Vulvar myiasis: a rare case report

Myiasis is the parasitic infestation of dipterous larvae (maggots) in humans and other vertebrate animals. Maggots are commonly seen on exposed body parts but it is very rare to find on covered body parts like external genitalia. Diagnosis and treatment are simple. We hereby present a rare case of vulvar myiasis in a young unmarried girl living in rural area in conditions of poor hygiene.

Comparative evaluation of antigen detection ELISA and reverse transcriptase PCR in acute stage of Japanese encephalitis prevalent in endemic areas of North-Eastern part of Uttar Pradesh, India

Background: Objective of current study was to compare and evaluate different diagnostic tests to establish a reliable and less time consuming diagnostic test for prompt diagnosis of acute Japanese encephalitis cases mainly amongst children and young adults from North-Eastern part of Uttar Pradesh.  Methods: A total of 100 subjects, including 50 suspected cases and 50 diseased controls were investigated to establish the diagnosis of JE in acute encephalitis patients. All CSF samples were subjected to MAC-ELISA, virus cultivation and RT-PCR.Results: Out of 50 cases, 6 showed negative results by all the three tests. 50% (22 out of 44), 47.5% (21 out of 44), and 66% (23 out of 44) were found positive by MAC-ELISA, Virus cultivation and RT-PCR respectively. The rate of detection by Virus cultivation and RT-PCR was higher in case of MAC-ELISA negative cases (57.1% and 78.5%) than that of MAC-ELISA positive cases (22.7% and 27.2%) respectively. Mean age of the patients was 12.5 years, which ranged from 1-24 years with male to female ratio of 3:1.Conclusions: The RT-PCR was found most reliable, sensitive and specific method amongst the three chosen methods for detection of JEV in suspected encephalitis patients

Myxoedemic coma: an uncommon presentation of Sheehan syndrome

This is a rare case of a 35 year old multiparous female who presented with electrolyte abnormality, hyponatremia in a setting of seizure and moderate pallor. She had a significant past history of childbirth complicated with post-partum haemorrhage after which she developed secondary amenorrhoea and lactation failure. Workup showed suppressed levels of all pituitary hormones and was treated as myxoedemic coma. A diagnosis of Sheehan’s syndrome presenting as myxoedemic coma - a rare but emergency presentation was made

Chronic pelvic pain in women: comparative study between ultrasonography and laparoscopy as diagnostic tool

Background: Chronic pelvic pain is a major cause of morbidity among the reproductive age group women. The study on patients of chronic pelvic pain aimed to compare the diagnostic accuracy of ultrasonography and laparoscopy in these patientsMethods: The study was conducted on 100 patients of chronic pelvic pain attending the gynaecology outdoor and were subjected to thorough clinical examination followed by ultrasonography and laparoscopic examination.Results: Maximum number of cases of chronic pelvic pain belonged to 25-30 years, were parous with mean duration of pain of 15.2 months. The most common complaint was vaginal discharge (70%) followed by menstrual irregularity. On clinical examination, pelvic tenderness was observed in majority (60%) of cases. USG examination showed chronic pelvic inflammatory disease in 43% cases followed by myoma (8%), ovarian cyst (5%), endometriosis (6%), pelvic congestion (5%) and no abnormal pathology in 25% cases. On laparoscopic examination, chronic pelvic inflammatory disease was present in 47% cases followed by endometriosis (11%), pelvic congestion (8%), myoma (8%), adhesions (7%) while 13% cases showed normal findings.Conclusions: Laparoscopy is more effective than ultrasonography as a diagnostic tool in patients of chronic pelvic pain.

Acute intermittent porphyria with syndrome of inappropriate antidiuretic hormone secretion (SIADH) and neurological crisis, successfully treated with haemodialysis

We report a 35 years old male, a case of Acute Intermittent Porphyria (AIP) with Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH) and neurological crisis for its rarity. Since specific parenteral medication (hemin) was not available, patient was empirically treated with haemodialysis with satisfactory outcome

Echocardiographic assessment of the impact of cardiovascular risk factors on left ventricular systolic function in patients with acute myocardial infarction

Background: Objectives of current study were to determine the magnitude of left ventricular systolic dysfunction in patients with acute myocardial infarction in the rural sub-population of Uttar Pradesh in India and to evaluate the impact of cardiovascular risk factors on the risk of impairment of left ventricular systolic function. Methods: One hundred and fifty seven consecutive patients with first acute myocardial infarction were enrolled into the study. Most patients were male (73.2%) and the mean age of presentation was 52.7 years. Two dimensional echocardiography was utilized to assess conventional parameters such as Left Ventricular End-Diastolic Diameter (LVEDD), Left Ventricular End-Systolic Diameter (LVESD), LV End-Diastolic Volume (LVEDV), LV End-Systolic Volume (LVESV) and Left Ventricular Ejection Fraction (LVEF). The LV volumes (end-systolic and end-diastolic) and LVEF were calculated from the conventional apical two-and four-chamber images using the biplane Simpson’s technique. LV systolic function was considered depressed when LVEF was less than 45%. The chi-square test was used in the statistical analysis to compare proportions and a logistic regression model was used to assess the independent effect of the each variable.Results:The study projects a high proportion (42.7% of the patient population) of left ventricular systolic dysfunction in patients with Acute Myocardial Infarction (AMI). No association was found between gender or age and LV systolic dysfunction. The proportion of patients with diabetes mellitus was higher in the sub-group of patients with impaired LV systolic function (45.2% vs. 30.2%, P = 0.01); the proportion of patients with history of current or past smoking was also higher in the sub-group of patients with impaired LV systolic function (48.9% vs. 34.2%, P = 0.03). On the other hand, hypertension and dyslipidemia were not associated with impaired LVEF. After adjustment of other variables, diabetes and smoking were associated with a significantly higher risk of LV systolic dysfunction (diabetes: OR = 3.73; 95% CI = 1.25-11.16; smoking: OR = 3.8; 95% CI = 1.37-11.05).Conclusion:Since the proportion of patients with LV systolic dysfunction in patients with AMI remains relatively high, LV systolic function variables such as LVEF and LVESV should be echocardiographically evaluated in all patients with AMI. Since the post-infarction LV systolic function remains the single most important determinant of survival, treatment of AMI patients should be aimed at limitation of infarct size and prevention of ventricular dilation. Moreover, cardiovascular risk factors such as diabetes mellitus and smoking have a significant impact on the likelihood of impairment of LV systolic function in patients with AMI and hence could influence long-term prognosis.

Atrial fibrillation associated with high voltage electric shock in a young healthy female: a case report

Atrial fibrillation is amongst the various arrhythmias resulting after electrical injury but its incidence has been reported to be extremely rare. Here we are reporting a case of 35 years old lady presenting to our Emergency department with atrial fibrillation with fast ventricular rate after accidentally being injured by high voltage electrical current. She was managed successfully with pharmacological cardioversion followed by a period of observation. The rhythm reverted back to normal sinus rhythm on 3rd day. This approach of management is amongst one of the few published cases where patient was managed conservatively

Study of hair dye poisoning and its outcome in tertiary care rural institute

Background: Hair dye poisoning is not rare but is an emerging poisoning in India. The main component of hair dye causing toxicity is para phenylene diamine (PPD). Due to its easy availability and low cost, it is becoming a common mode of self-poisoning in rural area. A prospective study was planned to assess the clinical profile and outcome in patients with hair dye poisoning.Methods: This prospective observational study was conducted on 260 patients of para-phenylene-diamine (hair dye) poisoning, hospitalized in the medical unit of UP Rural Institute of Medical Science and Research, Saifai from January  2011-2014 over a period of  4 years. The diagnosis of PPD poisoning was based on history of ingestion and clinical manifestations. All cases were thoroughly evaluated for different complications and were treated accordingly.Results: Out of 260 cases enrolled, majority were females and were in the age group of 21-30 years. The intent of poisoning was suicidal in 100% cases. Cervico-facial edema was the most common presentation followed by respiratory distress, hypotension and generalised bodyache. Nephro-toxicity was observed in 58.46% cases. Myocarditis was observed in 11.53% cases. Mortality in PPD poisoning was high (21.53%) due to cardiotoxicity and renal failureConclusions: Hair dye (PPD) poisoning is hepato-nephro as well as myo and cardiotoxic.

Chronic complications in newly diagnosed patients with type 2 diabetes mellitus in rural area of western Uttar Pradesh, India

Background: Diabetes is a serious public health problem that threatens the quality of life. Studies have shown that its prevalence is rapidly increasing. In India many studies have been done on diabetes and its complications but most of the studies have been done in urban area. There is limited data on diabetes from rural area. Our study is an attempt to provide data on diabetes in rural area that will guide health care professionals in managing the disease appropriately. The aim of the study was to determine the prevalence of chronic complications in newly diagnosed type 2 diabetes mellitus (T2DM) patients from rural area of western Uttar Pradesh, India.Methods: The study was conducted on 306 newly diagnosed type 2 diabetes mellitus patients. Each patient was screened for diabetic complications, hypertension, dyslipidemia, and body mass index. Standard protocols were used to make the diagnosis of retinopathy, neuropathy and nephropathy.Results: There were 174 males and 132 females. Majority were less than 60 years of age. 20.26% of patients had neuropathy 15.36%, retinopathy and 5.56%, nephropathy. Risk factors of macro-vascular complication such as hypertension, obesity, and dyslipidemia were observed in 38.9, 55.9%, and 54.6% of patients respectively. Coronary artery disease was noticed in 9.15%.Conclusions: Present study shows that high prevalence of micro vascular complications was present at diagnosis along with cardiovascular risk factors among T2DM patient from rural area of western Uttar Pradesh, India.

Sphingobacterium multivorum causing fatal meningoencephalitis: a rare case report

We report a case of fatal meningitis caused by bacteria, Sphingobacterium multivorum, probably first time being reported from India. S. mulivorum has been isolated from various clinical specimens but it is only rarely been associated with serious infections. Sphingobacterium species are generally resistant to aminoglycosides and polymyxin B. Susceptibility to β-lactam antibiotics is variable, requiring testing for individual drug. This 36 year male had two weeks history of high-grade fever with altered sensorium and occasional seizures. Patient admitted with septicemia and subsequently developed meningitis and succumbed to his illness after being discharged against medical advice. His CSF culture yielded S. multivorum subsequently confirmed by mini API, bioMérieux Inc. Marcy-l’Etoile France. Due to its rare association with common clinical conditions, it requires a high degree of suspicion and expertise to prove its presence in clinical specimens. Since this bacterium is inherently resistant to many classes of antibiotics, a vigilant and efficient microbiological work up is needed to establish its diagnosis and prompt treatment