Abstract. Systemic endemic mycoses, such as blastomycosis, are rare in Asia and have been reported as health risks among travelers who visit or reside in an endemic area. Adrenal involvement is rarely seen in blastomycosis and has never been reported from Asia. We report the first case of blastomycosis with bilateral involvement of the adrenals in a diabetic patient residing in the state of Arunachal Pradesh, India.

Background: This prospective study was done to assess the association between serum magnesium deficiency and its effect on exacerbation of chronic pulmonary obstructive disease (COPD), and also to probably suggest a cut-off level which may be useful for predicting clinical outcomes and serving as a target value for therapeutic intervention. Methods: This study was conducted among 100 patients in a tertiary hospital, who were diagnosed with COPD, and their serum magnesium levels were measured when they presented to the hospital during routine check-up (stable) and during an exacerbation. Their PEFR and oxygen saturation were also measured to assess severity. Results: Out of 100 patients studied, 91 were males and 9 were females, of which 38 of them were aged 60 or below and 62 of them aged 61 and above.  The average serum magnesium levels of patients presenting during routine check-up was 2.08 mg/dl (below 60) and 2.06 mg/dl (above 61) as compared to values during an exacerbation which was 1.58 mg/dl (below 60) and 1.60 mg/dl (above 60) which was significant. Our study also determined a serum magnesium cut-off value averaging 1.65 mg/dl, which may be useful therapeutic target for intervention.Conclusions: Serum low serum magnesium levels has a definite association with exacerbations of COPD. Earlier therapeutic interventions may help in decreasing the episodes of exacerbation. A significant reduction of magnesium levels may correlate with severity of airway obstruction.

Rheumatic heart disease(RHD) is an inflammatory disease that mostly occurs in children of 5-15 years old. The major complications of RHD include arrhythmias, especially atrial fibrillation, stroke, infective endocarditis, cardiac failure, and also noted that problems increased in pregnancy. This is a rare case of RHD and urosepsis in a 67- year- old patient with a known history of cerebrovascular accident, pulmonary Arteriovenous(AV) malformation, acute renal failure, and hyponatremia presented to the emergency department with complaints of fever, severe breathlessness, and cough. The patient initially showed clinical manifestations of elevated inflammatory markers, neutrophilic leucocytosis, and hyponatremia, indicating septic shock. Our patient had been empirically treated with Piperacillin-Tazobactam because of the clinical features of urosepsis with septic shock. Based on Bronchoalveolar lavage(BAL) culture with non-fermenter Presumptive Acinetobacter and Klebsiella species and culture sensitivity report antibiotics were changed to Colistin and meropenem. The presence of carbapenem-resistant Klebsiella pneumoniae (CR Kp) entails stopping meropenem and adding tigecycline. Further creatinine clearance declined, and the drug Colistin was changed to Polymixin B. Meropenem was readministered based on the culture reports with scanty growth of multidrug-resistant Proteus mirabilis. Rational use of antibiotics along with the appropriate supportive measures is a meaningful measure in treating a rare and complicated condition of RHD with urosepsis.

Averrhoa bilimbi is a fruit have high oxalic acid content. Excess intake of this fruit will cause acute kidney injury due to high oxalate concentration, and also increase creatinine. In case of high consumption, the only remedy is hemodialysis, but in lower consumption, the renal function will recover without specific treatment. Bilimbi contains 25.1% of oxalate, and its consumption carries a high risk of developing acute kidney injury by deposition of calcium oxalate crystals in renal tubules. The fruit plays an important role in nutrient profile like contain carbohydrates, fibers, proteins, vitamin C, vitamin B, calcium, iron, flavonoids, tannins and terpenes. It also helps to reduce the weight loss due to the high amount of dietary fiber found in bilimbi, which helps to control body weight. Here a male patient who consumed bilimbi fruit per day approximately 30 – 40 and his creatinine level become elevated to 3. 49 mg/dl. With conservative treatment, the patient creatinine becomes normal within one week without dialysis. In some cases did not show oxalate crystals because of low urine excretion, here the patient had oliguria, and because of that, no oxalate crystals were found. Here the main parameter was creatinine, and during admission, the serum creatinine was 3. 49 mg/dl on the first day then 2. 97 mg/dl on the second day, 2.39 mg/dl on the third day and 1.19 mg/dl on forth day and from the fifth day to the seventh day the patient was serially monitored the serum creatinine. It was 1. 19 mg/dl.

Context:Spontaneous bacterial peritonitis (SBP) is a commonly encountered infection seen in the setting of ascites secondary to advanced liver disease. Recurrence of SBP is common and is associated with high mortality. This study was designed to recognize a better initial choice of antibiotic in case of recurrent SBP – a third-generation cephalosporin or a carbapenem.Aims:This study aims to determine a better initial choice of antibiotic in case of recurrent SBP and to compare the all-cause mortality among two different groups of patients treated with a third-generation cephalosporin and a carbapenem.Settings and Design:This study was conducted among fifty patients presenting with recurrent SBP visiting the emergency department (ED) at a tertiary care center and who were subsequently admitted in a gastroenterology intensive care unit, during a period of 1 year.Subjects and Methods:This is a retrospective, observational study conducted among patients with chronic liver disease and diagnosed with recurrent SBP visiting the ED at a tertiary care center in South India treated with either of two classes of antibiotics – third-generation cephalosporins or carbapenems, and their outcomes were compared. Recurrence is defined as an episode of SBP after resolution of the first index case of SBP within 1 year.Statistical Analysis Used:Statistical analysis was done using IBM SPSS version 23.0 (SPSS Inc., Chicago, IL, USA). All categorical variables were represented as percentages, and all continuous variables were represented as mean ± standard deviation. To test the statistical significance of the association of categorical variables with the outcome, Chi-square test was used. P <0.05 was considered statistically significant.Results:A total of fifty patients with recurrent SBP were included in the study, of which 44 (88%) patients were male and 6 patients were female (12%). Twenty-nine (58%) patients survived and 21 (42%) patients expired within 28 days. Twenty-seven (54%) patients were treated with third-generation cephalosporins and 23 (46%) were treated with carbapenems. It was observed that mortality was statistically significantly lower among patients treated with carbapenem (P = 0.001). The incidence of acute kidney injury was also lower among patients treated with a carbapenem than patients treated with a third-generation cephalosporin (40.7% vs. 59.25%, respectively).Conclusions:Initiation of a carbapenem significantly reduced the all-cause mortality when compared to a third-generation cephalosporin as an initial antibiotic of choice in recurrent SBP.