Profile of organ dysfunction and predictors of mortality in severe scrub typhus infection requiring intensive care admission.

Background And Aims: Scrub typhus, a zoonotic rickettsial infection, is an important reason for intensive care unit (ICU) admission in the Indian subcontinent. We describe the clinical profile, organ dysfunction, and predictors of mortality of severe scrub typhus infection.

Materials And Methods: Retrospective study of patients admitted with scrub typhus infection to a tertiary care university affiliated teaching hospital in India during a 21-month period.

Supraphysiological 25-hydroxy vitamin D3 level at admission is associated with illness severity and mortality in critically ill patients.

We studied the association between admission serum 25-hydroxy vitamin D3 level and in-hospital mortality in a prospective cohort of critically ill patients admitted to the medical intensive care unit of a tertiary care referral center. Of the 180 patients enrolled, 129 were included. Vitamin D3 deficiency was observed in 37% (n = 48) and supra-physiological levels (≥250 nmol/L) in 15.

Clinico-epidemiological profile of seven adults with spotted fever from a tertiary care hospital in South India.

Spotted fever (SF), a tick-borne rickettsial infection, is being increasingly reported from mainly northern Indian states. A lack of awareness and confirmatory laboratory tests underestimate the incidence of this infection which, in India, is predominantly seen during the rainy season. Many patients diagnosed with viral exanthematous illnesses may be suffering from SF, which is treatable if detected early.

Central nervous system involvement in scrub typhus.

Scrub typhus is an emerging infectious disease in India. Among its protean clinical manifestations, central nervous system involvement is common. In this prospective observational study, altered sensorium, headache, seizures and aseptic meningitis were found to be common central nervous system manifestations.

Cleistanthus collinus poisoning.

Cleistanthus collinus, a toxic shrub, is used for deliberate self-harm in rural South India. MEDLINE (PUBMED) and Google were searched for published papers using the search/ MeSH terms "Cleistanthus collinus," "Euphorbiaceae," "Diphyllin," "Cleistanthin A," Cleistanthin B" and "Oduvanthalai." Non-indexed journals and abstracts were searched by tracing citations in published papers.

Cartap hydrochloride poisoning: A clinical experience.

Cartap hydrochloride, a nereistoxin analog, is a commonly used low toxicity insecticide. We describe a patient who presented to the emergency department with alleged history of ingestion of Cartap hydrochloride as an act of deliberate self-harm. The patient was managed conservatively.

Acute myocardial injury and rhabdomyolysis caused by multiple bee stings.

Massive envenomation by honey bees is capable of causing multiorgan dysfunction as a result of direct toxic effect of massive envenomation and secondary to systemic anaphylactic reactions. Acute myocardial ischemia due to bee envenomation is a rare event. We report the case of a 65 year old lady who presented with acute myocardial ischemia, severe rhabdomyolysis and angioedema following massive bee envenomation.

Mixed connective tissue disorder and Castleman's disease.

We present a 16-year-old girl who presented with polyarthritis in association with Raynaud's phenomenon, malar rash, oral ulcers, photosensitivity and alopecia of 6 months duration. On evaluation, it emerged that she had a mixed connective tissue disorder with a mesangio-proliferative glomerulonephritis. Her Chest radiograph revealed a well defined left mid and lower zone opacity with evidence of a hilar mass on CT Thorax.

Clinical profile and outcome of patients hospitalized with dimethyl and diethyl organophosphate poisoning.

Unlabelled: The two major classes of organophosphate compounds, dimethyl and diethyl organophosphates, have different toxicokinetic properties. This study evaluated the clinical profile and outcomes in patients admitted with poisoning with these two classes of organophosphates.

Methods: This retrospective study spanned 6 years (2002-2007).

Acute undifferentiated febrile illness in adult hospitalized patients: the disease spectrum and diagnostic predictors - an experience from a tertiary care hospital in South India.

Local prevalences of individual diseases influence the prioritization of the differential diagnoses of a clinical syndrome of acute undifferentiated febrile illness (AFI). This study was conducted in order to delineate the aetiology of AFI that present to a tertiary hospital in southern India and to describe disease-specific clinical profiles. An 1-year prospective, observational study was conducted in adults (age >16 years) who presented with an undifferentiated febrile illness of duration 5-21 days, requiring hospitalization.

Acute kidney injury in tropical acute febrile illness in a tertiary care centre--RIFLE criteria validation.

Background: Acute febrile illnesses are a common cause of tropical acute kidney injury (AKI). The incidence and severity of AKI in tropical febrile illnesses and validity of RIFLE classification are unclear.

Methods: Consecutive adult inpatients of a tertiary hospital in southern India with tropical acute febrile illness between January 2007 and January 2008 were prospectively studied for the incidence and severity of AKI based on RIFLE classification and its association with mortality and dialysis requirement.

The clinical profile and association of delirium in geriatric patients with hip fractures in a tertiary care hospital in India.

Introduction: Delirium is common in hospitalized geriatric patients with hip fractures. A number of peri-operative predisposing and postoperative precipitating factors have been identified in Western literature but data regarding this problem within the Indian context is scarce.

Method: The objectives of the study were to ascertain the incidence of delirium in geriatric patients admitted for the treatment of hip fractures in the Department of Orthopaedics of a tertiary care referral centre in South India, to delineate their clinical profile and identify probable contributing factors for development of delirium in this group of patients.

A clinical study of renal tubular dysfunction in Cleistanthus collinus (Oduvanthalai) poisoning.

Introduction: Self-poisoning through the ingestion of Oduvanthalai is common in South India. Mortality may occur because of arrhythmias, renal failure, shock, and respiratory distress. The mechanisms of toxicity are unclear.

Scrub typhus: an unrecognized threat in South India - clinical profile and predictors of mortality.

Scrub typhus is an important cause of acute undifferentiated febrile illnesses in the Indian subcontinent. Delay in diagnosis and in the initiation of appropriate treatment can result in severe complications such as acute respiratory distress syndrome (ARDS), septic shock and multisystem organ failure culminating in death. We conducted a prospective, observational study to delineate the clinical profile and predictors of mortality in scrub typhus in adults admitted to the medical wards of a tertiary care, referral hospital in South India over a one-year period.

Sternal tuberculous osteomyelitis presenting as a pulsatile swelling.

Primary sternal tuberculous osteomyelitis is a rare form of tuberculous osteomyelitis. We report a case of a young adult with primary tuberculous osteomyelitis of the sternum who presented with a pulsatile anterior chest wall swelling. Computed tomography of the thorax revealed a hypodense lytic lesion in the body of the sternum that had eroded into the anterior mediastinum where it lay in close contact with the right ventricle, resulting in the clinically evident transmitted pulsations.

Peduncular hallucinosis in 'top of the basilar syndrome': an unusual complication following coronary angiography.

Cerebral thromboembolism is a potential, although rare, complication of coronary angiography. An elderly woman presented with visual hallucinations, features of bilateral third nerve palsy, impaired vertical and horizontal gaze and mild motor weakness of the left upper limb, following diagnostic coronary catheterization. These findings suggested the anatomical location of the lesion to lie in the caudal midbrain, which was confirmed on computed tomography of the brain.

Amikacin-induced type 5 Bartter-like syndrome with severe hypocalcemia.

Aminoglycoside-induced renal toxicity is well known and may manifest with nonoliguric renal failure or renal tubular dysfunction. Aminoglycoside-induced renal tubular dysfunction could result in diffuse damage or manifest as a Fanconi-like syndrome, Bartter-like syndrome, or distal renal tubular acidosis. We discuss a patient who developed severe renal tubular dysfunction secondary to short-term therapy with Amikacin, resulting in refractory hypokalemia, hypocalcemia, hypomagnesemia, metabolic alkalosis, and polyuria.

The clinical profile and predictors of mortality in patients with melioidosis in South India.

Melioidosis is an underdiagnosed and underreported disease in India with protean clinical manifestations. Mortality in this study population was 17%. The predominant risk factor for melioidosis was diabetes mellitus.

Multifocal idiopathic fibrosclerosis mimicking tuberculosis of the abdomen.

We present a 13 year old girl from Assam who had been treated as abdominal tuberculosis for 2 years due to the presence of refractory lymphocyte-predominant ascites and multiple small bowel strictures associated with significant anorexia and weight loss. On evaluation she was found to have retroperitoneal fibrosis with hydroureteronephrosis, mediastinal fibrosis and a retro-orbital pseudotumour. Based on these findings the diagnosis of Multifocal Idiopathic Fibrosclerosis (MIFS) was made.

Hantavirus infection: a case report from India.

The clinical presentation of hantavirus infections in India is unclear. We report here a case of hantavirus infection in a 46 year old quarry worker presenting with fever, abdominal pain, jaundice, thrombocytopenia and renal dysfunction. Seroconversion and rising anti-hantavirus IgG titers were taken as evidence of hantavirus infection.