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Benign intrahepatic cholestasis (BRIC) is a rare genetic disorder characterized by episodic cholestasis. Each episode is characterized by repeated episodes of jaundice, intense pruritis last for weeks to months with complete remission. Although each episode is associated with significant morbidity, progressive liver injury and cirrhosis do not occur. In recent studies, few patients progressed to Progressive familial intrahepatic cholestasis. Here we report a case of 19 years boy with benign intrahepatic cholestasis due to an undulant course terminated by plasma exchange.

BACKGROUND Systemic Lupus Erythematosus (SLE) is a connective tissue disease with high morbidity that results in multiple admissions. This study was undertaken to determine trends in hospitalisation and outcomes in patients with SLE. MATERIALS AND METHODS This was a retrospective study of all patients admitted with SLE between January 2012 and 2015 at a tertiary care hospital in Chennai. Records were analysed and causes for recurrent admission looked at. RESULTS A total of 101 patients were included. Mean age was 33.4 years, mean number of admissions 3.44. Systemic symptoms were common, renal involvement 70.3% and haematological involvement 35.6%. 66 patients got admitted more than once. Infections, need for drug administration (cyclophosphamide) and disease flare were the causes for repeated admissions. CONCLUSIONS SLE results in high utilisation of medical resources, recurrent admissions are the norm and infections and disease flare are common causes for admission

Accurate diagnosis of glucose-6-phosphate dehydrogenase (G6PD) deficiency is required to avoid the risk of acute hemolysis associated with 8-aminoquinoline treatment. The performance of the BinaxNOW G6PD test compared with the quantitative spectrophotometric analysis of G6PD activity was assessed in 356 Plasmodium vivax-infected subjects in Brazil, Peru, Thailand, and India. In the quantitative assay, the median G6PD activity was 8.81 U/g hemoglobin (range = 0.05-20.19), with 11 (3%) subjects identified as deficient. Sensitivity of the BinaxNOW G6PD to detect deficient subjects was 54.5% (6 of 11), and specificity was 100% (345 of 345). Room temperatures inadvertently falling outside the range required to perform the rapid test (18-25 degrees C) together with subtlety of color change and insufficient training could partially explain the low sensitivity found. Ensuring safe use of 8-aminoquinolines depends on additional development of simple, highly sensitive G6PD deficiency diagnostic tests suitable for routine use in malaria-endemic areas.

BACKGROUND: Clinical effectiveness of previous regimens to treat Plasmodium vivax infection have been hampered by compliance. We aimed to assess the dose-response, safety, and tolerability of single-dose tafenoquine plus 3-day chloroquine for P vivax malaria radical cure. METHODS: In this double-blind, randomised, dose-ranging phase 2b study, men and women (aged >/=16 years) with microscopically confirmed P vivax monoinfection (parasite density >100 to 7500 per muL blood). The primary efficacy endpoint was relapse-free efficacy at 6 months from initial dose (ie, clearance of initial infection without subsequent microscopically confirmed infection), analysed by intention to treat. This study is registered with ClinicalTrials.gov, number NCT01376167. FINDINGS: Between Sept 19, 2011, and March 25, 2013, 329 patients were randomly assigned to a treatment group (chloroquine plus tafenoquine 50 mg [n=55], 100 mg [n=57], 300 mg [n=57], 600 mg [n=56]; or to chloroquine plus primaquine [n=50]; or chloroquine alone [n=54]). Relapse-free efficacy at 6 months was 57.7% (95% CI 43-70) with tafenoquine 50 mg, 54.1% (40-66) with tafenoquine 100 mg, 89.2% (77-95) with tafenoquine 300 mg, 91.9% (80-97) with tafenoquine 600 mg, 77.3% (63-87) with primaquine, and 37.5% (23-52) with chloroquine alone. Tafenoquine 300 mg and 600 mg had better efficacy than chloroquine alone (treatment differences 51.7% [95% CI 35-69], p

Background. Studies have shown that hypertensive retinal changes (HRC) have a moderate accuracy in predicting microalbuminuria (MA) in elderly hypertensive patients (age >65 years). This study is an effort to identify a similar relationship in hypertensive patients aged

Background: Though the association between microalbuminuria (MA) and inflammatory markers has been studied, the possible gender differences in these associations have not yet been analyzed. Our study aims to analyze the role of gender in the associations of MA and inflammatory markers. Methods: 1,060 hypertensive patients were assessed for MA (albumin-creatinine ratio), plasma levels of HsCRP (high-sensitivity C-reactive protein), IL-18, and sCD40L (soluble CD40 ligand). Patients with diabetes mellitus, metabolic syndrome and overt nephropathy were excluded. Results: Mean age was 46 ± 9.6 years, with 560 males and 500 females. The prevalence of MA was 35.6% (n = 378). MA was associated with HsCRP (OR: 2.13, CI: 1.155–3.168, p = 0.001) and sCD40L (OR: 2.35, CI: 1.014–3.912, p = 0.013) in the premenopausal females, whereas in males (OR: 1.83, CI: 1.037–3.920, p = 0.023) and postmenopausal females (OR: 2.31, CI: 1.688–3.274, p = 0.031) MA was associated only with HsCRP and not with sCD40L or IL-18. Conclusions: Association between MA and HsCRP is consistent in all hypertensive patients. However, MA is associated with sCD40L only in premenopausal females and not in males and postmenopausal females.

INTRODUCTI ON: Cerebral venous thrombosis (CVT) is an unusual cause of stroke that affects the young and is often missed or misdiagnosed . This study was undertaken to study the profile of patients who presented with CVT. METHODS: A cohort of 59 patients who presented to Sri Ramachandra Medical College and Research Institute, Chennai between June 2009 to September 2011 and were diagnosed to have CVT by neuro imaging were included in the study. Clinical and laboratory parameters were entered into a detailed questionnaire and patients were followed up during their stay in hospital. Data was analysed using SPSS software for Windows version SPSS 16.0. RESULTS: The mean age at diagnosis was 37 years. Headache was the most common symptom (86.4%) of patients followed by vomiting (44.1%) and seizures (42.4%). Papilledema was the most common sign in 37% of patients. Superior sagittal sinus was the most commonly affected. Hyperhomocysteinemia was the underlying etiological factor in 23% . 7 patients were in the pregnant and puerperal period. All patients were treated with anticoagulants. 2 patients died in hospital. CONCLUSION: CVT presents in the young, often with symptoms and signs of raised intracranial pressure. Response to therapy is better than with arterial stroke and there is a favourable outcome

Accurate identification of low-risk patients with acute pulmonary embolism (PE) who may be eligible for outpatient treatment or early discharge can have substantial cost-saving benefit. The purpose of this study was to derive and validate a prediction model to effectively identify patients with PE at low risk of short-term mortality, right ventricular dysfunction, and other nonfatal outcomes. This study analyzed data from 400 consecutive patients with acute PE. We derived and internally validated our prediction rule based on clinically significant variables that are routinely available at initial examination and that were categorized and weighted using coefficients in the multivariate logistic regression. The model was externally validated in an independent cohort of 82 patients. The final model (HOPPE score) consisted of 5 categorized patient variables (1, 2, or 3 points, respectively): systolic blood pressure (120, 100 to 119,99 mm Hg), diastolic blood pressure (80, 65 to 79,64 mm Hg), heart rate (80, 81 to 100,101 beats/min), arterial partial pressure of oxygen (80, 60 to 79,59 mm Hg), and modified electrocardiographic score (2, 2 to 4,4). The 30-day mortality rates were 0% in low risk (0 to 6 points), 7.5% to 8.5% in intermediate risk (7 to 10), and 18.2% to 18.8% in high-risk patients (≥11) across the derivation and validation cohorts. In comparison with the previously validated PESI score, the HOPPE score had a higher discriminatory power (area under the curve 0.74 vs 0.85, p = 0.033) and significantly improved both the discrimination (integrated discrimination improvement, p = 0.002) and reclassification (net reclassification improvement, p = 0.003) of the model for short-term mortality. In conclusion, the HOPPE score accurately identifies acute patients with PE at low risk of short-term mortality, right ventricular dysfunction, and other nonfatal outcomes. Prospective validation of the prediction model is necessary before implementation in clinical practice.