Background: Metabolic syndrome (MS) is associated with premature coronary artery disease (CAD). The aim of this study was to evaluate the prevalence of MS and its association with severity of CAD proven by coronary angiogram (CAG) in young patients.Methods: We included patients, aged 45 years or less, admitted with acute coronary syndrome (ACS), who had CAD confirmed by coronary angiography. They were divided into two groups according to the presence or absence of MS based on International Diabetes Federation (IDF) criteria. CAD was classified into single, double and triple vessel disease (TVD). The prevalence of MS and its individual parameters was calculated.Results: Among 90 young patients who presented with ACS, MS was present in 67 patients (74.44%). Among those with MS, the prevalence of each individual criterion was statistically significant in MS group (P <0.05). Prevalence of pre-existing hypertension and diabetes was significantly higher in MS group (p <0.01). Smoking, alcohol consumption and family history of CAD were not statistically significant in patients with and without MS. Fifteen out of 90 patients (14 in MS group) who presented with ACS had TVD in CAG, but this was not statistically significant (p 0.06).Conclusions: This study confirms a very high prevalence of MS in young Indian patients with premature CAD. MS was more prevalent than the conventional risk factor smoking in young CAD patients. We could not find significant difference in severity of CAD based on CAG between MS and non-MS group.

Background Phaeohyphomycosis is a rare infection caused by dematiaceous (pigmented) fungi, frequently reported in tropical and sub-tropical countries. Data regarding this infection is sparse and comprises mainly of case reports. This study was carried out to review epidemiology, causative spectrum, clinical features, and treatment outcomes in patients with Phaeohyphomycosis.Methods We reviewed 20 cases of culture proven Phaeohyphomycosis over a 10-year period at Christian Medical College, Vellore, South India.ResultsIn our cohort, 16 of the 20 patients were male (80%) with an average age of 42 (range 17–66 years). Most of them (35%) were from Tamil Nadu, India and some from Bhutan and Nepal. Eighty-five percent presented with cutaneous lesions, 5% with involvement of the paranasal sinuses, and 5% each had organ involvement in brain and liver. Possible predisposing factors included type II diabetes mellitus (35%), renal transplantation (30%), long-term use of steroids (15%), and human immunodeficiency virus (5%). For all the patients, the direct microscopy and the culture positivity was 100%. The common species isolated were Cladophialophora bantiana, Cladosporium cladosporoides, Cladosporium sphaerospermum, Phialophora oxyspora, and Exophiala spinifera. Most patients (60%) received monotherapy with itraconazole. Five patients were cured, four had recurrence, one patient died (due to leukemia), and 10 were lost to follow-up.Conclusion Phaeohyphomycosis, though an uncommon infection, causes life-threatening disease in both the immunocompetent and immunocompromised hosts. To our knowledge, this is the largest single-centre retrospective study on Phaeohyphomycosis. Though our follow-up was sub-optimal and possible in only 50%, it was noteworthy that disease recurrence was common. Better understanding of pathogenesis and newer antifungals are needed for optimal cure of this disease.Disclosures All authors: No reported disclosures.

No abstract

By definition, “quad fever” is an extreme elevation in body core temperature beyond 40.8°C (105.4°F) in a patient with spinal cord injury. This type of central nervous system hyperpyrexia is seen in spinal cord injury patients, particularly those with high cervical spine injury with quadriplegia. However, it has also been described in paraplegics with a mid- or higher level thoracic spine injury. The incidence of “quad fever” is rare, with the highest reported temperature being 44°C (111.2°F) with chronicled fatal outcomes.Though the use of antipyretics is generally efficacious, they are considerably ineffective in treating the hyperpyrexia seen in this type of severe central autonomic thermodysregulation.Here, we present a case of high cervical spine injury in a 24-year-old male. The trauma resulted in a C3–5 level cord contusion with incomplete quadriplegia (ASIA [American Spinal Cord Injury Association Impairment Scale] grade B). The patient developed high grade fever of 106°F within a week of admission postoperatively.Pancultures were negative and the wound was clean. Despite treatment with higher antibiotics and an infection disease specialist's consult, no obvious etiology was found. Drug-induced fever and thyroid function tests were excluded in other less-common causes.Based on the diagnosis of exclusion, “quad fever” was inferred as the cause. He had other signs of autonomic instability during the episodes such as bradycardia with hypotension.Our patient showed an almost early response to treatment to betablockers and antipsychotics after failure to respond to antibiotics, mechanical hypothermia, and antipyretics.