Acute Subperiosteal Hematoma of the Orbit with Visual Impairment: An Unconventional Presentation

Acute subperiosteal hematoma of orbit is a rare condition and its presentation with rapid severe diminution of vision is even rarest. Urgent intervention is required for these patients presenting with visual compromise. Needle aspiration is safe and simple procedure for management of such hematoma provided the patient presents early and does not have any associated complications. We present one such rare case highlighting the importance of timely diagnosis and urgent management to overcome functional complications in acute subperiosteal hematoma. To best of our knowledge this is the first pediatric case presenting with acute subperiosteal hematoma accompanied by severely diminished vision within few hours of trauma.

Protective role of diet supplements Spirulina and Tamarind fruit pulp on kidney in sodium fluoride exposed Swiss albino mice: Histological and biochemical indices

Fluoride toxicity through potable water, particularly ground water, is not uncommon in countries such as India, China, Iran, Iraq, Turkey, parts of Africa and Afghanistan. Kidney being the main organ involved in fluoride removal, it accumulates considerable amount of fluoride. Here, we report toxic effects of oral exposure of Swiss albino mice to fluoride (sub-acute: 190 mg/kg body wt. for 7 days; and sub-chronic: 94 mg/kg body wt. for 90 days) and recovery of sub-chronic fluoride exposed mice after 90 days of sodium fluoride (NaF) withdrawal. The role of diet supplements (Spirulina and tamarind fruit pulp @ 230 mg/kg body wt. independently as well as in combination) in amelioration of fluoride toxicity has also been screened. Compared with controls, feed intake decreased from 3-43%, body wt. 4-18%, and kidney wt. 5-12% in treated mice (except diet supplement groups of sub-chronic exposure) while their water intake increased from 4-43%. Histopathological changes in the cortical region of kidney in fluoride treated mice were as follows: dilation of bowman's capsule and thickening of its parietal and visceral layer; alterations in glomeruli size and their sclerotization; increase in bowman's space; proliferation of mesangial cells; reduction in podocyte counts; and dilation of proximal and distal tubules. Fluoride exposure altered tissue biochemistry (protein, acid phosphatase and alkaline phosphatase content) and increased urea (23-58%) and creatinine content (14-127%) in the serum. Sub-acute exposure was found more toxic. The diet modulation not only reduced fluoride toxicity but also led to better recovery of treated mice after withdrawal, especially in combination.

Assessing Health Status of Khanigaun Village Development Committee in Nuwakot District of Nepal

BACKGROUND

Assessing health status is crucial to understand the level of health in the community. Maternal health, child health and behavioral practice on diseases are key issues to assess health status of a community in Nepal. Nationwide surveys and literature suggest that there is improvement in health status of Nepalese community. Thus, the aim of this study was to assess general health status of Khanigaun VDC of Nepal and compare it with regional and national status.

METHODS

A descriptive cross-sectional study was undertaken using semi-structured questionnaire, interview and observation methods. Simple random sampling was done to conduct household survey among 346 (30%) households. Ethical approval was taken from Nepal Health Research Council, Ethical Review Board Results: General Fertility Rate (GFR) of the VDC was found 69.15 per 1000 Women. Literacy rate of the VDC was 71.14% and 74.92% of households depended on agriculture for income. The major health problem of the community was diarrhea followed by unknown fever and respiratory problems. More than 50% of women breastfed their children only up to the age of one year. Contraceptive prevalence rate was 72% and more than two third of women were found to be have delivered their most recent baby at home. It was found that 31% of newborn were born underweight and measles immunization coverage was 89%. After need identification and prioritization, Micro Health Project (MHP) was conducted to create health related awareness among the people through demonstration and exhibition.

CONCLUSIONS

Regular health status assessment of a community people that ultimately helps to plan the health programs and services accordingly.

Superbugs causing ventilator associated pneumonia in a tertiary care hospital and the return of pre-antibiotic era!

The rise in super bugs causing Ventilator-Associated Pneumonia (VAP) is a major cause of mortality and morbidity despite recent advances in management owing to the looming 'antibiotic apocalypse'. The aetiology and susceptibility pattern of the VAP isolates varies with patient population, type of intensive care unit (ICU) and is an urgent diagnostic challenge. The present study carried out for a period of one year in a tertiary care hospital, enrolled patients on mechanical ventilation (MV) for ≥48 hrs. Endotracheal aspirates (ETA) from suspected VAP patients were processed by semi quantitative method. Staphylococus aureus, members of Enterobacteriaceae were more common in early onset VAP (EOVAP), while Nonfermenting Gram negative bacilli (NFGNB) were significantly associated with late onset VAP (LOVAP). Most of the isolates were multi drug resistant (MDR) super bugs. With limited treatment options left for this crisis situation like the pre-antibiotic era; it is an alarm for rational antibiotic therapy usage and intensive education programs.

LED fluorescence microscopy increases the detection of smear-positive pulmonary tuberculosis in medical colleges of India

In July 2012, light-emitting diode fluorescence microscopy (LED-FM) replaced conventional light microscopy using Ziehl-Neelsen stain in the detection of sputum-positive pulmonary tuberculosis in 190 microscopy centres of medical colleges operating under India's Revised National Tuberculosis Control Programme. We compared the performance of LED-FM (July-December 2012) to that of conventional microscopy (July-December 2011) across 190 sites. Of 222 658 patients examined using conventional microscopy, 28 042 (12.6%) were smear-positive, while of 224 714 examined using LED-FM, 33 552 (14.9%) were smear-positive, an additional yield of 5251 cases after adjusting for the increase in patients examined. We recommend replacing conventional microscopy with LED-FM in high workload microscopy centres in India.

Socio-demographic characteristics of cancer patients: hospital based cancer registry in a tertiary care hospital of India

AIM

To determine the socio-demographic characteristics of cancer patients.

MATERIALS AND METHODS

Review of the Cancer registry, and patient interview. Information on socio-demographic profile, medical history, family history and previous treatment, if any, was retrieved from the patient. If the patient couldn't be contacted then information was taken from pathology/radiotherapy or medical records department.

RESULTS

A total of 684 patients participated in the study. More than 40% of males and 53.7% of females were illiterate, P < 0.05. The majority (33.5%) of participants were of low socioeconomic status. The most frequently reported cancer (ca) in males it was ca lung (40.9) and ca oesophagus (9.8). In females most common cancer were ca breast (23.9) followed by ca cervix (11.7).

Inflammatory markers in patients with rheumatoid arthritis

BACKGROUND

Autoimmune diseases such as rheumatoid arthritis (RA) are the consequence of a persistent imbalance between pro- and anti-inflammatory immune mechanisms, leading to chronic inflammation. The objective of this study was to determine whether the high sensitive C-reactive protein (hs-CRP) and cytokines are elevated in RA patients and to investigate the relationship between these markers and disease activity in RA, measured by disease activity score 28 (DAS28).

METHODS

We studied 110 RA patients according to American College of Rheumatology revised criteria for RA, and 55 controls matched by age and sex. Serum levels of hs-CRP and cytokines interleukin (IL)-6, IL-10 and tumour necrosis factor-α (TNF-α) were estimated and correlated with the DAS28. Serum hs-CRP was assayed immunoturbidimetrically and cytokines were analysed by commercially available ELISA kit.

RESULTS

We found that RA patients had significantly higher levels of serum hs-CRP (p<0.001), IL-6 (p<0.001), TNF-α (p<0.001), and IL-10 (p<0.01) as compared to healthy controls. hs-CRP, IL-6 and TNF-α correlated positively (p<0.001) and IL-10 correlated negatively (p<0.01) with DAS28.

CONCLUSIONS

These results demonstrate that RA patients have high levels of inflammatory markers, and these levels are correlated with the DAS28. These findings suggest a possible role of these markers in the pathogenesis of RA. Moreover, these biomarkers can be used as markers of disease activity in the diagnosis and treatment of RA.

Kinetic constraints and features imposed by the immobilization of enzymes onto solid matrices: a key to advanced biotransformation

The kinetics of immobilized enzymes can not be analyzed by means of the simple Michaelis-Menten concept, which generally fails to describe the immobilized state due to both its probable barriers, and because the active concentration of the enzyme approaches, or even exceeds this of its substrate(s). In such cases, the various experimental data are usually treated by complex rate equations comprising too many parameters acquiring different natures and meanings, depending on both the properties of the immobilization state and the experimental conditions; thus, more likely, only apparent values of the Michaelis-Menten kinetic parameters can be estimated experimentally. Likewise, immobilization is often a key method in optimizing the operational performance of enzymes, in both laboratory and industrial scale, and affects considerably the kinetics in non-aqueous and non-conventional media due to several issues as the structural changes of the enzyme molecule, the heterogeneity of the system, and the partial or total absence of water. In this work a theoretical approach is described on the formulation of simplified rate equations, reflecting also the actual mass balances of the reactants, in the case where esterification synthetic reactions are catalyzed by immobilized lipases, in either a non-aqueous organic solvent or in a non-solvent system.

A note on the insecticide susceptibility status of principal malaria vector Anopheles culicifacies in four states of India

BACKGROUND & OBJECTIVES

The major malaria vector, Anopheles culicifacies Giles is reported to contribute ~ 65% of the malaria cases in India. This species developed resistance to DDT and later to HCH, malathion and also to pyrethroids in some states due to their use in the national malaria control programme. In the present study, insecticide susceptibility of this species was monitored in four states of India.

METHODS

To determine insecticide susceptibility status of the major malaria vector An. culicifacies, adult mosquitoes were collected from different localities of 32 tribal districts in the states of Andhra Pradesh, Odisha, Jharkhand and West Bengal during October/November 2009-10. Mosquitoes were collected from stratified ecotypes comprising a group of districts in West Bengal and individual districts in three other states. Mosquitoes were exposed to papers treated with WHO diagnostic dose: 4% DDT, 5% malathion and 0.05% deltamethrin following the WHO tube method.

RESULTS

RESULTS provided the susceptibility status of An. culicifacies to different insecticides used in the public health programme in 32 districts in four states. An. culicifacies was found resistant to DDT (mortality range 0-36%) in all the 32 districts; to malathion it was resistant in 14 districts, verification required in 10 districts and susceptible in eight districts (mortality range 32.2-100%). It was resistant to deltamethrin in four districts, verification required in 11 districts and susceptible in 17 districts (mortality range 43.3-100%).

INTERPRETATION & CONCLUSION

Development of widespread resistance to insecticides used in public health sprays for vector control including to pyrethroids in An. culicifacies in the surveyed districts is of great concern for the malaria control programme as the major interventions for vector control are heavily reliant on chemical insecticides, mainly synthetic pyrethroids used both for indoor residual spraying and for long-lasting insecticidal nets. Thus, there is a need to periodically monitor and update the susceptibility status of malaria vector(s) to suggest alternative vector control strategies for effective disease management.

Mixed pulmonary infection in an immunocompromised patient: a rare case report

Patients who are immunocompromised are predisposed to a variety of common and uncommon pulmonary infections. We report a case of mixed pulmonary infection by drug resistant tuberculosis with a nocardiosis in a 49-year-old man who was a known case of chronic obstructive pulmonary disease, on prolonged corticosteroid use with diabetes mellitus. Chronic use of corticosteroids is a predisposing factor for opportunistic infections, such as nocardiosis or tuberculosis. Since such a mixed infection is rare, maybe a combined approach to therapy early in the course of disease would be effective in such cases.

Vancomycin-resistant Enterococcus faecium: report of two cases

Vancomycin-resistant Enterococci (VRE), especially Enterococcus faecium has emerged as an important nososcomial pathogen and represents a serious threat to patients with impaired host defense. Early detection of patients colonised or infected with VRE is an essential component of any hospital program designed to prevent nosocomial transmission of this organism. The authors report two cases of VRE isolated from blood and surgical site pus of two neonates admitted in the same neonatal unit, highlighting that early detection, prompt and appropriate infection control measures were keys to successful containment of this dreaded pathogen.