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BACKGROUND: Snakebite is a common but neglected public health problem of tropical & subtropical regions worldwide. This study was conducted to look into profile, first aid measures, management strategy and outcomes of snake bite patients. METHODS: This was an ambispective study conducted in the Department of Medicine & Emergency Medicine at AIIMS, New Delhi from June 2011 to May 2017 and enrolled 54 patients. In retrospective part 33 case records of snake bite patients were retrieved and in prospective part 21 patients were recruited. All relevant information including demographic parameters, first aid measures, clinical and laboratory profile and outcomes were recorded in pre made proformas. All data were analysed using IBM Stata version 13 and Microsoft Excel 2011. RESULTS: Majority of patients were male, and the mean age was 27.6 years. Maximum numbers of bites 34 (63%) happened in the rainy season and Krait was the most common culprit species. Neurological manifestations were most common (70.4%) followed by haematological. Most common complication was ventilatory failure (78.6%), and median dose of ASV was 20 vials. Forty-nine (90.7%) patients were discharged successfully. There was significant association of sepsis and shock with non survivors of snake bite with respective P values of 0.02 and 0.007. CONCLUSION: Neurotoxic snake bite (70.4%) was the most common type of envenomation. Most common complication was ventilatory failure and majority of patient (90.7%) successfully discharged. Sepsis and shock were significantly associated with non survivors of snake bite.

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Amebiasis is an endemic protozoal infection in developing countries. Extra-intestinal involvement in the form of abscess is frequently seen in liver and lungs. The occurrence of amebic brain abscess is a rare and life-threatening presentation of systemic amebiasis. Here, we report a case of a young male who simultaneously presented with amebic liver and brain abscesses. He was successfully managed with intravenous metronidazole, other antibiotics, and drainage of both brain and hepatic abscesses along with supportive measures. The rare occurrence of this simultaneous presentation of amebic hepatic and brain abscess, prompted us to report this case.

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PURPOSE: There is a paucity of scientific evidence from the Indian subcontinent regarding the magnitude and burden of Medically Unexplained Physical Symptoms (MUPS). This study aims to fill the evidence gap by assessing the prevalence and pattern of MUPS amongst patients attending the Medicine Out-Patient Department (OPD). METHODOLOGY: The study assessed all consecutive new patients, presenting to the Medicine OPD of a tertiary care center in India over a period of nine months. All consenting patients, between 18 and 60 years of age, irrespective of their reason for consultation were included for the study. The diagnosis in subjects was established by a combination of clinical history, physical examination, and relevant investigations. A diagnosis of MUPS was made in cases with no demonstrable organic cause, and after agreement in the opinion of two independent physicians. All recruited patients with MUPS were subsequently evaluated on a pre-validated symptom checklist of 23 symptoms. RESULTS: Out of 976 subjects included, a diagnosis of MUPS was established in 24.6% [95% CI = 21.9-27.3] of the sample. An additional 20.6% met the criteria of persistent MUPS (symptoms >2 months), and 19.7% of subjects had symptom duration of more than three months, meeting the stricter definition for 'persistent MUPS'. Prevalence was significantly higher in females (p = 0.02), and patients of MUPS were significantly younger (p = 0.004) than patients with other diagnoses. MUPS patients on average complained of 13 ±â€¯5 symptoms and sought multiple medical consultations [Median (IQR) = 3 (2 - 6)] in the last one year. Non-specific, general symptoms (94.6%) and various types of pain (93.7%) were the most frequent complaints. Pain symptoms, genitourinary symptoms, palpitation, and nausea were more frequent in females as compared to males. DISCUSSION: Medically unexplained symptoms are as common in India as in the west and therefore pose a significant burden on the healthcare delivery systems. There is a need to sensitize the medical fraternity and policymakers for this condition to develop effective services.

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Malaria has emerged as a major public health problem worldwide. Complications are commonly seen in Plasmodium falciparum (P. falciparum) and Plasmodium vivax (P. vivax) infection, but due to Plasmodium ovale (P. ovale) infection is rarely described in literature. Here we report a case of severe disease due to P. ovale infection complicated with jaundice, thrombocytopenia, hypotension and acute renal failure.

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