This study highlights that Gujarat and Rajasthan are an endemic region for histoplasmosis, and a systematic study is required to understand epidemiology of the disease. Histoplasmosis should be a differential diagnosis in a patient presenting with adrenal enlargement, lymphadenopathy, oral ulcers and fever of unknown origin in this region.

ObjectiveThis study was designed to explore the efficacy and safety of saroglitazar 4 mg on hypertriglyceridemia in patients with HIV associated lipodystrophy.MethodsDuring this 12-week prospective, multi-centric, open-label, single arm exploratory study, 50 patients were enrolled to receive saroglitazar 4 mg orally once daily in the morning before breakfast. The primary efficacy endpoint was the percent change in triglyceride (TG) levels from baseline to Week 6 and Week 12. The secondary efficacy endpoints were assessment of low-density-lipoprotein (LDL), very-low-density-lipoprotein (VLDL), high-density-lipoprotein (HDL), non-HDL cholesterol, total cholesterol, apo-lipoprotein (Apo) A1, Apo B, and C-peptide and fasting insulin for HOMA beta and HOMA IR. Safety assessment was performed during the study.ResultsSaroglitazar 4 mg significantly decreased the serum TG levels from baseline at Week 6 (percent change: -40.98; 95% CI: -50.82, -31.15) and Week 12 (percent change -45.11; 95% CI: -52.37, -37.86). Reduction in VLDL cholesterol (percent change: -46.33; 95% CI: -52.89, -39.76) and total cholesterol (percent change: 7.37; 95% CI: 1.96, 12.78) was observed at week 12 from baseline. Saroglitazar increased HDL cholesterol (percent change: 34.56, 95% CI: 22.22, 46.90), Apo A1 (percent change: 33.16; 95% CI: 18.69, 47.63) and Apo B (percent change: 10.55, 95% CI: 2.86, 18.25) levels at week 12 from baseline. Saroglitazar treatment led to increase in the C-peptide (percent change: 59.42, 95% CI: 48.78, 70.06), fasting insulin levels (percent change: 47.10; 95% CI: 38.63, 55.57), HOMA of beta cell function for C-peptide (percent change: 71.67; 95% CI: 39.09, 104.26) and HOMA of insulin resistance for C-peptide (percent change: 58.29, 95% CI: 46.74, 69.83) at week 12 from baseline. Saroglitazar treatment was safe and well tolerated in this study.ConclusionOverall, the observed changes in lipid profile after 12 weeks of saroglitazar treatment were in the direction of improvement in patients with HIV associated lipodystrophy.Trial RegistrationClinical Trial Registry of India Phase II/CTRI/2010/091/000107

Infective endocarditis in a patient with structural heart disease following coronary artery angiography is a rare complication. We report a rare case of Mycobacterium chelonae infective endocarditis following coronary artery angiography in a young male with congenital heart disease. This case illustrates the diagnostic as well as therapeutic challenges we faced when managing this rare infectious entity.

A 27 years old non diabetic, normotensive, female had undergone lower segment caesarean section (LSCS) with tubular ligation. She complained discharge at left side of stitch line after about 5 weeks of operation, and was treated with broad spectrum antibiotics. As she did not improve, first and second debridement was done in January and February 2017 and pyogenic cultures sent were sterile. Later she was advised  for Multiple detector computed tomography (MDCT) in March 2017, which revealed accumulations in pre-peritoneal space of urinary bladder posteriorly and reached to anterior wall of uterus. This pus was from multiple sinuses and were sent for mycobacterial cultures which showed growth of MOTT- M.mageritense further identified by MALDI-TOF and supported by molecular technologies. After identification of this Non-tuberculosis mycobacteria (NTM). She was treated for the same and recovered completely after seven months of anti-NTM treatment. This is the first reported case of M. mageritense in skin and soft tissue in India. Literature also reports a few cases around the globe.

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