| Tropical Diseases |
1. Coagulation Profile in Plasmodium Falciparum Malaria Infection D Srinivas, AK Behera, PK Padhi, BK Barik Aims and Objective : To observe the incidence of alteration in coagulation profile parameters in falciparum malaria infection and correlation of the above with the severity of the disease in patients admitted during the period of June 2005 to January 2007. Materials and Methods : In the present study 40 cases of slide positive plasmodium falciparum cases admitted in the Department of General Medicine were included at random. All the patients were subjected to detailed history taking and clinical examination at the time of presentation with special emphasis on particular complications. Total plates count, prothrombin time, activated thromboplastin time and serum fibrinogen level were estimated as coagulation profile parameters along with routine investigations. All the cases were evaluated at the time of discharge and were followed up at 1 month, 3 months and 6 months time. Observation : The clinical course of 40 slide positive falciparum malaria cases were studied. It was observed that all cases (100%) of falciparum malaria, both complicated and uncomplicated had abnormality in one or more of the coagulation parameters. The correlation between abnormalities of the coagulation parameters with the severity of the disease was not significant (p > 0.005). Bleeding manifestations were observed when more than two parameters were abnormal though the correlation was not significant. Conclusion : The present study was an endeavor to identify a major disorder that is associated with plasmodium falciparum malaria infection which will not only help to prognosticate the disease but also can lead to comprehensive approach for better management of this complex disease. 2. Serum Cortisol Levels in Malaria : A Hospital Based Study GC Nayak, PK Behera, A Devi Malaria affects almost all organs of body. The endocrine glands
are o exception. Pituitary-Thyroid axis abnormalities and
parathyroid dysfunction does occur. By contrast, the pituitaryadrenal
axis appears normal in acute malaria. Many studies have
been done to study the behaviour of pituitary-adrenal axis in
acute malaria. We have tried to study the cortisol level in both
complicated and severe malaria cases. A total of 85 Cases (50 3. Hypocortisolism : Case Report – A Lesson to Learn R Subramanian, BC Pruthvi, B Jayaprakash, NR Rau A 49 year old male had presented to us with a history of weight loss and weakness of 3 months duration. Examination was remarkable for evidence of palor with right sided pleural thickening. Investigations revealed a high ESR with normal renal, liver and metabolic parameters. Chest X-ray was suggestive of fibrothorax on the right side and USG abdomen was within normal limits. Mantoux was negative and serology for retrovirus was negative. A screening cortisol showed a low normal value and TSH levels were within normal limits. Patient was not willing for synacthen test and in the background of respiratory findings and high ESR, he was started on ATT and steroids at physiologic doses. There was a marked symptomatic improvement and regular follow up was advised. He was lost for follow up but 3 months later, he presented to us with altered sensorim and menigeal signs, though he was compliant with medications. A CT Head was done which showed a large axial lesion with evidence of obstructive hydrocephalus. A neurosurgical intervention was undertaken and the HPE reports were suggestive of a craniopharnygioma. 4. Variance in Complications amongst Vivax and Falciparum Malaria : A Study at CIMS LN Singh, AM Deshkar, HL Thakur, SN Somawar, AV Sinha Every year malaria is responsible for around 2.5 million deaths. The mortality is contributed to complications arising from it. Identifying them and treating it adequately at tertiary level is the need of hour. It is a cross sectional comparative study carried out in the Department of Medicine Chhattisgarh Institute of Medical Sciences, Bilaspur encompassing 60 patients admitted from July 2006 to May 2007. Each patient on admission was subjected to CBC, QBC antigen test, renal and liver profile. Glasgow coma score was noted on neurological evaluation. All the cases were treated adequately with combination therapy. Amongst falciparum cases mean Glassgow coma socre was 8.57, mean coma resolution time 2.96 days, parasite clearance on day four was 33% and antigen clearance after two weeks was 34%. The percentage of cases in falciparum having jaundice was 48.57 and those with severe anaemia was 34.28. Patients with derangement in acid base balance depicting metabolic acidosis was 31.42%. Amongst vivax cases the mean Glassgow coma score was 13, mean coma resolution time was 2.1 days. Parasite clearance on day four was 76% and antigen clearance after two weeks was 52%. Amongst vivax cases patients exhibiting jaundice were 24% and those with severe anaemia were 22.32%. Metabolic acidosis was exhibited in 6% of vivax cases. We conclude that inspite of adequate treatment with antimalarial, hemodynamic support, ventilation, dialysis, the incidence of complications amongst falciparum cases was significantly more. We advise chemoprophylaxis in the endemic areas in Bilaspur to reduce complications. 5. Cystic Echinococcosis Simulating Lung Abscess RK Singh Cystic echinococcosis, a zoonotic disease, is prevalent globally. Though causative helminth – echinococcus granulosus complements its cycle between dog and sheep, man is an occasional intermediate host. Incidence of lung involvement is second to liver involvement. Patients’ presentation various from asymptomatic to varied respiratory symptoms. A 21 year old patient presented with recurrent cough and haemoptysis for the last two years. His previous CXR showed large circular shadow in left middle zone. He had been treated with antibercular drugs and also various antibiotics for that circular shadow in CXR. Clinical examination revealed absence of clubbing, anaemia, icterus and cyanosis. CXR revealed solitary large thick wall cavitary lesion filled with fluid and air simulating lung abscess. ESR was 35 mm 1st hour. Total WBC count was 9800/cmm with eosinophils 10%. Sputum culture was sterile for aerobic and anaerobic bacteria. Serological test for cystic echinococcosis showed IgG-2.9 (normal value < 1.1). He was treated with 40cyclic doses of Albendazole with radiological clearance of lung shadow. Pulmonary echinococcosis is a lethal condition. Although diagnosis of cystic echinococcosis is by imaging methods but sometimes, radiological shadows simulate other pulmonary conditions, in such situation serological tests do help. 6. Kikuchi – Fujimoto Disease : A Clinical Mimic of Tuberculosis – Case Report RM Prashanth, U Sundar, S Chavan, MS Adwani, M Kushe,
ME Yeolekar Background : Kikuchi’s disease or acute necrotizing histiocytic lymphadenitis is a self-limited clinicopathological entify of unknown cause presenting as PUO with cervical lymphadenopathy affecting young females. Clinical and CT findings closely mimic lymph node tuberculosis. Case Report : Nineteen year old female presented with high grade intermittent fever of two weeks duration and tender right cervical non-matted lymphandenopathy with normal systemic examination. Antitubercular drugs were started following CT and USG report suggestive of tuberculosis (Central necrosis), persistent fever, negative cultures, and negative autoimmune workup. FNAC was not contributory due to persistant fever, excision biopsy was done which showed acute necrotizing lymphadenitis suggestive of Kikuchi Fujimoto disease 2 weeks into AKT therapy, patient developed drug induced hepatitis, which resolved 2 weeks after withdrawal of AKT. Learning points :
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7. Mild Cognitive Impairment – Prevalence and Treatment in Elderly Patients with Chronic Diseases P Paul Introduction : The age related physicological changes are seen from the age of 50 years and above. The decline in the age-related intellectual functions such as memory, concentration and attention is well known. A Cross-sectional study done in Indian population showed that the prevalence of Mild Cognitive Impairment (MCI) is 14.89% in elderly patients. However, it is not yet known whether elderly patients suffering from chronic diseases like diabetes and hypertension are at an increased risk of MCI. Objective : 1) To evaluate the incidence of mild cognitive impairment in patients suffering from chronic diseases. 2) To evaluate safety and efficacy of Piribedil (Trivastal L. A.) in patients presenting signs and symptoms of mild cognitive impairment. Method : A prospective, clinic-based epidemiological survey was conducted across various cities of India, which aimed to collect the presence/absence of symptoms of mild cognitive impairment in patients with chronic diseases. Simultaneously a prospective, open label phase-IV clinic-based study was also conducted across various cities of India to evaluate the efficacy and safety of Piribedil in patients suffering from memory impairment, concentration and other signs and symptoms of mild cognitive impairment. The questionnaire for the survey and the evaluation criteria for the study were standardized as per protocol approved by all the participating investigators. Both survey and the study were conducted simultaneously from October 2005 till September 2006. Results : Thirty eight physicians from 24 cities participated in the survey. Out of 108 patients (average age – 62.50 years), 16 had diabetes, 39 had hypertension and 44 had both. The prevalence of MCI (MMSE score ≥ 24.00) in these patients was found to be 52.80% and the mean MMSE score was 23.18 (± 5.45). Sixty four physicians from 39 cities participated in the study and 184 patients (average age – 67.20 years) were enrolled. There was a marked improvement in the signs and symptoms of mild cognitive impairment in majority of the patients (the mean MMSE score improved from an average of 17.64 to 25.57), after treatment with Piribedil. The tolerance for Piribedil was also excellent in all the cases. Conclusion : The survey results show that elderly patients with history of chronic diseases are at an increased risk of mild cognitive impairment. The study confirmed that in such patients Piribedil provides an effective and safe treatment option. |