Hashimoto's encephalopathy is a controversial and under-recognized condition, associated with autoimmune thyroiditis. Presentation may be an insidious development of cognitive impairment or recurrent acute episodes of focal neurological deficit with confusion. Here, we present a case of middle-aged female that presented with headache, vomiting with alteration of sensorium and left side weakness and responded well to steroids. A negative microbiological screen of the cerebrospinal fluid (CSF) and serum along with raised CSF protein, elevated serum antithyroid antibodies, and characteristic electroencephalographic and neuroimaging findings yielded the diagnosis.

Strongyloides stercoralis is an intestinal nematode acquired primarily in the tropics, estimated to infect approximately 100 million people worldwide. Strongyloidiasis can be asymptomatic in many individuals or present in a variety of ways including acute infection, chronic infection, hyperinfection, and disseminated infection. We present a case where recurrent pneumonia was being evaluated and later found to be due to strongyloides hyperinfection syndrome and successfully treated with ivermectin. A 74-year-old female background of seasonal bronchitis, recurrent lower respiratory tract infections presented to us with Gram-negative bronchopneumonia which was treated but recurred after a few days. Investigations were ongoing for fungal infections when we picked up the S. stercoralis hyperinfection. In tropical regions, the regional prevalence of strongyloides infection may exceed 25%. Strongyloides hyperinfection describes the syndrome of accelerated autoinfection, generally the result of an alteration in immune status. Hyperinfection syndrome is estimated to happen in 1-2.5% of the patients with strongyloidiasis. Hyperinfections are often complicated, and gut flora gain access to extraintestinal sites, presumably through ulcers induced by the filariform larvae or by virtue of being carried on the surface or in the intestinal tract of the larvae themselves. Our patient did not have symptoms of strongyloides or reasons for immunosuppression. She only could have been immunosuppressed due to age or possible steroid use for seasonal bronchitis. We want to point out that strongyloides hyperinfection is a possible cause of recurrent Gram-negative pneumonia and sepsis. Parasitic infection screening must be done in all patients in our country who are admitted with severe sepsis.

Background and Objectives: Chronic obstructive pulmonary disease is a common problem in both developed and developing nations. It is directly linked with smoking. It is associated with frequent exacerbations and then hospitalizations. A large percent of Gross domestic product is spent on its management. We conducted a hospital-based study in such patients who got admitted with exacerbation, whether infective or noninfective, and who required invasive ventilation during management. Such kind of study has not been reported from our country so far. The aim of this study is to determine the prevalence, etiology, and sensitivity of infective exacerbations and its impact on the outcome with the use of invasive ventilation. Materials and Methods: We enrolled 150 admitted patients for the study and recorded their clinical and laboratory parameters. The respiratory specimen was obtained by different ways and sent for culture and drug sensitivity. The outcome was noted with the use of invasive ventilation, and prognostic values of different variables were ascertained. Results: The infective exacerbation was seen in 65% and organisms involved were Gram-negative bacteria, with a predominance of Acinetobacter in 35%, Klebsiella in 32%, Pseudomonas in 17.5%, and Escherichia coli in 5%. The number of hospitalization days of the 150 patients ranged from 5 to 40 days with a mean of 16.39 ± 11.45 days. The number of Intensive Care Unit days range was 0-25 days with a mean of 7.35 ± 7.9 days. The number of days of invasive ventilation range was 2-18 days with a mean of 3.28 ± 5.2. The number of days on Bi-level positive airway pressure ventilation (BiPAP) was between 2 and 22 with a mean of 6.15 ± 5.7 days. The outcome was significant between the survivors/nonsurvivors in terms of a number of days of invasive ventilation required (P < 0.004). Conclusion: There was higher mortality among patients admitted with multiorgan dysfunction and multiple infiltrates on chest X ray, and there was significant advantage in outcome on invasive ventilation.

Background and Objectives: Treatment responsiveness to pegylated interferon-α and ribavirin against hepatitis C virus genotype 1 has strongly been associated with two single nucleotide polymorphisms (rs8099917 and rs12979860) in the region of the interleukin 28B (IL28B) gene. The aim was to perform three genotyping methods and evaluate their specificity, technical characteristics, and costs. In addition, the distribution of both polymorphisms in an Uruguayan population was assessed. Materials and Methods: One hundred DNA samples were genotyped by allele-specific polymerase chain reaction (AS-PCR), real-time PCR high resolution melting (RT-HRM), and Sanger sequencing methods. Results: The rs12979860 CC genotype, followed by the CT, was the most prevalent (52% and 39%, respectively). For rs8099917, the TT genotype was the most common (61%) followed by the GT (34%). AS-PCR and RT-HRM assays were specific for both IL28B genotypes determinations and showed a total concordance with Sanger sequencing results. Conclusions: Any of three genotyping methods is suitable for IL28B genotyping. The choice of the assay will depend on costs, special equipment availability, turnaround time, and specialized human resources.

Infections caused by hepatitis C virus (HCV) lead to persistent infection in most of the times and may cause fibrosis of liver, cirrhosis and hepatocellular carcinoma. At present, there is no vaccine available for prevention or treatment of it. With the development of newer and effective anti viral drugs, most of the infections are curable. But a proportion of infections may progress to cirrhosis of liver /or hepatocelllar carcinoma in spite of being cured from the infection. So, early diagnosis of HCV infections and treatment with effective antiviral drugs is required for prevention of end stage liver disease.

Emphysematous pyelonephritis (EPN) is a rare form of renal suppuration. It is associated with a high mortality in the absence of rapid and effective treatment. Nephrectomy is suggested as the reference treatment associated to medical treatment. However, medical treatment exclusive is a conservative therapeutic option which is effective and successful in some cases. Many clinical and radiological criteria must be analyzed and gathered; we describe three cases of EPN treated successfully with medical treatment alone in two cases and associated to nephrectomy in one case.

Background and Objectives: Appropriate empiric antibiotic therapy in patients with severe community-acquired pneumonia (CAP) is crucial in terms of outcome. International guidelines suggest combination therapy (CT) for CAP patients admitted to Intensive Care Units (ICU). However, that type of combination of antibiotics is not clear. This study aims to determine the empiric antibiotic treatment of severe CAP in two periods. Our hypothesis was that macrolide use has decreased in the recent years. Materials and Methods: We compared in two prospective similarly designed cohort studies (1) CAP in ICU (2000-2002) and (2) H1N1 SEMICYUC (2009-2011) of critically ill patients with CAP: (a) Rate of CT and (b) use of macrolide or quinolones in each period. Demographic, severity of illness and clinical data were recorded. Chi-square test (categorical variables) and Student's t-test (continuous variables) were used. Results are shown as median, standard deviation, odds ratio, and 95% confidence interval. P < 0.05 was considered. Results: We included 1059 patients, 529 (49.9%) in the first period and 530 (50.1%) in the second period. The severity of illness and mortality rate was not different between periods. In overall, 866 (81.7%) received CT and this therapy was more frequent in the second period (85.3% vs. 78.3%, P < 0.003). A significant reduction in macrolide use in the second period was observed (26% vs. 55%; P < 0.01) even in patients with shock. Conclusions: Despite published evidence, CT use with quinolones has increased in the last years in Spanish ICUs.

Background and Objectives: Antitubercular drugs just like other drugs used in clinical practice are not free from ADRs(Adverse drug reactions).The added problem is that combination of drugs are used for prolonged periods of time. Moreover the ADRs to drugs used is one of the major reasons for patient default, hence leading to emergence of resistant organisms. Identification of the ADR profile of drugs in a hospital setup can be useful for the prevention, early detection and management of ADRs. 1) We aim to study the demographic profile of patients receiving Antitubercular therapy. 2) To identify the pattern and incidence of ADRs in the intensive phase Antitubercular therapy following DOTS strategy. Materials and Methods: A descriptive longitudinal study conducted for twelve months at tertiary care hospital in Eastern India. All the adult T.B. patients attending the outpatient department from January 2015 till December 2015 were included as per the study criteria and were monitored for ADRs. The data were evaluated for patient demography, type of DOTS treatment, type of ADRs and Organ site/system affected. ADRs were then subjected to severity assessment as per Hartwig scale.Statistical analysis was done using statistical software Graf Pad Prism version 4.03 for Windows. Results: Out of 296 patients, majority were males (59.79%), belonged to the age group of 20-30years(53.37%). Out of 296 patients 196 patients developed 312 detected ADRS mostly reported in the 5th week of DOTS therapy. In 11(5.61%) cases drugs were withdrawn, 21(10.71%) cases drugs were reduced and remaining 164 (83.67%) cases drugs were continued in original dose. Among them 164 cases received symptomatic treatment. The most common organ system involved was G.I.T. The most common type of ADR was nausea and vomiting (23.07%). On evaluation of severity assessment showed that most of the patients ADRs were of mild level-1(79.39%). Conclusion: Regular ADR monitoring is required to reduce morbidity and development of multiple drug resistance among patients with ADRs and also to improve patient compliance.

Exacerbations are significant events in the course of bronchiectasis. Exacerbations are associated with accelerated lung function decline and deterioration in quality of life (QoL). Prevention of exacerbations is therefore one of the key objectives of management of bronchiectasis. A few treatments have been proven to reduce the risk of exacerbations, but these include the treatment of underlying causes of bronchiectasis and the use of prophylactic antibiotic therapies (macrolides and inhaled antibiotics). Nonantibiotic therapies, such as airway clearance and pulmonary rehabilitation, also play an important role in the prevention of exacerbations. Acute exacerbations are treated with antibiotics directed against the known bronchiectasis pathogens and guided by previous sputum culture results. This emphasizes the importance of screening sputum cultures in stable patients. Assessment of severity is used to determine whether patients should be treated at home or in hospital. Supportive therapy for exacerbations should include airway clearance alongside oxygen, hydration, and treatment of bronchospasm as required. Bronchiectasis is a rapidly developing field and new therapies, both for the prevention of exacerbations and the treatment of acute exacerbations, are currently being developed.

There is a higher prevalence of community-acquired pneumonia (CAP) worldwide. The stratification of the severity and prognosis of CAP is a vital feature as it is one of the most common causes of mortality among other infectious diseases in the developed countries. The mortality rate of patients with CAP depends on the severity of the disease, treatment failure along with the requirement of hospitalization and/or Intensive Care Unit (ICU) management which is quite cost-effective. To improve the outcomes in the management of CAP, there has recently been a significant attention paid to focus on the use and implication of evidence-based scoring systems and biological markers to justify hospital admission in either acute medical settings or ICU, also to classify the disease severity which will help in predicting the mortality rate. We have reviewed the significance of established and newly developed clinical scores, biological markers, and cytokines whether used alone or in conjunction with the clinical severity scores to assess the severity of the disease, prediction of early or late treatment failure, justify the acute in-hospital or ICU admission, and for the identification of short- and long-term mortality. In conclusion, the incorporation of the biological markers in the prognostic scales of the clinical scoring systems may improve the mortality prediction value of patients with CAP requiring acute hospitalization or ICU care and further studies at a larger scale are needed to corroborate the additive value of biological markers.

The recent upsurge of Zika virus infection has alarmed public health officials because of its possible association with thousands of suspected cases of microcephaly, thereby sparking a public health emergency. This mosquito-borne arboviral disease majorly remains asymptomatic. Unavailability of specific prophylaxis or vaccines or treatment necessitates the need to advocate preventive personal measures to get protected from these daytime bitters. Prevention and control measures should be aimed at reducing the vector density and minimizing the vector-patient contact.

Hemophagocytic lymphohistiocytosis (HLH) is an infrequent disorder occurring as a result of unrestrained immune activation. Tuberculosis (TB) is a catastrophic cause of secondary HLH if not treated appropriately. Here, we report an unusual case of secondary HLH associated with abdominal TB. Although rare, secondary HLH should be ruled out in patients with TB, especially in the presence of pancytopenia.

Background: Invasive pulmonary aspergillosis is a major cause of morbidity and mortality in neutropenic patients. Microbiological and serological tests are of limited value. The diagnosis should be considered in neutropenic patients with fever not responding to antibiotics, and typical findings on thoracic computed tomography scan. Whenever possible, diagnosis should be confirmed by tissue examination. Newer serological techniques like ß-D-Glucan Assay and Galactomannan assay are used in diagnosis and monitoring therapy in such patients. Aim: To early diagnose Invasive pulmonary aspergillosis and to decrease mortality. Methods: A total of 150 patients of hemato-oncological malignancies were prospectively enrolled intostudy. Results: Only 10 (6.6 %) patients developed invasive pulmonary aspergillosis and mortality was 30%.Patients were treated medically with never azoles and echinocandin antifungals, with long term survival in seven patients and early mortality in rest of patients. Conclusion: IPA is a difficult infection to treat in immucompromised state. It needs very high degree of suspicion to diagnose. Sick patients should be treated with combination antifungal of different mechanisms at outset and therapy should be continued for six months.

Background and Objectives: Trachoma is the most common cause of infectious blindness worldwide and despite various control programs, it persists, leads to significant ocular morbidity. In this article, we aim to determine the burden of trachoma and its related risk factors amongst the urban and rural populations of Sagar, Madhya Pradesh. Materials and Methods: Rapid assessment for trachoma was conducted in urban and rural Community Health Center (CHC) of Bundelkhand Medical College, Sagar according to standard World Health Organization guidelines. An average of 60 children in rural CHC and 50 children in urban CHC aged 1-10 years was assessed clinically for signs of active trachoma with status of hygiene. Additionally, all adults above 15 years of age in these centers community were examined for evidence of trachomatous trichiasis (TT) and corneal opacity. Environmental risk factors contributing to trachoma like limited access to potable water and functional latrine, presence of animal pen, hand wash and garbage within the urban and rural CHCs populations. Results: Overall, 18 of 110 children (16.36%; confidence interval [CI]: 9.5-23.2) had evidence of follicular stage of trachoma and 12 children (10.91%; CI: 5.2-16.6) had evidence of intense trachomatous inflammation intense and scarring stages trachomatous scarring of trachoma. Nearly 19 (17.27%; CI: 10.3-24.2) children were noted to have unclean faces and 17 (15.45%; CI: 8.8-22.1) children were found with unclean hands in both the centers. TTs & TO was noted in 19 adults (1.05%; CI: 0.8-1.2). The environmental sanitation was not found to be satisfactory in the study centers mainly due to the co-habitance of people with domestic animals like pigs, hens, goats, dogs, etc., in most (66.67%) of the person households. Conclusion: Active trachoma and trachomatous trichiasis were observed actively in both urban and rural populations wherein trachoma surveillance and control measures are needed.

Gastrointestinal tract infection with CMV can occur from mouth to anal canal. In the immunocompetent subjects, the upper GI tract is most commonly involved while immunocompromised individuals have colon as the most common site of involvement. In a study of CMV infection among AIDS patients, the most common site of CMV infection in the GI tract was the colon (55%), while gastric involvement was reported in 40% of cases. CMV mononucleosis, hepatitis and pneumonitis are among the most common manifestations.' GI tract involvement is common and it is easy to access for taking the diagnostic biopsies. Severity and extent of involvement within the GI tract is variable.