Utility of bone marrow examination (BME) in the diagnosis of pyrexia of unknown origin (PUO).

Introduction: Bone marrow examination (BME) is a useful tool in the diagnosis of haematological and non-haematological diseases. It plays an important role in early diagnosis of the underlying cause of pyrexia of unknown origin (PUO) and can influence the management of patients. Bone marrow aspiration (BMA) plays a very important role in establishing a definitive diagnosis in cases of PUO.

A study to evaluate the hepatoprotective effect of N- acetylcysteine on anti tuberculosis drug induced hepatotoxicity and quality of life.

Background: Drug induced liver injury (DILI) is a serious adverse effect caused by first-line anti-TB (ATT) drugs, limiting the TB-treatment. The tissue inflammation induced by free radical burst and poor dietary intake in TB induces oxidative stress, which was proposed as one of the mechanisms responsible for ATT induced DILI. N-acetylcysteine (NAC) exerts a hepato-protective effect by enhancing the cellular antioxidant defense mechanism.

Is Single-stage Microvascular Reconstruction for Facial Mucormycosis Safe?

This is a retrospective therapeutic series of eight cases of facial mucormycosis treated over a 15-year period to determine the safety of simultaneous debridement and free-flap reconstruction in facial mucormycosis. Surgical debridement was done for three cases that presented acutely with systemic manifestations (group 1) and five cases that presented in the subacute phase without systemic manifestations (group 2). The debridement involved total maxillectomy with orbital exenteration in three cases, total maxillectomy with orbital preservation in two, and subtotal maxillectomy in three cases.

Recurrent Diabetic Ketoacidosis and Extreme Insulin Resistance Due to Anti-Insulin Antibodies: Response to Immunosuppression and Plasma Exchange.

Anti-insulin antibodies (IAs) in patients with insulin-treated diabetes, though common, correlate poorly with glycemic control, insulin requirement, and insulin resistance. We are hereby reporting the clinical course and challenges in the management of a 70-year-old man who had severe insulin resistance as evidenced by recurrent diabetic ketoacidosis and poor glycemic control despite treatment with >9 U of insulin/kg body weight per day. He was found to have anti-IAs and responded clinically to plasmapheresis and immunosuppression with mycophenolate mofetil and prednisolone.

Evaluation of Risk Factors for Development of Anti-Tubercular Therapy Induced Hepatotoxicity: A Prospective Study.

Background: Incidence of Antitubercular Therapy (ATT)-induced hepatotoxicity is higher in India when compared to Western countries. As the occurrence of ATT-induced hepatotoxicity is unpredictable, serial intensive monitoring of hepatic function is now being recommended by the American Thoracic Society in individuals at high risk. This study was done to evaluate the risk factors for the development of ATT induced hepatotoxicity in India.

Calvarial tubercular osteomyelitic abscess in an elderly.

Tuberculous osteomyelitis of skull is very rare, even in areas where tuberculosis is endemic. We herein describe an elderly woman who was apparently immunocompetent and presented with left frontal scalp swelling and right cervical lymphadenopathy. CT scan showed irregular bony destruction of the frontal bone.

Outbreak of scrub typhus in Andhra Pradesh--experience at a tertiary care hospital.

Aim: To describe the clinical features, laboratory manifestations, complications in patients diagnosed with scrub typhus at a tertiary care hospital in south India.

Material And Methods: All cases of acute onset fever diagnosed to have scrub typhus August 2011 to December 2012 were analysed. Cases of scrub typhus confirmed by the well felix test with a titre of 1 in 80 or more and a positive immunochromatography test were studied.

Ganciclovir-tenofovir interaction leading to tenofovir-induced nephrotoxicity.

Viral enteritis is an important gastrointestinal disorder in human immunodeficiency virus (HIV)-infected patients. Cytomegalovirus (CMV) is the most common opportunistic agent in these patients. As ganciclovir and tenofovir are the most commonly used drugs for the treatment of CMV and HIV infection, respectively, this case report showcases the potentiality of drug interaction as well as the safety measures to be taken when using these two drugs together in unavoidable situations.

Delayed onset renal failure in a patient on tenofovir based antiretroviral regimen.

Tenofovir is recommended as one of the first line agents in combination with other antiretroviral drugs for management of human immunodeficiency virus (HIV). It is known to cause renal failure after exposure for a median duration of 5 months. We report tenofovir induced adverse drug reaction in a 56-year-old female patient who was diagnosed to have HIV 1 infection since 10 years.

A rare presentation of progressive disseminated histoplasmosis in an immunocompetent patient from a non-endemic region.

Histoplasmosis is an important systemic fungal infection in endemic areas. In India, the disease has been reported from several parts of the country, most cases being from eastern India considered to be endemic for the disease. There have been very few cases reported from the state of Andhra Pradesh, in the southern part of India.

Burkholderia pseudomallei: an uncommon cause of bacteraemic pneumonia in a diabetic.

A 55-year-old woman presented with fever, breathlessness and shock. She was diagnosed to have diabetes mellitus (Type 2) after admission. Blood culture grew Burkholderia pseudomallei.

Immune reconstitution and inflammatory syndrome due to disseminated tuberculosis in a case of human immunodeficiency virus 2 infection.

We present a case of human immunodeficiency virus 2 (HIV- 2) infection with acquired immune deficiency syndrome with immune reconstitution and inflammatory syndrome due to disseminated tuberculosis. We address here the drug interactions between antiretroviral therapy and antituberculous treatment (ATT), choice of ATT, and duration of ATT when rifampicin is omitted as in our case. Though this problem is encountered rarely, we felt that it is important to report the issue to counter drug resistance in tuberculosis and HIV.

Methyl ethyl ketone peroxide ingestion: a rare cause of corrosive chemical poisoning.

Methyl ethyl ketone peroxide, commonly used in the lamination industry, is a highly inflammable substance. Ingestion of methyl ethyl ketone peroxide is associated with a high morbidity and mortality. It can cause injury to the gastrointestinal tract on ingestion, leading to gangrene or perforation.

Emergence of dengue virus type 4 (genotype I) in India.

Dengue is an emerging arboviral disease and currently poses the greatest arboviral threat to human health. In recent decades, there has been a substantial increase in dengue outbreaks in many parts of the world including India. We performed an in-depth investigation of a major dengue outbreak in Andhra Pradesh, southern India in 2007 by serology, virus isolation, RT-PCR and genotyping.

Clinical features and molecular diagnosis of Chikungunya fever from South India.

An epidemic of Chikungunya fever of unprecedented magnitude occurred in many parts of India in early 2006 after an interval of 33 years, and there has been a resurgence in some parts of South India since June 2007. The article highlights clinical manifestations of infection and various molecular tests that were used for diagnoses of Chikungunya virus infection. Of particular interest is the real-time loop-mediated isothermal amplification (RT LAMP) assay, which is rapid and cost-effective and can be adopted at ill-equipped laboratories.