Journal of clinical and diagnostic research

Equal Blood Conservation In On- And Off-Pump Coronary Bypass Operation With The Routine Use Of Cell Saver

DEVBHANDARI M *,ABID Q**,AU J***, DUNCAN A J***

Background: The limitations of recent studies comparing usage of blood products in on and off- pump coronary artery bypass grafting (CABG) have been the routine use of cell saver in the former but not in the latter group. We routinely use cell savers in both on- and off-pump coronary bypasses. We analysed our prospectively collected data to get a more balanced comparison of the two methods. Methods: Data were prospectively collected on all patients undergoing isolated CABG from January 2003 to December 2004. One hundred and seventy-four patients operated on using off-pump technique (OPCAB) were compared with 1125 on-pump cases (ONCAB). They were well matched in terms of age, sex, disease severity, and priority of surgery. Results: There were no significant differences between OPCAB and ONCAB groups in terms of usage of red cells (18% vs. 21%, p not significant (NS)), platelet (6% vs. 7%, p NS), fresh frozen plasma (6% vs. 10%, p NS), chest drain output at 12 hours (mean 802 vs. 856 ml, p NS), or pre-discharge haemoglobin (10  1 vs. 9  1 g/dl, p NS). Conclusion: The routine use of cell saver can achieve the same blood conservation in both on- and off-pump CABG.

Speciation and Antimicrobial Susceptibility pattern of Enterococci from a Tertiary Health Care Center in North India.

GUPTA V, SINGLA N

Introduction: In recent years, Enterococci have become important nosocomial pathogens. Therefore, it is important for a hospital setting to continuously monitor such infections, and to determine their species and antimicrobial susceptibility pattern from time to time. Keeping these objectives in mind, the present study was conducted in our tertiary health care center in North India. Methods: A total of 100 enterococcal strains isolated from urine and blood samples were speciated as per the scheme of Facklam and Collins. Antibiotic susceptibility was determined for Amoxycillin, Penicillin, Cephalexin, Erythromycin, Cotrimoxazole, Gentamicin, Vancomycin, Teicoplanin, Linezolid, Imipenem, Piperacillin, Ampicillin- sulbactam, and Nitrofurantoin by the Kirby Bauer disc diffusion method. MIC detection was done by the agar dilution method for penicillin and vancomycin. HLAR detection was done by the agar dilution method for gentamicin and streptomycin, by supplementing the Mueller Hinton agar with 500μg/ml and 2000 μg/ml of the antibiotics, respectively. Results: 96 of the strains were of Enterococcus faecalis, and 4 were of Enterococcus faecium. Antibiotic susceptibility tests showed a high level of resistance to cephalexin (100%), gentamicin(96.42%), cotrimoxazole (87.03%), erythromycin (77.19%), and penicillin (61.17%). However, only two strains were found to be resistant to vancomycin and teicoplanin. All the strains were sensitive to linezolid. HLAR was seen in 75% of the strains for gentamicin, and in 69% strains for streptomycin. In case of penicillin, MIC values were found to be >16 μg/ml for 14 strains (14%). 6 strains had MIC values of upto 4μg/ml for vancomycin. Out of these, one E. faecalis strain turned out to be Vancomycin resistant enterococci (VRE) showing an MIC value as high as 512 μg/ml. Conclusion: We conclude that enterococcal strains with high rate of resistance to penicillin and aminoglycosides are prevalent in our nosocomial setting, and emergence of the VRE strain has further worsened this situation. There is an urgent need for more rational and restricted use of antimicrobials in order to minimize the selection and spread of such strains.

Subtenons vs. Intravitreal Triamcinolone in Refractory Diabetic Macular Oedema

INDIRA M M, NAEEM Z

Diabetic macular oedema has been treated with triamcinolone acetonide (TA) with varying results. The study aimed to compare the effectiveness of intravitreal vs. posterior subtenons injection of TA for treatment of refractory diabetic macular oedema. Method: Twelve patients received 40 mg of subtenons triamcinolone (STA) and 15 received 4 mg of intravitreal triamcinolone (IVTA). Results: IVTA and STA groups demonstrated a reduction in macular thickness of 48.4% and 12.4%, respectively, at 1 month. IVTA eyes remained statistically thinner at 3 months but not at 6 months. In the IVTA group, 50% had an improved visual acuity and 35.7% a stable visual acuity. Vision improved in 33.3% of patients in STA group and remained stable in 50%. Change in visual acuity was not statistically significant between the two groups. Conclusion: This study does not advocate the superiority of one route of administration of TA over another and recommends randomised control trials to establish best practise in this field. Key messages: Intravitreal and subtenons triamcinolone are equally effective in transiently improving vision in refractory diabetic macular oedema.

Biochemical Changes in Patients with Asthma

AL OBAIDI A H A*, JAWAD A K Y**, AL SAMARAI A G M*, AL JANABI J M***

Background: The changes that occur in diseases in chemical constituents and biochemical mechanisms are of vital importance for homeostasis within the human body. Aim: The study was performed on asthmatic patients and healthy non asthmatic control subjects to determine the changes in serum levels of some biochemicals in asthma. Setting and design:A cross – sectional study with matched control. Methods and materials: A total of 178 sera were used for determination of iron, calcium, very low density lipoprotein (VLDL), lactate dehydrogenase (LDH) and creatine kinase (CK) . The effect of Immunotherapy on serum iron, calcium, VLDL, LDH and CK was evaluated in 169 asthmatic patients after one year of hyposensitization. All the above were determined using a commercial kits and procedures were performed according to manufacturer instructions. Statistical analysis:Student t test was used to determined the significance of differences. Results: The iron and calcium serum levels were significantly lower in stable asthmatic group as compared to that in exacerbation asthmatic . Also, serum iron and calcium levels during asthma exacerbation were significantly higher than that in control. Very low density lipoprotein serum level in stable asthmatic patients was significantly higher (P<0.02) than that of asthmatic patients with exacerbation, but it was lower than that in control (P<0.05). Iron, calcium , LDH, and CK serum levels were significantly reduced following vaccination. However, serum VLDL was significantly higher following immunotherapy as compared to that before vaccination. Conclusions: Serum iron, calcium levels were higher during asthma exacerbation than in stable asthma and control, while VLDL serum level was lower. Immunotherapy for one year reduce serum iron, LDH, CK and calcium levels and increased VLDL serum level.

Effect of Topical Timolol and Betaxolol on Plasma Lipids in Indian Patients of Primary Open-Angle Glaucoma

SHARMA R*,KOHLI K*, KAPOOR B*, MENGI R K**, SADHOTRA P**

Background: The β-blockers adversely affect plasma lipids. Aim: To evaluate the effect of topical timolol and betaxolol on plasma lipids. Setting and Design: The present prospective randomised single-blind parallel study was conducted in Postgraduate Department of Pharmacology and Therapeutics in collaboration with Postgraduate Department of Ophthalmology of a medical college. Materials and Methods: Sixteen (23 eyes) and 12 (20 eyes) patients of primary open-angle glaucoma with intraocular pressure (IOP) more than 26 mmHg were randomised to receive timolol maleate 0.5% and betaxolol hydrochloride 0.5%, respectively, as one drop twice a day instillation for 12 weeks. Lipid profile and IOP of each patient were recorded at 0, 6 and 12 weeks. Plasma lipids were estimated by standard method using photoelectric colorimeter. Statistical Analysis: Effects of the individual drug on study parameters were analysed by using student’s paired t-test, and inter-group comparison was done by using unpaired t-test. P-value ≤0.05 was considered statistically significant; 95% confidence intervals (CI) were calculated according to the standard procedures laid down. Results: In the present study, topical timolol raised total cholesterol by 17.50 ± 2.69 mg% (p < 0.0001), LDL cholesterol by 16.27 ± 2.48 mg% (p < 0.0001), TG cholesterol by 14.56 ± 2.58 mg% (p = 0.0002), VLDL cholesterol by 2.91 ± 0.51 mg% (p = 0.0002), TC:HDL by 0.56 ± 0.07 (p < 0.0001), LDL:HDL by 0.47 ± 0.11 (p < 0.0001) and reduced HDL cholesterol by 1.68 ± 0.07 mg% (p = 0.035) after 12 weeks, while topical betaxolol produced insignificant effect on plasma lipids. Topical timolol and betaxolol lowered IOP by 13.05 ± 1.53 and 7.58 ± 0.90 mmHg, respectively, after 6 weeks and by 16.12 ± 1.67 and 8.535 ± 0.983 mmHg, respectively, after 12 weeks (p < 0.001). Conclusions: In the present study, topical instillation of betaxolol was found to be superior to topical timolol with better safety profile (plasma lipids).

Relationship of IQ with Glucose and Lipid Level

MITRA A, THAKUR G

IQ is the score derived from a set of standardized tests of intelligence. 190 male fresh students, in the B Tech and the integrated MSc and other courses, who get admitted in Indian Institute of Technology at Kharagpur and other institutes are considered for the study to see the relationship of IQ with glucose assimilation, utilization and metabolism in respect to a glucose load and also the corresponding changes in serum insulin levels. The study also deals with relationship of IQ with some common bio-chemical parameters like lipid profile and serum bilirubin. It is being observed that with an increase in IQ level, the blood glucose absorption remains high with a rise in serum insulin level. Logically this will lead to more cerebral blood glucose availability. Correlation of IQ with different blood biochemical parameters shows a positive relationship with total cholesterol, high density lipoprotein cholesterol, low density lipoprotein cholesterol, very low density lipoprotein cholesterol and triglycerides and with serum bilirubin the correlation is found to be negative.

Estimation of the Diagnostic Value of Myeloperoxidase Index and Lactate Dehydrogenase in Megaloblastic Anaemia

EIVAZI-ZIAEI J, DASTGIRI S, SANAAT Z

Background: Most cases of megaloblastic anaemia corresponded to anaemia with hyper-segmented neutrophils, macro-ovalocytosis and very high serum lactate dehydrogenase (LDH) level. Elevated neutrophil myeloperoxidase index (MPXI) may be indicative of a diagnosis of megaloblastic anaemia. Study Setting and Design: The aim of this study was to estimate the value of MPXI and LDH in the diagnosis of megaloblastic anaemia to facilitate the diagnosis prior to performing any bone marrow aspirate. Methods: MPXI and LDH were measured using the first blood sample obtained prior to any transfusion or medical therapy and after therapy in 29 patients diagnosed as megaloblastic anaemia. MPXI was assessed using complete blood count (CBC), performed by Technicon H1 (Bayer) automated cell counter. Results: Mean value of MPXI significantly decreased after treatment (20.4, CI 95%: 17–23 vs. 0.75, CI 95%: 4 to 2.7, before and after treatment, respectively). The same significant pattern was also observed for LDH (4230, CI 95%: 3096–5369 vs. 783, CI 95%: 492–1075, before and after treatment, respectively). The proportional diagnostic value was significantly higher when both MPXI and LDH were used together in the diagnosis of megaloblastic anaemia (83%, P < 0.001), while the same index was 71% (P < 0.001) for MPXI and 48% (P < 0.001) for LDH, respectively, when they were used alone. Conclusion: MPXI and LDH values may have a diagnostic role on megaloblastic anaemia. It might be used as a reliable screening tool before doing any other diagnostic procedure.

Incidence of Aplastic Anaemia in Khuzestan Province, Iran: A Retrospective Single-Centre Study

PANAHI M*'**, RAHIM F*, RASHIDI I***, IRANI S*

Introduction: Aplastic anaemia (AA) is a rare but serious disorder with high mortality and morbidity rates. The incidence of AA worldwide is 2–5 patients/million/year. There is paucity of studies on this disorder from Iran. The aim of the study is to find out the incidence of AA in Khuzestan province, Iran. Patients, Materials, and Methods: The study was conducted at the Research Center of Thalassemia and Hemoglobinopathies (PCTH), Khuzestan province, Iran, from 21 March 2002 through 21 March 2005. This centre covers the 4.3 million population of Khuzestan province (~20% of Iran’s population). All the haematological findings and bone marrow biopsy specimens were studied at Shafa Hospital, Jondishapur University of Medical Sciences, which is the only oncology centre in Khuzestan province. Patients were diagnosed as having AA if they satisfy two or more of the following criteria: (1) leukocytes <3500/mm3, (2) platelets <50,000/mm3, and (3) haemoglobin <10.0 g/dl or haematocrit <30%, in addition to bone marrow features compatible with AA. Results: A total of 1753 patients were examined during the study period. Of them, 257 (14.6%, 95% CI: 13.1–16.4%) satisfied AA criteria, giving an incidence of 20 (95% CI: 13–29) cases/million individuals/year in Khuzestan province, Iran. The age distribution of AA showed a bi-modal pattern; males and females aged 15–30 years, the majority of patients falling under this category, were affected equally. There was a gradual decline in the incidence over the studied years. Conclusion: The incidence established in this study is less than incidences from other parts of the world. This may reflect the role of environmental factors in aetiology of bone marrow suppression.

Learning session on Disease mongering- Student feedback

SHANKAR PR*, SUBISH P**, SAHA AC***

Background: Disease mongering may divert scarce resources from pressing health problems. Reports of learning sessions on disease mongering are lacking in the literature. The Manipal College of Medical Sciences, Pokhara, Nepal admits students from Nepal, India and Sri Lanka to the undergraduate medical (MBBS) course. Aim: The department of Pharmacology conducted a learning session on disease mongering for the third and fourth semester students. Student feedback about the session was obtained and student opinion was compared among different subgroups. Methods: The session was conducted in small groups of 7 or 8 students each. The students were shown a documentary about the creation of a new disease called ‘Motivational Deficiency Disorder’. There was a short presentation by the first author and the groups were given a set of exercises to solve and this was followed by a presentation and discussion. Student opinion was collected using a questionnaire. Basic demographic information was collected and the degree of agreement of the respondents with a set of 15 statements was noted using a Likert-type scale. Results: 117 students participated; 67 were from the third semester. The median total score of the respondents was 53 (maximum possible score 75) and the interquartile range was 48.5-55.5. The score of most individual statements was 4. Nepalese and Indians were the major nationalities. Majority of students were self-financing and from urban areas. No significant difference in the median score was seen among the different subgroups. Conclusion: The overall opinion about the session was positive. A single session can only serve as a preliminary introduction to this complex topic. The session should be continued and strengthened.

Pattern of Skin diseases in Black Africans of Sierra Leone, West Africa

BARI A U *, KHAN M B**

Background: Skin disorders are seen in all ethnic groups with varying frequency. This differential prevalence points towards some social, cultural, and environmental factors in addition to genetic factors in causation of these disorders. Aim of the Study: The purpose of the study was to see the patterns of skin diseases in Eastern province of Sierra Leone and to observe the role of ethnicity in causation of these disorders. Place and Duration of the Study: The study was carried out in Eastern province of Sierra Leone (Kenema) between November 2004 and September 2005. Type of Study: It was an observational study. Patients and Methods: Local black patients of all age groups having one or more skin disorders were included. After clinical history and physical examination, patients (lesions) were photographed. Laboratory investigations (macroscopic fungal examination, X-rays, USG, haematological profiles, STS, etc.) were also carried out when indicated. Non-black settlers in the area and UN troops were not included in the study. Data were recorded and analysed by Microsoft Excel. Results: A total of 2877 patients belonging to different local tribes having a variety of skin disorders were seen during the study period. Patients were of all ages, ranging from 1 month to 73 years, and of both sexes. Sex ratio was almost equal. Vast majority were from very low socioeconomic group. The most prevalent disorders seen were fungal infections (42.3%), followed by hair disorders (9.7%), sexually transmitted infections (9.2%), acne/folliculitis (7%), parasitic infections (6.6%), scars/keloidal disorders (5%), and pigmentary disorders (4.5%). Bacteria and viral infections were rare and so was the scabies. Onchodermatitis with all kinds of skin manifestations was seen in appreciable number of patients (>6%). Conclusion: Pattern of skin disorders in black Africans of Sierra Leone is different from other regions, and these differences may significantly be attributed to unique environmental and cultural factors prevailing there.

Invasive Papillary Carcinoma of Male Breast: A Case Report

SAMANTRAY S*, PATTANAYAK L**, KAKKAR S***

Background: Male breast cancer represents less than 1% of all cancers in men. Even in females, invasive papillary carcinoma of the breast is a rare morphological type. Case: A 60 year old male presented with a lump in the left breast. There were no palpable nodes in the axillae or supraclavicular region. Aspiration cytology revealed clusters of cells arranged in a papillary configuration, suggestive of a papillary lesion of the breast. A simple mastectomy was done, and the histopathology revealed columnar cells arranged in clusters. There was evidence of stromal invasion. One year after completion of treatment, he is asymptomatic and stable. Conclusion:Papillary carcinoma of the breast is extremely rare. The invasiveness and differential diagnosis must be studied from the histopathology specimen.

Life-Threatening Neutropenia

ABBAS M T

We report a 57-year-old male who was admitted to the hospital with mediastinal mass which was diagnosed as a case of mediastinal abscess. Patient was started on piperacillin/tazobactam 4.5 g IV every 8 hours; plus thoracotomy and abscess drainage. On the 25th day the patient developed leucopenia, the total leukocyte count (TLC) was 1900/μl with 0% neutrophils, 87% lymphocytes and 5% eosinophils; monocyte 8%, absolute neutrophilic count (ANC) was zero, while haemoglobin and platelets remained unchanged. Suspecting antibiotic-induced neutropenia, piperacillin/tazobactam was stopped and bone marrow examination was done, which showed arrest of maturation of the granulocyte series with normal other component. Neupogen granulocyte stimulating factor (GCSF), 300 μg, subcutaneously once daily was started and the patient was transferred for reverse isolation. Neutrophils count started to rise and it reached 4200/μl on the fourth day.

Streptococcal Shock Syndrome

PETER J V*, ZIMMERMAN A T**, OUI JU**, PHILPOT R ***

There appears to be a worldwide resurgence of invasive Group A streptococcal infections. We report a 41-year old male who presented with septic shock and multi-organ failure, secondary to Streptococcus pyogenes infection. We have reviewed the current knowledge on toxic streptococcal syndrome and the basis for the therapeutic recommendations of combination antibiotic therapy. Adjunct therapy with immunoglobulins may improve survival, possibly by enhancing neutralisation of bacterial exotoxins.

Acute Leukemia During Pregnancy

Coming Soon...

Review of Medical Management of BPH

SINGH I

Aim: The aim of this study is to review the literature regarding the medical management of benign prostatic hyperplasia (BPH), with emphasis on the current mechanistic insights and drugs, so as to provide an update and present recent data to the urologists, surgeons, and clinicians involved in managing the BPH disease. Methods: The National Library of Medicine and PubMed were searched for major published data and trials on the medical management of BPH using the key words benign prostatic hyperplasia, medical management, lower urinary tract symptoms (LUTS), α-blockers, 5-α reductase inhibitors, phytotherapy, and evidence-based medicine. Important landmark trials published in the last 15 years were analysed and tracked for recent changes, newer drugs, and medical therapies currently being used to manage BPH. Results: Major randomised, placebo-controlled landmark trials involving the three major prescriptions, namely α-adrenergic blockers, 5-α reductase inhibitors, and phytotherapeutic agents, were reviewed and discussed. Conclusions: Medical management of LUTS due to BPH is undoubtedly the first choice of BPH therapy, and it has drastically reduced the number of patients that were initially treated by surgery. Combination drug therapy is currently the most efficacious means to prevent BPH progression in terms of patient quality of life and morbidity. Successful medical management of BPH needs an integrated approach tailored to the patient’s symptoms so as to achieve a durable and sustained realistic goal. Key words: Benign prostatic hyperplasia, LUTS, α-adrenergic blockers, 5-α-reductase inhibitors, phytotherapy, evidence-based medicine

Burns Management: A Compendium

SARAF S, PARIHAR S

Burns are one of the most devastating conditions encountered in medicine and have a catastrophic influence on people in terms of suffering, social life, disability, and financial loss. Burn injuries present difficult, diverse and varied challenge to medical and paramedical staff. The prognosis of a burn essentially depends on prompt and proper management. The ability to accurately evaluate and provide correct management is a must for all the health-care providers. The aim of this article is to provide a comprehensive burn management reference to all physicians and primary health-care providers.

Modified Open Method of First Port Insertion in Laparoscopic Surgery

BHATTACHARJEE P K

Fixed drug eruptions secondary to Cefixime

GUPTA S*, PALAIAN S ** ***, PRABHU S****, ALAM K** ***, PRABHU M*****

Gastrointestinal Tuberculosis in Golestan province- northeast of Iran: A 5-year report

JABBARI A*, BESHARAT S*, ROSHANDEL G H*, SEMNANI S H

Drug Utilisation Study in Geriatric Type 2 Diabetic Patients

RAJESHWARI S*, ADHIKARI PRABHA M R**, PAI M R S M***

Isolated presumed tuberculomas of choroids

SINGH D V, SHARMA Y R, SHARMA R

Adherence to Long-Term Therapies Evidence for Action

SHANKAR P R, SUBISH P