Journal of clinical and diagnostic research

The Prevalence of ESBL among Enterobacteriaceae in a Tertiary Care Hospital of North Karnataka, India

METRI BASAVARAJ C,JYOTHI P PEERAPUR, BASAVARAJ V

Background and Objectives: Extended-spectrum β-lactamase (ESBL) production in the members of the family Enterobacteriaceae can confer resistance to expanded–spectrum cephalosporins such as aztreonam and the penicillins. In the recent years, there has been an increased incidence and prevalence of ESBLs all over the world and also in various parts of India. As there was no data which was available on the prevalence of ESBL in this region and as multi-drug resistance was rampant, the current study was undertaken to know the prevalence of ESBL producing Enterobacteriaceae at our tertiary health care centre. Aim: To know the prevalence of ESBL producing Enterobacteriaceae at our tertiary health care centre. Materials and Methods: This study was carried out on 218 clinical isolates of Enterobacteriaceae. The screening for ESBL production was done by the disc diffusion test which was recommended by the Clinical and Laboratory Standards Institute(CLSI)and the screen positive isolates were confirmed by the the double disc synergy test (DDST) and phenotypic disc confirmatory test (PDCT). Results: E.coli (57.8%) was most common isolate, followed by K. pneumoniae (25.6%). ESBL production was confirmed in 70(32.1%) isolates. The isolates of K. pneumoniae (46.4%) were the most common ESBL producers, followed by the isolates of E coli (31.7%) and others. ESBL production was most commonly seen in the Enterobacteriaceae which were isolated from the intensive care unit patients. Conclusion: There is a high prevalence of ESBL production in our hospital. Specific tests to detect ESBL production should be done routinely and an empirical therapy policy should be applied to the high risk units, based on the prevalence of the ESBL producing Enterobacteriaceae.

An assessment of falsely convicted type 1 diabetics in Jamaica by using the breathalyzer test

TAZHMOYE V., CRAWFORD DONOVAN, A. McGROWDER, JOAN M. RAWLINS

Objective: The close similarity between the symptoms of alcohol intoxication and low blood glucose levels makes it difficult for breathalyzers to make the distinction between a diabetic and an individual who is driving under the influence (DUI) of alcohol or driving while intoxicated (DWI). In Jamaica, it is illegal if a person’s blood alcohol concentration (BAC) is ≥ 35 microgram per 100 milliliter of breath on the breathalyzer and the intoxilyzer devices. The aim of the present study was to examine the extent to which the breathalyzer test provided false blood alcohol measurements in persons with type 1 diabetes mellitus. Design: The purposive and snowball sampling methods were used to collect information from motorists who were accused and charged by the police for DUI/DWI. Data was collected during the period from 2007-2009, from respondents at the St. Andrew Traffic Court, at their work stations and other convenient locations. The data were stored and analyzed by using SPSS version 17.0. Results: Of the 53 respondents, 73.6% were of type 1 diabetes mellitus status and 53.8% were those who were suspected by the police to be DUI/DWI and hence, the breathalyzer test resulted in 42.9% of the respondents showing a reading of ≥ 35 microgram per 100 millilitre of breath. The findings showed a correlation (χ² = 0.75) between the respondents with type 1 diabetes mellitus and wobbly (41.7%) and faintish/dizzy (20.8%) equilibrium when examined by the police. There was a high association between the diabetics who were unlikely to consume alcohol and those who were unlikely to be DUI/DWI (C = 0.725, P < 0.01, α = 0.01). The respondents of type 2 diabetes were 14 (26.4%), of which 8 failed the breathalyzer examination and were subjected to a blood test. Conclusions: Motorists with type 1 diabetes mellitus, who were subjected to a breathalyzer examination, were charged and they faced the court for being accused of DUI/DWI. The ignorance of the police officers and the respondents on this matter can result in similar repeated cases of this nature.

Oxidative stress and antioxidant status in primary dysmenorrhea

S.VENKATA RAO, RAVI KIRAN.V.S, M.VIJYASREE

Objectives : Primary dysmenorrhea is the menstrual pain associated with ovulatory cycles in the absence of pathological findings common in adolescents. Oxygen free radicals and the formation of primary dysmenorrhea is closely related to atrial contraction of uterine smooth muscle. The present study was to investigate the oxidative stress and antioxidants status in primary dysmenorrhea. Methods : A 45 cases of primary dysmenorrhea and 25 age and sex matched controls were included in the study. The lipid peroxidation status was measured by estimating malondialdehyde. The antioxidant status was measured by estimating reduced glutathione, superoxide dismutase, vitamin E and vitamin C respectively. Reslults : The malondialdehyde level was increased in cases than controls (p = 0.001). The antioxidant parameters studied like reduced glutathione, superoxide dismutase, vitamin E and vitamin C, all were decreased individually in cases than controls respectively (p = 0.001). Conclusions : Our study showed a significant increased lipid per oxidation and decreased anti oxidants levels in primary dysmenorrhea cases than controls. This study reveals increased oxidative stress and decreased antioxidants as one of the important contributing factor in the pathogenesis of primary dysmenorrhea.

The Cutaneous Adverse Effects of Lithium

NAVEEN K KANSAL, OMNA CHAWLA , AMANDEEP SINGH, PRITHPAL S MATREJA

Lithium is the one of the most commonly prescribed psychotropic medications for bipolar disorder and it is associated with a wide range of cutaneous side effects. Psychiatrists should closely monitor the side effects in patients who are on lithium treatment. Early recognition and propermanagement will help in avoiding the issues of noncompliance and the further deterioration of the mood symptoms in these patients. The liaison of psychiatry, dermatology, and primary care services could prove to be very helpful in the management of these patients.

The laterality of Handedness, Foot Preference and Foot Overlapping

RAJESHWARI.C.ELIGAR

This study was aimed at the distribution, the frequencies and the correlation between the laterality of handedness, arm folding, digital interlocking, foot preference and foot overlapping. The subjects who were selected for this study were teenagers between the age group of 13 to 15 years. The study was conducted at Belgaum city which is situated in North Karnataka, India, during 2000. There is no relevant information in the literature regarding a similar study which was done in this part of the country. The population here exhibits a wide diversity in cultural and traditional lifestyles and hence this study was taken up. Personal data was collected from the subjects by providing them a questionnaire. Various tests were conducted to determine the handedness, the laterality of arm folding, digital interlocking, foot preference and foot overlapping. The data which were collected were subjected to tabulation and statistical analysis and those were tested for statistical significance. The Chi square test was used with the paired ‘T’ test. Male subjects exhibited a highly significant correlation between handedness and digital interlocking (P<0.01) Female subjects showed a highly significant correlation between handedness and digital interlocking (P<0.005) A highly significant correlation existed between digital interlocking and arm folding in both the sexes (P<0.0001). A significantcorrelation was seen between handedness and foot overlapping (P<0.005) in both males and females. Both females and males showed a significant correlation between foot preference and foot overlapping (P<0.01).

Effect of Age and Sex on QRS Axis Deviation of Healthy Indian Population and Its Clinical Significance

SHIVETA BANSAL, RAJIV ARORA

Introduction: Electrocardiogram from 150 apparently healthy adults in the age group of 20–80 years, were analyzed using Schiller Cardiovit AT 1,3 channeled ECG machine to study the impact of increasing age and sex on QRS Axis deviation. The mean electrical axis was recorded in frontal plane for QRS complex using the Hexaxial Reference system. Result: It was observed that there occurred highly significant leftward shift of QRS frontal plane axis with increase in age. This shift of QRS axis was also found on comparison among malesand females of the three groups separately. However there was no significant variation of QRS frontal plane axis with sex in any of three age groups. Conclusion: It was concluded from the present study that age influences the prevalence of electrocardiographic variations and the diagnostic criterion for abnormality must be based upon the sound understanding of the normal electrocardiogram. Discussion: The leftward shift of the frontal QRS axis with age was attributed to increased left ventricular wall thickness.

A Study Of Visual Evoked Potentials In Patients Of Type 2 Diabetes Mellitus

Introduction: Type-2 diabetes mellitus (DM) is one of the most serious challenges to healthcare, primarily because of the increase in the prevalence of sedentary life styles and obesity. Neuropathies are the common complications of type-2 DM. Abnormalities within the peripheral nervous system are well documented, but however, changes in the central nervous system and particularly their correlation with visual function, have received much less attention. Visual Evoked Potentials (VEPs) can be used to evaluate the disturbances in the CNS with a simple, sensitive and non-invasive methodology. Aims And Objectives: To compare the visual evoked potentials in type-2 DM patients with that of healthy controls and to find out any possible correlation with the duration of the disease. Material And Methods: The present study was conducted on three groups (30 patients each) of type 2 DM (different durationsof disease) and one group of 30 healthy age and sex matched controls. The patients with reduced visual acuity which was not correctable with lenses or with retinopathy were excluded. VEP was recorded by using pattern reversal stimulation with A PC Based 2ch. RMS EMG EP Mark II Machine. The peak latencies N70, P100 and N155 and the peak to peak amplitudes N70- P100 and P100-N155 of the waves were measured. Results: Our results showed significantly prolonged N70 and P100 latencies in diabetic patients and also a significant correlation between the delay in the P100 latency and the duration of the disease. Conclusion: Abnormalities in the VEP response occur in diabetic patients before the development of overt retinopathy. So, VEP measurements can be used for the early diagnosis of central neuropathy to offer an early opportunity for proper management.

The Study Of Salmonellosis With Reference To Salmonella Typhi In Enteric Fever Patients

ABHIJIT AWARI, SUNITA NIGUTHE

The present study was carried out at the College of Medical Sciences and K J Mehta Hospital, Amargadh, Dist. Bhavnagar, Gujarat, during the period from January 2010 to December 2010, to detect Salmonella (S. typhi) cases and carriers by various methods, in clinically suspected cases of enteric fever. The sensitivity of each microbiological test for the diagnosis of salmonella was also evaluated. A total of 300 blood samples, 50 controls and 100 stool samples were processed, among which 90 cases were of clinically suspected enteric fever and 10 were of gastroenteritis. One hundred stool samples from healthy individuals as the controlswere processed and urine was processed in 10 cases, while CSF and pus were processed in one case each. S. typhi was the commonest isolate (75%), followed by S. Paratyphi A (15 %) and S. Paratyphi B (2.5 %) from blood, S. enteritidis (2.5 %) was isolated from pus and S. typhimurium (5 %) was isolated from the stool samples. The Widal test positivity was 38.66 % and the blood culture positivity was 12.33 %. The coagglutination test is a valuable adjuvant for the diagnosis of enteric fever. The Quinolone group of drugs is an alternative drug of choice for multi drug resistant salmonellosis. The incorporation of this drug in the base line restoration, if technically feasible, has to be advised.

The duplication of the optic canals in human skulls

GIRISH V PATIL, SANJEEV KOLAGI, PADMAVATHI G., G B RAIRAM

Introduction: Optic canal connects the middle cranial fossa to the apex of the orbit . It is traversed by the optic nerve, ophthalmic artery, and branches from the periarterial sympathetic plexuses. Duplication of the optic canal is rare, seen in both sexes, at various ages and in a number of racesMaterial and methods: The presence of duplication of optic canals was studied in 400 adult human skulls, collected from the department of Anatomy & Forensic medicine. It includes 80skulls aged below 40 years of age and 320 skulls aged above 40 years. Results: Duplication of optic canal was found in 11 skulls. Among which 3 skulls had Bilateral and the rest had unilateral duplication of optic canal. Conclusion: Knowledge regarding duplication of optic canal is useful in performing surgical exploration of optic canal during tumor removal, decompression, or while approaching cavernous sinus or sella.

Coronary Artery Disease risk factors in Type 2 Diabetes mellitus with metabolic syndrome in the urban South Indian population

PRIYA KALIDHAS, DESIGAMINI KANNIYAPPAN, KAVITHA GANDHI, RITA MARY ARUNA

Introduction: Insulin resistance increases the risk of developing metabolic syndrome, a major cause of dyslipidaemia and heart disease. Metabolic syndrome is a cluster of metabolic risk factors that come together in a single individual. Hence, in the present study, the occurrence of metabolic syndrome among type 2 diabetes mellitus patients by the WHO criteria has been carried out. The risk factors were compared between patients with type 2 diabetes mellitus, with and without metabolic syndrome. Materials and Methods: Eighty seven, age matched, type 2 diabetic patients who attended a diabetic clinic were included in this study. They were grouped as diabetic patients with metabolic syndrome and diabetic patients without metabolic syndrome, based on the WHO criteria. The biochemical parameters like fasting blood sugar (FBS), post prandial blood sugar (PPBS) and lipid profile were estimated by using diagnostic kits. The bloodpressure (BP) was measured and the body mass index (BMI) and the atherogenic index of plasma (AIP) were calculated. Statistical analysis was done by the Student’s t test. Results: The occurrence of metabolic syndrome among the type 2 diabetic patients was 33%. A significant increase was seen in triglycerides (TGLs), very low density lipoproteins (VLDLs), the TGL/HDL ratio, AIP, BP and BMI and a decrease was observed in the high density lipoproteins (HDLs) of type 2 diabetic patients with metabolic syndrome when compared with the type 2 diabetic patients without metabolic syndrome. Conclusion: The significant increase in the TGLs, the TGL/HDL ratio, AIP, BP and the BMI of diabetic patients with metabolic syndrome when compared to the type 2 diabetic patients without metabolic syndrome, predicts that patients with type 2 diabetes mellitus with metabolic syndrome are at a higher risk level for coronary heart disease (CHD).

A correlative study on the Aminotransferases and Gamma Glutamyl Transferase in the Saliva and Serum of Chronic Alcoholics before and after Alcohol Deaddiction

SHIVASHANKARA AR,CLAUDIA JOHNNY,MALATHI M,ARUN KUMAR K,AVINASH SS,TONI THOMAS

Objective: The present study was taken up to evaluate the effects of chronic alcoholism on the activities of γ-glutamyl transferase (GGT), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in serum and saliva, and to assess the effects of alcohol abstinence on these enzyme-activities. Methods: This was a case-control study. Fifty chronic male alcoholics (with a history of alcohol abuse for five years or more) who were aged 30-70 years, who were admitted to the Deaddiction Center for Alcohol Withdrawal Treatment, were the subjects. Age-matched, normal, healthy controls were also included in the study. GGT, ALT and AST were assayed in the saliva and serum of fifty chronic alcoholics before and after the deaddiction of one month. Results: The activities of the enzymes in the saliva as well as inthe serum were significantly higher in the alcoholics as compared to that in the healthy controls. The serum GGT, ALT and AST levels were higher by 4.4 fold, 2 fold and 1.8 fold respectively, while the salivary activities of these enzymes were higher by 2.1, 3.2 and 2.6 fold respectively in the alcoholics. The activities of these enzymes in the serum and saliva decreased significantly after one month of the alcohol withdrawal regimen. There was a significant correlation between the serum and the salivary activities in the alcoholics, with respect to each enzyme. Conclusions: The enzymes ALT, AST and GGT in blood and saliva, served as the markers of alcoholism and alcohol deaddiction. The strong correlation between the salivary and serum activities of the enzymes in alcoholics indicates the potential use of saliva as an alternate to blood in the future.

Accuracy of the Drug Advertisements in Medical Journals in India

MOTILAL C. TAYADE,NANDKUMAR. B. KULKARNI

Introduction: Drug advertisements in medical journals are an important tool to inform physicians about drug usage. The ethical criteria for drug promotion were laid down by the WHO in 1988. Aims and Objectives: The present study was planned to assess the accuracy of the drug advertisements which were published in Indian medical journals from different specialties. Materials and Methods: We studied 882 drug advertisements which were published in different indexed medical journals from various specialties during the period from January 2008 to December 2010. The advertisements for laboratory equipments were excluded. The advertisements were independently categorized into different groups of specialties. The information content of the drug advertisements were analyzed. Statistical analysis: In this representative survey, we found more than 70 % advertisements which had not mentioned drug storage instructions and had not warned about major interactions. We also found that more than 50% advertisements had not included the information regarding side effects and the precautions which had to be taken during drug usage. The information about pharmacological data was found in less than 1% of the advertisements. Conclusion and Results: Our analysis indicated that the drug advertisements which were published in various Indian medical journals provided less information which was related to the vital aspects of the drug.

Psychiatric morbidity and the Socio-demographic determinants of Deliberate Self Harm

P D BANSAL, RAJDIP BARMAN

Background: Man’s attempt to harm himself or to end his life is probably as old as himself. Even then, this topic fascinates researchers and it continues to be one of the most talked about, written and discussed subjects, but it still is an enigma. Deliberate self harm (DSH) is common; however, there is scanty data on this issue from India. Objectives: To study the socio-demographic and the clinical profiles of the subjects who had the tendency to deliberately self harm themselves. Materials and Methods: A cross sectional study was performed for a period of 1 year in a medical college and research institute in north India. The data were recorded in an especially designed proforma which documented the socio-demographic variables, psychiatric illnesses, psychosocial stress factors, past and family history and the details of the suicide attempt. Chi2,Fisher exact, and t tests were used to note the statistically significant associations. Results: Younger people <25 years of age (53%) predominated in the study. Females (58%) outnumbered the males (42%). Most of the DSH patients were married and housewives, and were from urban and low socioeconomic backgrounds. A majority of the patients were 1st time attempters, they had no family history and they used poison as the most preferred method. Half of the patients (50%) had psychiatric illness which was predominated by depression (36%). Family quarrel (32%) and marital disharmony (17%) were found to be the most common precipitating factors for DSH. Conclusion: Population based prospective studies, awareness programs, preventive measures and proper psychiatric referral systems should be built up to decrease the incidence of self harm.

A Clinico-Morphological Spectrum Of The Non Neoplastic Lesions Of The Uterine Cervix At AJ Hospital, Mangalore

Background and objectives: Cervices from hysterectomies and biopsies constitute the majority of gynaecological specimens which are received in the department of histopathology and non-neoplastic lesions form the huge chunk of diagnosis among them. However, there are many lesions that appear to be exuberant and can be misdiagnosed to be malignant. On the basis of this, a detailed histomorphological study of the non-neoplastic lesions of the cervix was taken up . Methods: 1015 non-neoplastic cervices were evaluated either from hysterectomy or biopsy specimens. These cervices were subjected to detailed gross and microscopic examination and were further subclassified into various non-neoplastic lesions. Results: All the 1015 (100%) cervical specimens showed the features of cervicitis. However, acute on chronic cervicitis was found in only 43 cervices (4.23%) and tuberculous cervicitis was encountered in only one patient (0.9%). The commonestendocervical epithelial lesions which were encountered were polypoidal endocervicitis (29.26%) and squamous metaplasia (73.390%) and the uncommon lesions included microglandular endocervical hyperplasia (2.6%), tunnel clusters (2.46%) ands mesonephric rests (1.18%). A majority of the ectocervical changes were attributed to the patients who presented with uterine prolapse (214 patients), which included hyperplasia with and without hyperkeratosis and parakeratosis and rarer lesions like decubitus ulcer and prominent melanocytes in the basal layer of the ectocerivix. Interpretation and Conclusion: During the study, a number of non-neoplastic lesions of the cervix were encountered, which caused a great deal of morbidity to the patients. It has been recommended to take up further community based studies in association with a microbiological and colposcopic correlation to evaluate the exact incidence of these non-neoplastic lesions of the cervix.

A study on the Sociodemographic Profile of the Attendees at the Integrated Counselling and Testing Centre of a Medical College in Southern India

CHENNAVEERAPPA PK,HALESHA BR, VITTAL BG,JAYASHREE N

HIV (human immunodeficiency virus) counselling and testing services are a key entry point to the prevention of HIV infection and to the treatment and care of the people who are infected with HIV. The integrated counselling and testing centre (ICTC) services are a cost effective intervention in the prevention of HIV/ AIDS (acquired immunodeficiency syndrome). To study the socio demographic characteristics and the risky behaviour pattern of the attendees at the ICTC centre. The ICTC at the Sri Chamarajendra Hospital which is attached to the Hassan Institute of Medical Sciences (HIMS), Hassan, Karnataka. A cross sectional, record based study. The study population included 9327 clients who attended the ICTC centres from January 2009 to December 2010. An overall 10.13% of the ICTC attendees were HIV seropositive subjects. About 78.6% of the HIV seropositive subjects belonged to the age group of 15-49 years. 63% of the males and 72% of the females among the HIV seropositive subjects were married; 45.1% of the female seropositive subjects were illiterate. Among the male seropositive subjects, 30% were unskilled and 12.3% were drivers. An overall 67% of the HIV seropositive subjects were from rural areas. The most common mode of transmission was having multiple heterosexual partners. People’s attitudes towards HIV is changing after the introduction of the ICTC, which plays a major role in the primary and secondary prevention of HIV. There is a more urgent need for the introduction of interventional measures like sex education and preventive education among the general population.

Sexual dimorphism in the Humerus : south Indians-RETRACTED ARTICLE

GIRISH PATIL ,SANJEEV KOLAGI, UMESH RAMADURG

The prevalence of obesity and hypertension in urban Tamilnadu

MANMOHAN GUPTA, RAJKUMAR PATIL, MOHD.IQBAL KHAN, SANJEEV KUMAR GUPTA

Background: Obesity and hypertension are undesirable outcomes of changing lifestyles and behaviours especially in traditional societies in many developing countries which have experienced rapid and unplanned urbanization. Objective: To know the prevalence of obesity and hypertension in an urban adult population of Salem, Tamilnadu. Materials and Methods: An observational cross-sectional study in the Salem town of Tamilnadu was carried out by using a predesigned and a pretested schedule. 10 hospitals of the Salem town were selected randomly, after making a list of all the hospitals. Every 10th adult patient was selected in the hospital OPD clinic, till the number reached 30 during a 2 week duration. Consent was taken before the study. 263 respondents (94 females and 169 males) were selected for the analysis out of 300 adults. The Epi Info software was used for the analysis. The Chi-square test, t test and the Pearson’s correlation tests were used for studying the significance. Results: The age range was 18 to 85 years; the majority (79.8%) was above 35 years of age. The waist circumference (WC) was positively correlated with the body mass index (BMI) and the systolic blood pressure. Females had a significantly higher BMI value than the males. Based on the internationally recommended BMI cut-off points, 44.9% respondents were found to be pre-obese and 19.0% were obese. The estimated risk for the females to have an increased metabolic risk was 9.4 times that of the males. 60.8% persons had abdominal fat accumulation, based on the waist to hip ratio. 43.3% persons were hypertensive. A significantly higher proportion of males were severely hypertensive than the females. Conclusion: The females were at an increased risk of obesity, but the males were at increased risk of hypertension. Age was found to be a stronger risk factor for obesity and hypertension.

Extraintestinal infections Due To Escherichia Coli: An Emerging Issue

ASIMA BANU, JYOTI S KABIN, MRIDU ANAND

Background: Infections due to Extraintestinal pathogenic Escherichia coli(ExPEC) represent a major but little-appreciated health threat. Proper antibiotic sensitivity testing and judicious use of antibiotics are crucial in treatment of such infections. Aims: This study was done to determine the spectrum of infections caused by ExPEC and their antimicrobial susceptibility pattern. Settings and Design: Department of Microbiology, Bowring and Lady Curzon Hospital which is a tertiary care, teaching hospital attached to Bangalore Medical College and Research Institute. This is a prospective study from January 2009 to December 2010. Materials & Methods: A total of 379 E. coli isolates from various extraintestinal infections were studied for the antimicrobial sensitivity. The isolates were processed using standard procedures. All strains of E.coli were tested for antimicrobialsusceptibility pattern by modified Kirby Bauer disc diffusion method. The results were interpreted using CLSI guidelines and statistically analyzed. Results: A total of 379 strains of E.coli were isolated from extraintestinal infections. Out of these 253(66.7%) were from urine, 101(26.6%) were from pus & exudates, 23(6.1%) from sputum and 2(0.5%) from blood. The analysis of drug resistance pattern shows that among 349 isolates of E.coli maximum number 357(94.2%) were resistant to ampicillin and least, 0(0%) were resistant to carbapenams followed by 59(15.6%) to netilmicin. Conclusions: This study demonstrates a significant increase in the prevalence of antimicrobial resistance among E.coli isolates. When selecting empirical therapy, in vitro susceptibility patterns must be considered along with other factors, such as expected efficacy, adverse effects, cost, cost-effectiveness, and selection of resistant strains.

Comparison of the methods of diagnosis of bacterial vaginosis

UDAYALAXMI, GOPALAKRISHNA BHAT, SUBBANNAYYA KOTIGADD, SHALINI SHENOY

Background and Objective: Although Nugent’s criterion is considered as the gold standard, routinely a combination of various methods is used for the diagnosis of bacterial vaginosis. In the present study we compared culture, Spiegel’s criteria and Amsel’s criteria with Nugent’s method for the diagnosis of bacterial vaginosis. Materials and Methods: Five hundred and twenty seven women who attended the Government Maternity Hospital and a tertiary care centre in south India for antenatal care or forany other complaint formed the study population. Diagnosis of bacterial vaginosis was done by culture, Amsel’s, Nugent’s and Spiegel’s criteria. The positive predictive value, the negative predictive value and the sensitivity and specificity of these methods,in comparison with Nugent’s criteria, by considering it as the gold standard, were calculated. Statistical analysis was doneby using the Chi Square test or the Fisher’s exact test as was appropriate. Results: In comparison with Nugent’s criteria, the positive predictive value, negative predictive value and the sensitivity and specificity of Amsel’s criteria were 80.4%, 94.8%, 78% and 95.6% and that of Spiegel’s criteria were 77.5%, 100%, 100% and 93.2%. The culture was 51% sensitive and 88.7% specific, the positive predictive value was 85.5% and the negative predictive value was 58%. We diagnosed 100 (19%) casesof bacterial vaginosisby Nugent’s method,129 (24%) casesby Spiegel’s method,97 (18%) cases by Amsel’s criteria and 88 (16.7%) cases by culturing. Conclusion: Amsel’s and Spiegel’s criteria were comparable with Nugent’s criteria for the diagnosis of bacterial vaginosis. Diagnosis of bacterial vaginosis by culture was least sensitive method.

The Pattern of Antibiotic Use in a Family Medicine Department of a Tertiary Hospital in Sokoto, North Western Nigeria

ABDULGAFAR O.JIMOH, EMMANUEL U. ETUK, ZUWAIRA SANI, HUDU A. SHUAIBU

Background: Antibiotics are substances or compounds which are used to treat infections which are caused by microorganisms including fungi and protozoa. The inappropriate and indiscriminate use of antimicrobial agents can potentially cause a number of problems. The emergence of anti- microbial resistant bacteria, an increased number of patients experiencing adverse drug events and an increase in drug-related costs have been documented. Objective: This research was conducted with the objective of studying the pattern of antibiotic prescription in a tertiary hospital’s general out patients department. Methods: A cross sectional, retrospective study was carried out in the Family Medicine Department, at the Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria, from January to June 2008. The records of all the patients who had any courses of antimicrobial agents within this period were isolated and screened and relevant data were extracted by using a prepiloted data collection form and the filled forms were analyzed. Results: A total of 336 patients, consisting of 146 males (43.45%) and 190 females (56.54%) were enrolled. Among these, 139(41.36%) were in the age group of 21–30 years and 134 (39.88%) had gastro intestinal infections as an indication of antibiotic use. 69 (20.53%) had requested for investigations. The investigations were relevant in 66 (95.65%) and in 57 (82.60%), the samples were taken before the commencement of the antibiotic therapy. Only 27 (39.13%) had got their results before the antibiotic prescription, while 42 (60.86%) had antibiotics prescribed for them without their laboratory results. Among the various antibiotics which were prescribed, 149 (35.83%) were quinolones and 109 (26.29%) were pencillins. The antibiotic combination pattern showed that 56 (44.44%) were given a combination of amoxicillin and metronidazole and that 27 (21.47%) were given a combination of amoxicillin, metronidazole and doxycycline. Conclusions: Only about one fifth of the patients who were studied had any form of laboratory investigations as a guide for the antibiotic prescription and out of these, only less than half of the results were used as a guide for the antibiotic prescription. The commonest indications for antibiotic use in this study included gastro intestinal infections, genitor-urinary infections, and respiratory tract infections. Quinolones (Ciprofloxacin) were the most commonly prescribed antibiotics in this study.

A Post-Marketing Surveillance Study of Tolperisone [MYOTOP-150]: It’s Use in the General Clinical Practice in India

BHUPESH DEWAN, NISHA PHILIPOSE

Background and Objective: Tolperisone hydrochloride is a centrally acting muscle relaxant that has been used for the symptomatic treatment of spasticity and muscle spasm. The present observational study was undertaken to assess the safety and efficacy of Tolperisone (Myotop-150) in Indian patients. Settings and Design: An observational study involving 92 physicians across the various states of India, who prescribed Tolperisone (Myotop-150) to their patients. Methods and Material: The demographic exposure and outcome data of the patients who were prescribed Myotop-150 (Tolperisone hydrochloride) were obtained from the completed case record forms which were received from the physicians. Adverse events which were observed during the therapy wererecorded. Symptom severity was given a scoring on a 7-point Likert scale before and after the therapy. Results: Data was collected for 165 patients, with a mean age of 43.88 ± (SD) 11.27 years [Range: 15 to 72 years]. At the baseline, the mean ± SD of the score on the 7-point Likert scale was 4.96 ± 1.01. After treatment with tolperisone, the mean score was 1.87 ± 0.91, with a significant reduction of 3.08 ± 1.14; p < 0.0001. After therapy, 42.04% of the patients reported “no problem”. In 88.02% of the patients who were treated, the physicians rated the treatment with tolperisone as excellent, very good or good. Side-effects were observed in 7.88% of the patients. Conclusions: The present observational study demonstrates that the therapy with tolperisone is an effective and welltolerated strategy in patients with diseases or conditions which are associated with spasticity or muscle spasm.

Diagnostic value of Platelet count in Malaria

FASEELA T.S,RONALD A. ROCHE,ANITA K. B., CHAITHRA S MALLI,YASHWANTH RAI

Objective: To evaluate the significance of the platelet count in the diagnosis of malaria. Design: A hospital based prospective study. Place and duration of study: Department of Microbiology, AJIMS, Mangalore. From January 2010 to July 2010. Material and methods: A total of 1101 patients with a short history of febrile illness were included in the study. The peripheral blood was tested for malarial parasites by the quantitative buffy coat (QBC) method. The complete blood counts of all the sub-jects were done by using an automated haematology analyzer. Results: Among the 1101 patients with febrile illness who participated in the study, 267 were positive for malaria by the QBC method. Of these, 221 patients had thrombocytopaenia. Conclusion: Thrombocytopaenia is a common haematological finding in malaria, having a sensitivity of 83% and a specificity of 68%. Our study stresses the importance of thrombocytopaenia as an indicator for acute malaria.

The pattern of fatal head injury in a teaching hospital in eastern Nepal.

Background : Head injury is an important cause of mortality worldwide, as the head is the most vulnerable part of the body which is involved in fatal road traffic accidents. Objective: To study the pattern of fatal head injury in the victims of road traffic accidents, who presented to the B.P. Koirala Institute of Health Sciences, Dharan, Nepal, which is a focal place for autopsies in the Sunsari district. Materials and methods: All cases of head injuries in road traffic accident victims, who were autopsied at the B.P. Koirala Institute of Health Sciences, Dharan, Nepal from Feb 2006 to May 2007, were included in the study. Results: 77 people died in road traffic accidents due to head injuries in the study period. There was a marked male preponderance (78%). The most vulnerable age group was young adults between the ages of 21 - 40 years (38%)).Pedestrians were the most commonly involved victims (48%). Skull fractures were present in 85.7% of the cases. Fractures of the vault were found in 93.9% and those of the base of the skull were found in 57.50% of the cases. Comminuted fractures were found (45.16%) in a maximum number of cases, followed by depressed and linear fractures (38%) in almost the same numbers of cases. Among intra-cranial haemorrhages, subdural haemorrhage was found in 50.6%, extradural in 48% and subarachnoid haemorrhage in 35% of the cases. More than half of the victims (57.1%) suffered injury to the cerebrum and 18.1% victims to the cerebellum. Contusions and lacerations of brain were found equally (35%) in the cases. Conclusion: Injuries to the skull and brain are the major and significant contributory factors in the causation of the fatalities on the roads, resulting from the accidents.

Fine Needle Aspiration Cytology Of Intra-Abdominal Lesions

SIDHALINGREDDY, SAINATH K. ANDOLA

Background: Intra-abdominal masses always remain as an enigma in surgical practice. A documentary evidence of the nature of the pathology before the institution of therapy and for the prognosis is mandatory. FNAC is a substitute for surgical procedures like diagnostic laparotomy. Aims: To assess the utility of FNAC in the diagnosis of intraabdominal lesions. Objectives: To study the cytomorphological features, age and sex distribution of intra-abdominal lesions and to categorize them organwise and as inflammatory, benign and malignant lesions. To classify the malignant lesions according to their cell type. To evaluate the sensitivity, specificity and diagnostic accuracy . Materials and methods: The study included 245 intra-abdominal lesions which were detected clinically or radiologically. The lesions were divided clinically into palpable and non-palpablelumps. USG or CT were used for all the non-palpable lesions and for a few palpable lesions and direct in selected palpable lesions . Giemsa’s and Papanicolaou’s stains were used. Results: The mean age was 45.16 years, with M:F of 1:1.3. The diagnostic yield was 92.1% in USG guided, 100% in CT guided and 95% in direct aspiration. There were 148 (60.3%) malignant, 55 (22.4%) benign, 25 (10.2%) inflammatory and one (0.6%) suspicious lesions and 16 (6.5%) unsatisfactory smears. The liver and the ovary were the most common sites . Adenocarcinomas and hepatocellular carcinomas were the most common malignant lesions. This study showed 94.1% sensitivity, 100% specificity, 100% positive predictive value, 92.3% negative predictive value and 96.5% diagnostic accuracy . Conclusion: Intra-abdominal FNAC is a simple, economical and a safe procedure with high sensitivity, specificity and diagnostic accuracy and it can be utilized as a pre-operative procedure for the management of intra-abdominal lesions.

Cardiac Involvement in Patients with Pulmonary Tuberculosis

RAJESH S, SRICHARAN K.N, JAYAPRAKASH K, FRANCIS N P MONTEIRO

Pulmonary tuberculosis is one of the commonest infectious diseases which are encountered in clinical practice, more so in developing countries. Very few studies have been reported regarding the cardiac manifestations of pulmonary tuberculosis. This was an earnest effort in the direction of knowing the cardiac involvement of pulmonary tuberculosis. 50 patients of sputum positive pulmonary tuberculosis, without any preexisting heart disease and those who satisfied the inclusion and exclusion criteria, were selected. Detailed investigations were conducted for the diagnosis of pulmonary tuberculosis and its cardiac involvement. 12 out of 50 patients had cardiac involvement. Pericardial effusion was the commonest cardiac involvement of pulmonary tuberculosis, followed by myocardial involvement in the form of systolic and diastolic dysfunction.

The impact of body mass index on the expiratory reserve volume

SRINIVAS.CH, RAVI SHEKHAR ,MADHAVI LATHA M.

Background and objectives: Obesity is a common health problem all over the world and it is closely associated with many diseases that cause disturbances in the lung function. The objective of the present study was to assess the impact of increased body mass index (BMI) on the expiratory reserve volume (ERV). Materials and Methods: This study was conducted on 80 subjects of ages ranging from 25-40 years, of both the sexes. Of these, 40 were non-obese (BMI < 25 kg/m²) and 40 were obese(BMI > 30kg/m²). This study was carried out in the Department of T.B and Chest Diseases at the Infections Disease Hospital, Guntur, by using a computerized spirometer (Spiro-232, PK Morgan limited). Results: On the comparison of the results, the subjects with a BMI of more than 30 kg/m² showed a decrease in ERV by 48.13%, than the normal subjects. Conclusion: An increased BMI resulted in decreased expiratory reserve volume and the changes were more marked in males than in the females.

Routine Urine Culture in Febrile Young Children

CHANDRASHEKAR GOPAL SHETTIGAR, DIVAKAR RAO, PAVAN HEGDE, SANTHOSH SOANS

Objective: To assess the usefulness of the routine urine culture in febrile young children. Setting: Tertiary care teaching hospital Design: One year’s prospective study from October 2009 to September 2010 Patients: 334 febrile young children who were less than 5 years of age, who were admitted to the paediatric ward. Results: Out of 334 febrile children, 27 cases were diagnosed to have UTI , with overall estimated prevalence of 8.08%. Of the 27 patients with UTI, 17 (62.96%) cases had a provisional diagnosis which was other than UTI. One or the other symptoms which were referable to the urinary tract were present only in 52% of the patients with UTI. In 24% of the children with UTI, no othersign which was referable to the urinary tract was present, other than fever. A low yield was obtained in patients with respiratory infection (2.18%), neuroinfection (3.70%) and with enteric fever (3.84%). Of the 52 patients with gastroenteritis (GE), 5(9.61%) cases had UTI. Female patients with GE are particularly at an increased risk of UTI (23.52%). A high yield was obtained in patients with a provisional diagnosis of UTI (47.61%). Out of 31 patients who presented with fever with no apparent source, 7(22.58%) cases showed a significant growth on urine culture. Conclusion: Urinary tract infection Should be considered as a potential cause of fever in children below 5 years of age. A high yield was obtained whenever UTI was suspected, or in patients with fever with no apparent source and in female children with gastroenteritis.

Declining Age of Onset of Type 2 Diabetes Mellitus in the North-West Punjabi Population

SUKHRAJ KAUR, MRIDULA MAHAJAN

Context: Diabetes mellitus, an inherited metabolic disorder which is associated with devastating complications, is one of the biggest burdens on the society, in terms of the expenditure of money on health care and wastage of the prime years of life. The increasing prevalence of diabetes mellitus is attributed to adverse lifestyles like obesity and physical inactivity and this is prevalent even among school going children, thus making them vulnerable to the disease at an earlier age. Aim: The present study was designed to decipher the prevalence of type 2 diabetes mellitus in various age groups of the north west Punjabi population. Settings and design: The subjects were selected by conducting a door to door survey of a few villages of the border belt of Amritsar and the Tarn Taran district. One patient of diabetesmellitus was considered as one family unit and the offsprings of these diabetic patients, who were siblings amongst themselves were recruited for the study. Material and Method: All the selected families were required to fill up a consent form by the head of the family. Fasting samples of the participating families were collected and analyzed for fasting plasma glucose, glycated haemoglobin, complete lipid profile, serum insulin and C-peptide. Statistical analysis was done by using the Student’s t test. Results and conclusions The prevalence of diabetes mellitus in the north-west Punjabi population was found to be 25%. IFG was more prevalent in females as compared to the males and the age of onset of diabetes mellitus was observed to decline both in males and females, as was evident from its occurrence in the age group of 19-24 years.

The Clinical Profile and the Efficacy of Prazosin in Scorpion Sting Envenomation in Children of North Karnataka (India)

RAMESH POL, RAGHAVENDRA VANAKI, MANSWINI POL

Objective: This study was an evaluation of the pattern of presentation, the outcome and the efficacy of Prazosin in scorpion sting envenomation at a tertiary care hospital in Bagalkot, India. Methods: A total of 240 consecutive children were prospectively studied. The data included demographics, the time of presentation to the hospital, the clinical features, and the premedication which was given before the arrival of the subjects at the hospital, response to the oral Prazosin and the hospital outcome. Results: Local pain, sweating and peripheral circulatory failure were the common clinical presentations. Complications like acutepulmonary oedema, myocarditis, shock and encephalopathy were also seen. These were treated with a combination of Prazosin with either inotropes or vasodilators. Mortality was seen in 18 (7.5%) children. The usage of antihistaminics and steroids in these children led to higher mortality. Oral Prazosin, a postsynaptic alpha –1 blocker, is a highly effective drug for scorpion sting envenomation. Conclusion: Scorpion sting envenomation is an acute life threatening emergency and an early presentation to the hospital and an early intervention with Prazosin can hasten the recovery in the scorpion sting victim.

A study on the Utility of Nerve Conduction Studies in Type 2 Diabetes Mellitus

KANAVI ROOPA, SHEKHARAPPA SRINIVASA K. K.J. VEDAVATHI, GIRIYAPPA VENKATESH

Back ground and Objectives: Neuropathy is one of the common complications of diabetes, in which the patient’s quality of life is compromised. Nerve conduction studies (NCS) are not commonly employed to detect the neuropathy. The present study was undertaken to find out the utility of NCS as early indicator of neuropathy in diabetic patients. Methods: 45 diabetes mellitus patients with normal HbA1c levels and 45 diabetes mellitus patients with elevated HbA1c levels were selected, making it a total of 90 diabetes mellitus patients. 45 non-diabetic, healthy subjects were chosen as acontrol group. The nerve conduction velocity was tested in all the diabetic subjects and the healthy controls. Results: The analysis showed that the nerve conduction velocity progressively decreased from the controls (49.0 ± 3.9) to the diabetics with a good glycaemic control (47.2 ± 2.8), to the diabetics with a poor glycaemic control (45.3 ± 3.1). Interpretation and Conclusion: There is a progressive neuronal involvement in the diabetic process which is accelerated by poor glycaemic control. Therefore, nerve conduction studies can be employed for testing and for the early indication of neuropathy in diabetic patients.

Evaluation of the diuretic effect of the Chloroform extract of the Benincasa Hispida Rind (Pericarp) extract in Guinea-pigs

Background: Pharmacological research on the medicinal properties of phytochemicals has become mandatory to establish the claimed medicinal properties of herbs. Aims: To evaluate the diuretic activity of the Benincasa hispida fruit rind extract (outer thick pericarp) and to compare its activity withthat of the control (normal saline) and the standard diuretic,hydrochlorothiazide in guinea-pigs. Methods and Material: A total of 54 adult, male guinea-pigs were taken, whose weights ranged from 400-450gm. The guinea-pigs were divided into three groups of 18 each (control, standard and test). The control group received 0.9% normal saline /25ml/kg orally. The standard group received hydrochlorothiazide -2.5mg/ kg body weight orally, along with normal saline, while keepingthe volume of the fluid which was administered constant. The test group received the aqueous extract of the rind of Benincasa hispida at the dose of 90mg/kg orally, along with normal saline- 25ml/kg. Urine was collected for a period of 5 hours by placing the animals in metabolism cages. The urinary volume, pH of the urine and the urinary excretion of sodium, potassium and chloride were measured and compared. Results: The extract produced a significant increase (p<0.001) in the urinary volume. There was a significant increase in the sodium and chloride excretion and a decrease (p<0.001) in the potassium excretion. Conclusion: The Benincasahispida rind (pericarp) extract possesses a significant diuretic activity with a potassium sparing effect.

Utility of donor rim culture – A study in tertiary care hospital located in rural area

SONU N. LOHIYA, SMITA SINGH, RUCHITA O,. ATTAL S. BASAK

Background : Contamination of the donor corneal button before transplantation may result in one of the most serious complications of corneal transplantation, post-operative ocular infection, which may result in loss of the eye. Purpose : Hence, the present study was undertaken to assess the utility of the donor corneoscleral rim culture. Material and Method: We analysed 60 consecutive penetrating keratoplasties (PK) to determine the frequency of positivedonor rim cultures and their relationship with post-operative endophthalmitis. Result : In the present study, 13.4% corneoscleral rim cultures yielded microorganisms, mostly coagulase negative Staphylococcus (CONS). Conclusion : To conclude, we must say that donor corneoscleral rim cultures must be done before corneal transplantation to prevent post-operative endophthalmitis, as per antibiotic sensitivity reports.

The Clinical Prognostic Indicators of Acute Pancreatitis by Apache II Scoring

RITHIN SUVARNA, ARAVIND PALLIPADY, NITHISH BHANDARY, HANUMANTHAPPA

Background and Objectives: Acute pancreatitis is a catastrophic condition with many complications and poses a great challenge to the treating surgeon. 10-20% of the patients who develop complications will not recover with simple supportive therapy. Hence, an accurate prediction of severity and prognostic monitoring are necessary to anticipate the early and late complications, so as to consider aggressive treatment. The present study aimed at predicting the prognosis in patients with acute pancreatitis by using the APACHE II scoring system and at determining the utility of these scores in further management. Methods and Material: 51 patients who were admitted to the AJ Institute of Medical Sciences with the clinical and radiologicalevidence of acute pancreatitis, with an elevation in the serum amylase levels, were the subjects of this study. Results And Interpretation: The mean APACHE II scores were 6.62 and 11 in 32 uncomplicated cases and 19 complicated cases respectively.4 complicated patients who died eventually had scores which were persistently above 14. Sequential variations in the APACHE II scores correlated with the patient outcome. Conclusion: The APACHE II scores which are calculated on admission accurately predict the outcome of the patients with acute pancreatitis. This scoring system is superior to other systems like Ranson’s criteria, because it takes into account all the major risk factors that influence the patient outcome.

The Antimicrobial Resistance Pattern In The Clinical Isolates Of Pseudomonas Aeruginosa In A Tertiary Care Hospital; 2008-2010 (A 3 Year Study)

K.M.MOHANASOUNDARAM

Introduction: Pseudomonas aeruginosa is an opportunistic human pathogen and is the leading cause of nosocomial infections especially among patients admitted to intensive care units. (ICU).It has been implicated in diverse nosocomial infections. In recent years, a considerable increase in the prevalence and multidrug resistance (MDR) P.aeruginosa has been noticed with high morbidity and mortality. So we aimed in the present study to determine the status of antimicrobial resistance to individual antipseudomonal agents and the magnitude of multidrug resistance in these organisms. The aim of the study was to retrospectively analyze and determine the distribution rate and antimicrobial resistance pattern in P.aeruginosa among clinical specimens for a period of 3 years. Methods: P.aeruginosa were isolated and identified by conventional methods. The antimicrobial susceptibility testing was performed by Kirby-Bauer disc diffusion method. The clinical and specimen distribution properties of P.aeruginosa were evaluated based on their resistance. Results: The isolation rate of P.aeruginosa in this study was 5%, 6.8% and 5% in 2008, 2009 and 2010 respectively. Pus, tracheal aspirates and urine were important sources of P.aeruginosaisolation in ICU and non ICU inpatients. Resistance rates of pseudomonas varied with the antibiotics and the high resistance observed was related to the increased use of broad spectrum antibiotics. Multidrug resistance P.aeruginosa is on the rise especially in nosocomial infections. Hence rigorous monitoring of MDR strains, restriction of inappropriate use of antimicrobial agents and adherence of infection control practices should be emphasized to delay the emergence of clinically significant MDR-P.aeruginosa Conclusion: To conclude, although multidrug resistance has commonly been reported in nosocomial P.aeruginosa, community acquired data are less frequently reported. For this reason epidemiological studies on the prevalence and antimicrobial susceptibility pattern of resistant isolates in different geographical settings would provide useful information to guide clinicians in their choice of therapy and to contribute to the global picture of antimicrobial resistance. Rigorous monitoring of MDR in P.aeruginosa, restriction of the inappropriate use of antimicrobial agents and adherence of infection control practices should be emphasized to delay the emergence of clinically significant P.aeruginosa.

A study of the clinical features and the outcome of cerebral venous sinus thrombosis in a tertiary care centre in South India

HALESHA BR, CHENNAVEERAPPA PK, VITTAK BG, JAYASHREE N
Background: Cerebral venous sinus thrombosis (CVST) is an uncommon cause of stroke with extremely diverse clinical features, predisposing factors, brain imaging findings and outcomes. The prognosis of CVST is variable and its outcome may vary from recovery to permanent neurological deficits. Aims: To study the clinical features, prognostic factors and the outcome in CVST. Study Design: Prospective study. Materials and Methods: Fifty patients with radiologically confirmed CVST were studied from November 2005 to October 2006. The demographical, clinical, radiological and outcome data were recorded and analyzed. The prognostic factors in patients who were enrolled in the study were prospectively investigated.A poor outcome after 12 weeks, which was defined as death or dependency (by the modified Rankin scale [mRS] ≥3), was used as the principal outcome measure. Results: The most common presenting features were headache (90%), focal deficits (48%), seizures (44%), and coma (14%). Puerperium was the most common risk factor. After 12 weeks of follow up, nine patients (18%) had a poor outcome (mRS≥3or death). The multivariate predictors of a poor outcome were age >30 years, male sex, coma at presentation, cerebral haemorrhage and deep cerebral venous system thrombosis. Conclusion: CVST can affect all age groups, particularly women of the child bearing age. The overall prognosis of CVST is fairly good with an independent survival of 82%.

A Study On Surgical Site Infections Caused By Staphylococcus Aureus, With A Special Search For Methicillin-Resistant Isolates

GAYATHREE NAIK, SRINIVASR DESHPANDE
Objective: To study the prevalence of Staphylococcus aureus and Methicillin-Resistant Staphylococcus aureus (MRSA) in surgical site infections (SSIs) in referral hospitals at the coastal city of Mangalore, India. Materials and Methods: This study was conducted on 300 patients who underwent surgery in the obstetrics and gynaecology, orthopaedic and surgical departments which were attached to the referral hospitals which were attached to Kasturba Medical College, Mangalore. Pus samples were collected with two sterile swabs and processed in the Microbiology department. Results: Of the 300 pus samples, 216(72%) showed growth. 258 aerobic bacteria were isolated. The most commonorganism which was isolated was Staphylococcus aureus, with 83(32.2%) isolates. Of these, 8 (9.6%) were Methicillin Resistant Staphylococcus aureus (MRSA). Conclusions: Indian clinicians and infectious disease specialists in the coastal areas are facing formidable challenges from Methicillin Resistant Staphylococcus aureus. Despite the best surgical practices, nearly a tenth of all the SSIs cases could be caused by MRSA. Routine screening for these multidrug resistant organisms in the hospital staff, especially in the surgical departments and pre-surgical screening of the patients could help in reducing the incidence of MRSA.

An investigation of MRSA from the Burns Ward: the importance of hand hygiene

SHALINI DUGGAL, NIRMALJEET KAUR, CHAROO HANS
Introduction: MRSA (Methicillin Resistant Staphylococcus aureus) deserves special attention in health care settings. It becomes difficult to treat this infection/eradicate its colonization once it has established. However, its spread can be controlled. An increase in MRSA isolation from the wound swabs of the burns patients over a period of four months prompted us to undertake the present investigation. Material and Methods: Eleven HCWs (Health Care workers) were screened. Hand smears and nasal swabs were cultured and identified by standard microbiological methods. A re-orientation programme was arranged for all HCWs in the burns ward and the importance of standard work precautions, especially hand hygiene was highlighted. Swabs were taken from the same workers after six weeks. Results: Out of eleven health care workers, seven were found to be MRSA carriers (63.6%). Swabs which were taken from the same workers after six weeks, revealed a decrease in the MRSA colonization in the hands by 75% and in the nose by 25%. Also, the number of MRSA isolations from the wound swabs of patients in the burns ward decreased from 35.3% to 13.9%. Conclusion: The current study emphasizes the need for an early diagnosis of MRSA and for being vigilant so that if any outbreak of multidrug resistant organisms occurs in a ward/ ICU, steps to control them can be initiated at the earliest. It also highlights the importance of hand hygiene so that the hands that deliver care may not deliver germs.

Prescribing Trends in Depression – A Drug Utilization Study Done at a Tertiary Healthcare Centre

SUJOY RAY,BHARTI CHOGTU
Introduction: Depression is one of the most prevalent forms of mental illnesses.The ‘Global Burden of Disease’ study showed that depressive disorders were the fourth leading cause of burden among all the diseases. Depression accounted for 4.46% of the total DALYs (Disability Adjusted Life Years) and 12.1% of the YLDs (Years Lived with Disability) in 2002, as opposed to 3.7% of the DALYs and 10.7% of the YLDs in 1990.With the increase in the number of patients, there has been an increase in the number and the type of antidepressants which are available to the psychiatrists and other clinicians. This study was aimed to assess the current prescribing practice. Materials and Methods: The data which was collected included information on the age, sex and the drug prescribed, including the group, subgroup, trade name, dosage and distribution in 50 outpatients who attended the psychiatry OPD. Results: In this study, 82% of the subjects were females whereas 18% were males. Most of the patients were in the age group of 41-60 years followed by the 21–40 years age group, the above 60 years age group and the below 21 years age group. Most of the patients were prescribed selective serotonin reuptake inhibitors (SSRIs), followed by serotonin nor-epinephrine reuptake inhibitors (SNRIs) and tricyclic antidepressants (TCAs). The most prescribed SSRI was Escitalopram. Conclusion: In this study on depression, most of the subjects were females. Most of the patients were in the age group of 41–60 yrs. By and large, the newer groups of drugs, namely the SSRIs and the SNRIs seem to have replaced the older group, namely the TCAs. This seems to be in accordance with other research findings especially considering the fewer side effects of the newer group of drugs and the prolonged therapy which was needed to combat depression effectively.

Japanese Encephalitis Virus – Common Cause of Viral Encephalitis in Paediatric Age Group in Bellary, Karnataka, India

ANURADHA SUREKHA SATHYANARAYAN, SURESH SONTH KRISHNA, SATISH MARIRAJ, RAVIKUMAR
Background: A study was conducted in VIMS hospital at Bellary during the epidemic of August 2004 to July 2005. Objectives: To know the hospital based incidence of J.E and to study the age and sex pattern of the infection in the paediatric age group. Materials and Methods: 82 children admitted to the Paediatric ward, VIMS, Bellary with clinical diagnosis of acute viral encephalitis, during the epidemic of August 2004 to July 2005 were studied. After pooling the samples, they were subjected to J.E. MAC ELISA. Results: Out of 82 patients tested by J.E. MAC ELISA, 19 (24%) were positive for J.E. and 12 (14.63%) were positive for flaviviral infection. CSF was positive in all 19 cases with 100% positivity.Serum was positive in 10 cases with 15.87% positivity. This indicates that there are significant number of J.E. cases in Bellary emphasising the rampant nature and stressing the measures to be taken to overwhelm this devastating disease. Conclusion: The hospital based incidence of J.E. was found to be significant in the area of the study. The paediatric age group, between 4to 6 years was found to be most predisposed to J.E., probably because of low immunity in the age group. Male predominance was seen with male to female ratio of 1.42:1. Illiteracy, low socio economic status and living in unhygienic conditions near rice fields contributed to the high incidence of J.E. in and around Bellary. The serological results clearly establish the etiology. Isolation of JEV from specimens would have strengthened the diagnosis.

Moraxella catarrhalis: An Often Overlooked Pathogen of the Respiratory Tract

ANITA K, Faseela T.S, Yashvanth K RAI, Ms.CHAITHRA S, M SRIKARA MALLYA
Background: Moraxella catarrhalis is an upper respiratory tract commensal which can also be pathogenic. It is now considered as the third most common pathogen of the respiratory tract. Aim: The aim of the present study was to assess and evaluate the risk factors in adults with lower respiratory tract infections which were caused by M. catarrhalis. Material and methods: Sputum samples from 1402 adults with lower respiratory tract infections were studied over two years. M. catarrhalis was isolated from 137 samples. Data such as date, name, sex, age, smoking history and underlying disease conditions were collected to study the risk factors. Results: Most patients (68%) were of above 50 years of age. Underlying risk factors such as COPD (37%) and diabetes mellitus (18%) were seen in a majority of the cases (87%). No underlying risk factors were detected in 12(12.7%) patients. The isolation was more during the colder months (63.5%). While all isolates were susceptible to Amoxyclav, only 14% were sensitive to Penicillin. Conclusion: The isolation of M.catarrhalis should be considered significant in adult patients with lower respiratory tract infections and associated underlying risk factors. Since 86% of the isolates showed penicillin resistance, treatment with appropriate antibiotics should be instituted.

Choice of Antibiotics in Community Acquired UTI due to Escherichia Coli in Adult Age group

HENA RANI, NEELAM KAISTHA, PROF. VARSHA GUPTA, Prof. JAGDISH CHANDER
Background: Urinary tract infections (UTI), being the most common infections diagnosed in community and hospital, are to be treated scrupulously considering the type of infecting organism and its antibiotic resistance pattern. The study of changing antibiotic resistance pattern is pertinent for appropriate treatment. Aim: The aim of this study was to find out the drug options for treatment of community acquired urinary tract infection (UTI) due to Escherichia coli in adult age group in our geographical area in the current scenario of increasing antimicrobial resistance. Setting and Design: A total of 208 Escherichia coli isolates from urine of adult patients presenting in various out patient department of Government Medical College & Hospital, Chandigarh were studied between January 2009 to June 2009. Antimicrobial susceptibility of various drugs was carried out by disc diffusion method following CLSI guidelines. Results: Amongst the orally administered drugs ampicillin, amoxycillin/clavulanic acid, norfloxacin, ciprofloxacin, tetracycline and co-trimoxazole showed 100%, 83.6%, 78.1%, 72.5%, 69.1% and 69% resistance respectively. Amongst parenterally administered antibiotics, the antimicrobial resistance for cefotaxime, ceftazidime, gentamicin, netilmicin and amikacin was found to be 58.8%, 67.2%, 18.7%, 4.8% and 4.6% respectively. Nitrofurantoin showed only 3.8% resistance. No drug resistance was seen with imipenem. Conclusion: Amongst oral drugs, nitrofurantoin was shown to be suitable for the treatment of UTI due to Escherichia coli. Ampicillin, amoxycillin/clavulanic acid, norfloxacin, ciprofloxacin, tetracycline, co-trimoxazole should no longer be considered first line drugs for empirical treatment of clinically evident UTI because of very high resistance rates. Aminoglycosides though parentral drugs can be the alternative choice for community acquired UTI.

Prevalence of Work-Related Wrist and Hand Musculoskeletal Disorders (WMSD) among Computer Users, Karnataka State, India

SRILATHA, MAIYA ARUN G., VINOD BHAT, NALINI SATHIKUMAR
Background: Work-related musculoskeletal (WMSD) disorders of the wrist and hand have been reported among computer users. Data on estimates of prevalence of computer users in India are limited. Aim: To Find prevalence of self-reported WMSD of the wrist and hand among computer users. Method: A survey using questionnaire distributed to 783 computer users, employed at two workplaces in Karnataka, India. Result: Prevalence of self-reported WMSD of the wrist and hand was 58%. Women were more to report symptoms than men (69% vs. 53%). Computer users between 21 to 30 years of age were more to report symptoms than those between 40 to 55 years (76% vs. 9 %). Conclusion: The prevalence of WMSD of wrist and hand is high and dependent on gender and age. There is a need to develop specific strategies in workplace to reduce the occurrence of WMSD of the wrist and hand.

Vertebral Artery Groove in the Atlas and Its Clinical Significance

RAVICHANDRAN D., SHANTHI K.C, VIJAYA SRINIVASAN
ntroduction: The vertebral artery groove is located on the superior surface of the posterior arch of atlas vertebra lodging the third part of the vertebral artery. The morphometric data of the groove including the groove length, width and thickness of the bone forming the floor of the groove is scarce in Indian literature. The distance between the groove and the posterior midline is of surgical importance. Iatrogenic injury to the vertebral artery is common in posterior approaches of the atlas vertebra. The objective of the present study is to obtain the morphometric data of the groove and to assess the distance of the groove from the posterior midline for providing a safety guideline to the surgeons. Materials and Methods: 75 dry human atlas vertebrae were measured manually using vernier calipers. The morphometry of VAG and its distance from midline were evaluated through eight linear measurements. The results were analysed stastically using SPSS 16 version. Results: The inner groove length was 7.71 mm and 7.49 mm on the right and left sides respectively. The outer groove length was 8.1 mm on the right and 8.24 mm on the left side. The mean width was 7.89 mm on the right and 8.08 mm on the left side. The mean thickness was 4.7 mm on the right and 4.55 mm on the left side. The safe zone from the midline during posterior approach to C1 to avoid potential injury to vertebral artery was found to be 11.26mm. Discussion: Iatrogenic injury to vertebral artery is the most commonest per-operative complication during a posterior approach. The distance of the groove from the posterior midline and knowledge of the morphometric data of the groove is important for instrumentation procedures in the atlas vertebra. Conclusion: The present study reveals the morphometry of the vertebral artery groove and recommends a safe zone of 11.26 mm from the midline in posterior approach for atlas vertebrae.

Myeloma in the Young

GARIMA GOEL, SHARADA RAI, ASTHA GUPTA, RAMDAS NAIK,POORNIMA BALIGA
Introduction: Multiple myeloma (MM) is a neoplastic plasma cell proliferation involving the bone marrow and extraosseous tissues which usually occurs in the elderly, (aged, 60 to 70 years), while patients younger than 30 or 40 years account for only 0.3 and 2.2 %,of all myelomas, respectively. Materials and Methods: The present study analyzed 7 patients younger than 40 years among 87 patients of MM who presentedto our hospital from 2005 to 2008. Complete diagnostic workup was carried out for all the patients. Results: The youngest of the 7 patients included in the study was a 30 year old female. All the patients had marrow involvement by neoplastic plasma cells. Conclusion: The survival of patients younger than 40years with MM is longer than observed in other series of patients of all ages with MM.

Pulmonary Function Tests in Air Conditioner Users

R. BABITHA, R. RANGARAJAN, M. MUHIL, M.G. BASAVARAJAIAH
Objective: The present study was aimed at the measurement of the pulmonary function tests in healthy air conditioner users at its comparison with that of non air conditioner(AC) users and at considering whether air conditioner usage affected pulmonary functions. Study method: The study group comprised of 50 healthy males between the ages of 25-50 years, who were working in air conditioned rooms. 50 age and sex matched controls werechosen and their pulmonary functions were compared by using a computerized spirometer, SPIROBANK-G. Results: There was a significant decrease in Forced Expiratory Volume in first second[FEV1], Forced Expiratory Flow at 25-75 percent of lung volume [FEF25-75], Peak Expiratory Flow Rate [PEFR] and a significant increase in the respiratory rate. Conclusion: There is a significant decrease in the pulmonary functions in air conditioner users.

To Study the Attitudes, Beliefs and Perceptions Regarding the Use of Inhalers among Patients of Obstructive Pulmonary Diseases and in the General Population in Punjab
Introduction: Inhaler devices are an important part of the armamentarium of clinicians who treat ing obstructive pulmonary diseases. The effectiveness of inhaled drugs depends on the patient’s’ ability to use the inhaler device correctly and the adherence to the treatment regimens is likely to be influenced by their opinions and feelings about the use of the inhaler as a mode of therapy. The patients’ beliefs about their illnesses and therapy play a key role in determining their adherence to the treatment. Aims and Objectives: However, there is paucity of studies investigating attitudes, beliefs and perceptions about the use of inhalers in patents of obstructive pulmonary disease and in the general population in India so we sought to study the attitudes, beliefs and perceptions regarding the use of inhalers by obstructive pulmonary disease patients and by the general population. Material and Methods: Patients of COPD and asthma and the general population visiting the hospital were screened for recruitment into this study. A questionnaire which could identify the patients’ potential attitudes, beliefs and perceptions about inhalers was designed and the answers were sought during interviews with the first contact OPD patients and the generalpublic visiting the hospital as relatives accompanying the patients, other than the patients of respiratory diseases. All the ‘yes’ answers were analyzed on a percentage scale. Results: We studied 1276 patients and 1832 people from the general population. Only 15.1% patients and 17.2% subjects from the general population considered inhalers as the preferred mode of therapy . A majority of the patient population and subjects from the general population thought that the use of inhalers was a social stigma and preferred oral medication;, they expressed their inhibitions for inhaler use in public, wanted to keep the inhaler use as a secret, expressed preference for a smaller inhaler device and a single dose inhaler and thought that inhalers are were used in for serious diseases, which once started on, inhalers had to be taken life long. Conclusion: We conclude that the results of our study highlighted the misplaced beliefs, attitudes and perceptions about inhalers among a majority of the patients and the common population, thus necessitating the urgent need for an individual and a collective national effort in the form of national educative programmes to dispel the misconceptions and inadequate knowledge, beliefs, attitudes and perceptions of the patients and the common people towards inhalers.

A study of finger prints – bilateral asymmetry and sex difference in the region of Andhra Pradesh

MURALIDHAR REDDY SANGAM, KARUMANCHI KRUPADANAM, KOLLA ANASUYA
Introduction: Fingerprints are considered to be the most reliable criteria for personal identification. The present study was undertaken to observe the distribution of finger print pattern in males and females, and to observe the bilateral asymmetry in the region of Andhra Pradesh. Material and methods: The study was carried out in 506 individuals in NRI medical college, Chinakakani, Guntur, Andhra Pradesh. In the study 268 were males and 238 were females.Finger prints are collected by Cummins ink method, then studied and analyzed statistically. Results: Whorls were of high frequency on thumb, index and ring fingers in males. But females presented high frequency of loops on all fingers expect ring finger. There is a significant bimanual difference. Whorls are more common in right hands. Arches and radial loops are more on left index finger. Conclusion: Such studies may be useful particularly in Forensic Medicine.

Phyllodes tumour of the breast associated with concomitant tuberculous and sarcoid like lesions in the axillary lymph nodes: A case report

PREM SINGH, JYOTI BALA, DEEBA MUSHTAQ, MAYANK MADAN
The concomitant presence of tuberculous and sarcoid like lesions in the lymph nodes, which drain a neoplasm, is very rare. The case which is reported here is that of a 40 years old female patient who presented with a history of a right sided breast mass of 5 years duration. Fine needle aspiration cytology (FNAC) of the breast lump suggested the features of a phyllodes tumour of questionable malignant potential. She underwent a simple mastectomy with axillary lymph node clearance. The histopathological examination of the tumour revealed the features of a borderline phyllodes tumour of the breast. The axillary lymph nodes revealed a florid, sarcoid like, granulomatous reaction and caseating granulomas with acid fast bacillus positivity. There was no clinical, radiological or immunological evidence of systemic sarcoidosis. No metastatic deposits were seen in the lymph nodes. The occurrence of the sarcoid like reaction and tuberculosis concomitantly in the lymph nodes, which drain a breast neoplasm, has been described and discussed.

Multiple Carpometacarpal Fracture Dislocation of the Hand – An Uncommon Pattern of Injury Which is Often Missed: A Case Report with Review of Literature

YASIR SALAM SIDDQUI, MOHAMAD ZAHID AAMIR BIN SABIR, JULFIQAR, GAURAV KUMAR
Carpometacarpal fracture dislocations of the hand are a relatively uncommon pattern of injury. The injury is difficult to diagnose because of the gross swelling of the hand. The diagnosis of this unusual form of injury requires a high index of suspicion, vigilant examination and high-quality radiography. Apart from the routine antero-posterior and oblique radiographs, a lateral radiograph of the hand is essential for making a precise diagnosis in suspected cases of carpometacarpal fracture dislocations. In the case which is discussed here, the diagnosis of the fracture dislocation was missed by the treating doctor at the initial presentation itself, probably due to the gross swelling and ignorance about the entity.

An Unusual Case of a Forgotten Intrauterine Contraceptive Device Which was Found Embedded in the Rectosigmoid Colon

MAHESHA NAVADA H., B POORNIMA RAMACHANDRA BHAT, Prof. GOPALA NAGARATHNA
An intrauterine contraceptive device (IUD) is an effective, safe and convenient contraceptive method. It can cause serious complications like uterine perforation during the insertion process. The perforation of the bowel by the IUD is usually symptomatic, but asymptomatic colon perforation has rarely been reported. We are reporting one such case of a forgotten IUD, which perforated through the uterine wall into the rectosigmoid colon and was found incidentally during hysterectomy.

Pulmonary Hydatid Cyst Presenting with Massive Haemoptysis in a Child – An Unusual Presentation: A Case Report

BHANU KIRAN BHAKHRI, RICHA ARORA, LAVANYA P, PREMILA PAUL
Echinococcosis (Hydatidosis) is an endemic disease in India. Hydatid disease of the lung, though uncommon, is a well described entity. We describe here, a 10-year-old girl with pulmonary hydatidosis, who had an unusual clinical presentation and investigational findings.

Calcified Intravesical Gossypiboma Following Abdominal Hysterectomy: A Case Report

PRASAD MYLARAPPA, H.C. SRIKANTAIAH
A retained surgical foreign body is a ubiquitous medical error which occurs when nonabsorbable materials are used. The migration of a retained surgical sponge into the bladder after a gynecological procedure is rare. The calcification of migrated sponge inside the bladder without a fistula is even more unusual. This is a rare case in which the surgical sponge accidentally retained after abdominal hysterectomy, eroded into the bladder with calcification around it forming a big vesical calculus.

An Unusual Case of Uterine Inversion: A Case Report

SUNITHA,VANI RAMKUMAR
Acute puerperal uterine inversion is a rare but potentially fatal obstetric emergency. A prompt recognition will enable the immediate repositioning of the uterus before it becomes edematous and incarcerated by a constriction ring which requires surgical intervention.

Colocolic Intussusception In The Elderly On The Left Side- With An Unusual Presentation

NIRUPAMA.M, URMILA N KHADILKAR
Intussusception is the telescoping of a segment of the intestine into the distal segment. It is common in children in the first two years of life (90-95%) and it is rare in adults (5-10%). Malignant tumours are more common than the benign tumours in the colon, leading to intussusception in adults, although the reverse is true in the small intestine. Colocolic intussusception in adults due to a benign cause is veryrare . Intussusceptions due to lipomas have been reported on the right side of the colon, especially in the caecum and at the illeocaecal junction. It is even very rare on the left side of the colon, especially in the splenic flexture in elderly type II diabetic patients. Here, we wish to document a rare case of colocolic intussusception with pedunculated lipoma as the lead point. The CT was diagnostic and the patient underwent a non- oncological resection of the colon. Grossly, a pedunculated lipoma with the cut surface showing lobulated yellow areas was seen. The histological examination showed an ulcerated and infarcted lipoma which caused pressure atrophy of the adjacent mucosal glands.

Thoracoabdominal ectopia cordis: A report of two cases

RAJENDRE K GHRITLAHAREY, K S BUDHWANI, JYOTI SRIVASTAVA
Ectopia cordis (EC) is defined as the complete or partial displacement of the heart outside the thoracic cavity. It is a rare congenital defect in the fusion of the anterior chest wall, resulting in the extra thoracic location of the heart. We are describing here, two cases of thoracoabdominal EC. One died after emergency surgery and another is awaiting definitive procedures.

Caecal volulus: A rare cause of caecal gangrene in children

RAMESH. B HATTI, SURESH I. BASARKOD, MARUTHI. B. TALWAR
The Caecal volvulus, a serious surgical condition, has a mortality of 10% which is extremely rare in children. We report a case of a 12 year old child, presenting with the acute signs and symptoms of peritonitis. An exploratory laparotomy revealed caecal volvulus which had resulted in caecal gangrene. This was treated by primary resection and anastomosis.

Superficial Brachial Artery With A High Origin Of Profunda Brachii And Common Interosseous Artery- A Case Report

RAJAN KUMAR SINGLA, MONIKA LALIT
Variations in the arterial pattern of the upper limb are observed frequently and may be seen in routine dissections or in clinical practice. These have important influences on the predisposition to illness, clinical examination, investigations and patient management, including operative surgery. The knowledge of such a variability is however not only desirable, but also essential. In this article, the superficial brachial artery with a high origin of profunda Brachii and the common Interosseous artery is being reported. The axillary artery in its third part gave the profunda brachii artery and continued as the brachial artery which crossed the median nerve superficially from the medial to the lateral side, in the middle of the arm, as the superficial brachial artery. In the lower one third of the arm, it gave a branch of almost equal calibre, which coursed laterally and continued in the forearm as the common interosseus artery. Then, just at the base of the cubital fossa, it divided into the radial and the ulnar arteries. These arteries may also be mistaken for veins and the results may be disastrous, like gangrene or loss of the hand. Its ontogeny and clinical implications have been discussed in detail.

Neck Schwannoma Masquerading As A Carotid Body Tumour

SATHISH KUMAR BHANDARY, VINAY VAIDYANATHAN,VADISH BHAT, BINIYAM K,SHWETA SHENOY
Schwannomas, are uncommon nerve sheath neoplasms that may originate from any nerve of the body. These benign tumours often present as diagnostic and managementchallenges. A classical case of neck schwannoma was mimicking as a vascular tumour both clinically and radiologically which was surgically resected and later proved to be a scwannoma on histopathology.

Anaesthetic Management of a Case of Osteogenesis Imperfecta with Bladder Outlet Obstruction: A Case Report

VINOD HOSALI, UDAY AMBI, SHIVANAND HULKUND, HARIHAR V. HEGDE
Osteogenesis Imperfecta (OI) is a fibro-osseous disorder of the collagen tissue which leads to defects in the skeletal growth and short stature. OI poses various anaesthetic challenges, which include difficult intubation, problems with positioning and a tendency to develop malignant hyperthermia, coagulopathy and cardiovascular abnormalities. We describe the anaesthetic management of an 18 year old boy, a known case of OI with kyphoscoliosis, who presented with acute retention of urine due to urethral stone and was successfully managed foremergency suprapubic cystolithotomy with caudal anaesthesia. He had characteristic features like short stature, short neck, blue sclera, a receding mandible, pectus carinatum (pigeon chest), hyper mobile joints, kyphoscoliosis and a history of recurrent hospitalization for long bone fractures. Since our patient presented for an emergency surgery, we had only little time to evaluate and plan out the management, which posed significant challenges. A successful outcome was ensured by the carefully obtained history, examination and gentle care, with the application of basic principles in managing this patient.

Carcinosarcoma of the Pancreas – Report of a case with a concise review of the literature

PALANIAPPAN, WESLEY JOSE, BINDHU, SUDHEER, PAVITHRAN
Carcinosarcomas are rare, mixed, malignant neoplasms which are composed of both carcinomatous and sarcomatous elements, showing distinct immunohistochemical and ultra structural features. While the uterus is one organ where they are encountered most often, some cases have been diagnosed in other organs, including the pancreas. We have reported a case of pancreatic carcinosarcoma which was diagnosed in our institute and have reviewed the epidemiology and the clinico-pathological characteristics of all cases of carcinosarcoma of the pancreas which have been reported worldwide.

Mycosis Fungoides: Tumor D´ emblee – A Rare Presentation: A Case Report

CLEMENT R S D’SOUZA, HILDA FERNANDES, SAFEENA AMBER, KIRANA PAILOOR, PREETHI RAI
Mycosis Fungoides (MF) is a condition characterized by infiltration of skin by neoplastic T lymphocytes. The disease has various stages viz. premycotic, patch, plaques, nodules, tumors and erythroderma. ‘Tumor d’emblee’ is a variant of tumor stage that develops from an apparently normal skin without prior patch or plaque stage. We present Case of a 70 year old lady with a reddish nodule over her right leg without prior plaques or itching. Fine Needle Aspiration Cytology, Histopathology and Immunohistochemistry studies were done to diagnose it as mycosis fungoides. Mycosis fungoides is the most common subtype of cutaneous T cell lymphoma. Tumors are the initial manifestation in 10% of patients.

Aplastic anaemia complicating systemic lupus erythematosus (SLE) at presentation – A clinical vignette and review of literature
Context : Systemic lupus erythematosus (SLE) is a common disease with myriad presentation. Aplastic anaemia is occasionally associated with this disorder; however, a simultaneous diagnosis of aplastic anaemia with SLE on presentation is unusual. Case Report: We present here, probably the first reported case of simultaneous presentation of aplastic anaemia with florid features of SLE.

Vancomycin Induced Redman Syndrome: A Case Report

M.VINAY, K. ASHA, UMAKANTH VENKAT., T. JAYASHREE,ROHIT DIXIT
Vancomycin is a glycopeptide antibiotic active against gram positive bacterial infections. Most important adverse reaction with vancomycin is hypersensitivity reaction. It is of two types, one is anaphylaxis and other redman syndrome. Redman syndrome commonly manifests with pruritus, flushing and lessfrequently with hypotension and cardiovascular collapse on intravenous infusion. Discontinuation of the intravenous infusion of vancomycin and administration of antihistamines such as diphenhydramine can abort most of the reaction.Herewith, presenting a case report of Redman syndrome with hypotension and cardiovascular collapse type.

Neonatal meningitis due to Listeria monocytogenes: a case report from Southern India

SADIA KHAN, S. SUJATHA,B.N. HARISH ,IRA PRAHARAJ, S.C.PARIJA
Introduction: Listeria monocytogenes is an uncommon cause of bacterial meningitis in neonates. The infection due to this organism in the neonates can be categorized as an early onset or a late onset disease. While the early onset neonatal listeriosis is due to an in utero infection, the late onset form primarily occurs due to exposure to the organism during vaginal delivery. Case presentation: Here, we report a 2 week old female child who presented with late onset meningitis due to Listeria monocytogenes and responded adequately to appropriate antimicrobial therapy. Conclusion: Physicians should always consider Listeria as a possible aetiological agent of meningitis in paediatric patients, regardless of their age or immunological status in a developing country. It is important to differentiate meningitis which is caused due to Listeria monocytogenes from other causes, as cephalosporins which are the most commonly used antimicrobial in bacterial meningitis, are unlikely to elicit a favourable response in such cases.

Endometrial ossification: an unusual cause of infertility

MANISHA MAKKAR, PINKI PANDEY, CHINKI GUPTA, KALYANI KAPUR
Endometrial ossification, a rare but well recognized phenomenon in uterus, is the presence of bone in endometrium. It is an uncommon entity related to secondary infertility following an abortion. It is of paramount importance for the pathologists to recognize the non neoplastic nature of this condition to avoidmaking erroneous diagnosis of malignant mixed mullerian tumor of the uterus. Removal of these bony bits leads to spontaneous conception. We are describing a case of endometrial ossification in a 28 years old female, presented with menorrhagia and secondary infertility.

Hyperesoinophilic syndrome with FIP1L1 PDGFRα mutation: A case study

ASMITA A. MEHTA, WESLEY JOSE, PAVITHRAN K.
In India , a clinical and / or a laboratory diagnosis of hypereosinophilia is very common and is usually attributed to parasitic infestations (viz helminthiasis and filariasis) or atopy. The treatment usually includes deworming or antifilarial drugs in the filaria endemic regions. We report here, a case of hypereosinophilic syndrome ina middle-aged man, who presented with features which mimicked asthma with eosinophilia that did not respond to the routine treatment measures. He was found to have a FIP1L1-PDGFR-α mutation and he improved on treatment with the small molecule, tyrosine kinase inhibitor, Imatinib that is commonly used in patients with malignant diseases of haematological origin.

Preanalytical Errors: Some common errors in Blood Specimen Collection for routine investigations in hospital patients

PRABHAT KUMAR NIGAM
Preanalytical variables include specimen collection, handling, processing, physiological influences and/or interference factors. Since the blood collection is the first step, any error in this step will jeopardize the whole test results, no matter how accurately these are analysed in the laboratory. Here, some common errors in blood collection and handling in hospital patients have been highlighed by giving some instances . Preanalytics involve the patient, the physician, the resident doctor, the Prabhat Kumar Nigam nurse, the technician, the laboratory personnel and the transport service. Therefore, all of them are required to know about preanalytical variables, their possible sources and their effect on the test results. Moreover, since the resident doctors have a direct interaction with the paramedical staff, it is very important for them to understand the preanalytical variables so that they could instruct the paramedical staff accordingly.

Hyperdontia- 3 Cases Reported

SUJATA.M.BHYATTI
A supernumerary tooth may closely resemble the teeth of the group to which it belongs, i.e molars, premolars, or anterior teeth or it may bear little resemblance in size or shape to the teeth with which it is associated. It has been suggested that supernumerary teeth develop from a third tooth bud which arises from the dental lamina near the permanent tooth bud or possibly from the splitting of the permanent tooth bud itself. In some cases, there appears to be a hereditary tendency for the development of supernumerary teeth. A supernumerary tooth is an additional entity to the normal series and is seen in all quadrantsof the jaw. The incidence of these teeth is not uncommon. Different variants of supernumerary teeth are discussed and reviewed in detail in the following article.

The Prevalence of the Developmental Defects of Enamel in a group of 8 -15 years old Indian children with developmental disturbances

CHHAVI JINDAL, SANGEETA PALASKAR, SHIKHA KLER
Aims: To find the overall prevalence of the developmental defects of enamel among the total number of disabled children in the Panchkula district of Haryana, India. To compare the prevalence of this dental developmental anomaly with the various types of disabilities like mental handicap, locomotor handicap, hearing impairment, partial sight and multiple handicaps. Material and Methods: A total of 996 subjects (499 controls and 496 disabled children) were examined for the developmental defects of enamel by using a Modified DDE index. The 496 disabled children included 189 with mental retardation, 203 with locomotor handicaps, 39 with hearing impairment, 31 with partial sight and 34 with multiple handicaps. Statistical analysis: The data which was obtained was analyzed by using the SPSS package version 13. The differences weretested for statistical significance by using the Pearson’s Chi- Square test. Results: The percent prevalence of the developmental defects of enamel among the disabled group was 40.9% and in the controls it was 5.4%. The percent prevalence of the various developmental defects of enamel,in decreasing order, among the various disabled groups was found to be as follows: 73.5% in the group with multiple handicaps, 56.4% in the group with the hearing impairment, 39.4% in the group with the locomotor handicaps, 37.6% in the group with the mental handicap and 16.1% in the group with the partial sight. Conclusions: Overall, a high prevalence rate of the developmental defects of enamel was observed in this study in the disabled children. This reflects the association of various systemic disturbances with the development of the tooth.

AMSA (Anterior Middle Superior Alveolar) Injection: A Boon To Maxillary Periodontal Surger

MOHAMMED NAZISH ALAM,S.C.CHANDRASEKARAN,MOHAN.V,ANITHA Balaji
Introduction: Local anesthetics have been in use in dental practice for more than 100 years. The advent of local anesthetics with the development of nerve blockade injection techniques heralded a new era of patient comfort while permitting more extensive and invasive dental procedures. Discussion: Today’s availability of a variety of local anesthetic agents enables dentists to select an anesthetic that possesses specific properties such as time of onset and duration, hemostatic control and degree of cardiac side effects that are appropriate foreach individual patient and for each specific dental procedure. The ease of the technique is its advantage and disadvantage should always be considered before its acceptance. Conclusion: The importance of this review was to bring about awareness among the general clinician who have to use multiple injection for any treatment to be performed in the maxillary arch. The non compliance of the treatment on the maxillary arch is usually due to these factors. Hence introducing this technique can help patient compliance as well ease for the clinician. Also the duration of treatment is reduced.

Prosthetic rehabilitation of a patient with congenital oro-nasal defect: A case report

SEEMA PATTNAIK, AARTIP WADKAR, BIKASHK PATTNAIK
The rehabilitation of the patients with facial defects requires a multidisciplinary approach involving a head and neck surgeon, a maxillofacial prosthodontist and a reconstructive surgeon. Here, we discuss a case of a mid-facial defect due to a congenital anomaly for which a sectional impression was made. A removable nasal prosthesis which obturated a oronasal defect along with an overlay partial maxillary denture for the correction of malocclusion was given to the patient till a definitive reconstructive surgery was performed.

Basics in Research Methodology- the Clinical Audit

ASHWINI NAVEEN SHANKAR, VEMANNA NAVEEN SHANKAR, VEMANNA PRAVEENA
Health care organisations regularly undergo quality assurance for safe and effective patient care. Such quality improving programs are considered as audit. The purpose of audits is to generate findings that will benefit patients and their programmes of care. Audits should be regularly carried out in a systematic manner as patient welfare is at the heart of any audit process. Auditprocess should maintain professional and ethical perspectives also. However, clinical audits are often poorly carried out and consequently have minimal effect on improving patient care. Health care organizations should encourage clinicians to participate in regular clinical audit. This review explains the basics of audit and describes in detail how a clinical audit should be performed and monitored.

Imaging in osteoid osteoma

SUSHIL. G. KACHEWAR, SMITA . B. SANKAYE DEVIDAS.S. KULKARNI
Osteoid osteoma is a benign osseous lesion which is mostly found in the appendicular skeleton. It produces excess bone and secretes pain-causing prostaglandins, resulting in intense night pain that is temporarily relieved by Aspirin or Ibuprofen. Few of the osteoid osteomas resolve spontaneously and some respond to a less-invasive procedure which is known as radiofrequency ablation. Surgical intervention is usually necessary for the rest. The imaging findings of osteoid osteoma are presented in this article.

Journal of clinical and diagnostic research

The Prevalence of ESBL among Enterobacteriaceae in a Tertiary Care Hospital of North Karnataka, India

An assessment of falsely convicted type 1 diabetics in Jamaica by using the breathalyzer test

Oxidative stress and antioxidant status in primary dysmenorrhea

The Cutaneous Adverse Effects of Lithium

The laterality of Handedness, Foot Preference and Foot Overlapping

Effect of Age and Sex on QRS Axis Deviation of Healthy Indian Population and Its Clinical Significance

A Study Of Visual Evoked Potentials In Patients Of Type 2 Diabetes Mellitus

The Study Of Salmonellosis With Reference To Salmonella Typhi In Enteric Fever Patients

The duplication of the optic canals in human skulls

Coronary Artery Disease risk factors in Type 2 Diabetes mellitus with metabolic syndrome in the urban South Indian population

A correlative study on the Aminotransferases and Gamma Glutamyl Transferase in the Saliva and Serum of Chronic Alcoholics before and after Alcohol Deaddiction

Accuracy of the Drug Advertisements in Medical Journals in India

Psychiatric morbidity and the Socio-demographic determinants of Deliberate Self Harm

A Clinico-Morphological Spectrum Of The Non Neoplastic Lesions Of The Uterine Cervix At AJ Hospital, Mangalore

A study on the Sociodemographic Profile of the Attendees at the Integrated Counselling and Testing Centre of a Medical College in Southern India

Sexual dimorphism in the Humerus : south Indians-RETRACTED ARTICLE

The prevalence of obesity and hypertension in urban Tamilnadu

Extraintestinal infections Due To Escherichia Coli: An Emerging Issue

Comparison of the methods of diagnosis of bacterial vaginosis

The Pattern of Antibiotic Use in a Family Medicine Department of a Tertiary Hospital in Sokoto, North Western Nigeria

A Post-Marketing Surveillance Study of Tolperisone [MYOTOP-150]: It’s Use in the General Clinical Practice in India

Diagnostic value of Platelet count in Malaria

The pattern of fatal head injury in a teaching hospital in eastern Nepal.

Fine Needle Aspiration Cytology Of Intra-Abdominal Lesions

Cardiac Involvement in Patients with Pulmonary Tuberculosis

The impact of body mass index on the expiratory reserve volume

Routine Urine Culture in Febrile Young Children

Declining Age of Onset of Type 2 Diabetes Mellitus in the North-West Punjabi Population

The Clinical Profile and the Efficacy of Prazosin in Scorpion Sting Envenomation in Children of North Karnataka (India)

A study on the Utility of Nerve Conduction Studies in Type 2 Diabetes Mellitus

Evaluation of the diuretic effect of the Chloroform extract of the Benincasa Hispida Rind (Pericarp) extract in Guinea-pigs

Utility of donor rim culture – A study in tertiary care hospital located in rural area

The Clinical Prognostic Indicators of Acute Pancreatitis by Apache II Scoring

The Antimicrobial Resistance Pattern In The Clinical Isolates Of Pseudomonas Aeruginosa In A Tertiary Care Hospital; 2008-2010 (A 3 Year Study)

A study of the clinical features and the outcome of cerebral venous sinus thrombosis in a tertiary care centre in South India

A Study On Surgical Site Infections Caused By Staphylococcus Aureus, With A Special Search For Methicillin-Resistant Isolates

An investigation of MRSA from the Burns Ward: the importance of hand hygiene

Prescribing Trends in Depression – A Drug Utilization Study Done at a Tertiary Healthcare Centre

Japanese Encephalitis Virus – Common Cause of Viral Encephalitis in Paediatric Age Group in Bellary, Karnataka, India

Moraxella catarrhalis: An Often Overlooked Pathogen of the Respiratory Tract

Choice of Antibiotics in Community Acquired UTI due to Escherichia Coli in Adult Age group

Prevalence of Work-Related Wrist and Hand Musculoskeletal Disorders (WMSD) among Computer Users, Karnataka State, India

Vertebral Artery Groove in the Atlas and Its Clinical Significance

Myeloma in the Young

Pulmonary Function Tests in Air Conditioner Users

To Study the Attitudes, Beliefs and Perceptions Regarding the Use of Inhalers among Patients of Obstructive Pulmonary Diseases and in the General Population in Punjab

A study of finger prints – bilateral asymmetry and sex difference in the region of Andhra Pradesh

Phyllodes tumour of the breast associated with concomitant tuberculous and sarcoid like lesions in the axillary lymph nodes: A case report

Multiple Carpometacarpal Fracture Dislocation of the Hand – An Uncommon Pattern of Injury Which is Often Missed: A Case Report with Review of Literature

An Unusual Case of a Forgotten Intrauterine Contraceptive Device Which was Found Embedded in the Rectosigmoid Colon

Pulmonary Hydatid Cyst Presenting with Massive Haemoptysis in a Child – An Unusual Presentation: A Case Report

Calcified Intravesical Gossypiboma Following Abdominal Hysterectomy: A Case Report

An Unusual Case of Uterine Inversion: A Case Report

Colocolic Intussusception In The Elderly On The Left Side- With An Unusual Presentation

Thoracoabdominal ectopia cordis: A report of two cases

Caecal volulus: A rare cause of caecal gangrene in children

Superficial Brachial Artery With A High Origin Of Profunda Brachii And Common Interosseous Artery- A Case Report

Neck Schwannoma Masquerading As A Carotid Body Tumour

Anaesthetic Management of a Case of Osteogenesis Imperfecta with Bladder Outlet Obstruction: A Case Report

Carcinosarcoma of the Pancreas – Report of a case with a concise review of the literature

Mycosis Fungoides: Tumor D´ emblee – A Rare Presentation: A Case Report

Aplastic anaemia complicating systemic lupus erythematosus (SLE) at presentation – A clinical vignette and review of literature

Vancomycin Induced Redman Syndrome: A Case Report

Neonatal meningitis due to Listeria monocytogenes: a case report from Southern India

Endometrial ossification: an unusual cause of infertility

Hyperesoinophilic syndrome with FIP1L1 PDGFRα mutation: A case study

Preanalytical Errors: Some common errors in Blood Specimen Collection for routine investigations in hospital patients

Hyperdontia- 3 Cases Reported

The Prevalence of the Developmental Defects of Enamel in a group of 8 -15 years old Indian children with developmental disturbances

AMSA (Anterior Middle Superior Alveolar) Injection: A Boon To Maxillary Periodontal Surger

Prosthetic rehabilitation of a patient with congenital oro-nasal defect: A case report

Basics in Research Methodology- the Clinical Audit

Imaging in osteoid osteoma