A 45-year-old female who was a teacher by profession with a history of chronic asymptomatic anemia in the past presented to our hospital with complaints of intermittent fever for two weeks, cough with expectoration, dyspnea on exertion, and left upper limb edema for four days. She had a history of abdominal pain after food intake. She gave a history of having anemia for the past 23 years. Evaluation after admission showed raised inflammatory markers, marked thrombocytosis, and severe iron deficiency anemia. Further imaging in the form of a CT of the abdomen and thorax showed that she had a left-sided pleural effusion which showed an exudative picture, splenomegaly with a splenic infarct with a splenic abscess, and a suprarenal abdominal aorta thrombus. She was also found to have deep vein thrombosis (DVT) of the left subclavian and proximal internal jugular vein in a ultrasonogram (USG) Doppler. The workup done ruled out congenital and acquired causes of thrombosis and after extensive evaluation the patient was found to have unexplained thrombosis. The cause of unexplained thrombosis is the point of interest in this patient. Despite extensive workup, no precise cause for thrombosis, which was both arterial and venous in nature could be found out initially. Hence by exclusion, the possibility of secondary thrombocytosis causing the thrombosis was considered. Over the next few years, this patient underwent repeat esophageal endoscopies, colonoscopies, and capsule studies all without being able to pinpoint a diagnosis. Eventually three years later, a CT enteroscopy with biopsy showed the diagnosis of Crohn's disease and the patient was started on appropriate immunosuppressive treatment for the same. There have been multiple case reports of thrombocytosis causing arterial or venous thrombus but not many have recorded both arterial and venous thrombosis in the same patient.

This study has demonstrated that CSF-ADA can be used as an important diagnostic tool in early diagnosis of TBM using a cut off value of 6.65. This cut off value gave a good sensitivity and specificity in differentiating it from non-TBM.

INTRODUCTIONAcute coronary syndrome (ACS) consists of a spectrum of diseases ranging from unstable angina to transmural myocardial infarction. It is a set of signs and symptoms due to rupture of a plaque and are a consequence of platelet rich coronary thrombus formation. Platelets have a major role in the pathogenesis of acute coronary ABSTRACT Background: Acute coronary syndrome (ACS) is a set of signs and symptoms due to rupture of a plaque and are a consequence of platelet rich coronary thrombus formation. Larger platelets are haemostatically more active and and hence carry risk for developing coronary thrombosis leading to ACS. Platelet parameters especially mean platelet volume (MPV) could be used as an important and reliable marker in early detection of ACS when the patients come to emergency department with chest pain. The primary objective is to study the association between mean platelet volume and acute coronary syndrome. The secondary objectives are to analyse if there is a statistically significant difference in mean platelet volume between Non-ST elevation (NSTEMI) and ST-elevation Myocardial Infarction (STEMI) and between double vessel disease (DVD) and triple vessel disease (TVD). Methods: A total of 260 patients were included in the study depending on the inclusion and exclusion criteria. After dividing the patients with chest pain into control (Non-cardiac chest pain) and study group (ACS) which contained 130 each, venous blood was drawn and taken to haematology laboratory for analysis of MPV within 2 hrs. The statistical analysis used were mean, median, test of significance in difference (t-test) and chi-square test. Results: Mean platelet volume (MPV) was found to be higher among ACS patients (9.4868±0.85270) as compared to control (7.430±0.72172) and it was significant with a P value <0.05. It was also noticed that MPV was higher among patients with STEMI when compared to NSTEMI, 10.32±0.77932 and 9.22±0.52743 and it was statistically significant (P<0.05). Similarly, MPV between patients with triple and double vessel disease were compared and the mean MPV of 10.04±0.88738 of TVD was greater than the mean MPV of 9.22±0.67438 in DVD and was statistically significant (P<0.05). Conclusions: In this study the MPV was higher in patients with ACS than those in control group. The study also showed that there was significant difference in MPV values between people with STEMI and NSTEMI and between people with DVD and TVD. Hence it might be useful as an additional cost efficient test in conjunction with other markers in the early prediction of ACS in the emergency room. Larger platelets are haemostatically more active and hence carry risk for developing coronary thrombosis leading to ACS. Patients with increased MPV could be easily identified during routine haematological analysis and hence could play an important role in early detection of acute coronary syndrome (ACS).

Introduction: Gram Negative Bacilli (GNB) account for about 70% of Hospital Acquired Pneumonia (HAP), Ventilator Acquired Pneumonia (VAP) and Healthcare Associated Pneumonia (HCAP). Increasing use of carbapenems lead to infections caused by GNBs with therapeutically challenging Extended-Spectrum Beta-Lactamases (ESBLs). Aim: To assess the risk factors and clinical outcomes associated with HAP, VAP and HCAP caused by Carbapenem Resistant (CR) GNB at a Tertiary Care Centre. Materials and Methods: The present study was a prospective cohort study which was conducted from February 2015 to September 2016 that included 66 patients with Broncho Alveolar Lavage (BAL) cultures for GNB. Clinical, demographic and microbiological data (including antibiotic sensitivity) along with overall mortality, occurrence of sepsis and length of stay were collected for each patient. Data were analysed using OpenStat 30.0 along with relevant descriptive statistics. Comparison of outcomes between CR and Carbapenem Sensitive (CS) group were studied along with the concordance between initial antibiotics and BAL culture sensitivity. Results: Overall prevalence of CR in the cohort was 54.54%. The most common organism to be ESBL positive was Klebsiella pneumoniae (45.45%). Exposure to previous antibiotics was a risk factor for CR (p=0.017). Mortality was higher (50%) in CR group than in CS group (23.3%; p=0.026). There were 45.8% of the cases having lack of concordance of initial antibiotics that died in comparison to 16.7% who had an appropriate initial antibiotic therapy (p=0.030). Conclusion: There is a high prevalence of CR in nosocomial pneumonia. Judicious use of antibiotics is the need of the hour and can be implemented by an Antibiotic Stewardship program.

Background: One of the most significant complications of type 2 diabetes mellitus (T2DM) is diabetic nephropathy, the leading cause of end-stage renal disease. Another important clinical marker in patients with type 2 diabetes is QTc interval prolongation. We aimed to study the association between QTc interval prolongation and microalbuminuria in patients with T2DM.Objective: The primary objective of this study was to examine the association between QTc interval prolongation and microalbuminuria in patients with T2DM. The secondary objective was to correlate the prolongation of the QTc interval with the duration of T2DM.Materials and methods: This study was conducted as a single-centre, prospective, observational study in a tertiary-care centre in South India, Amrita Institute of Medical Sciences and Research Center. The study was conducted over two years, between April 2020 and April 2022. Patients aged more than 18 with T2DM with and without microalbuminuria were recruited into the study and control groups, and various parameters, including QTC intervals, were recorded.Results: A total of 120 patients were enrolled in the study, with 60 patients with microalbuminuria forming the study group and 60 patients without microalbuminuria forming the control group. There was a statistically significant association between microalbuminuria with a prolonged QTc interval, hypertension, a longer duration of T2DM, higher haemoglobin AIc (HbA1c) levels, and higher serum creatinine values.