Impacted leopard tooth in thyroid gland of victim in a case of leopard attack – A case report

Attacks by wild animals on humans are not rare in India. Most of the cases are seen in rural areas and areas adjoining forest lands. The nature of the attack may be predatory or defensive. The main culprit for this is deforestation and encroachment of humans into the natural habitats of wild animals. Wild animal attacks can cause very severe injuries, including lacerations, fractures, and vascular injuries, and are often associated with high rates of mortality. Treatment depends on the type and nature of the injury. Those who survive the initial attack often succumb to infection and septicemia during the early hospital stay. Psychiatric complications are also common in survivors. We present the case of a 70-year-old man, who was attacked by a leopard. He sustained a few lacerated bite injuries to the neck and was treated at North Bengal Medical College and Hospital. A computed tomography scan of the neck revealed a tooth of the animal impacted in the thyroid gland of the patient. The patient is currently receiving treatment for deranged thyroid function, and awaiting normalization of the same, to get anesthetic fitness for surgical removal of the tooth. Treating surgeons must be well aware of the patterns of injuries and their treatment in cases of animal attack injuries. In-depth clinical and radiological investigations are of utmost importance to find out occult injuries that may become life-threatening. A standardized treatment protocol needs to be developed for the treatment of wild animal attack victims. There is a need to extend health care into the remote areas of the nation, for early treatment of such cases.

Evaluation of the effectiveness of dequalinium chloride vaginal tablets in aerobic vaginitis: A placebo-controlled study

Background: Aerobic vaginitis is a disturbance of vaginal homeostasis caused by the colonization of enteric bacteria. They are not clinically well-defined and do not have standard treatment regimes. Hence, the present study was conducted to evaluate the effectiveness of dequalinium chloride topical vaginal administration in aerobic vaginitis in a placebo-controlled manner. Materials and Methods: This study was conducted in a placebo-controlled manner to demonstrate the effectiveness of vaginal 10 mg dequalinium chloride. A total of 30 patients with different vaginal infections were included in the study. The patients included in the study were divided between the drug group and the placebo group and were treated with one vaginal tablet daily for 6 days. The total symptom score, which consists of the assessment of discharge, itching, and burning sensation, and the lactobacillus grade evaluated microscopically, was determined. Results: It was found that the effectiveness of dequalinium chloride was very high compared to placebo (92% vs. 0%). The reproduction frequency in the first visit was statistically significantly lower in the drug group compared to the placebo group (P < 0.001). Conclusion: It was found that dequalinium chloride is effective for the treatment of aerobic vaginitis. However, studies containing a larger sample group, including the long-term effects (efficacy and side effects) of the drug, should be conducted to prove our conclusion.

C-reactive protein as a prognostic marker in coronavirus disease-2019

Background: Coronavirus disease-2019 (COVID-19) is a recently emerged viral disease, for which there’s currently no definitive treatment. It is, therefore, necessary to determine biomarkers to know the extent of disease severity so that timely action can be taken to reduce mortality. We aimed to determine the usefulness of C-reactive protein (CRP) levels in assessing COVID-19 disease severity and correlate them with mortality due to the same. Methods: Data for COVID-19 were retrospectively collected and analyzed from May 2020 to October 2020. The CRP value was correlated with disease severity using Karl Pearson’s correlation coefficient. A logistic regression model was adopted to analyze the association between mortality and related factors. Results: Out of 642 patients enrolled, 22 died while 620 recovered. Most of the non-survivors were male. Multivariate analysis showed that age, diabetes, hypertension, and CRP values were significantly associated with mortality. CRP showed a strong positive correlation with disease severity and, hence, mortality. Conclusion: In patients with COVID-19, CRP correlated with disease severity and tended to be a good predictor of adverse outcome.

Perforating urinary bladder foreign body managed with minimally invasive surgery

Foreign bodies are occasionally reported in the urinary bladder, especially in females. The consequences and clinical impact depend on the route of insertion and the patient’s hemodynamic condition, and their removal may include minimally invasive procedures to open cystostomy. In most cases, foreign bodies are removed through transurethral approach. Here, we report one such case of a foreign body in the urinary bladder, which was self-inserted and had perforated through the bladder wall, yet could be successfully managed by cystoscopic removal without any complications.

Prevalence of low bone mineral density in Human Immunodeficiency Virus-infected patients and its correlation with other determinants

Background: The patients infected with human immunodeficiency virus (HIV) are potentially at risk of low bone mineral density (BMD). The present study was done to find out the prevalence of low BMD in HIV-infected patients and its correlation with other factors such as gender, body mass index (BMI), CD4 count, and highly active antiretroviral therapy (HAART). Methods: This was an observational cross-sectional study conducted in a tertiary care center for 1 year period. A total of 127 HIV-infected patients were evaluated for BMD by dual-energy X-ray absorptiometry (DEXA) scans at two sites lumbosacral spine and bilateral neck femur. Correlation with other factors was also studied. Results: The diagnosis of low BMD was established in 105 (82.67%) patients. Osteoporosis (44.1%) was more common than osteopenia (38.6%) at the lumbosacral spine. The mean T score of the DEXA lumbar spine and bilateral neck femur was observed to be ?2.113 and ?1.379, respectively. Males (88.73%) had low BMD than females (75%). Approximately 94.5% of subjects having BMI <18 had low BMD in contrast to 80.8% among subjects having BMI >18. After treatment, 47 patients had CD4 count <400 and 80 > 400. Forty-three patients out of 47 (91.5%) had low BMD and 62 out of 80 (77.5%) had low BMD. Conclusion: Low BMD is prevalent in HIV-infected subjects. Low BMI, persistently low CD4 count, tenofovir containing HAART regimen showed a positive correlation with low BMD. Hence, HIV infection should be considered as a risk factor for bone disease.

Clinico-pathological features of the drug reaction with eosinophilia and systemic Symptoms syndrome: A case study

Drug reaction with eosinophilia and systemic symptoms syndrome is a syndrome with a varied spectrum of clinical features. The cutaneous manifestations can be an urticarial, maculopapular eruption also including, vesicles, bullae, pustules, purpura, target lesions, facial edema, cheilitis, and erythroderma. Systemic manifestations include lymphadenopathy, fever, and leukocytosis (often with eosinophilia or atypical lymphocytosis), as well as hepatitis, nephritis, pneumonitis, myositis, and gastroenteritis, in descending order. Diagnosis can be made on the basis of the clinical picture and the RegiSCAR (Registry of Severe Cutaneous Adverse Reaction group) scoring system. Here, we present the case of a 40-year-old male with a history of herbal medicine intake after which he developed a diffuse skin rash.