Extensive Worm Infestation - A Case Report

Aspergillus infection in an immunocompetent human host is a rare entity. In most cases it presents as an opportunistic pathogen in immunocompromised patients. The portal of entry is usually the respiratory tract or direct inoculation of the organism to the site. Aspergillusosteomyelitis is a debilitating and severe form of Invasive Aspergillosis.
This paper presents a case of osteomyelitis of the hip without a recent obvious source of entry and reviews the literature of osteomyelitis and bone infections caused by Aspergillus.
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Osteomyelitis of the Hip secondary to Aspergillus fumigatus - A Case Report and Comprehensive Review of the Literature

Aspergillus infection in an immunocompetent human host is a rare entity. In most cases it presents as an opportunistic pathogen in immunocompromised patients. The portal of entry is usually the respiratory tract or direct inoculation of the organism to the site. Aspergillusosteomyelitis is a debilitating and severe form of Invasive Aspergillosis.
This paper presents a case of osteomyelitis of the hip without a recent obvious source of entry and reviews the literature of osteomyelitis and bone infections caused by Aspergillus.
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Sarcoidosis - A Case of “Resistant Tuberculosis”

Context: Sarcoidosis is a multisystem granulomatous disease of unknown aetiology. It is an under diagnosed disease in India. The close resemblance to tuberculosis and the lack of awareness contribute to the under reporting of cases.
Case report: We present a 17 year-old male who was refractory to antituberculous treatment and ultimately turned out to have sarcoidosis.
Conclusion: This case report highlights the importance of considering sarcoidosis as a differential diagnosis, in a country like India, where tuberculosis is endemic. The clinical course of this case was different from that reported in Western Literature.

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Procalcitonin versus C-Reactive Protein in Neonatal Sepsis

Objectives: To compare between C-reactive protein (CRP) and Procalcitonin (PCT) regarding diagnosis and outcome of neonatal sepsis.
Design: Prospective observational study.
Setting: Neonatal Intensive Care Unit (NICU).
Participants: Seventy newborn Infants admitted to NICU for sepsis management.
Results: Of the total 70 Neonates admitted in NICU, 31.4%, 42.9% and 25.7% were categorized as proven sepsis, suspected sepsis and clinical sepsis respectively. Procalcitonin was positive in 100% compared to the CRP positivity in 63.6% of the proven sepsis cases. Mortality rate is significantly increased in proven sepsis compared to clinical sepsis.
Intervention: Sepsis workup laboratory tests.
Main Outcome Measures: Specific diagnostic and prognostic impact of the tests.
Conclusion: Comparing with CRP, PCT is not only a good diagnostic measure of neonatal sepsis but also effective predictor of sepsis outcome.
Keywords:Procalcitonin; CRP; Neonatal; Sepsis; UTI

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Case Series of Pneumococcal Meningitis in the Post 13-valent Pneumococcal Conjugate Vaccine Era

Streptococcus pneumoniae is a leading cause of meningitis. Although rates of bacterial meningitis have decreased after pneumococcal conjugate vaccine introduction, pneumococcal meningitis has not been eliminated. In this case series, we describe the presentation, serotypes, and outcomes of 11 children with pneumococcal meningitis at a tertiary children's hospital after the 13-valent pneumococcal conjugate vaccine (PCV13) was introduced, from 2011-2013. The median age of children with meningitis was 7 years. The majority of the isolates (82%) were susceptible to penicillin. Most isolates (73%) were serotyped and there was no evidence of disease caused by serotypes contained in PCV7. Only two patients had disease caused by serotypes contained in PCV13 and neither of these patients was eligible to receive PCV13. Significant findings from our study include: lack of documented fever in a portion of patients admitted with meningitis, older age of children with pneumococcal meningitis, and no evidence of PCV7 serotypes causing invasive disease.


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Therapeutic Hypothermia Still Effective in Prevention of Anoxic Encephalopathy following Extended Period of Pulselessness during Cardiac Arrest

There are approximately 300,000 out-of-hospital cardiac arrests per year with less than 10% of those surviving. More than half of survivors suffer permanent neurologic deficits. Therapeutic hypothermia has proven effective at thwarting neurologic damage occurring in the 16-hour window following return of spontaneous circulation (ROSC). Despite recommendations by the American Heart Association (AHA), many cardiologists have been slow to implement therapeutic hypothermia. While many trials have discussed the relevance of initial rhythm and delay of cooling, there has been limited discussion of the efficacy of therapeutic hypothermia in the presence of extended pulselessness.
A 40-year-old male with past medical history of an ST-segment elevation myocardial infarction 8 years prior, presented with an out-ofhospital cardiac arrest. Cardiopulmonary resuscitation was immediately initiated. The patient remained in ventricular fibrillation for 50 minutes with only one episode of a momentary pulse prior to persistent ROSC.


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Acculturation and Subclinical Atherosclerosis among U.S. South Asians:Findings from the MASALA study

Objective: Longer duration of residence among immigrants to the United States, a proxy measure of acculturation, has been associated with higher subclinical atherosclerosis. South Asian immigrants are the second fastest growing immigrant group in the U.S. but little is known about the effects of acculturation with atherosclerosis in this high cardiovascular risk population.
Methods: We conducted a cross-sectional analysis using data from a community-based cohort called the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study. Participants (n=900) were between ages of 40-84 years and had no existing cardiovascular disease. We developed a multi-dimensional measure of acculturation in South Asians, called traditional cultural beliefs, and measured other proxy measures of acculturation to determine whether they were associated with higher levels of subclinical atherosclerosis after controlling for socioeconomic, behavior/lifestyle, and cardiovascular risk factors.
Results: Mean duration of residence in the U.S. was 27±11 years and tertiles of strength of traditional cultural beliefs were examined. Longer duration of U.S. residence was associated with higher levels of coronary artery calcium even after adjustment for covariates and lifestyle mediators. The novel measure of strength of traditional cultural beliefs was associated with lower common carotid intima media thickness among those with moderate traditional beliefs only.
Conclusions: These findings support the need for better conceptualization and measurement of how migration influences cultural beliefs and practices, and their subsequent influence on health behaviors and cardiovascular disease risk.


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