Comparison of Three Dimensional Test and Double Disc Synergy Test for detection of Extended Spectrum ?-Lactamase (ESBL) producing Gram negative bacteria

Extended spectrum ?-lactamase (ESBLs), produced by Gram negative organisms, are enzymes capable of hydrolyzing extended spectrum cephalosporins, penicillins and monobactam but inactive against cephamycin and imipenem. Detection of some ESBL strains are missed by Double disc synergy test but detected by three dimensional test. So this study was carried out to see the rate of ESBL producer by three dimensional test and double disc synergy test among Gram negative bacteria. Total 110 Gram negative isolates were studied, among them 30 were wound swab isolates and 80 were laboratory isolates, of which 88(80%) were ESBL producer. Three dimensional tests detected ESBL in 88 (80%) strain whereas 66.36% strains detected by double disc synergy test, so 15 (13.63%) isolates were missed by Double disc synergy test. In this study among the 30 wound swab isolates Three dimensional test detected 26 (86.67%) whereas 14 (46.67) were detected by double disc synergy test and similarly among the 80 laboratory isolates, three dimensional test detected 62 (77.5%) and double disc synergy test detected 59 (73.75%). So, the three dimensional test has been found to be better than Double disc synergy test in the detection of ESBLs. ESBL producing organisms are resistance to most of the antibiotics but 100% sensitive to Imipenem. DOI: http://dx.doi.org/10.3329/pulse.v6i1-2.20328 Pulse Vol.6 January-December 2013 p.12-19

Pattern of Elevated Serum Alkaline Phosphatase (ALP) Levels in Hospitalized Patients: A Single Centre Study

Background: Persistent elevation of serum ALP is frequently encountered and can pose a diagnostic dilemma due to its association with a wide range of clinical conditions. However, the significance of ALP in these clinical conditions in routine practice is often underestimated or overrated. Objectives: This study was determined to assess the pattern of ALP with an aim to elucidate its clinical utility among hospitalized patients. Method & materials: The inpatients with high ALP level were enlisted & analysed between January to December 2012 excluding cases of (a) patients who have bone involvements with malignancies and (b) HIV-seropositive patients attending a tertiary care Hospital at Dhaka. Extremely high levels of ALP were defined as being more than 1000 U/L. These patients were divided into different groups according to their final diagnosis. Results: A total of 154 hospitalized patients with eligible medical records were identified (98 male and 56 female, mean age 36 years). Their ALP levels are ranging from 1,006 to 3,067 IU/L; very extreme values of > 3000 IU/L being rarely (only about 2%) documented. Patients with sepsis can have an extremely high alkaline phosphatase level (1,648.2 ± 328.4 IU/L) and a normal bilirubin. Conclusion: High serum ALP levels in hospitalized patients were commonly found in three major groups having obstructive biliary diseases, infiltrative liver disease and sepsis. A variety of other causes were also noted. This routine laboratory test should receive more attention in clinical decision-making than has previously been given. DOI: http://dx.doi.org/10.3329/pulse.v6i1-2.20329 Pulse Vol.6 January-December 2013 p.20-26

Utility Of Procalcitonin As A Diagnostic And Prognostic Biomarker Of Sepsis In Comparison To Culture & Other Inflammatory Markers

Background Rapid diagnosis and timely initiation of effective therapy are the major challenges in intensive care units (ICUs) despite the advances in critical care medicine. Procalcitonin (PCT) is an innovative valuable laboratory marker in this regard. Objectives This study was undertaken to introduce PCT as a routine tool in regional hospitals by evaluating the utility of PCT in early diagnosis as well as in assessment of severity in septic patients in comparison to the traditional methods and inflammatory markers like cultures and C-reactive Protein (CRP). Method & Materials PCT and CRP were simultaneously measured in 73 medico-surgical ICU patients. The results of PCT, CRP and microbiological cultures were compared according to the five categories of PCT concentrations and the American College of Chest Physicians (ACCP) criteria based study groups. Results The clinical presentation of 75.3 % cases revealed a range of systemic inflammatory responses (SIRS). The diagnostic accuracy of PCT was higher (75.34%) with greater specificity (72.2 %), sensitivity (76.36%), positive and negative predictive values (89.36 % and 50%), positive likelihood ratio (2.75) as well as the smaller negative likelihood ratio (0.33). Both serum PCT and CRP values in cases with sepsis, severe sepsis and septic shock were significantly higher from that of the cases with SIRS and no SIRS (p< 0.01). Conclusion The diagnostic utility of both PCT and CRP are close yet PCT is found to be superior to that of CRP or microbiological culture in terms of accuracy in identification of patients with sepsis and to assess the severity of sepsis as well DOI: http://dx.doi.org/10.3329/pulse.v5i2.20259 Pulse Vol.5 July 2011 p.5-15

Longitudinal comparison of visual acuity as measured by the ETDRS chart and by the potential acuity meter in eyes with macular edema, and its relationship with retinal thickness and sensitivity

PURPOSE

To evaluate the relationship between visual acuity as measured by the Early Treatment Diabetic Retinopathy Study (ETDRS) chart and by the potential acuity meter (PAM) with retinal thickness and sensitivity measured by a combined microperimetry/optical coherence tomography system (OCT).

METHODS

Forty-four patients with macular edema (ME) were included in a prospective observational study. Visual acuity (VA) was assessed using the ETDRS chart (with best correction) as well as by the PAM. Retinal thickness and sensitivity was measured by an automatic fundus perimetry/tomography system.

RESULTS

Best-corrected VA using the ETDRS chart ranged from 20/20 to 20/400 (median: 20/50). VA measured by the PAM without correction ranged from 20/20 to 20/400 (median: 20/40). The mean retinal thickness was 369.57 μm (s.d.: 140.28 μm) on spectral domain-OCT and the mean retinal sensitivity was 8.12 decibels (dB) (s.d.: 5.78 dB). The mean LogMAR value using the ETDRS chart was 0.43, whereas it was 0.38 using the PAM (P-value: 0.009).

CONCLUSIONS

VA values measured by the PAM were statistically significantly better than those measured by the ETDRS chart in eyes with ME secondary to various retinal vascular and uveitic diseases. VA measured by the PAM may be a more sensitive predictor of macular function than that obtained by ETDRS testing in eyes with ME.

Ultrasonographic spleen size and haematological parameters in children with sickle cell anaemia in Kano, Nigeria

AIMS AND OBJECTIVES

To determine spleen size using abdominal ultrasonography and haematological parameters in steady state children with sickle cell anaemia (SCA).

SUBJECTS AND METHODS

An analytical case control study of 150 children with SCA in steady state aged 6 months to 15 years was undertaken. Children with HbAA matched for sex and age were used as controls. The spleen sizes of children with SCA and the controls were determined using abdominal ultrasonography. Haematological parameters (RBC, Hb, MCV, MCH, MCHC,WBC, Platelet and Reticulocyte counts) were also assessed.

RESULTS

Fifty three children (35.3%) with SCA against 19 children (12.7%)with HbAA had splenomegaly defined as spleen index > 31cm². among the children with SCA who had splenomegaly, 17 (11.3%) were older than 10 years. None of those above 10 years with HbAA had splenomegaly. The mean values of RBC, Hb, MCV and MCH were significantly lower in children with SCA compared to age- sex matched HbAA controls (p = 0.001, 0.001, 0.15 and 0.016 respectively), while the mean values of MCHC, WBC, platelet and reticulocyte counts were significantly higher in children with SCA than in the HbAA controls (p = 0.022, 0.001, 0.013 and 0.001) respectively. Among the SCA subjects, as spleen index increased from grade II through grade V, the mean values of RBC, Hb, WBC and platelet count significantly decreased (p =0.001, 0.001, 0.032 and 0.007), while the mean value of reticulocyte count significantly increased (p = 0.001). However, with increasing spleen index from grade II to grade V, the mean values of MCV, MCH and MCHC were not significantly different (p = 0.077, 0.741 and 0.995).

CONCLUSION

Splenomegaly persists in much older age group in children with SCA and is associated with mild cytopaenia. Spleen size in children with SCA should be assessed using a more sensitive and reliable method of ultrasonography.

Raise the bar and lower the dose: current and future strategies for radiation dose reduction in head and neck imaging

SUMMARY

Technologic advances in CT have generated a dramatic increase in the number of CT studies, with a resultant increase in the radiation dose related to CT scanning. Such increase in radiation dose is becoming a concern for the radiology community, especially with increasing public awareness of the dose burden related to examinations. To cope with the increase in CT-related radiation exposure, it is becoming necessary to optimize CT imaging protocols and apply radiation dose reduction techniques to ensure the best imaging with the lowest radiation dose.

Pattern of childhood malignant tumors at a teaching hospital in Kano, Northern Nigeria: A prospective study

Background: Childhood cancers represent an important global public health problem. Survival is still dismal in most low income countries. Materials and Methods: A prospective study of childhood cancers diagnosed at AKTH, Kano was undertaken from January 2003 to December 2009 to determine the pattern, socio-economic and geographical features. Results: Malignant lymphomas constituted 46.5% of all cases, of which 30.1% were Burkitt's lymphoma, 9.8% were Non-Hodgkin (non Burkitt's) lymphoma and 6.6% were Hodgkin lymphoma. Retinoblastoma was the second most common malignancy constituting 15.2% of all cases, followed by Nephroblastoma 12.5% and acute leukemia's accounted for 14.1% of all cases. Others were Neuroblastoma 5.5%, Rhabdomyosarcoma 1.9% and CNS and Hepatissc tumors 4.3%. About 80% of parents of these children are very poor and could not afford the cost of treatment. Fifty one percent of the patients were alive at 12 months and the mortality was 24%. Conclusion: Childhood cancer is common in Kano. Free treatment is what is required since majority of the parents could not afford the cost of treatment.

High-resolution MRI evaluation of neonatal brachial plexus palsy: A promising alternative to traditional CT myelography

BACKGROUND AND PURPOSE

Despite recent improvements in perinatal care, the incidence of neonatal brachial plexus palsy remains relatively common. CT myelography is currently considered to be the optimal imaging technique for evaluating nerve root integrity. Recent improvements in MR imaging techniques have made it an attractive alternative to evaluate nerve root avulsions (preganglionic injuries). We aim to demonstrate utility of MR imaging in the evaluation of normal and avulsed spinal nerve roots.

MATERIALS AND METHODS

All study patients with clinically diagnosed neonatal brachial plexus palsy underwent MR imaging by use of a high-resolution, heavily T2-weighted (driven equilibrium) sequence. MR imaging findings were reviewed for presence of nerve root avulsion from C5-T1 and for presence of pseudomeningocele. The intraoperative findings were reviewed and compared with the preoperative MR imaging findings.

RESULTS

Thirteen patients (9 male, 4 female) underwent MR imaging; 6 patients underwent nerve reconstruction surgery, during which a total of 19 nerve roots were evaluated. Eight avulsions were noted at surgery and in the remainder, the nerve injury was more distal (rupture/postganglionic injury). Six of the 8 nerve root avulsions identified at surgery were at C5-6 level, whereas 1 nerve root avulsion was identified at C7 and C8 levels, respectively. The overall sensitivity and specificity of MR imaging for nerve root avulsions was 75% and 82%, respectively.

CONCLUSIONS

Our preliminary results demonstrate that high-resolution MR imaging offers an excellent alternative to CT myelography for the evaluation of neonatal brachial plexus palsy with similar sensitivity compared with CT myelography.

Pediatric HIV in Kano, Nigeria

BACKGROUND

Pediatric human immunodeficiency virus (HIV) infection is still an important public health issue despite a decrease in global, national, and local seroprevalence rates.

DESIGN

A prospective, hospital-based study was conducted.

MATERIALS AND METHODS

One-hundred and sixty children presenting for the first time to the hospital were studied. Each child had a detailed physical examination and initial double rapid HIV antibody tests. A virological confirmatory test was done for those aged less than 18 months of age with positive results. Mothers of HIV-infected children also had HIV testing. HIV-infected children were enrolled into HIV care and followed up for 6 months. Data were analyzed using the SPSS 16.0 for Windows.

RESULTS

Twenty-two (13.8%) children were confirmed HIV-infected. The mean age was 26.9 ± 30.8 months. Male to female ratio was 1.1:1. Probable modes of transmission were mother-to-child in 63.6%, group circumcision in 22.7%, sexual transmission in 9.1% and unscreened blood transfusion in 4.5%. The most frequent symptoms on presentation were fever in 95.4% of patients, cough and weight loss in 77.3% and diarrhoea in 59.1%. The most common signs were hepatomegaly in 77.3%, pyrexia and crepitations in 72.7%, and pallor in 40.9%. Commonly diagnosed conditions were undernutrition, diarrheal disease, oral thrush, and pneumonia. Tuberculosis co-infection was diagnosed in 18.2% of children. Fourteen (63.6%) children had advanced and severe immunodeficiency. Mortality rate over 6 months was 18.2%.

CONCLUSION

Early diagnosis of pediatric HIV and prompt institution of treatment in children would go a long way in reducing the scourge of the disease.

Efficacy of a static progressive stretch device as an adjunct to physical therapy in treating adhesive capsulitis of the shoulder: a prospective, randomised study

BACKGROUND

Stress relaxation and static progressive stretch are techniques used for non-surgical restoration of shoulder range of motion for patients with adhesive capsulitis.

OBJECTIVES

To compare a static progressive stretch device plus traditional therapy with traditional therapy alone for the treatment of adhesive capsulitis of the shoulder.

DESIGN

Prospective, randomised controlled trial.

PARTICIPANTS

Sixty patients with adhesive capsulitis of the shoulder were assigned at random to an experimental group or a control group.

INTERVENTIONS

Both groups received three traditional therapy sessions per week for 4 weeks. In addition, the experimental group used a static progressive stretch device for 4 weeks.

MAIN OUTCOME MEASURES

The primary outcome measure was shoulder range of motion (active and passive shoulder abduction, and passive shoulder external rotation). The secondary outcome measures were function [measured by the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire] and pain [measured using a visual analogue scale (VAS)].

RESULTS

At baseline, there were no differences between the two groups. However, after the intervention, there were significant (P<0.05) differences between the groups for all outcome parameters: 0.3 for mean VAS scores [95% confidence interval (CI) -0.6 to 1.1], -10.1 for DASH scores (95% CI -21.0 to 0.9), 21.2° for shoulder passive external rotation (95% CI 16.8 to 25.7), 26.4° for shoulder passive abduction (95% CI 17.4 to 35.3), and 27.7° for shoulder active abduction (95% CI 20.3 to 35.0). At 12-month follow-up, the differences between the groups were maintained and even increased for mean shoulder range of motion, VAS scores and DASH scores, with significant differences (P<0.001) between the groups: -2.0 for VAS scores (95% CI -2.9 to -1.2), -53.8 for DASH scores (95% CI -64.7 to -42.9), 47.9° for shoulder passive external rotation (95% CI 43.5 to 52.3), 44.9° for shoulder passive abduction (95% CI 36.0 to 53.8), and 94.3° for shoulder active abduction (95% CI 87.0 to 101.7).

CONCLUSION

Use of a static progressive stretch device in combination with traditional therapy appears to have beneficial long-term effects on shoulder range of motion, pain and functional outcomes in patients with adhesive capsulitis of the shoulder. At 12-month follow-up, the experimental group had continued to improve, while the control group had relapsed.

On the spectroscopic analyses of thioindigo dye

A combined experimental and theoretical study on molecular structure and vibrational frequencies of thioindigo was reported. The FT-IR spectrum of thioindigo is recorded in the solid phase. The equilibrium geometries, harmonic vibrational frequencies, thermo-chemical parameters, total dipole moment and HOMO-LUMO energies are calculated by density functional theory DFT/B3LYP utilizing 6-311G(d,p) basis set. Results showed that cis-isomer is highly recommended to be a promising structure for many applications in optoelectronic devices due to its high calculated dipole moment value (3.44 Debye) which indicates its high reactivity to interact with the surrounding molecules as compared to the trans-isomer which has no dipole moment. Both isomers have a similar HOMO-LUMO energy gap, of 3.02 eV (cis-isomer) and 2.78 eV (trans-isomer).

FT-IR spectroscopic analyses of 3-Methyl-5-Pyrazolone (MP)

In the present work both experimental and computational FT-IR spectroscopic studies on 3-Methyl-5-Pyrazolone (MP) were reported. Experimental FT-IR spectrum for MP compound is recorded in powder form. Important physical parameters were reported such as structural parameters, vibrational frequencies, entropy, total energy, total dipole moment and HOMO-LUMO energy gap using DFT/B3LYP/6-311G(d,p) basis set. MP molecule has a total dipole moment of 2.83 Debye and HOMO-LUMO energy gap of 5.80 eV. Results indicate also that exposure to UV changes the spin from singlet to doublet state; one can conclude that MP compound may undergo anomalous Zeeman like effect.