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  Citation statistics : Table of Contents
   2012| May-June  | Volume 5 | Issue 3  
    Online since July 17, 2012

 
 
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ORIGINAL ARTICLES
Etiology and sensitivity of uropathogens in outpatients and inpatients with urinary tract infection: Implications on empiric therapy
Vidya Pai, Bhaskaran Nair
May-June 2012, 5(3):181-184
DOI:10.4103/1755-6783.98610  
Background and Objectives: Urinary Tract Infections (UTI) are the second most common infections after the respiratory tract infections and constitute a great proportion of prescription of antibiotics. The present study was designed to determine the etiology of uropathogens and their susceptibility pattern in outpatients and inpatients of our hospital so as to arrive at an empirical treatment for patients with UTI. Materials and Methods : A total of 924 urine samples were obtained from inpatients and outpatients with a clinical diagnosis of UTI. The samples were cultured and antibiotic susceptibility of isolates determined by disc diffusion method. Results: Of 924 urine samples processed (828 from inpatients and 96 from outpatients), 262 (28.35%) yielded bacterial isolates. About 216 (26.08%) samples from inpatients and 46 (47.9%) from outpatients showed significant bacteriuria. Escherichia coli predominated in both groups, followed by Klebsiella spp., Pseudomonas spp., Acinetobacter spp., and Enterobacter spp., which were isolated from only the inpatient samples. Sensitivity to nitrofurantoin varied from 73% to 94% and fluoroquinolone resistance was documented as 11%-80%. Resistance to amikacin, ceftazidime, and ceftriaxone was less than 25%. Imipenem resistance was found in <5% of the bacterial isolates. Conclusion: E. coli and Klebsiella spp. are the major uropathogens. Resistant strains are prevalent in the community, as evident by the fact that there is not much difference in resistance patterns of isolates from inpatients and outpatients. Taking into account the resistant pattern, nitrofurantoin represents the option of first choice for empirical therapy of uncomplicated UTI.
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REVIEW ARTICLES
Physico-chemical properties and toxic effect of fruit-ripening agent calcium carbide
Mohammad Asif
May-June 2012, 5(3):150-156
DOI:10.4103/1755-6783.98602  
Ripening is the final stage of the maturation process, when the fruit changes color, softens and develops the flavor, texture and aroma that constitute optimum eating quality. This study was conducted to discuss the use of unsatisfactory calcium carbide to ripen fruits for domestic markets as well as their toxic effects on human health. The commonly used ripening agents are calcium carbide, acetylene, ethylene, propylene, ethrel (2-chloroethyl phosphonic acid), glycol, ethanol and some other agents. The calcium carbide is one of the most commonly used ripening agent for fruits, while other calcium salts like calcium ammonium nitrate, calcium chloride and calcium sulfate are used to delay fruit ripening agents for local fruit industries. The use of calcium carbide is being discouraged worldwide, due to associated health hazards. Calcium carbide treatment of food is extremely hazardous because it contains traces of arsenic and phosphorous, and once dissolved in water, it produces acetylene gas. Arsenic, phosphorous and acetylene gas may affect the different body organs and causes various health problems like headache, dizziness, mood disturbances, sleepiness, mental confusion, memory loss, cerebral edema, seizures and prolonged hypoxia.
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CASE REPORTS
Splenic abscesses: Reports of two cases with review of the literature
Shilpi Gupta, Onkar Singh, Ankur Hastir, Sumit Shukla, Raj Kumar Mathur
May-June 2012, 5(3):273-277
DOI:10.4103/1755-6783.98638  
Abscess of the spleen is a rare discovery, with about 600 cases reported in the international literature so far. It is more common in the presence of infection at different primary sites, especially endocarditis or in cases of ischemic infarcts that are secondarily infected. Immunosuppression and trauma are well-known risk factors. Recently, intravenous drug abusers and alcoholics have shown an increased incidence compared to other high-risk groups. However, encountering this entity in general population is uncommon. Clinical examination and laboratory findings are not constant; thus, imaging is a necessary tool for establishing the diagnosis, with a choice between ultrasound and computed tomography. If untreated, the mortality reaches almost 100%. Treatment includes conservative measures and surgical interventions. Splenectomy has been the preferred approach in most centers. More recent studies have suggested the use of advanced and alternative options, including laparoscopic surgical and percutaneous interventions. Changing trends, in view of the importance of immunological role of spleen, have emphasized more on spleen preserving protocols, especially in children and young patients, and in cases of solitary abscess with a thick wall. conducted a literature review by analysis of various high-risk groups, presentation, diagnosis and treatment of splenic abscess, and have presented here a report of two cases.
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ORIGINAL ARTICLES
A comparative study of different methods used in the detection of Giardia lamblia on fecal specimens of children
Muhammad Farooq Baig, Saleem Ahmed Kharal, Saleem A Qadeer, Javaid Ahmed Badvi
May-June 2012, 5(3):163-167
DOI:10.4103/1755-6783.98604  
Objective: The purpose of this study was to compare results obtained using a single fecal specimen for ova and parasite (O and P) examination, direct immunofluorescent assay (DFA), and two conventional staining methods. Design: Fecal specimens of 150 children were collected and examined by each method. The O and P and the DFA were used as the reference methods. Setting: The study was performed at the laboratory in the Basic Medical Science Institute JPMC Karachi. Materials and Methods: The fecal specimens were collected from children with a suspected Giardia lamblia infection. Agreement and disagreement between the methods was determined based on (1) the presence of giardiasis in our population and (2) the sensitivity and specificity of each method. Results: There was 45 (30%) positive and 105 (70%) negative cases found with DFA, 41 (27.4%) positive and 109 (72.6%) negative cases detected by iodine method, and 34 (22.6%) positive and 116 (77.4%) negative cases found with saline method. The sensitivity and specificity of DFA in comparison to iodine were 92.2 and 92.7%, respectively. The sensitivity and specificity of DFA in comparison to saline method were 91.2 and 87.9%, respectively. The sensitivities of iodine method and saline method in comparison to DFA were 82.2 and 68.8%, respectively. There is marked difference in sensitivity of DFA compared to conventional methods. Conclusion: The study supported the findings of other investigators who concluded that DFA method has the greatest sensitivity. The immunologic methods were more efficient and quicker than the conventional O and P method.
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The spectrum of hydatid disease in rural central India: An 11-year experience
Siddharth S Rao, Bhupendra Mehra, Ravindra Narang
May-June 2012, 5(3):225-230
DOI:10.4103/1755-6783.98624  
Background: Hydatid disease or Echinococcosis is a zoonotic disease caused by the larva of Echinococcus species and is one of the oldest known diseases to man. The disease has a worldwide distribution and is also well recognized and documented in India. Aims: This study was carried out with the aim of describing the epidemiology (demography, clinical presentation, imaging characteristics, and in-hospital course) of Cystic Echinococcosis (CE) in central India. Materials and Methods: The clinical study of hydatid disease was conducted as a single case series including both historical and current cases at the Mahatma Gandhi Institute of Medical Sciences, Central India. The study investigator screened all the histopathology records from 1997 to 2004 for historical case group. The current case group extended from 2005 to 2007. The historical case group included 91 patients and the current case group had 26 surgically treated patients. Results: Females were the dominant sex affected by the disease. Hydatid of the liver was more common, especially in the right lobe. Pain in the abdomen was the most common presenting complaint. Lump in the abdomen was the most common clinical finding. Patients with pulmonary hydatid presented to the hospital earlier than the patients with abdominal hydatid (P=0.03). Partial pericystectomy and external drainage was the most commonly performed surgery. The most common postoperative complication was wound infection. Conclusions: This study highlights the epidemiology of CE in the rural region of Indian subcontinent. The population in rural areas are more exposed to zoonotic diseases. Proper education, creating awareness, and implementing strict rules regarding the disposal of remains of slaughtered animals can help eradicate this disease.
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Community-based study of circumcision practices in Nigeria
Lukman Olajide Abdur-Rahman, Omotoso I Musa, Gordon K Oshagbemi
May-June 2012, 5(3):231-235
DOI:10.4103/1755-6783.98625  
Background: Circumcision practice around the world has various implications and has generated a lot of debate about the pros and cons of the practice. Nigeria is one of the countries where male and female circumcision practice still occurs however, there has been claim of reduction in female genital cutting. Congregational or 'group' circumcision prevails in some communities as a means of upholding traditions and commemoration of festive period. Objective: To determine the pattern of circumcision practice and identify factors affecting the practice in Ilorin community. Materials and Methods: The study was a descriptive, cross sectional study conducted among parents of under-5 children of both the sexes using pre-tested, semi-structured questionnaires, which were administered to the respondents by trained research assistants over a six-week period. Clinical examination of genital area in index child of each respondent was done by a pediatric surgeon, who was the principal investigator. Results: Three hundred and ninety three (93%) respondents completed the questionnaire and the same number of index children's external genitalia was examined by the pediatric surgeon. The mean age of respondents was 33.2±9.3 years, and the main source of family income was private enterprises and civil services. The circumcision status of fathers was 100%, mothers, 65.6%, and overall female-child circumcision rate was 46.7%. Though, most of the index children were delivered at health centers (72.3%), the circumcisions were performed at almost equal frequencies by traditional circumcisionists (39.8%) and doctors (39.2%), with more than half of the circumcision being done outside the hospital. The mean age at circumcision was 22 ±0.69 months, with 73.9% of girls as against 91.7% boys being circumcised by the age of five years. Family choice was the main determinant of the age at circumcision and the circumcisionist. Female circumcision was done by traditional circumcisionist, nurses, and doctors in 1 in 4, 1 in 5, and 1 in 10 cases of circumcision, respectively. Traditional open (classical) circumcision technique was mostly used (40.4%), followed by Plastibel TM (ring type) (32.6%), and 'group' circumcision was practiced among 41.2% of respondents. Post-circumcision complications were seen in 116 (33.7%) of circumcised children examined. Conclusion: Circumcision practice in Ilorin is still higher among the traditional circumcisionists, despite of high hospital delivery. Female circumcision and 'group' circumcision were also being practiced, using mainly the traditional open circumcision technique. The high rate of circumcision complications indicate the need for proper enlightenment and retraining of health care providers and traditional circumcisionists on the safe methods available. The government should involve the religion and opinion leaders in the community to assist in the prevention of negative and harmful traditional practices including female circumcision.
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Case fatality rate of leptospirosis in a tertiary care hospital in Kerala, India
Jimmy Antony, TM Celine, Michale Chacko
May-June 2012, 5(3):236-239
DOI:10.4103/1755-6783.98626  
Context: Leptospirosis is under-reported because of its wide spectrum of signs and symptoms. The infection mainly occurs in farmers and individuals involved in water-related jobs and activities and it can be 100 times more frequent in tropical areas. Aim : The present hospital-based study was conducted in an endemic area of tropical country to find out the case fatality of this disease over time, age, and sex. Settings and Design : It was a hospital-based retrospective study of five years conducted in a tertiary care hospital in Kerala, India. Materials and Methods : The data were collected from registers maintained in the medical records department and analysed by using Microsoft excel. Statistical Analysis : Chi-square and 'Z' tests were applied for the comparison of proportions. Results : Of the 1,523 confirmed cases, 993 (65.20%) were male and 530 (33.02%) were female. Of the confirmed cases, 63 died: 44 (69.84%) male and 19 (30.15%) female. The case fatality of leptospirosis was 4.13%, and it was high in the age group 40-60 years in both sexes. Of the 63 deaths, 20 (31.74%) were due to multiple organ dysfunction and 12 (19.04%) due to renal failure. The case fatality rate was high in males and it increased with age in both sexes. The case fatality rate of leptospirosis varied in the age groups <20 and ≥60 years, which were 1.22% and 19.32%, respectively. The case fatality of males was 4.43% and of females it was 3.58%. Conclusion : It was suggested that effective leptospirosis control in endemic areas needs a multifactorial approach.
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Study of some epidemological aspects of Malaria in a tribal district (Nandurbar), Maharashtra
Vinod D Mundada, Sunil V Gitte, Sandip B Patil
May-June 2012, 5(3):195-198
DOI:10.4103/1755-6783.98617  
Background : Ten percent of the total population of the State of Maharashtra belongs to tribal population groups. These groups remain isolated, living in remote forest and hilly areas far from civilization. Nandurbar district has been a newly carved tribal district (July 1998). Objective : To find out the prevalence of various type of malaria and to see the correlation between rainfall and incidence of malaria cases. Materials and Methods : It was a retrospective, cross sectional study carried out during 1999 to 2004. The reports from the years, 1999 to 2004, were taken from district health office and district malaria office, respectively. Results : There were total 5228 cases of malaria; out of these, 3237 were Plasmodium vivax (PV) cases, and 2001 were Plasmodium falciparum (PF) malarial cases, during the years, 1999 to 2004. In the years, 1999 to 2002, percentage of PV malaria was more than PF malaria. Majority of PV malaria cases was observed in the year 1999. In the year 2004, the PV malaria started showing an upward trend in Nandurbar district, Maximum numbers of cases were reported in rainy season as compared to winter and summer seasons. It was observed that the PF cases were increased during the months of July to October, every year. It was also observed that as rain fall increases, the number of malaria cases also increases. Conclusion : There is an upward trend of malarial cases in the tribal block. Incidence of malarial cases closely correlates with the rainfall.
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To study the knowledge about tuberculosis management and national tuberculosis program among medical students and aspiring doctors in a high tubercular endemic country
Dinesh Mehta, Rishabh Bassi, Manjeet Singh, Chavi Mehta
May-June 2012, 5(3):206-208
DOI:10.4103/1755-6783.98620  
Background : More than eight million people develop active tuberculosis annually and most of the cases are detected in the developing world. This study aims to describe the knowledge about tuberculosis management and knowledge about national tuberculosis control program among medical students and young doctors in a developing country. Materials and Methods : A questionnaire based survey was conducted among 112 interns and post graduate students of a tertiary care hospital to study the knowledge about tuberculosis and national tuberculosis control program among these doctors. Results : Of the 112 respondents to the questionnaire The number of sputum specimens required for diagnosis under RNTCP was responded correctly by only 57%, the time duration in which sputum specimen should be processed was told correctly by only 42.5%, while the sputum examination guidelines for extra-pulmonary tuberculosis was responded correctly by only 27%. The awareness of serious forms of sputum-negative pulmonary tuberculosis was 21%, while serious form of extra pulmonary tuberculosis was known to be only 33%. The correct categorization of tuberculosis patients was done by only 56% of the respondents, while treatment of tubercular meningitis was marked correctly by 69% of the respondents. Conclusions : This study indicates a low level of knowledge among participants despite DOTS covering the entire country at present. This study indicates an enormous challenge and an urgent need to revamp and reform undergraduate medical education and change in medical curriculum with need instituting practical training at Directly Observed treatment Short Course (DOTS) centers in the curriculum of medical students in India.
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A clinicopathological study of tuberculous pleural effusion in a tertiary care hospital
Amitabha Basu, Indranil Chakrabarti, Nilanjana Ghosh, Subrata Chakraborty
May-June 2012, 5(3):168-172
DOI:10.4103/1755-6783.98606  
Context: Tuberculosis is a major contributor of exudative pleural effusion which is the second most common extra-pulmonary manifestation of tuberculosis following tubercular lymphadenitis. Aims: To re-evaluate the time tested and easily available investigation of closed pleural biopsy and its relation with pleural fluid adenosine deaminase (ADA) level and cytological findings in the clinically suspected cases of tuberculous pleural effusion. Materials and Methods: A total of 44 cases of suspected tubercular pleural effusion were selected from the indoor ward of a tertiary care hospital, over a period of 13 months. Apart from the relevant history taking and clinical examination, thorough investigations were done in each case to prove the etiological diagnosis, which comprised of routine hemogram, bleeding time, clotting time, Mantoux test, sputum microscopy, enzyme-linked immunosorbent assay (ELISA) for HIV, chest X-ray, examination of pleural fluid including ADA estimation, culture for Mycobacterium tuberculosis (BACTEC), and finally, pleural biopsy by Abram's needle. Results: A total of 65.8% cases of tuberculous pleural effusion were diagnosed by pleural biopsy results. Second biopsy attempts improved the diagnostic ability by 18.4%. The highest incidence was observed in the 11-20 years age group (36.8%). Chest pain (86.8%) was the predominant symptom. Positive Tuberculin skin test was observed in 89.5% cases. Pleural fluid analysis showed a predominance of lymphocytes in all the cases, with 97.3% patients having ADA levels > 70 U/L. There was no major complication of pleural biopsy. Conclusions: Pleural biopsy is a very important tool for diagnosing tuberculous pleural effusion without any major complication. ADA values > 70 U/L are highly suggestive of tubercular etiology and correlated well with histopathological findings of pleural biopsy.
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Pattern and magnitude of treatment delay among TB patients in five states in southern Nigeria
Onyeonoro U Uchenna, JN Chukwu, UU Onyeonoro, DC Oshi, CC Nwafor, AO Meka, C Ogbudebe, JN Ikebudu
May-June 2012, 5(3):173-177
DOI:10.4103/1755-6783.98608  
Prompt diagnosis and early treatment of Tuberculosis (TB) cases is an important strategy in TB prevention and control. Thus, passive case finding of TB suspects, sputum examination for diagnosis, and prompt treatment using Directly Observed Treatment Short Course (DOTS) are key elements in the national guideline for TB control programme. The aim of this study is to determine the time interval between diagnosis of smear-positive TB cases and the commencement of treatment in DOTS facilities in southern Nigeria. The study was carried out in 20 healthcare facilities supported by TB Control Assistance Program (TB-CAP) involved in TB management in southern Nigeria, which comprised tertiary, secondary, and primary healthcare facilities including public and private facilities. Data were collected through review of clients' and facility records covering July-September 2009. Data collected were sociodemographic characteristics, sputum-smear result, date of diagnosis, and date of commencement of treatment. Data were analyzed using SPSS version 15.0 software. Of the total 2,507 TB suspects examined for Acid-Fast Bacillus (AFB), 323 were diagnosed to be Sputum-Smear-Positive (SS+ve), However, 269 new smear positive cases were commenced on treatment within the period, thus 54 (17.0%) of the new SS+ve cases defaulted initially. One hundred and two (38%) of them commenced TB treatment within 3 days of smear examination for diagnosis, while 59 (22%) commenced 4-6 days after diagnosis. The study revealed significant delay in commencement of TB treatment for most new smear positive TB cases in southern Nigeria and underlines the need to further explore factors responsible for delay in commencement of TB treatment following diagnosis.
  1 2,574 13
German measles outbreak bursts in two unvaccinated border hilly districts of Northern Himachal Pradesh, India
Surender N Gupta, Naveen Gupta, Nirankar S Neki
May-June 2012, 5(3):219-224
DOI:10.4103/1755-6783.98623  
Background: We investigated German measles outbreak as a suspected one of measles to confirm diagnosis and recommend for control and prevention. Materials and Methods: We defined a case of German measles as the occurrence of febrile rash in any resident of the eight villages from 20 th October to 16 th January, 2007. Case patients were line listed and information on age, sex, residence, date of onset, symptoms, signs, traveling, treatment history, vaccination status, and pregnancy status were collected. The outbreak was described by time, place, and person characteristics. Diagnosis was confirmed clinically, epidemiologically, and serologically; first to measles, scrub typhus and later to German measles viruses. Results: We identified 116 cases in eight villages (112/116 clinically and 04/116 laboratory confirmed). The overall attack rate (AR) was 11%; highest in the age group of 11-20 years (range 13% to 44%). Sex specific AR for male was 12%. All case patients were <20 years of age with a median age of 12 years. Complication rate was 05%, but no death reported on account of German measles. No pregnant woman was found to be affected. None of them were immunized against rubella. Four tested positive for immunoglobulin M (IgM) antibodies to rubella out of eight samples. Thirty three percent (38/116) had their treatment of choice to the modern medicine. Conclusion: German measles outbreak was confirmed in unvaccinated populations, which was possibly due to the frequent traveling of Bengali colony vendors' case patients to other areas. We advised the local health authorities to provide MR vaccination to the unexposed in eight affected and neighboring villages.
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CASE REPORTS
Multiple splenic abscesses in a child with enteric fever treated by percutaneous aspiration and antibiotics
Sandeep Kumar Kanwal, Sharandeep Kaur, Virendra Kumar
May-June 2012, 5(3):245-247
DOI:10.4103/1755-6783.98628  
Multiple splenic abscesses are a condition associated with high mortality if there is delay in the diagnosis and initiation of specific treatment. Salmonella typhi as an etiological cause of multiple splenic abscesses is a distinct rarity. In the past treatment for splenic abscess including in enteric fever was splenectomy however; conservative treatment by percutaneous drainage is increasingly being reported for isolated splenic abscess and now for multiple splenic abscesses. We report a child with enteric fever who presented with multiple splenic abscesses and was successfully treated by percutaneous aspiration and antibiotics.
  - 3,252 12
Acute Brucellosis in a young adult
Girija Subramanian, Jeyakumari Duraipandian, Gopal Rangasamy, Chand Pavan
May-June 2012, 5(3):248-249
DOI:10.4103/1755-6783.98629  
Brucellosis is a zoonotic disease primarily affecting cattle, goats, sheep and other animals occasionally transmitted to man. The clinical manifestations are protean and often missed. A case of acute brucellosis in a young adult male who presented primarily with loss of weight, malaise, fatigue and with no known risk factors is reported here. Brucella melitensis was isolated from blood culture and confirmed by polymerase chain reaction (PCR). Brucella IgM antibodies were detected by ELISA test and the patient was treated successfully with injection Amikacin for two weeks and oral Doxycycline for a period of six weeks.
  - 2,293 10
Paraneoplastic limbic encephalitis in bronchogenic carcinoma: A rare case report
Sunita Gupta, Amit Mittal, Gagan Mittal, Anuj Jain
May-June 2012, 5(3):250-252
DOI:10.4103/1755-6783.98630  
We illustrate here a rare case of paraneoplastic limbic encephalitis in bronchogenic carcinoma where the patient presented primarily with neurological symptoms of encephalitis. We have described the radiological findings of the case.
  - 3,183 14
Spontaneous reno-jejuno-cutaneous fistula with stone: An unusual presentation of genito-urinary tuberculosis
Punit Tiwari, Suresh Kumar, Praveen Pandey, Jitendra Pratap, Pramod Sharma
May-June 2012, 5(3):253-255
DOI:10.4103/1755-6783.98631  
We are reporting an unusual case of spontaneous reno-jejuno-cuteneous fistula with staghorn calculus. A 19-year-old female presented with pus discharging sinus in the left lumbar and gluteal region. Fistulography and computed tomography showed nonfunctioning kidney and fistula involving left kidney and jejunal loops. The patient was successfully treated by nephrectomy and excision of fistulous tract followed by antituberculous therapy. Histopathology revealed features of renal tuberculosis. To the best of our knowledge our case is the first case reported having reno-jejunal fistula because of tuberculosis and having cuteneous extension in the lumbar as well as gluteal region.
  - 2,828 11
Unilateral blindness following sino-orbito-cranial aspergillosis in a diabetic
Mitrakrishan C Shivanthan, Bandula Wijesiriwardena, Riyaaz Ahamed, Kalum Somaratne
May-June 2012, 5(3):256-258
DOI:10.4103/1755-6783.98632  
A 56-year-old diabetic female presented with acute onset blindness with ptosis and complete ophthalmoplegia of the right eye. CT scan of the head showed soft tissue swelling of the right orbital cavity contents with proptosis and the CSF examination revealed sterile pleocytosis. Ipsilateral sinus mucosal histology showed inflammatory changes on H&E staining and fungal staining with methenamine-silver showed typical fungal hyphae of aspergillosis. The infection cleared with a course of IV amphotericin B however blindness and ophthalmoplegia of the right eye were permanent.
  - 1,358 8
Bilateral ruptured pulmonary hydatid cysts
Mohamed Regal, Yasser Al-Jehani, Hanan Bousbait
May-June 2012, 5(3):259-261
DOI:10.4103/1755-6783.98633  
Pulmonary hydatid disease remains a significant health problem in endemic areas including Saudi Arabia. Different surgical tactics and approaches are still a subject of discussion. Here, we present a case of bilateral pulmonary hydatid cysts with spontaneous rupture that underwent successful one-stage bilateral enucleation and capitonnage.
  - 3,118 10
Primary tuberculosis of breast: A case series
Anand A Bhosale, Avinash R Joshi, Amrut V Ashturkar, Gayatri S Pathak
May-June 2012, 5(3):262-264
DOI:10.4103/1755-6783.98634  
Though the incidence of tuberculosis is high in India, primary tuberculosis of breast is extremely rare. Tuberculosis of breast often mimics breast cancers clinically. We are reporting here five cases of primary tuberculosis of breast presented with painless breast lumps. Diagnosis was done by fine-needle aspiration cytology (FNAC) of breast lump by the presence of epitheloid cell granulomas, caseation, Langhan's type of giant cells and in two cases by the presence of acid-fast bacilli. All these cases responded to six month anti-tuberculosis regimen.
  - 3,216 13
An unusual case of fever and abdominal pain
Arundhati G Diwan, Varsha S Dabadghao, TA Najeeb, Priti Dave
May-June 2012, 5(3):265-267
DOI:10.4103/1755-6783.98635  
Ascariasis is one of the commonest parasitic infestations in tropical countries. Main symptoms are pain in abdomen, weight loss, diarrhea and passage of worms in stool. If acute, it may present as intestinal obstruction, perforation, cholangitis, appendicitis and pancreatitis. The incidence of hepato-biliary ascariasis is probably underestimated. We report a case which presented to us with fever, abdominal pain and weight loss of a month's duration, mimicking abdominal tuberculosis. On investigations, patient was found to have ascariasis of gall bladder, terminal ileum, caecum and appendix, causing simultaneous inflammation of all these structures.
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Cerebral venous thrombosis complicated by intracranial hypertension
Amit Agrawal, Nikhil Swarnakar
May-June 2012, 5(3):268-270
DOI:10.4103/1755-6783.98636  
Thrombosis of the cerebral dural sinuses has been well described in the literature and rarely the dural sinus obstruction can result in unremitting papilledema (benign intracranial hypertension or pseudotumor cerebri) causing blindness. We report a case of a 55-year-old man, who was diagnosed to have superior sagittal sinus thrombosis and developed visual deterioration. The patient did not respond to conservative treatment and a thecoperitoneal shunt was performed. Patient is doing well at one-year follow-up with good outcome.
  - 4,128 11
Unusual presentation of malaria in an adolescent girl
JL Baidya, J Ray, AK Rakshit, S Majumder
May-June 2012, 5(3):271-272
DOI:10.4103/1755-6783.98637  
We describe a rare case of idiopathic thrombocytopenic purpura triggered by Plasmodium vivax malarial infection in an adolescent girl. The patient developed thrombocytopenia and menorrhagia associated with an episode of malaria, and became dependent on corticosteroid therapy. The mechanisms by which this parasite evokes thrombocytopenia remain obscure.
  - 1,528 15
EDITORIAL COMMENTARY
Cancer risk assessment and cancer prevention: Promises and challenges
Oludotun Olugbemi
May-June 2012, 5(3):149-149
DOI:10.4103/1755-6783.98601  
  - 1,680 14
ORIGINAL ARTICLES
Study of vancomycin susceptibility in methicillin-resistant Staphylococcus aureus isolated from clinical samples
Prajna Sharma, G Vishwanath
May-June 2012, 5(3):178-180
DOI:10.4103/1755-6783.98609  
Background : Staphylococcus aureus is one of the most commonly isolated organisms in nosocomial infections. While the prevalence of methicillin--resistant Staphylococcus aureus (MRSA) continues to increase worldwide, there is a concern about an increase in vancomycin minimum inhibitory concentrations (MIC,s) among S. aureus strains. An attempt was, therefore, made to study vancomycin susceptibility in 156 MRSA isolates from various clinical samples during the period of February 2008 to January 2009. Materials and Methods: A total of 156 isolates of S. aureus were collected from various clinical specimens. MIC of vancomycin was detected by agar dilution method. Results : Out of 156 MRSA isolates all were susceptible to vancomycin by disc diffusion method. By agar dilution method, 138 isolates were susceptible to vancomycin (VISA MIC 0.5-2 μgm/ml) and 18 isolates showed intermediate susceptibility to vancomycin (VISA MIC 4-8 μgm/ml). No vancomycin resistant S. aureus (VRSA) with MIC ≥ 16 μgm/ml was detected. Conclusion : The present study reveals the emergence of MRSA with reduced susceptibility to vancomycin and indicates the magnitude of antibiotic resistance in and around Davangere.
  - 5,810 16
An educational intervention study on adolescent reproductive health among pre-university girls in Davangere district, South India
Rangappa Manjula, Sangappa V Kashinakunti, RG Geethalakshmi, DK Sangam
May-June 2012, 5(3):185-189
DOI:10.4103/1755-6783.98612  
Background: Sex education should be an integral part of the learning process, beginning in childhood and continuing into the adult life. The 1994 international conference on population and 1995 fourth world conference on women held in Beijing recommended educational services for adolescents in a friendly environment. Objectives: 1. To know about the reproductive health awareness, like adolescent reproductive health by a pre-test, among pre-university girls (XI and XII standard). 2. To study the change in knowledge after the educational intervention by post-test. Materials and Methods: The study was conducted in pre-university colleges present in Davangere city. A pre-structured proforma was used to assess the existing knowledge, which consists of both open-ended and close-ended questions on growth and development during adolescence, pregnancy, and Sexually Transmitted Infections (STI) including HIV/AIDS. Educational intervention was done on the second day with the help of posters, printed materials, flip charts, Overhead Projectors (OHPs), and black board. One week after the educational intervention, post-test was conducted to know the change in the knowledge. Results: For a majority of them, the source of information about the above-mentioned aspects was television, followed by magazines. About 98% of them preferred doctors for getting sex education. There was overall significant change in knowledge (P<0.001, HS) after educational intervention. Conclusion: There were substantial lacunae in the knowledge about reproductive health among the study group. After educational intervention, there was significant change in the knowledge. Students felt that sex education is necessary in school and should be introduced in the school syllabus.
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Outbreak of hepatitis E with bimodal peak in rural area of Bhavnagar, India, 2010
Devang A Raval, Naresh T Chauhan, Rajesh S Katara, Pankhuri P Mishra, Dharmendra V Zankar
May-June 2012, 5(3):190-194
DOI:10.4103/1755-6783.98615  
Context : Rise in the number of jaundice cases were reported on 24 th of June 2010, in Dhola village, India. We investigated the outbreak to identify the source of infection and to facilitate control measures. Materials and Methods : We confirmed the outbreak by reviewing the rate of acute viral hepatitis in the year 2009-10. We defined a case of acute hepatitis as an acute illness with (a) discrete onset of symptoms and (b) jaundice or elevated serum aminotransferase levels, since March 2010 in Dhola village. We described the outbreak in terms of time, place, and person. We tested 20 blood samples of the case patient for hepatitis B surface antigen (HBs Ag), and immunoglobulin M (IgM) antibody for hepatitis A and E. We collected water samples for the bacteriological examination, and to test free chlorine in the water. Results : A total of 137 cases (attack rate 27.2/1000) were reported in this outbreak from March to August 2010. The attack rate was highest among the age group of 20-29 years. The attack rate was significantly higher in male (35/1000) than in female (18/1000). Out of 20 case-patients, 19 were found positive for hepatitis E virus (HEV) IgM antibodies. The water samples taken from households contained more than 10 coliforms in 100 ml sample. The relative risk of developing hepatitis E among people using pipeline water against those using ground water was 3.23 (95% CI of RR 1.59, 6.57). Conclusion : Outbreak that affected Dhola village was due to hepatitis E virus. Fecal contamination of water was the most likely source of this bimodal outbreak of hepatitis E.
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A study of reproductive tract infections among pregnant women in the reproductive age group, in Urban Field Practice Area in Hubli, Karnataka, India
S Sangeetha, Bendigeri
May-June 2012, 5(3):209-213
DOI:10.4103/1755-6783.98621  
Background: Reproductive tract infections (RTIs) is a global health problem including both sexually transmitted infections (STIs) and non-sexually transmitted infections (non-STIs) of the reproductive tract. The risk of RTIs in pregnant women includes post abortal and puerperal sepsis to fetal and perinatal deaths. Hence a community study was done in Hubli, in terms of active search of the cases among pregnant women with feasible laboratory tests for RTI and thereby providing treatment, counseling and follow-up. Objectives: 1. To know the prevalence of RTIs using feasible laboratory tests among reproductive age group, pregnant women. 2. To find the socio-demographic factors influencing RTIs in pregnant women. Materials and Methods: A cross-sectional study was done using a simple random sampling technique to select households. A pre-tested structured proforma was used to collect data on socio-demographic and reproductive characteristics. Specimens were collected for laboratory analyses of Gonorrhea, Trichomoniasis, Vaginal Candidiasis (VC), Bacterial vaginosis (BV) and Syphilis in Urban Health Training Centre (UHTC), attached to Karnataka Institute of Medical Sciences (KIMS), Hubli. Results: In all 51.3% of the women were diagnosed as having an RTI, including 8.9% with sexually transmitted infections. Endogenous infections were most prevalent (VC 35.9%, BV 6.4%), followed by Syphilis 5.1%, Trichomoniasis 3.8% and Gonorrhea 0%. Conclusion: In this study, the prevalence of RTI among pregnant women is high and steps should be taken for appropriate management of these cases, to reduce further risk of transmission of HIV/AIDS. This study suggests for integrating RTI/STI services into primary health care in order to know the true prevalence of RTI/STI in the community. The study also highlights the need for the introduction and/or strengthening of facilities for simple diagnostic tests for RTIs/STIs, especially at the peripheral healthcare level.
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A study on parapneumonic effusions/lower respiratory infections and their burden on rural population of Khammam district, Andhra Pradesh, South India
Debkishore Gupta, Suguna S Hemachander
May-June 2012, 5(3):214-218
DOI:10.4103/1755-6783.98622  
Context : Varied microbial etiology of parapneumonic effusions/lower respiratory infections casts a heavy burden on rural population in India. Aims : To determine microbial etiology, and burden of parapneumonic effusions (PPE) and lower respiratory infections (LRI), affecting adults hailing from rural areas. Settings and Design : Hospital-based, longitudinal and prospective study during the period of March 2009 to March 2010. Materials and Methods : Sputum, endotracheal (ET) tube secretion, bronchial alveolar lavage (BAL), and pleural fluids were collected from adult patients in intensive care unit (ICU) and wards. Economic burden of hospital stay, treatment, and loss of income for patients/family were noted and analyzed. Statistical Analysis : Percentages and proportions. Results : Infections of lower respiratory tract clinically appear as pneumonia, bronchitis, lung abscess, and emphysema. Hence, the types of specimen collected from the patients were varied, and all patients were from rural background. One hundred and fifty three samples were collected. Seventeen sputum samples were rejected by the selection criteria of Murray and Washington grading system. Hence, 136 samples were processed. Fifty-nine out of 136 yielded 48 bacterial isolates and 11 fungi. S. pneumoniae, Klebsiella pneumoniae, and S. aureus were responsible for most of the infections. P. aeruginosa from chronic obstructive pulmonary disease (COPD) patients had history of hospitalization. Acinetobacter baumannii (2), Stenotrophomonas maltophilia (1) were noteworthy among the bacterial isolates. Conclusion : S. pneumoniae was the most frequently isolated organism, over all. In parapneumonic effusions, 36% were Gram-negative bacilli, Escherichia coli being the commonest. Isolation of Acinetobacter and Stenotrophomonas from critically ill patients in ICU and their sensitivity to higher antibiotics warrants strict vigilance. In more than half of the cases (56.62%), a specific etiology could not be determined. The morbidity, mortality, and economic burden due to these infections in rural population are indeed heavy.
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Clinico-laboratory study on filarial lymphoedema
Mohamad A Ebrahim, Hala A El-Nahas, Nermen M Nabih, Husam M Al-Wakeel
May-June 2012, 5(3):199-205
Context: Lymphatic filariasis is considered the second leading cause of permanent physical disability in humans next to mood disorder. Aims: To evaluate filarial lymphoedema as a considerable burden to patients and the community. Settings and Design: This study was conducted on 45 patients with filarial lymphoedema among 2,350 patients with lower limb edema and 22 age- and sex-matched controls, from May 2005 to May 2008. Materials and Methods: Subjects were subjected to full history taking, clinical examination, Doppler ultrasound on the affected leg, laboratory tests for filariasis. Statistical Analysis: Data were analyzed using the Statistical Package for Social Scientist (SPSS) for windows 7.5. (SPSS Inc, Chicago, USA). Results: Male to female ratio was approximately 1:1.8. The age group 21-30 years was more affected (42%). The majority of cases of filarial lymphoedema in the present study were diagnosed in advanced irreversible stages. Five patients had hydrocele. Four cases (8.9%) were detected to be microfilaremic, 60% of cases were positive for Immunoglobulin (Ig) G, 4.44% were IgM positive and positive cases for filarial antigenemia were 64.4%. Conclusion: The majority of cases in the present study were detected in advanced irreversible stages with patient disability and serious socioeconomic impact.
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Predictors of the development of myocarditis and acute renal failure in patients with leptospirosis
Dinesh Dassanayake, H Wimalaratna, SB Agampodi, D Nandadewa, A Nugaliyadda, CN Ratnatunga
May-June 2012, 5(3):240-244
DOI:10.4103/1755-6783.98627  
Background: Leptospirosis has a varied clinical presentation with complications such as myocarditis and acute renal failure. There are various predictors of severity and mortality, including clinical and laboratory parameters. Early detection and treatment can reduce complications. Therefore, recognizing the early predictors of the complications of leptospirosis is important in patient management. Aims: This study was aimed at determining the clinical and laboratory predictors of myocarditis and acute renal failure. Setting and Design: This is a prospective descriptive study carried out in medical wards of our hospital from July 1, 2007, to July 31, 2008. Materials and Methods: Patients with clinical features compatible with leptospirosis case definition were confirmed using the Microscopic Agglutination Test (MAT). Clinical features and laboratory investigations done on admission were recorded. The patients were observed for the development of acute renal failure and myocarditis. Statistical Analysis: Chi-square statistics, Fisher's exact test, and Student's t test were used to compare patients with and without complications. A logistic regression model and backward stepwise elimination of variables was carried out to select final variables. Results: Sixty-two confirmed leptospirosis patients were included in the study. Six patients (9.6%) developed acute renal failure and five (8%) developed myocarditis, while three (4.8%) had acute renal failure and myocarditis together. Conjunctival suffusion - 40 (65%), muscle tenderness - 28 (45%), oliguria - 20 (32%), jaundice - 12 (19%), hepatomegaly - 10 (16%), arrhythmias (irregular radial pulse) - 8 (13%), chest pain - 6 (10%), bleeding - 5 (8%), and shortness of breath (SOB) - 4 (6%) were the common clinical features present in the patients. Of these, only oliguria {Odds Ratio (OR) = 4.14, 95% Confidence Interval (CI) = 1.003 - 17.261}, jaundice (OR = 5.13, 95% CI = 1.149 - 28.003), and arrhythmias (OR = 5.774, 95% CI = 1.001 - 34.692), were predictors of myocarditis and acute renal failure and none of the laboratory investigations could predict the two complications. Conclusion: This study shows that out of clinical and laboratory variables, only oliguria, jaundice, and arrhythmia are strong predictors of development of acute renal failure and myocarditis.
  - 2,038 12
REVIEW ARTICLES
Targeted sexual exploitation of children and women in India: Policy perspectives on Devadasi system
TN Sathyanarayana, Giridhara R Babu
May-June 2012, 5(3):157-162
DOI:10.4103/1755-6783.98603  
This paper introduces an alternative comprehensive approach to reduce sexual exploitation and child prostitution. The paper focuses on female devadasi temple prostitutes (Child sex workers but popularly understood as temple prostitutes in the name of dedication to deity) children in South India and the provision of support to integrate devadasi girls into the community and improve their psychosocial situation. The paper is designed broadly, taking cultural practices into consideration and also with a community participatory approach to achieve the goal. The broad objective of the paper is to promote alternative policy approaches, such as: 1. Community participation to integrate current devadasi girls into regular community life, 2. Community participation to avoid future initiation of young girls into the devadasi system, 3. Meeting the psychosocial needs through health, counseling and economical needs of devadasi girls in the community, 4. Assistance to devadasi girls as an alternative to devadasi service in the community. The policy advocacy includes participation by key community members and women's local Self-Help Groups (SHG's) networking to support existing devadasi girls to overcome stigma, social discrimination through cleansing rituals, and organizing vocational training skills to enhance their economic status. Other policy issues are integration of primary healthcare services to these girls and extending counseling services on sexual health and behavioral practices and also to introduce a micro credit system to existing devadasi girls. The paper draws its conceptual framework from psychosocial working group to provide comprehensive strategies to address community complexities. A community participatory approach has been proposed to adopt, in order to build a sustainable strategy to provide the psychosocial needs of the girls initiated into devadasi services, especially in South Indian states where it is prevalent.
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