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Strongyloides stercoralis is an intestinal nematode which persists as chronic asymptomatic infection for several years. Clinical manifestations become apparent long after initial infection which includes non specific gastrointestinal (GI) symptoms like pain abdomen, nausea, vomiting, altered bowel habits or weight loss. Larval reproduction can lead to disseminated infection in the immunocompromised. Very rarely, hyperinfection or disseminated strongyloides can lead to ulceration, bleeding, small bowel obstruction, colitis or ascites. In severe cases, electrolyte disturbances and protein losing enteropathy may occur. We present a unique case of intestinal infestation of Strongyloides stercoralis in a 42-year-old immunocompetent male with a rare manifestation of protein losing enteropathy and dyselectrolytaemia without any GI symptoms at the outset, whose presentation was anasarca and initial investigations including work-up for cardiovascular, hepatic and renal causes of anasarca were unremarkable except for hypoalbuminaemia and electrolyte abnormalities and notable absence of peripheral eosinophilia. The diagnosis was arrived at by simple and conventional investigations like stool microscopy which demonstrated the Strongyloides larvae and upper GI endoscopy aided the biopsy which was confirmatory. He responded to appropriate medical treatment. Helminthic infestation should be kept in mind as a rare cause of malabsorption syndrome manifesting as protein losing enteropathy in a tropical and endemic country like India. These are treatable causes and respond to specific cost-effective antihelminthic treatments. [ABSTRACT FROM AUTHOR]

Introduction: There is rising concern about vitamin D deficiency around the globe due to its increasing association with multiple medical disorders. Diabetes Mellitus (DM) is an established risk factor for atherosclerotic disorders, and Carotid Artery Intima- Media Thickness (CIMT) is considered a radiological marker of subclinical atherosclerosis. Aim: To find a correlation between serum 25-hydroxy vitamin D (25-(OH)-D) levels and CIMT among patients with DM. Materials and Methods: A hospital-based cross-sectional study was conducted, including 100 adult patients with Type 2 DM who were admitted to the Department of Medicine at SCB Medical College and Hospital in Cuttack, Odisha, India from October 2020 to September 2021. Vitamin D deficiency was defined as serum 25-(OH)-D levels <20 ng/mL, and insufficiency as <30 ng/mL. The demographic profile of patients, family history of Type 2 DM, smoking history, blood pressure, haemogram, blood sugar, serum electrolytes, and lipid profile were studied. CIMT of the bilateral Common Carotid Artery (CCA) was measured by B-mode ultrasonography. CIMT values ≥ 0.8 mm were considered abnormal. Data were analysed using appropriate statistical tests in Statistical Packages for Social Sciences (SPSS) version 26.0. Results: The present study included 55% males (n=55) and 45% females (n=45). The average age of the patients was 60 ±10 years, ranging from 26-75 years. Vitamin D deficiency was highly prevalent among patients with Type 2 DM (73% deficient, 12.5 ng/mL; 21% insufficient, 24.7 ng/mL). Vitamin D deficiency/ insufficiency was higher among male participants (57.5%, 62%) compared to females (42.4%, 38%). Vitamin D levels were significantly associated with dyslipidemia. Mean CIMT among the vitamin D deficiency versus insufficiency versus normal group were 0.87 versus 0.87 versus 0.7 mm on the right Common Carotid Artery (CCA), and 0.95 versus 0.86 versus 0.75 mm on the left CCA, respectively. Significant negative correlations were observed for HbA1c (r=-0.025), Triglycerides (r=-0.274), right CIMT (r=-0.284), and left CIMT (r=-0.264) with serum 25-(OH)-D levels. Conclusion: The majority of patients with Type 2 DM have concurrent vitamin D deficiency. A significant inverse linear association between serum vitamin D levels and CIMT was observed, indicating the association of vitamin D deficiency with subclinical atherosclerosis. Although unproven in the present study, the role of vitamin D supplementation in the improvement of atherosclerosis remains unclear. [ABSTRACT FROM AUTHOR]

Background: Claudins are a clan of proteins that are the most important component of tight junctions. The claudin-4 expression has been linked to tumour cell invasion and progression in a variety of primary malignancies. Evaluation of lymphovascular density (LVD) correlates with tumour aggressiveness and may correlate with prognosis. D2-40 is a highly specific marker of lymphatic vessels. Aims: To evaluate the claudin-4 expression in relation to LVD by D2-40 expression and with clinicopathological parameters in prostatic adenocarcinoma. Settings and Design: Prospective study Materials and Methods: 39 cases of prostatic adenocarcinoma were taken, the D2-40 and claudin-4 immunohistochemical stains were performed and correlation was done with clinicopathological parameters. Statistical Analysis Used: Statistical analyses such as mean, median, standard deviation, Mann-Whitney U test, Fischer exact test, Spearman's rank-order correlation coefficient, Chi-square test and T-test were used. Results: The claudin-4 expression was seen higher in cases with higher Gleason score but it was statistically non-significant (P = 0.778). The claudin-4 expression did not correlate with any clinicopathological parameters. LVD in the peritumoral area was significantly higher as compared to the intratumoral area (P = 0.005). Intratumoral LVD and perineural invasion were found to be statistically significant (P = 0.048). Conclusion: The claudin-4 expression may correlate with adverse prognostic parameters. Higher lymphatic vessels can be responsible for the higher metastatic potential of prostatic adenocarcinomas. [ABSTRACT FROM AUTHOR]

Hypersensitivity Pneumonitis (HP), also known as extrinsic allergic alveolitis, is a pulmonary disorder characterised by an inflammatory response of the alveoli and small airways due to exposure to a variety of antigens. HP can manifest as acute, subacute, or chronic, depending on the mode of onset and its duration. A broad spectrum of antigens, derived from fungi, bacteria, mycobacteria, birds, chemical sources, and certain drugs such as cyclophosphamide and sulfonamides, has been associated with the development of HP. However, HP developed by Ceftriaxone is an extremely rare occurrence. Here, the authors presented a case of a 26-year-old male who experienced the onset of HP immediately following the administration of injectable Ceftriaxone. He developed a sudden onset of breathlessness and cough, necessitating Mechanical Ventilation (MV) and steroid support. Radiological imaging indicated pneumonitis, and the symptoms gradually resolved after discontinuing Ceftriaxone. Ceftriaxone-induced acute HP represents an unusual clinical presentation. In the present case report, the authors highlighted the possibility of Ceftriaxone as a potential cause of HP, given its capacity for rapid reversal upon its timely removal. [ABSTRACT FROM AUTHOR]

Background: Coronary artery disease (CAD) is one of the most common morbidities associated with diabetes mellitus. Impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) are precursors to diabetes and major risk factors for atherosclerosis. The study aimed to evaluate the prevalence of IFG and IGT in nondiabetic patients with CAD. Methods: The study was performed on 100 non-diabetic patients with CAD and 50 healthy age- and sex-matched controls. Data were collected via detailed medical history taking, clinical examination, routine blood chemistry tests, fasting blood sugar test, 2-hour post-prandial blood sugar test, lipid profile, electrocardiogram, 2D-echocardiogram, and carotid Doppler. Results: Dyslipidemia was more prevalent among the patients. The mean carotid intima-media thickness was higher in the patients. Overall, IFG was found in 9 (15%) cases and IGT was found in 13 (22%) cases. The co-existence of IFG and IGT was detected in 3 (5%) cases. Abnormal glucose regulation was found in 42% of patients. Conclusion: The findings indicate the need for early screening and management of prediabetes for the prevention of further progression to diabetes. [ABSTRACT FROM AUTHOR]

Background: Sickle cell disease (SCD) is a hemoglobinopathy characterized by chronic hemolytic anemia and vaso-occlusive painful crisis. The vascular occlusion in SCD is a complex process that is responsible for most clinical manifestations of the disease. Abdominal pain is an important component of vaso-occlusive painful crisis and may mimic diseases, such as acute appendicitis and cholecystitis. Acute pancreatitis is rarely encountered as a cause of abdominal pain in patients with SCD. Gallstones and alcohol abuse account for the majority of the cases of acute pancreatitis. Pancreatic ischemia is an uncommon but established cause of pancreatitis associated with connective tissue diseases, vasculitis, and shock. In SCD, the deformed red blood cells resulting from deoxygenation during stress, infection or dehydration, cause vaso-occlusion, tissue ischemia, and infarction. Case description: We present a case of SCD presenting as acute pancreatitis apparently due to microvascular occlusion and ischemic injury to the pancreas. The patient responded to conservative management. Conclusion:Our case will help to always keep in mind and consider acute pancreatitis as a differential diagnosis in patients with SCD presenting with abdominal pain. [ABSTRACT FROM AUTHOR]

Background: Magnetic resonance cholangiopancreatography (MRCP) is a non-invasive imaging modality that has high diagnostic accuracy for a wide range of bile duct and pancreatic duct pathologies. Endoscopic retrograde cholangiopancreatography (ERCP) is still the gold standard for the exploration of the biliopancreatic region., Aim: The aim of the study was to compare the diagnostic accuracy of MRCP with that of ERCP in the diagnosis of bile duct and pancreatic duct pathologies., Material and Methods: A total of 60 patients with common bile duct (CBD) and pancreatic duct pathologies detected on MRCP were subsequently evaluated by ERCP in this observational study. A comparison of MRCP findings with ERCP was made., Results: MRCP had a sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 88.1%, 94.4%, 97.3%, 72.7%, and 90%, respectively, in diagnosing choledocholithiasis in comparison to ERCP. For CBD dilation, the sensitivity was 90.91%, specificity was 93.75% and the PPV, NPV, and accuracy were 97.56%, 78.95%, and 91.67%, respectively, for MRCP. In CBD stricture, MRCP showed a sensitivity, specificity, PPV, NPV, and accuracy of 83.33%, 97.92%, 90.91%, 95.92%, and 95%, respectively. In pancreatic duct dilatation, the sensitivity, specificity, PPV, NPV, and accuracy were all 100%. Pancreatic duct stricture showed a sensitivity, specificity, PPV, NPV, and accuracy of 80%, 98%, 88.89%, 96.08%, and 95%, respectively. For the diagnosis of periampullary carcinoma, the sensitivity, specificity, PPV, NPV, and accuracy rate of MRCP were 80%, 98%, 88.89%, 96.08%, and 95%, respectively., Conclusion: No significant difference was found between MRCP and ERCP in diagnosing those six pathologies., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Kumar, Mohanty, Mohanty and Dash.)