. Results: Forty patients diagnosed to have cryptococcal
meningitis were analyzed. Twenty-two (55%) patients had acute/ subacute
presentation. Thirty-six (90%) patients presented with headache and 18
(45%) had altered sensorium. Twenty (50%) patients had no cells in the
CSF. Hypoglycorrhchia was seen in 30 (75%) patients. Cryptococcal
meningitis was the first acquired immune deficiency syndrome
(AIDS)-defining illness in 30 (75%) patients. Thirty-five patients
developed some adverse effects to amphotericin-B. Thirty-three patients
improved with treatment while three patients died. Four patients had
recurrence of cryptococcal meningitis within six months of first
episode. Non-compliance of fluconazole therapy was the reason for
recurrence in all of these patients. Conclusions: Cryptococcal
meningitis is a common initial AIDS-defining illness. Acute and/or
subacute presentation of cryptococcal meningitis is not uncommon in
HIV-infected individuals. An early diagnosis of HIV infection might
reduce the incidence of this infection