Occult strongyloides stercoralis infection masquerading as a drug reaction with eosinophilic pneumonia

Background: Pseudomelanosis or melanosis duodeni is seen in association with drugs, microorganisms or occasional bleeding, usually from peptic ulceration. We present a case of Strongyloides stercoralis presenting as pseudomelanosis duodeni during anemia workup after patient’s initial presentation as eosinophilic pneumonia. Case presentation: The patient is a 77 year-old female with a history of diastolic congestive heart failure, chronic kidney disease, diabetes mellitus, and hypertension who presented for evaluation of black stool. Two months earlier, in her prior admission for acute eosinophilic pneumonitis, the patient’s hematocrit was 26%. In her current admission with heme-positive dark stool on exam, the hematocrit dropped to 19%. The patient underwent esophagogastroduodenoscopy to identify the source of bleeding. The upper endoscopy revealed three non-bleeding ulcers in the gastric antrum and discoloration of the duodenal bulb and second portion of the duodenum. By histology, the duodenal biopsies showed areas of hemosiderin-laden macrophages in the lamina propria, focal helminth eggs and larvae in the crypt lumen with sizes ranging from 35-65 microns x ~20 microns. Polymerase chain reaction of the paraffin embedded tissue with 28S primer set detected Strongyloides stercoralis DNA, confirming the histologic findings. Given the confirmation of Strongyloides stercoralis, the patient’s initial presentation of eosinophilic pneumonia (Loeffler syndrome) may be a result of the parasitic infection or the successful response to steroid treatment for acute eosinophilic pneumonia caused Strongyloidiasis hyperinfection. The patient’s symptoms were improved with Ivermectin and hematocrit level increased to 28%. Conclusions: This case highlights the importance in recognition of helminth infection in the evaluation of eosinophilic pneumonia and pseudomelanosis duodeni. Keywords: Pseudomelanosis duodeni; Strongyloides stercoralis; Eosinophilic pneumonia; polymerase chain reaction.

Incidence of writing double NSAIDs in a single prescription for osteoarthritis.

Objective: To determine how frequent NSAIDs are used for osteoarthritic patients because OA is common old age patients and NSAIDs can cause divesting complications on their health. In our study we tried to identify the main reasons and suggest a best possible solution. Study Design: Community Based Cross-sectional study. Setting: Mohammad Medical College and Hospital Mirpurkhas Pakistan. Period: June 2018 to August 2018. Material & Methods: In this study, we included more than 300 prescriptions written for Osteoarthritis, a degenerative joint disease. Prescriptions collected from hospital pharmacy (80%) and from other pharmacies (20%). Data was collected on preformed proforma and was analyzed in SPSS version 25. Results: Osteoarthritis mainly affects elderly population. NSAIDs are used for pain relief but can cause acute renal failure and GIT bleeding ulcers. In our study 69% patients were prescribed double NSAIDs. Traditional NSAIDs were used 95% of the time and only 5% percent of the time selective cox 2 were used. Along with these NSAIDS only 20% patient were given prophylactically gastroprotective agents like PPI and other medications. Conclusion: Prescription osteoarthritis include multiple NSAID without any protocol and over dosage was observed commonly.

Multiple Site Peripheral Arteriovenous Malformations: A Definitive Diagnosis Using Duplex Ultrasound

We present a case of a 70-year-old woman with extensive, multiple, dystrophic, necrotic, and bleeding ulcers on her forearm stump, shoulder, and chest wall. She had previously undergone a mid-forearm amputation due to a bleeding fungating ulcer from an arteriovenous malformation (AVM) on the dorsum of her right hand. Considering her history, AVM was suspected as the cause of the lesions. Due to significant renal impairment, duplex ultrasound (DU) was crucial in diagnosing and subsequent surgical management of her multifocal AVMs.

In-vitro Gastric acid percent neutralizing potential of household remedies verses marketed antacid preparation: A case report

Gastric acidity is a very common condition among the peoples of developing and developed countries. Increased gastric pH is associated with gastric ulceration, Bleeding ulcers, GERD, heartburn, discomfort, nausea and vomiting. The instant and quick relief from acidity can be obtained by oral administration of antacids. Current study was carried out to determine the acid neutralizing effect of household remedies like cold milk, Baking soda, Baking soda + citric acid in water verses marked preparations like Effervescent granules (ENO, Digene) and liquid antacid Gelusil (5ml and 10ml). Gastric simulation fluid of pH1.2 was prepared and pH was recorded before and after addition of marketed antacid/ household remedies. Observations were recorded in multiple of three for 0 min to 60 min. percent acid neutralization were calculated for each marketed/ household preparation. Results advocate that baking soda in water and Gelusil 10ml shows significant percent acid neutralization 444.35% and 428.57% respectively. The effect of acid neutralization of baking soda in water was instant and remained same whereas Gelusil 10ml showed progressive acid neutralization over a period of time. Effervescent granules ENO and Digene showed 322.58303.14% acid neutralization respectively. Milk 259.67% Gelusil188.28% and Baking soda + citric acidin Water421.25% showed acid neutralization. From results it can be concluded that household remedies are also significantly effective to control the acidity. Keywords: Antacid, Effervescent granules, Milk, Baking soda. % acid neutralization.

Prevention of recurrent idiopathic gastroduodenal ulcer bleeding: a double-blind, randomised trial

ObjectivePatients with a history of Helicobacter pylori-negative idiopathic bleeding ulcers have a considerable risk of recurrent ulcer complications. We hypothesised that a proton pump inhibitor (lansoprazole) is superior to a histamine 2 receptor antagonist (famotidine) for the prevention of recurrent ulcer bleeding in such patients.DesignIn this industry-independent, double-blind, randomised trial, we recruited patients with a history of idiopathic bleeding ulcers. After ulcer healing, we randomly assigned (1:1) patients to receive oral lansoprazole 30 mg or famotidine 40 mg daily for 24 months. The primary endpoint was recurrent upper GI bleeding within 24 months, analysed in the intention-to-treat population as determined by an independent adjudication committee.ResultsBetween 2010 and 2018, we enrolled 228 patients (114 patients in each study group). Recurrent upper GI bleeding occurred in one patient receiving lansoprazole (duodenal ulcer) and three receiving famotidine (two gastric ulcers and one duodenal ulcer). The cumulative incidence of recurrent upper GI bleeding in 24 months was 0.88% (95% CI 0.08% to 4.37%) in the lansoprazole arm and 2.63% (95% CI 0.71% to 6.91%) in the famotidine arm (p=0.313; crude HR 0.33, 95% CI 0.03 to 3.16, p=0.336). None of the patients who rebled used aspirin, non-steroidal anti-inflammatory drugs or other antithrombotic drugs.ConclusionThis 2-year, double-blind randomised trial showed that among patients with a history of H. pylori-negative idiopathic ulcer bleeding, recurrent bleeding rates were comparable between users of lansoprazole and famotidine, although a small difference in efficacy cannot be excluded.Trial registration numberNCT01180179; Results.