Hashimoto's encephalopathy is a controversial and under-recognized condition, associated with autoimmune thyroiditis. Presentation may be an insidious development of cognitive impairment or recurrent acute episodes of focal neurological deficit with confusion. Here, we present a case of middle-aged female that presented with headache, vomiting with alteration of sensorium and left side weakness and responded well to steroids. A negative microbiological screen of the cerebrospinal fluid (CSF) and serum along with raised CSF protein, elevated serum antithyroid antibodies, and characteristic electroencephalographic and neuroimaging findings yielded the diagnosis.

Strongyloides stercoralis is an intestinal nematode acquired primarily in the tropics, estimated to infect approximately 100 million people worldwide. Strongyloidiasis can be asymptomatic in many individuals or present in a variety of ways including acute infection, chronic infection, hyperinfection, and disseminated infection. We present a case where recurrent pneumonia was being evaluated and later found to be due to strongyloides hyperinfection syndrome and successfully treated with ivermectin. A 74-year-old female background of seasonal bronchitis, recurrent lower respiratory tract infections presented to us with Gram-negative bronchopneumonia which was treated but recurred after a few days. Investigations were ongoing for fungal infections when we picked up the S. stercoralis hyperinfection. In tropical regions, the regional prevalence of strongyloides infection may exceed 25%. Strongyloides hyperinfection describes the syndrome of accelerated autoinfection, generally the result of an alteration in immune status. Hyperinfection syndrome is estimated to happen in 1-2.5% of the patients with strongyloidiasis. Hyperinfections are often complicated, and gut flora gain access to extraintestinal sites, presumably through ulcers induced by the filariform larvae or by virtue of being carried on the surface or in the intestinal tract of the larvae themselves. Our patient did not have symptoms of strongyloides or reasons for immunosuppression. She only could have been immunosuppressed due to age or possible steroid use for seasonal bronchitis. We want to point out that strongyloides hyperinfection is a possible cause of recurrent Gram-negative pneumonia and sepsis. Parasitic infection screening must be done in all patients in our country who are admitted with severe sepsis.

Background and Objectives: Chronic obstructive pulmonary disease is a common problem in both developed and developing nations. It is directly linked with smoking. It is associated with frequent exacerbations and then hospitalizations. A large percent of Gross domestic product is spent on its management. We conducted a hospital-based study in such patients who got admitted with exacerbation, whether infective or noninfective, and who required invasive ventilation during management. Such kind of study has not been reported from our country so far. The aim of this study is to determine the prevalence, etiology, and sensitivity of infective exacerbations and its impact on the outcome with the use of invasive ventilation. Materials and Methods: We enrolled 150 admitted patients for the study and recorded their clinical and laboratory parameters. The respiratory specimen was obtained by different ways and sent for culture and drug sensitivity. The outcome was noted with the use of invasive ventilation, and prognostic values of different variables were ascertained. Results: The infective exacerbation was seen in 65% and organisms involved were Gram-negative bacteria, with a predominance of Acinetobacter in 35%, Klebsiella in 32%, Pseudomonas in 17.5%, and Escherichia coli in 5%. The number of hospitalization days of the 150 patients ranged from 5 to 40 days with a mean of 16.39 ± 11.45 days. The number of Intensive Care Unit days range was 0-25 days with a mean of 7.35 ± 7.9 days. The number of days of invasive ventilation range was 2-18 days with a mean of 3.28 ± 5.2. The number of days on Bi-level positive airway pressure ventilation (BiPAP) was between 2 and 22 with a mean of 6.15 ± 5.7 days. The outcome was significant between the survivors/nonsurvivors in terms of a number of days of invasive ventilation required (P < 0.004). Conclusion: There was higher mortality among patients admitted with multiorgan dysfunction and multiple infiltrates on chest X ray, and there was significant advantage in outcome on invasive ventilation.

Background and Objectives: Treatment responsiveness to pegylated interferon-α and ribavirin against hepatitis C virus genotype 1 has strongly been associated with two single nucleotide polymorphisms (rs8099917 and rs12979860) in the region of the interleukin 28B (IL28B) gene. The aim was to perform three genotyping methods and evaluate their specificity, technical characteristics, and costs. In addition, the distribution of both polymorphisms in an Uruguayan population was assessed. Materials and Methods: One hundred DNA samples were genotyped by allele-specific polymerase chain reaction (AS-PCR), real-time PCR high resolution melting (RT-HRM), and Sanger sequencing methods. Results: The rs12979860 CC genotype, followed by the CT, was the most prevalent (52% and 39%, respectively). For rs8099917, the TT genotype was the most common (61%) followed by the GT (34%). AS-PCR and RT-HRM assays were specific for both IL28B genotypes determinations and showed a total concordance with Sanger sequencing results. Conclusions: Any of three genotyping methods is suitable for IL28B genotyping. The choice of the assay will depend on costs, special equipment availability, turnaround time, and specialized human resources.

Infections caused by hepatitis C virus (HCV) lead to persistent infection in most of the times and may cause fibrosis of liver, cirrhosis and hepatocellular carcinoma. At present, there is no vaccine available for prevention or treatment of it. With the development of newer and effective anti viral drugs, most of the infections are curable. But a proportion of infections may progress to cirrhosis of liver /or hepatocelllar carcinoma in spite of being cured from the infection. So, early diagnosis of HCV infections and treatment with effective antiviral drugs is required for prevention of end stage liver disease.