Acute Disease ; Adult ; Glomerulonephritis ; etiology ; Hepatitis ; etiology ; Humans ; Male ; Meningitis, Aseptic ; etiology ; Pancreatitis ; etiology ; Typhoid Fever ; complications

This is the report of a 28 year old woman who had a holocranial pulsating headache once a month with nausea, photophobia and phonophobia lasting about 48 hours. There was no preceding aura. The headache used to subside on every occasion with profuse epistaxis from both nostrils. Her neurological and otolaryngological examination was normal. MRI brain showed no abnormality. During one of the examinations at the time of the headache and epistaxis, she was found to have bilateral congestion of nasal mucosa with no obvious identifi cation of bleeding points. This case illustrates that migraine can result in epistaxis in some patients.

In India food reflects the warmth, hospitality, status, symbol of wealth and aesthetics. The synergistic combination of pre and probiotics is known as synbiotics. Regular consumption of synbiotics in diets imparts health benefits like improved immune response, maintain intestinal integrity, decrease intestinal infections and down regulate the allergic response, influence digestion and gastric motility. Because of the changes in life styles due to globalization, unhealthy diets, lack of physical activity and exposure to tobacco smoke or harmful use of alcohol non communicable diseases are disproportionately affecting the 80% of low and middle income countries. This review covers the mechanism of probiotic action, use of probiotics in treatment and prevention of diseases of modern age, progress in delivery systems for the administration and finally some regulatory considerations. In conclusion, combined skills of the microbiologist, food technologist and clinician are necessary to sustain effect of probiotics. The role of probiotic organisms as alternative or complementary therapy in combating a large number of disorders can be achieved with balance and healthy life style as well as clean external environmental conditions. It is hoped that more detailed research will be conducted regarding the efficacy of probiotics so that clinically well documented and simplest formulation will be developed and can be regarded as effective for everyone. With validated results strong market will be formed and expanded in near future.

To assess the feasibility and results of screening diabetes mellitus (DM) patients for tuberculosis (TB) and TB patients for DM within the routine health care setting. Prospective observational study carried out within the Diabetes Centre and Pulmonary Medicine Department from February 2012 to September 2012. The screening for active TB in DM and DM in TB patients is followed as per the guidelines of the Revised National Tuberculosis Control Programme and national programmes in India. Total of 307 patients diagnosed with TB during the study period. Among the TB patients 9.77% were smokers, 19.54% were known cases diabetes, and 15.96% were newly diagnosed cases of diabetes. Total of 4,118 diabetes patients were screened for TB in which 111 patients found to have TB. The strengths of this study are that we implemented screening within the routine health system. It is feasible to screen DM patients for TB resulting in high rates of TB detection.
Delivery of Health Care ; Diabetes Mellitus ; Humans ; India ; Mass Screening ; Prevalence ; Prospective Studies ; Pulmonary Medicine ; Tuberculosis

Amoxicillin-Clavulanic acid continues to be one of the most commonly used antibiotic combinations. Hepatic injury due to this antibiotic is rare. We report a case of amoxicillin-clavulanic acid induced hepatitis causing painless jaundice to bring to attention this rare side effect of this commonly used antibiotic. This is a case of a 62-year-old Caucasian female, who presented with acute onset severe painless jaundice, nausea, vomiting, and pruritus of less than 1-week duration. She had completed a course of amoxicillin-clavulanic acid 3 weeks prior to presentation. A careful history pointed to this simple diagnosis. It may be easily missed without an in-depth history and the patient may be subjected to unnecessary expensive tests. This case is reported to highlight cost conscious care by keeping in mind a rare side effect of the commonly used antibiotic.
Amoxicillin-Potassium Clavulanate Combination* ; Diagnosis ; Female ; Gastroenterology ; Hepatitis* ; Humans ; Jaundice ; Middle Aged ; Nausea ; Pruritus ; Vomiting

The gallbladder neck cancer and perihilar cholangiocarcinoma present as painless progressive surgical obstructive jaundice. Sometimes it becomes difficult to differentiate between them even on cross-sectional imaging studies including computed tomography and magnetic resonance imaging. Staging laparoscopy and positron emission tomography may be useful in detecting metastases in gallbladder neck cancer, but are not recommended in perihilar cholangiocarcinoma. Most patients with gallbladder neck cancer and perihilar cholangiocarcinoma require preoperative biliary drainage. The differentiation is, however, important because their behavior and prognosis are totally different. Gallbladder neck cancer is biologically aggressive, thus long-term surviver are rare even after major resection. On the other hand, perihilar cholangiocarcinoma is often less aggressive and major proceduresresections are justified. Gallbladder neck cancer and perihilar cholangiocarcinoma, though not siblings, they tend to look alike sometimes.
Cholangiocarcinoma* ; Drainage ; Gallbladder* ; Hand ; Head and Neck Neoplasms* ; Humans ; Jaundice, Obstructive ; Laparoscopy ; Magnetic Resonance Imaging ; Neoplasm Metastasis ; Positron-Emission Tomography ; Prognosis ; Siblings*

Cervical cancer is the most common cancer in developing world and 80% of global burden is reported from these nations. Human papillomavirus along with poverty, illiteracy/lower education level and standards, multi-parity, tobacco, malnutrition and poor genital hygiene may act synergistically to cause cervical cancer. Risk factor of cervical cancer may in itself be the reason for non-viability of cervical cancer vaccine program in this part of the world. Interventions to address these risk factors in addition to vaccination of girls before their sexual debut may hold promises of reducing the morbidity and mortality of female genital cancers.
Developing Countries ; Female ; Humans ; Hygiene ; Literacy ; Malnutrition ; Poverty ; Risk Factors ; Tobacco ; Uterine Cervical Neoplasms ; Vaccination

Female ; Foreign Bodies ; diagnostic imaging ; therapy ; Headache ; therapy ; Humans ; Medicine, Traditional ; Metals ; Middle Aged ; Radiography ; Skull ; diagnostic imaging ; injuries ; Witchcraft ; Wounds, Penetrating ; diagnostic imaging ; therapy

Objective: To examine the survivability and stability of probiotic strains in presence and absence of pharmaceutical excipients for a long period of time at (4 ± 1) ℃. Methods: The survival rates of probiotic strains, Pediococcus pentosaceus GS4 (MTCC12683)(NCBI HM044322),GS17(NCBI KJ608061)and Lactobacillus gasseri (ATCC 19992), were evaluated. Probiotic strains were lyophilized individually and in combination of excipients (sorbitol, ascorbic acid, fructose and skim milk). The prepa-ration was monitored for 120 d storing at(4 ± 1) ℃.During storage,all the preparations were evaluated for viability and stability of probiotic properties like lactic acid produc-tion, antimicrobial effect,water activity,and adherence to epithelial cells. Results: Sorbitol,ascorbic acid and skim milk favoured the viability of freeze-dried cells and sustained probiotic properties during storage. Without excipients (control group), strains showed percentage of survivability not more than 70% while strains with excip-ients survived for 73%–93% for a long period of time. Conclusions: Commonly used excipients can be considered as a vehicle for delivering active principle in probiotic formulation and for sustaining the viability and stability of probiotic strains for a period of 120 d.

Acute-on-chronic liver failure is an acute deterioration of liver function manifesting as jaundice and coagulopathy with the development of ascites, with a high probability of extrahepatic organ involvement and high 28-day mortality. The pathogenesis involves extensive hepatic necrosis, which is associated with severe systemic inflammation and subsequently causes the cytokine storm, leading to portal hypertension, organ dysfunction, and organ failure. These patients have increased gut permeability, releasing lipopolysaccharide (LPS) and damage-associated molecular patterns (DAMPS) in the blood, leading to hyper-immune activation and the secretion of cytokines, followed by immune paralysis, causing the development of infections and organ failure in a proportion of patients. Early detection and the institution of treatment, especially in the "Golden Window" period of 7 days, gives an opportunity for reversal of the syndrome. Scores like the Asian Pacific Association for the Study of the Liver (APASL) ACLF research consortium (AARC) score, a model for end stage liver disease (MELD), and the CLIF Consortium acute-on-chronic liver failure (CLIF-C ACLF) score can help in the prediction of mortality. Treatment strategy includes treatment of acute insult. Patients should be considered for early transplant with MELD score >28, AARC score >10, high-grade hepatic encephalopathy, and in the absence of >2 organ failure or overt sepsis to improve survival of up to 80% at five years. Patients, with no option of transplant, can be treated with emerging therapies like faecal microbial transplant, plasma exchange, etc., which need further evaluation.