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   2011| July-December  | Volume 4 | Issue 2  
    Online since October 8, 2011

 
 
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CASE REPORTS
Breast tuberculosis or granulomatous mastitis: A diagnostic dilemma
R De Sousa, R Patil
July-December 2011, 4(2):122-125
DOI:10.4103/1755-6783.85767  
Breast tuberculosis is an uncommon disease with nonspecific clinical, radiological, and histological findings. Investigations such as microscopy and culture are frequently negative, and diagnosis is frequently one of exclusion. We report a case of tuberculous breast abscess in a 46-year-old female case of Carcinoma Maxilla on palliative radiochemotherapy. Equivocal histology, negative Ziehl-Neelsen stain, and culture for acid-fast bacilli resulted in the abscess initially being diagnosed as granulomatous mastitis and treated accordingly. Subsequent development of a discharging sinus and history of immunosuppression raised suspicion of culture-negative tuberculosis. Treatment with standard antituberculous drugs was associated with complete resolution of the breast abscess. This case highlights the difficulty in differentiating culture negative tuberculosis from granulomatous mastitis. Also, the unusual age of presentation following radio and chemotherapy is noteworthy.
  26,150 24 -
Negative staining of mycobacteria - A clue to the diagnosis in cytological aspirates: Two case reports
C.S.B.R Prasad, Aparna Narasimha, ML Harendra Kumar
July-December 2011, 4(2):110-112
DOI:10.4103/1755-6783.85763  
Large amounts of lipids present in the cell wall of mycobacteria render them impermeable to dyes used in routine stains. Special staining techniques like Ziehl-Neelsen (ZN), Auromine Rhodamine are needed to demonstrate them. However, they may appear as negatively stained ghosts in Leishman, Giemsa, Hematoxylin and Eosin stain (H and E) and Gram stained smears. Awareness of this feature prompts one to look for mycobacteria by special techniques, even in the absence of cytological features of tuberculous infection like epithelioid granulomas and caseous necrosis. In this paper, we aim to present two cases showing negatively stained images in the lymphnode aspirates of Human Immunodeficiency Virus (HIV) positive patients. A study has been done of two cases of HIV positive patients with cervical lymphadenopathy. Fine needle aspiration cytology (FNAC) was carried out for them from the enlarged lymph nodes which revealed purulent material. Smears of FNAC material were prepared for histopathological examination. Fixed smears were stained with Papanicolaou stain and air dried smears were stained with Giemsa and ZN-stain and studied. Smear study showed scant cellularity, cells composed of neutrophils, lymphocytes, plasma cells and macrophages. Background was necrotic. Giemsa stained smears showed, in addition to cells mentioned, negatively stained ghostly rod shaped structures in the cytoplasm of macrophages and also in the background. ZN-stain showed numerous acid fast bacilli. Both the aspirates were signed out as tuberculous lymphadenitis. In both the cases, cultures grew Mycobacterium avium Intracellulare. Classical cytological features of tuberculosis may not be present in immunocompromised patients and on the contrary there may be suppuration rich in neutrophils or sheets of histiocytes in tuberculosis. One may miss these cases if mycobacteria are not looked for specifically by special stains. Negatively stained ghost images of Tuberculous bacilli on different types of strains are a very helpful finding in such cases.
  18,884 16 2
ORIGINAL ARTICLES
Dental health awareness, attitude, oral health-related habits, and behaviors in relation to socio-economic factors among the municipal employees of Mysore city
BR Chandra Shekar, C.V.K Reddy, BC Manjunath, S Suma
July-December 2011, 4(2):99-106
DOI:10.4103/1755-6783.85761  
Objective: To assess the dental health awareness, attitude, oral health-related habits, and behaviors in relation to socioeconomic factors among the municipal employees of Mysore city. Study Design and Methodology: This study was cross-sectional in nature and involved completion of a predesigned structured questionnaire. The questionnaire included multiple option questions to collect information on awareness on dental diseases, visit to dentist, reasons for visit, reasons for not visiting dentist on routine basis, oral hygiene practices, and deleterious oral habits. Modified Kuppuswamy scale with readjustment of per capita income was used to classify individuals into different socioeconomic status (SES) categories. Data were entered onto a personal computer and analysis was done using SPSS version 14. Results: Awareness on dental diseases was 100% in upper SES and nil (0%) in the lower SES. Visit to dentist in the last 1 year was 100% in the upper SES and 32.3% in the lower SES. The prevalence of smoking, pan-chewing, and alcohol consumption was high in lower SES than in upper SES. Oral hygiene practices were better among the subjects in upper class than the lower ones. Conclusion: A direct relation was noted between the favorable dental health awareness, attitude, oral hygiene behavior, and SES.
  17,586 28 1
LETTERS TO THE EDITOR
Natural honey helps as diet-mediated for tuberculosis prevention or treatment
A Mehrabi Tavana
July-December 2011, 4(2):145-146
DOI:10.4103/1755-6783.85775  
  9,052 16 1
CASE REPORTS
Multicystic ovarian disease secondary to hypothyroidism in a prepubertal girl
SP Gupta, Amit Mittal, Vinod Mehta, Rajeev Mahendru
July-December 2011, 4(2):107-109
DOI:10.4103/1755-6783.85762  
We present a case of bilateral ovarian enlargement with multiple ovarian cysts associated with hypothyroidism in a prepubescent female. The patient was managed conservatively with hormonal therapy.
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Escherichia coli pleural empyema: Two case reports and literature review
Fahmi Yousef Khan
July-December 2011, 4(2):128-132
DOI:10.4103/1755-6783.85770  
Escherichia coli (E. coli) was isolated from the pleural space of two patients; the first one was a 32-year-old Nepali man who was healthy before, presented with 15 day fever and cough. Chest x-ray showed left-sided pleural effusion. After diagnostic workup, he was diagnosed to have E. coli parapneumonic empyema. In addition to the antibiotics and intrapleural streptokinase, decortication was required to improve his condition. The second patient was a 61-year-old Egyptian man who was presented with one-week fever with shortness of breath. He had a history of liver cirrhosis with multiple admissions for decompensated liver diseases. Chest x-ray showed right-sided massive pleural effusion. He was diagnosed with spontaneous bacterial empyema. The patient responded well to fluid drainage and administration of antibiotics; the pleural fluid decreased to minimum in 14 days.
  7,176 16 -
ORIGINAL ARTICLES
Prevalence and pattern of tobacco use among tribal adolescents: Are tobacco prevention messages reaching the tribal people in India?
Quazi S Zahiruddin, Abhay Gaidhane, Shilpa Bawankule, Khatib Nazli, Sanjay Zodpey
July-December 2011, 4(2):74-80
DOI:10.4103/1755-6783.85756  
Objectives: The objective of the study was to find the prevalence and pattern of tobacco use, exposure to tobacco prevention activity among adolescent from tribal area. Materials and Methods: A cross-sectional study was conducted in six tribal villages. Data was collected by interview from 240 adolescent by home visits. Results: Prevalence of tobacco use (all forms), smokeless tobacco use and smoking in tribal adolescents were 54.45%, 53.41%, and 23.14%, respectively. Prevalence of tobacco use in boys (66.25%; 95% Confidence Interval (CI) = 60.29-72.21) was more than girls (26%; 95% CI = 25.84-37.57). Prevalence of tobacco use was more in late adolescent period and earning adolescents. The average age of starting smokeless tobacco use and smoking was 13.75 years (SD 2.26) and 14.22 years (SD 2.54), respectively. Boys start smoking relatively earlier than girls (P = 0.04). Education shows significant protective effect on tobacco use. Bidi was commonly used for smoking, while pan masala and gutka were the preferred smokeless tobacco. Almost all smokers were also using smokeless tobacco. Around 69% adolescents from the tribal area have heard of the tobacco prevention message, but only three could interpret it correctly. Radio and television were the commonest modes of information. Conclusion: Considering the high prevalence of tobacco use among tribal adolescents, anti-tobacco activities need to scale up for tribal people, with more emphasis on behavior change through group or personal approach. School programs may have some limitation in tribal area due to high school dropout, and low enrolment. Prevention activities need more focus on smokeless tobacco use and bidi smoking.
  7,020 23 2
EDITORIAL COMMENTARY
"Opportunities for improving public health system in India" analysis of current state of affairs and pointers for future
Giridhara R Babu
July-December 2011, 4(2):69-70
DOI:10.4103/1755-6783.85754  
  6,794 17 3
CASE REPORTS
Isoniazid-induced psychosis in a patient on DOTS therapy
Imran Masood, Sanjay Bhat, Aadil Beigh, Veena Gupta
July-December 2011, 4(2):126-127
DOI:10.4103/1755-6783.85769  
Acute psychosis induced by INH, especially when given as part of the DOTS regimen, has a variable presentation, and should always be kept in mind in the differential diagnosis. The diagnosis becomes especially challenging when the patient has tubercular meningitis or some other neurological disease. Here we present a case report of a patient who after 2 days of INH therapy under the DOTS regimen developed acute psychosis that resolved only after discontinuation of the drug.
  6,156 21 -
LETTERS TO THE EDITOR
Skin in the spectrum of mycoplasma infections
Dilip Gude, Dharam Pal Bansal
July-December 2011, 4(2):151-152
DOI:10.4103/1755-6783.85780  
  6,077 12 -
ORIGINAL ARTICLES
Seroprevalence of Hepatitis B, Hepatitis C, and human immunodeficiency virus among healthy voluntary first-time blood donors in Kolkata
BK Das, BK Gayen, Subhra Aditya, Sumit Kumar Chakrovorty, PK Datta, Ajay Joseph
July-December 2011, 4(2):86-90
DOI:10.4103/1755-6783.85758  
Background: Transfusion transmitted infections (TTIs) threaten safety of the recipients and the community as a whole and are a subject of real concern worldwide. Aims and Objectives: To know prevalence of Hepatitis-B (HBV), Hepatitis-C (HCV), and Human immunodeficiency virus (HIV) in voluntary first-time blood donors. Design and Setting: Cross-sectional observational study done in a teaching hospital. Materials and Methods: A total of 3 745 voluntary first-time blood donors were recruited and tested for HBV, HCV, and HIV with Enzyme-linked immunosorbent assay (ELISA). Results and Analysis: Among 3 745 blood donors, majority (90.95%) were male and 18 to 39 years age group. Prevalence of HBV was higher than HCV and HIV. HBV was maximum in 40 to 49 years (2.25%) and 18 to 29 years (1.86%) age group, whereas HCV and HIV were maximum in >50 years age group (0.93% and 1.86%, respectively). HIV positivity showed increasing prevalence with increase in age. Statistical Analysis: Statistical analysis was done using %, Chi square test, and Chi square for trend analysis. Conclusion: Seroprevalence of HBV, HCV, and HIV in voluntary blood donors is high in Kolkata and is high throughout this decade. Prevalence is even higher in other parts of India and Indian subcontinent. As voluntary blood donations are the major source of blood supply, chance of TTIs are very high in this part of the world.
  6,020 24 7
A fatal case of Trypanosoma lewesi in Maharashtra, India
PP Doke, A Kar
July-December 2011, 4(2):91-95
DOI:10.4103/1755-6783.85759  
In the state of Maharashtra, India, in the three years 2004-05 to 2006-07, animal Trypanosoma parasites T. lewisi and T. evansi resulted in human illnesses in three different geographical regions. The first two cases have already been reported. The recent case was a man aged 57 years, residing in a small village in district Pune. Since September 2006 he had chronic intermittent fever, anemia, firm hepatosplenomegaly and edema on feet. The investigations in March 2007 revealed that it was a case of T. lewisi. The primary epidemiological investigations showed no other cases in the village. The investigations pointed to the probability of transmission through rat fleas. The case was brought under Suramin treatment in the B.J. Medical College and Sassoon General Hospital Pune. The patient expired after second dose in June 2007. His blood was sent for genetic study in the School of Health Sciences, University of Pune. The genetic study for mutation in the APOL 1 gene revealed that the four DNA fragments from the patient did not have any mutation in the amplified exonic fragments.
  4,092 21 2
PRACTITIONERS SECTION
India's tryst with creation of public health cadre
Giridhara R Babu
July-December 2011, 4(2):143-144
DOI:10.4103/1755-6783.85774  
India should have dedicated public health cadre by incorporating high quality training, appropriate career structure and recruitment policy to attract young and talented multi-disciplinary professionals committed to prevention and health promotion. In addition, rewarding good performance and offering continuing professional development are necessary.
  3,920 12 1
CASE REPORTS
Acute disseminated encephalomyelitis subsequent to Leptospira infection
Paramdeep Singh, Arun Kumar Gupta, Kavita Saggar, Maninderbir Kaur
July-December 2011, 4(2):133-135
DOI:10.4103/1755-6783.85771  
Acute disseminated encephalomyelitis has been rarely reported following leptospirosis. Here, we reveal an adult patient who developed the condition after Leptospira infection, which responded to intravenous steroids. Due to high prevalence of leptospirosis in developing countries, acute disseminated encephalomyelitis should be considered as a possibility in patients presenting with acute neurological disease. Increased awareness of this complication among physicians, and early diagnosis and treatment, may lessen morbidity and mortality.
  3,700 15 2
Unusual localization of hydatidosis: Hydatid cyst of gallbladder
K Rabbani, Y Narjis, A Louzi, R Benelkhaiat, Hicham Jalal, B Finech
July-December 2011, 4(2):119-121
DOI:10.4103/1755-6783.85766  
The case of a 38-year-old man suffering from hydatid cyst located in the gallbladder is presented. Although Morocco remains an endemic area for echinococcosis, this presentation of the disease is rare. Pericyst was tightly attached to the liver. Complete pericystectomy followed by cholecystectomy was done. Histopathology confirmed the presence of calcified hydatid cyst of the gallbladder. Perioperative adjuvant medical therapy with albendazole was administered. In a 2-year follow-up, no recurrence has occurred.
  3,458 13 3
PRACTITIONERS SECTION
Emerging antithrombotic drugs: A review
P Sikka, VK Bindra
July-December 2011, 4(2):138-142
DOI:10.4103/1755-6783.85773  
Thromboembolic disorders are one of the disorders for which the researchers are still in search for a safe and efficient drug. Despite the widespread use of antithrombotic drugs for the prevention and treatment of arterial and venous thrombosis, thromboembolic diseases continue to be a major cause of death and disability worldwide. This shows the researchers' inefficiency in searching efficacious and safe antithrombotic drugs. The researchers have reached to the basic mechanism of thrombus formation and by interrupting various steps of this mechanism, they can prevent as well as treat thromboembolic disorders. In continuation of Aspirin, now, the researchers are using clopedogrel, Ticlopidine and GpIIb/IIIa inhibitors (Abciximab, Tirofiban and Eptifibatide). Warfarin is an old antithrombotic drug, which is still being used but due to various side effects and drug interactions, they are bound to use newer drugs. Newer antiplatelet drugs include prasugrel, ticagrelor, cangrelor and elinogrel whereas newer thrombin inhibitors are Ximelgatran and Dabigatran. Apixaban and edoxaban are also newer entry in this category as Factor Xa inhibitors. Idrabiotaparinux is an indirect inhibitor of Xa as it accelerates the activity of antithrombin. Moreover, researches and trials for better and safe drugs are going on.
  3,430 18 -
LETTERS TO THE EDITOR
Trichuris dysentery syndrome
Charles Panackel, Benoy Sebastian, Sunil Mathai, Renu Thomas
July-December 2011, 4(2):148-149
DOI:10.4103/1755-6783.85777  
  2,712 15 -
ORIGINAL ARTICLES
Determinants in initiation of breastfeeding among lactating women in block R. S. Pura of district Jammu (India)
Sunil Kumar Raina, Vijay Mengi, Gurdeep Singh
July-December 2011, 4(2):71-73
DOI:10.4103/1755-6783.85755  
Research Question: What determines the trend in initiation of breastfeeding among lactating women? Objective: To assess the role of various factors in determining the initiation of breastfeeding among lactating women in block R. S. Pura of district Jammu. Material and Methods: A stratified two-stage design with villages as the primary sampling unit and lactating mothers as secondary sampling unit. Villages were divided into different clusters on the basis of population and sampling units were selected by a simple random technique. Results and Conclusion: Breastfeeding is almost universal in R. S. Pura. Education is a key determinant of early initiation of breastfeeding although there is slight variation between rural and urban areas.
  2,556 12 1
CASE REPORTS
Staphylococcal splenic abscess in a septicemic pediatric patient
Ashwani Kumar, Bineeta Kashyap, Piyush Gupta
July-December 2011, 4(2):116-118
DOI:10.4103/1755-6783.85765  
Splenic abscess is a rare entity and occurs after trauma or as a result of systemic bacteremia. Splenic abscess is an uncommon surgical problem in pediatric age group and difficulty in diagnosis in this group is because of rarity, insidious onset, and nonspecific clinical picture. Splenic abscess, found mostly in autopsies and progressing rather fatally, can be diagnosed and treated earlier with the help of recently developed radiological techniques. Patients, as seen in our case, are mostly admitted to the hospital with nonspecific complaints of abdominal pain and vomiting. It has a high rate of mortality when it is diagnosed late. Early diagnosis, prompt treatment, and splenic preservation as a goal in children should be considered unless there are multiple abscesses and nonresponsiveness to conservative regimen.
  2,542 12 1
ORIGINAL ARTICLES
A study of presentation and complications among the malaria death cases from three municipal corporation hospitals and civil hospital of Ahmedabad during the year 2007
S Vyas, G Bhatt, K Gupta, H Tiwari
July-December 2011, 4(2):81-85
DOI:10.4103/1755-6783.85757  
Context: Characterization of severe malaria cases on arrival to hospital may lead to early recognition and improved management. Understanding of symptoms, signs, and laboratory parameters which are associated with high case-fatality rate (CFR) can help in appropriate and early management of cases. Aims: To study the profile, symptoms, signs, and laboratory parameters of malaria death cases. Materials and Methods: Information about deaths due to malaria, as reported to malaria Department of Ahmedabad Municipal Corporation by three municipal corporation hospitals and civil hospital Ahmedabad between January 2007 and December 2007, was used to locate details of those deaths in respective hospitals. Indoor case papers and death reports of those cases were obtained from Medical Record Section of respective hospitals and were analyzed by using appropriate statistical software. Results: A total of 57 malaria deaths occurred in the abovementioned four hospitals. Overall CFR was 3.03% for indoor malaria cases. Complete information could be obtained for about 42 cases. Mean age of cases was 36.50 years. There were 45.23% of patients falling in the age group >=40 years. There were 57.1% males and 42.9% females. Fifty-five cases were positive for Plasmodium falciparum, one case for Plasmodium vivax, and one case was having mixed infection. Average duration of hospital stay was 2.87 days and average total duration of illness was 6.82 days. The most common presenting symptom was intermittent fever with vomiting and altered sensorium in 38.88% of cases. Acute renal failure was the most common complication seen in 45.2% of the cases. Paired t-test was applied on the investigations carried out on the day of admission and those carried out on the day or before a day of death and found significant for the levels of hemoglobin, blood urea, and serum bilirubin. Conclusions: Malaria still remains one of the important causes of admission and mortality. In view of changes in antimalarial drug policy artemisinin combination therapy and accurate, rapid diagnostic tools are necessary to target treatment to people in need.
  2,188 10 -
LETTERS TO THE EDITOR
Burn wound septicemia--A pilot study from a tertiary care hospital
Smita Sarma, Deepthi Nair, Deepti Rawat, Deepak Nanda, Azra Hasan, Sahil Diwan, Monorama Deb, Pushpa Aggarwal
July-December 2011, 4(2):146-148
DOI:10.4103/1755-6783.85776  
  2,140 11 -
CASE REPORTS
Gastric mucosa-associated lymphoid tissue: The need for prompt histologic diagnosis
HE Omunakwe, OC Madubuike, SO Nwosu, CO Pughikumo, CA Nwauche
July-December 2011, 4(2):113-115
DOI:10.4103/1755-6783.85764  
Gastric mucosa-associated lymphoid tissue has a well established pathophysiologic link with Helicobacter pylori infection. Mucosa-associated lymphoid tissue (MALT) is acquired through chronic inflammation/antigenic stimulation in organs which are normally devoid of lymphoid tissue. We report a case of a 65 years old man with a two year history of dyspeptic symptoms associated with gradual weight loss and an epigastric mass. With poor response to anti-ulcer regimens in a peripheral hospital, he was offered a gastrectomy. The histologic report of the mass showed atypical lymphoid cells infiltration of the gastric mucosa up to the muscularis propria. He was promptly commenced on a standard chemotherapeutic regimen for Non Hodgkin's lymphoma, but demised before the second course of chemotherapy. This case highlights the need for prompt endoscopy with biopsy and histologic diagnosis of specimen to shorten delays in diagnosis and improve outcome of patients with gastric mucosa-associated lymphoid tissue.
  2,108 10 -
ORIGINAL ARTICLES
Prevalence of extended spectrum β-lactamase-producing clinical isolates of Klebsiella pneumoniae in intensive care unit patients of a tertiary care hospital
Sheetal Harakuni, SG Karadesai, MB Mutnal, SC Metgud
July-December 2011, 4(2):96-98
DOI:10.4103/1755-6783.85760  
Aim: To identify the extended-spectrum β-lactamase producing Klebsiella pneumoniae (ESBL-KP) isolated from intensive care unit (ICU) patients of a tertiary care hospital. Materials and Methods: Seventy Klebsiella pneumoniae clinical isolates from ICU patients were screened for ESBL production. All were confirmed for ESBL production by potentiated disc diffusion test. Minimum inhibitory concentrationby agar dilution technique was performed. Sensitivity to other group of drugs was determined by Kirby-Bauer method against ciprofloxacin, amikacin, co-trimoxazole. Results: In all, 74% of the isolates were ESBL-KP; 57% were from blood samples. Coresistance to other group of drugs ranged from 63 to 83%. Conclusion: There is a high prevalence of ESBL-KP. The prompt reporting of ESBL producing bacteria is necessary to prevent their dissemination. This alarms for strict infection control measures to be practised in hospital settings.
  2,085 21 1
LETTERS TO THE EDITOR
Fissure sign in dengue
Mukul P Agarwal, Subhash Giri, Srimanta K Sahu, Vishal Sharma
July-December 2011, 4(2):149-150
DOI:10.4103/1755-6783.85779  
  1,886 19 -
PRACTITIONERS SECTION
Swine flu vaccination for patients with cancers
Viroj Wiwanitkit
July-December 2011, 4(2):136-137
DOI:10.4103/1755-6783.85772  
In oncology, vaccination is accepted as an important preventive measure. As a tertiary prevention protocol, several vaccines are recommended for the oncology patients. The newest vaccine in medicine is swine flu vaccine which is developed for prevention of novel H1N1 influenza virus infection. In this paper, the author will briefly discuss on swine flu vaccination for oncology patients.
  1,295 13 -
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