Objective:Plasmodium vivax infection has been recognized to be a cause of severe malaria in recent time. We report findings from a prospective observational study aimed at analyzing the clinical spectrum, complications, and outcome of patients infected with P. vivax malaria.Materials and Methods:The study was conducted in a tertiary care hospital of Delhi over a period of 2 years. All adults hospitalized with P. vivax malaria, confirmed on peripheral smear and/or rapid diagnostic test, were included in the study. The cases were categorized into uncomplicated and severe malaria groups according to WHO criteria. The clinical and biochemical profile of cases in each group were compared for determining the predictors of severe malaria.Results:One hundred and fifty consecutive cases of P. vivax monoinfection were included in the study. All patients had fever, and 63 (42%) developed severe malaria, while 87 (58%) were uncomplicated. Vomiting, abdominal pain, headache, altered consciousness, cough with breathlessness, icterus, and hepatosplenomegaly were more frequent in severe malaria. Severe malaria was associated with severe thrombocytopenia, leucopenia, raised serum bilirubin, elevated serum creatinine, and prolonged prothrombin time. Jaundice (54 patients) was the most common complication, followed by acute respiratory distress syndrome, spontaneous bleeding, metabolic acidosis, shock, renal failure, and cerebral malaria. Multiple complications were observed in 17 (26.9%) cases of severe malaria. Overall mortality of 1.33% was recorded. However, case fatality of 40% was observed in cases with evidence of multiorgan dysfunction.Conclusion:P. vivax malaria has a varying clinical profile, from a relatively benign uncomplicated form to severe, even fatal disease. Certain clinical and laboratory parameters may serve as predictors of severe disease.

Background: Approximtely one third of cases of acute ischemic stroke are of undetermined etiology (cryptogenic). Among these cases, cardio embolic tend to be more severe than other causes. Transthoracic echocardiography is used as a standard imaging modality to study structural aspects of heart, however, transesophageal echocardiography (TEE) is a better and much more yielding modality. The present study was carried out in a tertiary care multispecialty hospital to enumerate the findings on TEE in the patients undergoing TEE for “cryptogenic stroke.” Methods: This retrospective observational study was done at our echo lab based on the TEE data of the last 10 years. Sixty-one consecutive adult patients admitted under department of neurology with a diagnosis of acute ischemic stroke and referred for TEE were included in the study. Results: Sixty one consecutive patients of cryptogenic acute ischemic stroke undergoing TEE were studied. Overall, 33% patients had grossly normal TEE findings. Patent foramen ovale (PFO) was the commonest abnormal finding present in 36%, atrial septal aneurysm (ASA) in 18% and both PFO and ASA were present in 18%. No statistical difference was noted between young (0-50 years) and elderly patients (>50 years) with respect to inter atrial septum abnormalities. Twenty eight percent had atheroma in descending aorta. Left atrial appendage clot or spontaneous echo contrast was present in 5% and vegetation was present in 5%. Conclusion: Dilated left atrium was present in 16% and left ventricular dysfunction was present in 18% of the patients. Our results reinforce the idea of a TEE examination in all patients of ischemic stroke which are not explained by routine clinical evaluation and transthoracic echo.

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Background  Constrictive pericarditis is a chronic inflammation of the pericardium leading to the thickening of the pericardium that restricts cardiac filling. Globally tuberculosis is the commonest aetiology of constrictive pericarditis. Though normally considered to be an irreversible pathology; which requires surgical pericardiectomy, in early stage of the disease antitubercular therapy (ATT) along with steroids and other anti-inflammatory therapy can reverse the pathology. But, complete reversal of constrictive physiology with ATT without any anti-inflammatory drugs is not documented. Case summary  Here, we describe a case where a 54-year-old lady presented with progressive dyspnoea and pedal oedema for 2 years along with anorexia and weight loss for two months. Two-dimensional echocardiography and computed tomography scan was suggestive of constrictive pericarditis. In view of systemic features and high acute phase reactants, patient was started on oral ATT without any steroids. After 4 months, constriction physiology was completely reversed. Discussion  Constriction physiology if treated timely can be largely reversed only with ATT without adjuvant anti-inflammatory therapy. Further studies are required to find out the specific indications of anti-inflammatory therapy in tubercular constrictive pericarditis.