Prevalence of extended spectrum -lactamase producing Klebsiella pneumoniae in a tertiary care hospital

PURPOSE

The purpose of this study was to know prevalence of extended spectrum -lactamase (ESBL) in multi drug resistant (MDR) strains of Klebsiella pneumoniae isolated from different clinical samples.

METHODS

A total of 120 MDR strain of K. pneumoniae were selected for the study, 106 of which were resistant to at least one of the third generation cephalosporins (3GC). They were studied for ESBL production by phenotypic confirmatory disc diffusion test (PCDDT) and by double disc synergy test (DDST).

RESULTS

88.3% (106) of the isolates were found to be resistant to at least one of the 3GC tested (cefotaxime, ceftazidime and ceftriaxone) and 72% of the isolates were resistant to all the 3GC tested. ESBL was detected in 30.18% (32) of the K. pneumoniae by PCDDT and in 27.3% (29) by DDST. Among the ESBL producers 6 (18.75%) were sensitive to cefotaxime, 2 (6.25%) to ceftazidime and 3 (9.37%) to ceftriaxone by disc diffusion test. The minimum inhibitory concentrations (MICs) of 3GC for these strains ranged from 2-8 microg/mL while for non ESBL producer sensitive counterparts it ranged from 0.03-1 microg/mL. Resistance to cefotaxime was transferred to recipient E. coli K12 strains J62-1. All the K. pneumoniae isolates were sensitive to imipenem. Resistance against amoxicillin, gentamicin, ciprofloxacin and amikacin was found in 93.28, 70, 10.37 and 26.14% of the isolates respectively.

CONCLUSIONS

Our study shows presence of ESBL producer K. pneumoniae in clinical isolates. The routine antimicrobial sensitivity test may fail to detect ESBL mediated resistance against 3GC and detection of ESBL production should be carried out as a routine in diagnostic laboratories by PCDDT as it is a simple and cost effective test.

Effect of air pollution on peri-urban agriculture: a case study

Peri-urban agriculture is vital for the urban populations of many developing countries. Increases in both industrialization and urbanization, and associated air pollution threaten urban food production and its quality. Six hour mean concentrations were monitored for SO(2), NO(2) and O(3) and plant responses were measured in terms of physiological characteristics, pigment, biomass and yield. Parameter reductions in mung bean (Vigna radiata), palak (Beta vulgaris), wheat (Triticum aestivum) and mustard (Brassica compestris) grown within the urban fringes of Varanasi, India correlated directly with the gaseous pollutants levels. The magnitude of response involved all three gaseous pollutants at peri-urban sites; O(3) had more influence at a rural site. The study concluded that air pollution in Varanasi could negatively influence crop yield.

Neuroleptic malignant syndrome presenting as pulmonary edema and severe bronchorrhea

Neuroleptic malignant syndrome is a rare (incidence, 0.02%-3.2%) but dangerous complication following the use of neuroleptic drugs. When not promptly recognized, this disease carries a high mortality (10%-20%) and morbidity rate. We report an unusual case of neuroleptic malignant syndrome that presented predominantly with autonomic instability in the form of recurrent episodes of respiratory distress. The respiratory distress was initially caused by pulmonary edema and later was caused by severe bronchorrhea. We propose that aspiration pneumonia resulting in respiratory failure, the leading cause of death in neuroleptic malignant syndrome, may be a result of a combination of altered mental status and bronchorrhea. This has therapeutic implications because early institution of bromocriptine/dantrolene can prevent aspiration pneumonia and, hence, mortality from respiratory failure.

Characterization of wet and dry deposition in the downwind of industrial sources in a dry tropical area

An atmospheric deposition study was conducted in the downwind of Shaktinagar Thermal Power Plant (STPP), Renusagar Thermal Power Plant (RTPP), and Anpara Thermal Power Plant (ATPP), at Singrauli region, Uttar Pradesh (UP), India to characterize dry and wet deposition in relation to different pollution loading. During the study period, dry and wet depositions and levels of gaseous pollutants (SO2 and NO2) were estimated across the sites. Dry deposition was collected on a monthly basis and wet deposition on an event basis. Depositions were analyzed for pH, nitrate (NO3-), ammonium (NH4+), and sulphate (SO4(2-)) contents. Dry deposition rate both collected as clearfall and throughfall varied between 0.15 to 2.28 and 0.33 to 3.48 g m(-2) day(-1), respectively, at control and maximally polluted sites. The pH of dry deposition varied from 5.81 to 6.89 during winter and 6.09 to 7.02 during summer across the sites. During the rainy season, the mean pH of clear wet deposition varied from 6.56 to 7.04 and throughfall varied from 6.81 to 7.22. The concentrations of NO2 and SO2 pollutants were highest during the winter season. Mean SO2 concentrations varied from 18 to 75 g m(-3) at control and differently polluted sites during the winter season. The variation in NO2 concentrations did not show a pattern similar to that of SO2. The highest NO2 concentration during the winter season was 50 g m(-3), observed near RTPP. NO2 concentration did not show much variation among different sites, suggesting that the sources of NO2 emission are evenly distributed along the sites. The concentrations of NH4+, NO3-, and SO4(2-) ions in dry deposition were found to be higher in summer as compared to the winter season. In dry deposition (clearfall) the concentrations of NH4+, NO3-, and SO4(2-) varied from 0.13 to 1.0, 0.81 to 1.95, and 0.82 to 3.27 mg l(-1), respectively, during winter. In wet deposition (clearfall), the above varied from 0.14 to 0.74, 0.81 to 1.82, and 0.67 to 2.70 mg l(-1), respectively. The study clearly showed that both dry and wet depositions varied between the sites and season, suggesting significant impact of industrial activities in modifying the atmospheric input. The nonacidic deposition suggests that there is no threat of acidification of the receiving ecosystem at present.

Influence of elevated CO(2) on the sensitivity of two soybean cultivars to sulphur dioxide

Two cultivars of soybean (Glycine max cv. Bragg and PK 472) were subjected to elevated concentrations of CO(2) (600 &mgr;l l(-1)) and/or SO(2) (0.06 &mgr;l l(-1)), for 8 h from germination to grain maturity in open top chambers under field conditions to assess the modification in response to SO(2) exposure resulting form CO(2) enrichment. Exposure to SO(2) alone resulted in reductions in plant growth, biomass and yield, as well as declines in foliar starch and protein content in both the cultivars of soybean. Elevated CO(2) stimulated plant growth, yield and enhanced foliar starch content, photosynthesis and WUE in both the cultivars. In plants exposed to the combination of elevated CO(2)+SO(2), the adverse influence of SO(2) was mitigated by CO(2) enrichment. This effect was considered to result from the provision of extra carbon sources required for repair and detoxification processes and a reduction in SO(2) uptake through reduction in stomatal conductance. PK 472 exhibited greater sensitivity to SO(2) than Bragg. PK 472 also showed greater stimulation of yield under CO(2)+SO(2) treatment than Bragg.

Percutaneous transfemoral testicular vein embolisation in the treatment of childhood varicocoele

BACKGROUND

Controversy surrounds the early treatment of childhood varicocoele and its role in the prevention of testicular atrophy and male infertility. Various techniques exist, all with varying degrees of success.

OBJECTIVES

To show that percutaneous transfemoral testicular vein embolisation is an effective alternative when compared to the conventional open surgical approach.

MATERIALS AND METHODS

A retrospective review examining 48 boys (aged 9-18 years; mean 13.2 years) who were treated with transcatheter testicular vein embolisation between 1985 and 1999. Follow-up took the form of out-patient clinical assessment and a telephone questionnaire. Patients were graded as 'good', 'moderate' or 'poor', according to various criteria.

RESULTS

Of the 48 patients, 43 (90%) had satisfactory embolisations. Thirty-eight (88 %) had a 'good' clinical outcome at follow-up. There were five technical failures due to a combination of abnormal venous anatomy and severe venospasm.

CONCLUSIONS

We believe that where the expertise necessary for testicular embolisation is available, it should be offered as the intervention of first choice. Surgery should be reserved for the rare cases where embolisation is not possible or when recurrence has occurred.

Managing obesity like any other chronic condition. Long-term therapy may reduce comorbidity as well

Patients often seek help from their primary care physician for weight loss, so familiarity with pharmacologic options and their risks is important. Anorexiants have been available for decades and are relatively safe. Orlistat and sibutramine are two of the newer medications that patients may have heard about in television, newspaper, and magazine advertising. In addition, patients often ask for advice regarding various herbal or nonprescription medications for weight loss. In this article, the authors help physicians prepare to address these questions.

Acute renal failure

Acute renal failure occurs in 5 percent of hospitalized patients. Etiologically, this common condition can be categorized as prerenal, intrinsic or postrenal. Most patients have prerenal acute renal failure or acute tubular necrosis (a type of intrinsic acute renal failure that is usually caused by ischemia or toxins). Using a systematic approach, physicians can determine the cause of acute renal failure in most patients. This approach includes a thorough history and physical examination, blood tests, urine studies and a renal ultrasound examination. In certain situations, such as when a patient has glomerular disease, microvascular disease or obstructive disease, rapid diagnosis and treatment are necessary to prevent permanent renal damage. By maintaining euvolemia, recognizing patients who are at increased risk and minimizing exposure to nephrotoxins, physicians can decrease the incidence of acute renal failure. Once acute renal failure develops, supportive therapy is critical to maintain fluid and electrolyte balances, minimize nitrogenous waste production and sustain nutrition. Death is most often caused by infection or cardiorespiratory complications.

OTC cold, cough and allergy products: more choice or more confusion?

Cold and allergy remedies are one of the most confusing markets to consumers. There are several reasons why there is confusion among consumers when forced to select a cough/cold/allergy product. This paper examines the over-the-counter cold/cough/allergy products market specifically with respect to: (1) What are the common pharmaceutical active ingredients in cold/cough/allergy products? (2) What percentage of products are single ingredient, two ingredient, three ingredient or more? (3) What are the common combinations of pharmaceutical ingredients present in cold/cough/allergy products? The answers to the above questions could help health professionals such as pharmacists in rendering services such as counseling consumers when approached with questions about cold/cough/allergy products. The results could also help retailers in developing better shelf placement and positioning of cold/cough/allergy products.

Molecular cloning and expression of human grap-2, a novel leukocyte-specific SH2- and SH3-containing adaptor-like protein that binds to gab-1

The SH2- and SH3-containing adaptor molecules serve to recruit cytosolic signal-transducing molecules to the activated receptor tyrosine kinases. In this study, we report the molecular cloning of a novel adaptor-like protein, Grap-2 (Grb-2 related adaptor protein 2), using the multisubstrate docking protein Gab-1 as bait in the yeast two-hybrid system. Sequence analysis revealed that Grap-2 contains a SH3-SH2-SH3 structure that has a high degree of sequence homology to those of the Grb-2 and Grap adaptor molecules. However, unlike in Grap and Grb-2, the SH2 and the C-terminal SH3 domains of Grap-2 are separated by a 120-amino-acid glutamine-rich sequence that shows no apparent homology to any known molecule or structural motif. The C-terminal SH3 domain of Grap-2 alone is sufficient to bind to Gab-1. Furthermore, Northern blot analysis demonstrated that Grap-2 has two major transcripts of 1.4 and 4.0 kb that can only be detected in tissues rich in leukocytes and in two leukemia cell lines. This highly restricted pattern of expression suggests that Grap-2 may participate in leukocyte-specific protein tyrosine kinase signaling.

Vancomycin-resistant enterococcal colonization in nonhospitalized HIV-infected patients

We studied fecal colonization with vancomycin-resistant enterococci (VRE) in 89 HIV-infected nonhospitalized patients ages 24 to 62 years, including 70 (79%) men (including 41 homosexual and 5 bisexual men) and 19 (21%) women. Of the 89 patients, 61 (69%) were black, 25 (28%) Hispanic, and 3 (3%) white; 53 (60%) had history of ongoing or recent antibacterial therapy with trimethoprim/sulfamethoxazole (29), clarithromycin (18), amoxicillin (7), ofloxacin (3), and metronidazole, doxycycline, dicloxacillin, and cephalexin (1 each). VRE were not isolated from any of the patients studied.

Gingival fibromatosis with prune-belly syndrome

A case is described in which a child appeared for evaluation with marked gingival overgrowth, facial dysmorphism, and abdominal defects consistent with prune-belly syndrome. The relationship between this case and other reports of gingival enlargement are discussed. Coincidence of the oral, facial, and abdominal abnormalities has not been previously reported.

Congenital thyroid teratoma: a case with persistent neuroglial involvement of cervical lymph nodes

A case of congenital thyroid teratoma with nodal spread is reported. Primary surgery was performed on a female infant on the 6th day of life. The thyroid mass was removed in toto, and an adjacent 1.2 cm lymph node was also removed. Histology showed solid and cystic teratoma with a variety of elements including prominent neurological tissue that was neuroblastoma-like in places. Residual compressed non-neoplastic thyroid tissue was identified in the subcapsular plane. The lymph node was largely replaced by neuroglial tissue that was cellular in some areas and showed intrasinusoidal growth and some mitotic activity. Recurrent cervical lymphadenopathy gradually developed, commencing a few months after surgery. Excision of cervical nodes was undertaken at 9 months of age. About 13 nodes up to 2 cm in diameter were excised. Most of the specimens consisted of reactive lymph nodes, but in three of the smaller nodes, there were subcapsular and sinusoidal masses of focally cellular neuroglial tissue, again with occasional mitoses. This tissue stained strongly for glial fibrillary acidic protein, in addition to expressing neural markers. The lymph node "deposits" were interpreted as "displaced" lesional tissue rather than metastases in the usual, aggressive sense. The girl remains well at 5 years of age.

Morbidity after neonatal inguinal herniotomy

Neonatal inguinal herniotomy is recognised by paediatric surgeons to be a potentially difficult procedure. This study reviewed the clinical, operative, and outcome details of 74 infants undergoing herniotomy at less than 44 weeks' gestation with particular reference to the incidence of complications such as recurrent hernia and testicular atrophy. Follow-up information was obtained in 69 patients (93%, mean follow-up, 8.1 months). There were 8 recurrent hernias in 5 patients (2 bilateral recurrences, 1 second recurrence) giving an overall hernia recurrence rate of 8.6%. There was only 1 case of testicular atrophy (secondary to a wound infection and scrotal abscess). Despite the provision of a consultant-led service, the recurrence rate in neonates is much higher than that seen in the paediatric population as a whole. In light of commissioners' current demands for quality standards and managed healthcare, it is important that outcomes in this high-risk group are defined separately from those of other patients undergoing inguinal herniotomy.

Urokinase-type plasminogen activator regulates cranial neural crest cell migration in vitro

Proper migration and differentiation of neural crest (NC) cells are required for normal development of craniofacial structures, heart and great vessels, sensory and autonomic nervous systems, and other organs with vertebrate embryos. Serine-protease inhibitors reduce NC cell migration in vitro, suggesting the extracellular proteases are important mediators of NC cell migration. While plasminogen activator activity levels are high in NC cells relative to other embryonic tissue, its ability to regulate NC cell migration has not been specifically tested in vivo or in vitro through its ability to convert plasminogen to plasmin. Using a transfilter migration assay, NC cell migration was measured in the presence or absence of plasminogen. Our results showed that plasminogen significantly enhanced NC cell migration. This increase could not be attributed to differences in initial NC cell attachment or cytotoxicity and did not require a chemotactic gradient. The plasminogen-enhanced NC cell migration was blocked by aprotinin (a plasmin inhibitor) and was mimicked by the direct addition of plasmin to the NC cells, indicating that the plasminogen effect was mediated through plasmin generation. Furthermore, anticatalytic-uPA antibody blocked the plasminogen-enhanced NC cell migration showing that NC cell-associated uPA activity was required for this effect. Finally, decreasing NC-uPA activity by treating cells with transforming growth factor-Beta, also blocked the plasminogen-dependent increase in cell migration. These data show that in vitro, NC cell migration is regulated by NC-associated uPA activity suggesting that growth factor-regulation of this activity may play a major role in regulating NC cell migratory capacity in vivo.

Urinary excretion of meperidine and normeperidine in man upon acute and chronic exposure to high altitude

The urinary excretion of unchanged meperidine (M) varies with change of pH and metabolism. Since exposure of man to high altitude (H) may cause significant physiologic changes, we investigated its effects on the urinary excretion of M. The study was carried out in 3 groups of healthy, male volunteers (ages 18-20 years): at sea level (L), at 4360 m the day after arrival at H (HA), and at 4360 m in subjects residing for > 10 months at H (HC). Urine was collected for the periods of 0-4, 4-8, 8-12 and 12-24 h. Urinary pH was measured and the concentrations of M and normeperidine (N) were determined. The 24 h excretion of M and N was significantly decreased for L vs. HA and L vs. HC. Significance was also seen for the periods 0-4, 4-8 and 8-12 h. The ratio of amount excreted M/N for the 24 h period was highly significant for L vs. HA and L vs. HC. The urinary pH ranged from 5.3-5.9 for L, 5.9-7.0 for HA, and 5.1-5.7 for HC. The Fel (fraction of M eliminated in the unchanged form in urine) significantly decreased from L to HA and HC.

Response of two cultivars of Triticum aestivum L. to simulated acid rain

The present experiment was aimed at assessing the impact of simulated acidic precipitation (SAR) on growth, biomass accumulation and yield of two cultivars of wheat (Triticum aestivum L.), Malviya 206 and 234, varying in cuticular thickness and leaf area. Wheat cultivars were exposed to simulated rain acidified to pH 5.6 (control), 5.0, 4.5, 4.0 and 3.0 from 30 days of age, twice a week for five weeks. The plants received ambient precipitation of unknown acidity, as well as the acid rain treatments. Growth parameters such as shoot height, root length, and leaf area were reduced significantly in treated plants at different growth stages. Above and below-ground biomass also decreased significantly in the plants treated with acidic precipitation. Relative to control, the number of grains per plant and yield per m(2) declined significantly at all SAR treatments. The hypothesis that the variety with thinner cuticle and greater leaf area would be more susceptible to acidic precipitation was not supported by the present study.

Examining the applicability of market forecasting models to new pharmaceutical products

Developing new products is a complex and risky business, particularly in the pharmaceutical industry. In recent years, several pretest and test market models have been proposed to evaluate the performance of a new product. Although these models have been tested and validated with a wide variety of frequently purchased products, certain unique characteristics of the market for pharmaceutical products render the models subject to modification. This study examines and evaluates the applicability of three types of market forecasting models (Awareness forecasting models, Pre-test market models, and Test market models) in predicting the market potential of new pharmaceutical products.

Management of alimentary tract duplication in children

Duplication of the alimentary tract is rare but potentially dangerous. Five of 72 children with alimentary tract duplication treated between 1973 and 1992 died from postoperative complications; a further ten required more than one operation. Ileal duplications were the commonest, occurring in 16 patients (22 per cent). Thoracoabdominal duplications were the most complicated and responsible for much of the overall morbidity and mortality. Surgical complications were related to the size and location of the duplication, communication with the gastrointestinal tract or vertebral canal, presence of heterotopic gastric mucosa and involvement of mesenteric vessels. Complete excision of the duplication should be possible in most cases.

New drug adoption models: a review and assessment of future needs

New drug products today are the key to survival in the pharmaceutical industry. However, the new product development process in the pharmaceutical industry also happens to be one of the riskiest and most expensive undertakings because of the huge research and development costs involved. Consequently market forecasting of new pharmaceutical products takes on added importance if the formidable investments are to be recovered. New drug adoption models provide the marketer with a means to assess new product potential. Although several adoption models are available in the marketing literature for assessing potential of common consumer goods, the unique characteristics of the prescription drug market makes it necessary to examine the current state of pharmaceutical innovations. The purpose of this study, therefore, is to: (1) review new drug adoption models in the pharmaceutical literature, (2) evaluate the existing models of new drug adoption using the ten criteria for a good model as prescribed by Zaltman and Wallendorf (1983), and (3) provide an overall assessment and a ¿prescription¿ for better forecasting of new drug products.

An indirect immunoperoxidase assay for rapid serodiagnosis of visceral leishmaniasis

An easy, inexpensive and rapid indirect immunoperoxidase assay for serodiagnosis of Kala-azar (VL) has been tried using whole promastigotes of L. donovani in dried smear form as antigen. A total of 138 sera were tested including sera from parasite positive cases of VL (32), normal controls from endemic (20) and non-endemic (20) areas, cases of tuberculosis (10), leprosy (10), amoebic hepatitis (10), malaria (10) and tropical splenomegaly (26). All the positive control sera were positive in very high dilutions of serum ranging from 1/500 to 1/64,000. None of the sera with other diseases were positive by this method except 3 cases with tropical splenomegaly were positive in low titres. No other cause could be established in these cases for splenomegaly. Sensitivity and specificity of the test were found to be 100 and 95.3% respectively. Predictive values of the negative and positive tests were 100 and 86.5% respectively.

Effect of power plant emissions on plant community structure

A field study was conducted around two coal-fired thermal power plants (TPP) to analyse the impact of their emission on the structure of herbaceous communities in a dry tropical area. Phytosociological studies reflected that Cassia tora, Cynodon dactylon and Dichanthium annulatum dominate at heavily polluted sites. Alsycarpus monilifer, Convolvulus pluricaulis, and Desmodium triflorum are uniformly distributed, whereas Paspalidium flavidum, Phyllanthus simplex, and Rungia repens are dominant at less polluted sites. On the basis of Importance Value Index, the species were classified as sensitive, intermediate and resistant to TPP emissions. Shannon-Wiener Index of species diversity, species richness and evenness were inversely related, whereas concentration of dominance was directly related to the pollution load in the area. Significant negative correlation between ambient SO2 concentration and species diversity suggested selective elimination of sensitive species from the heavily polluted sites.

Meconium ileus due to extensive intestinal aganglionosis

Seven full-term infants with aganglionosis extending into the small bowel presented with clinical, radiological, and operative features of meconium ileus. Misdiagnosis resulted in inappropriate treatment. The correct diagnosis was eventually established by rectal suction biopsy, mostly after either recurrent intestinal obstruction or stomal dysfunction, and after cystic fibrosis had been excluded. For two patients, the results of rectal suction biopsies were initially misleading. Two infants died. Extensive intestinal aganglionosis should be considered a rare possibility in all infants with meconium ileus. In such cases, histological examination of the appendix may avoid this potential pitfall.

Antioxidant potential of specific estrogens on lipid peroxidation

Coronary heart disease (CHD) is the leading cause of death in postmenopause. Estrogen administration in postmenopause lowers the risk of CHD by 50%. A variety of estrogen preparations are currently used in postmenopausal hormone replacement therapy. It is unknown, however, if structural differences in the estrogen molecule influence the cardioprotective effects of estrogens. In this communication we have shown that equine estrogens (especially equilin) exhibit higher antioxidant potency (as measured by fatty acids and sterols oxidation) when compared to estrone and estradiol-17 beta.

Congenital fistulation of a Meckel's diverticulum to the surface of an exomphalos sac

Exomphalos and vitellointestinal duct remnants are well-known entities. This report details the presentation of congenital fistulation of a Meckel's diverticulum to the surface of an exomphalos minor.

Beliefs about the world and recovery from myocardial infarction

Seventy male, Hindu Myocardial Infarction (MI) patients were interviewed twice--4 to 5 days after their first heart attack (Time 1) and a month after their first heart attack (Time 2). The patients' beliefs about the world (world beliefs), about the causes of the disease (causal beliefs), and about the factors contributing to their recovery (recovery beliefs) were measured. Each category of beliefs was concerned with three domains: karma, God, and just world (or self). The patients' physical and psychological recovery was evaluated. World and recovery beliefs were intercorrelated, but these beliefs were only weakly correlated with causal beliefs. Furthermore, world beliefs and recovery beliefs were positively associated with recovery from MI at both Time 1 and Time 2. Attribution of causality to God was negatively correlated with medical recovery, perceived recovery, and mood state at Time 2. This trend was in the reverse direction for attribution of causality to self.

Cold abscess due to malignant pleural mesothelioma

A middle aged male presented to us with a cold abscess on the left side of chest which later proved to be a malignant pleural mesothelioma. The clinical, radiological and histopathological findings have been discussed.

Pneumonitis secondary to drug induced gastric perforation

Chemical pneumonitis in a 3-year-old child due to drug-induced gastric perforation at fundus is reported. The child was managed by closure of perforation with omental patch, gastrostomy and conservative treatment.