Stenotrophomonas maltophilia is a common nosocomial organism but an uncommon cause of infective endocarditis. We report a case of S. maltophilia endocarditis of the native aortic valve. We have reviewed other cases of S. maltophilia endocarditis, associated complications, and treatment options.
Psoriasis patients are at increased risk of developing the metabolic syndrome (MS). Proinflammatory cytokines such as tumor necrosis factor-α, interleukin-6 that are increased in the psoriatic plaques are known to contribute to features of MS such as hypertension, dyslipidemia and insulin resistance.(1) To establish the frequency of MS in patients with psoriasis. (2) To study the risk factors associated with MS in psoriasis.A hospital based comparative study was conducted involving 40 adult patients with psoriasis and 40 age- and sex-matched controls. All participants were evaluated for components of MS.Both groups included 31 males and 9 females. The mean age of the cases and controls were 49.95 years and 49.35 years, respectively. Psoriasis patients with MS had a statistically significant higher mean age (56.31 ± 11.36 years) compared with those without MS (46.89 ± 11.51 years). MS was present in 13 out of 40 (32.5%) patients with psoriasis and 12 out of 40 (30%) controls; this difference was not statistically significant. Higher age and female gender correlated with the presence of MS in psoriasis patients. The presence of MS in psoriasis patients was statistically independent of psoriasis area severity index score, body surface area involvement or psoriatic arthropathy.Our results suggest that there is no close correlation between psoriasis and MS in South Indian patients.
A 54-year-old Caucasian woman presented with corneal ulcer of the right eye of 4 weeks duration after scratching her cornea while removing her contact lens and artificial eye lashes. Her visual acuity was 20/32 (left eye) and finger counting (right eye). She had a 3x3 mm epithelial defect with underlying corneal oedema and hypopyon. Right eye cultures grew Paecilomyces species. Topical and systemic antifungal agents were initiated. Due to the sight-threatening disease, the patient underwent surgical intervention with intrastromal injection of amphotericin B and a large conjunctival flap covering 75% of the right eye corneal ulcer. After 3 months of therapy, she had near-complete resolution of the corneal ulcer. Unfortunately, recurrence of the corneal ulcer occurred within 3 weeks of cessation of therapy, prompting reinitiation of ophthalmic and systemic antifungal agents. The patient was advised to continue therapy for 6 months with regular follow-up.
Oil and Gas Industry plays a very important role in the socio-economic growth of India. This work is intended to make obvious analysis of liquidity and Working Capital structure of Oil and Gas Industries, this study is mainly based on secondary data and the statistical tools like Mean, Standard Deviation, Coefficient Of Variance and Analysis Of Variance(ANOVA) have been used to the study. The study revealed that the liquidity of this industry is not in satisfactory level.
Recurrent Clostridium difficile infection (CDI) is associated with significant morbidity, mortality and healthcare related costs. Up to 30% of CDI cases recur, resulting in 83,000 cases of recurrent CDI per year. Although agents for primary and secondary prophylaxis for CDI including the use of probiotics, antibiotics, fecal microbiota transplantations, and newer therapies such as bezlotoxumab have been reported, there is no consensus guidelines regarding their use. The purpose of this study was to assess physician practices regarding secondary prophylaxis for CDI. This cross-sectional study using Qualtrics electronic survey (24 questions) assessed physician practice preferences. The survey was distributed through institutional emails and through the Infectious Disease Society of America “IDea Exchange” forum. Responses were collected and analyzed using descriptive statistics. A total of 246 surveys were completed. Physicians were surveyed from greater than 100 locations (see Figure 1). Most (229, 93%) of the physicians practiced in an inpatient setting. Respondent specialties were primarily infectious diseases (138, 56%) followed by internal medicine (72, 29%). Most physicians (173, 71%) use secondary prophylaxis for CDI prevention (see Figure 2). Vancomycin (121, 70%) and probiotics (114, 66%) were most commonly used for CDI secondary prophylaxis, (see Figure 3). Of 164 physicians who used secondary prophylaxis half of them (89, 54.2%), used prophylaxis only for patients with a history of recurrent CDI receiving antibiotics and about a third, (49, 29.9%) utilized it for patients with a history of CDI who were receiving antibiotics. ID physicians were more likely to prescribe secondary prophylaxis as compared with non-ID physicians (85% of 127 respondents vs. 75% of 85 respondents, P = 0.052). The use of secondary prophylaxis was similar among private practice and academic physicians (84% of 39 vs. 80% of 157 respondents, P = 0.591). The majority of the physicians who responded to this survey use secondary prophylaxis to prevent recurrent CDI, hence future CDI guidelines need to address the role of secondary prophylaxis in clinical practice. All authors: No reported disclosures.
Abstract Sub-acute appendicitis is a condition where some episodes of acute appendicitis apparently subside spontaneously before they reach the acute stage. A 29-year-old man presented with pain in the right iliac fossa for the last 1 week with periumbilical radiation of pain associated with continual nausea, occasional bouts of vomiting, chill and rigours. Computed tomography scan report suggested a case of sub-acute appendicitis. On the basis of presenting features, the patient was treated with Belladonna and Calcarea carbonica in 30c and 200c (centesimal) potencies, respectively, with repetitions. The patient was under treatment for nearly 6 months with favourable improvement of the generalities along with the underlying pathology. The case was indicative of further studies with adequate sample size in such pathological condition to come to any decisive conclusion.
Abstract Acute cholangitis is a bacterial infection superimposed on an obstruction of biliary tree from a gall stone, neoplasm or stricture. The biliary obstruction is most commonly caused by choledocholithiasis benign or malignant stricture of the bile duct or hepatic ducts, pancreatic cancer, ampullary adenoma or cancer, porta hepatis tumour or metastasis, biliary stent obstruction (due to microbial biofilm formation, biliary sludge deposition and duodenal reflux of food content), primary sclerosing cholangitis and amyloid deposition in the biliary system. Classically, patients present with high fever persisting for more than 24 hours, abdominal pain and jaundice (Charcot's triad). The right upper quadrant abdominal (RUQ) pain is generally mild. When the cholangitis becomes more severe, patients become hypotensive and confused (Reynold's pentad). Charcot's triad has low sensitivity (26.4%) and high specificity (95.9%). Although the presence of Charcot's triad is suggestive of acute cholangitis, it is not diagnostic. Charcot's triad is present in 26.4 to 72% of patients with acute cholangitis. TG07 diagnostic criteria for acute cholangitis also do not have enough sensitivity and specificity and its severity criteria are also not suitable for clinical use. Antibiotics, intravenous fluid, Vitamin K supplementation and biliary drainage are the options available in conventional mode of treatment for acute cholangitis. Presented here is one case report of acute cholangitis in a patient of adenocarcinoma of gall bladder with metastasis. The case was treated using classical method of homoeopathy with complete improvement in clinical and laboratory parameters of acute cholangitis.
