58. CHLAMYDIA SCREENING OF ANTENATAL WOMEN IN MELBOURNE BETWEEN 16-25 YEARS

Objective: Routine chlamydia screening of pregnant women is not widely practiced in Australia and limited data are available on the prevalence of infection in this population. This cross-sectional study sought to determine the prevalence of genital chlamydial infection among pregnant women aged 16-25 attending antenatal clinics in Melbourne. Methods: Consecutive women attending 4 major maternity services covering northern, western, eastern and south-eastern Melbourne were approached between October 2006 and May 2007. Of 931 eligible women (those aged 16-25 who had not already been tested for chlamydia) attending the clinics at the time of recruitment, 882 (95%) were approached and 845 (96%) agreed to participate. Participants completed a questionnaire which was translated into Chinese, Vietnamese and Arabic, and provided first-void urine which was tested for Chlamydia trachomatis using polymerase chain reaction. Results: Eighteen percent of women had a preferred language other than English. Of the 826 tests which were non assessable, 30 were positive representing a prevalence rate of 3.6% (95% CI: 2.5-5.1%). However, among women aged 16-20, 14 of 203 women were infected, representing a prevalence rate of 6.9% (95% CI: 3.8-11.3%). All infected women received treatment with azithromycin and all who have had repeat chlamydia tests to date have been negative. Conclusion: In this study of a wide cross-section of pregnant Melbourne women, chlamydial infection was common, particularly among teenagers. Screening was highly acceptable, with the great majority of women approached agreeing to be screened.

Interleukin-1 receptor antagonist gene polymorphism in patients with rheumatoid arthritis in India

BACKGROUND & OBJECTIVES

Interleukin-1 receptor antagonist (IL-1Ra) is a naturally occurring anti-inflammatory molecule that blocks action of IL-1. Polymorphism in IL-1Ra gene intron 2 results in differences in production of IL-1Ra. These polymorphisms are reportedly associated with autoimmune disease susceptibility in different studies. However, such data are lacking from India. We undertook this study to examine the IL-1Ra polymorphism as a susceptibility marker in patients with rheumatoid arthritis (RA).

METHODS

DNA samples from 107 patients with RA and 111 healthy controls were used to study genotypes of the IL-1RA gene by PCR. Allelic frequencies and carriage rates were calculated and compared in both the groups.

RESULTS

Among the 107 patients with RA, 93 were females and 75 per cent were seropositive for rheumatoid factor. The frequencies of IL-1RA alleles in controls were as follows: Allele 1 (IL- 1RN*1) was 83.33 per cent, IL-1RA allele 2 (IL-1RN*2) was 16.21 per cent and allele 3 (0.46%). In RA patients the allele frequencies were 84.11 per cent for IL-1RN*1, 14.95 per cent for IL- 1RN*2, 0.47 per cent each for IL-1RN*3 and IL-1RN*4. There was no difference in frequency of different alleles between the two groups. However, homozygosity for allele 2 was more frequent in controls (9.91%) as compared to patients (4.67%).

INTERPRETATION & CONCLUSION

Our findings indicated that IL-1RA polymorphism was not a susceptibility marker in RA nor did it show any association with seropositivity, Sjögren's syndrome or subcutaneous nodules. Further studies with large sample need to be done to confirm these findings.

Substance-dependent women attending a de-addiction center in North India: sociodemographic and clinical profile

BACKGROUND

Treatment-seeking is limited in women substance abusers. Studying the sociodemographic and clinical profile of treatment-seeking substance-dependent women can help us to understand the problem better and respond appropriately in terms of primary and secondary prevention strategies.

AIM

To study the sociodemographic and clinical profile of women attending a de-addiction centre in North India.

DESIGN AND METHODOLOGY

Retrospective structured chart review of 35 women substance abusers.

RESULTS

The results indicated that a typical subject was urban (86%), married (63%), nuclear family (60%), based housewife (57%), educated up to school completion (54%), and having poor social support (57%). The common substances were opioids (60%), followed by alcohol (17%), and tobacco and benzodiazepines (11.5% each). The mean age at onset of substance use was 30.5 years, the mean duration of use was 9 years and mean duration to develop dependence was 5.5 years. The common reasons for initiating use were medical (63%) and curiosity (34%). Comorbidity profile was: physical illness (34%), psychiatric illness (23%) and dependence on another substance (14%). Only 20% had a family history of substance dependence. The social impairment ranged from 77% for social to 40% for financial and none for legal aspects. A typical subject had followed up 4.2 times in 8.4 months, while 54% were abstaining, 40% were continuing their substance dependence at the last follow up.

CONCLUSIONS

The results suggest that the development of substance dependence in women is a combination of genetic, personal, and social vulnerability factors, including the drug culture of the social milieu and the poor social support. Comorbidity and impairment are common features.

Two cases of subungual glomus tumor

Glomus tumors are uncommon, small, painful, and usually benign hamartomas arising from the arterial end of the glomus body. They often present early in the subungual stage because of intense pain. Two female patients with subungual glomus tumor are reported here. The intense pain associated with this tumor had led to disuse atrophy of the upper limb in one case. Hildreth's sign and Love's test were positive in both, but imaging did not help in preoperative diagnosis. Tumors were resected by transungual approach, leaving a 3-mm-wide margin. There was no recurrence after 1-year follow-up in both instances.

Cost of ambulatory care of diabetes mellitus: a study from north India

BACKGROUND

Diabetes mellitus is a chronic and potentially disabling disease that represents an important public health and clinical concern because of the economic burden it imposes on the person, family, and society. Despite this, data regarding cost of care of diabetes mellitus from developing countries are scarce. This study aimed to assess the cost of care of Indian patients with diabetes mellitus.

METHODS

Cost of illness in 50 outpatients with diabetes mellitus (diagnosed according to WHO criteria, Expert Committee, 1997) was assessed over a six month period using a specially designed questionnaire, together with structured assessments of disability.

RESULTS

Total annual cost of care was 14 508 rupees (263.78 euros). The largest proportion of the total cost was made up of direct costs (68%), followed by indirect costs (28.76%) and provider's costs (2.8%). Drug costs were high. Total treatment cost was significantly higher in those who were more educated, those who visited the hospital more often, and those receiving a greater number of drugs.

CONCLUSION

From this study it can be concluded that diabetes mellitus is an expensive illness to treat even in developing countries. The main brunt of financial burden is borne by the family. Any efforts at cost reduction should, therefore, have the family as its focus, and relieving the family of this financial burden needs to be prioritised.

Cost of care of schizophrenia: a study of Indian out-patient attenders

OBJECTIVE

To assess the cost of care of Indian out-patients with schizophrenia.

METHOD

Cost of illness in 50 out-patients with schizophrenia was assessed over a 6-month period together with structured assessments of psychopathology and disability, and compared with 50 out-patients with diabetes mellitus.

RESULTS

Total annual costs of care of schizophrenia were 274 US dollars; these were not significantly different from diabetes mellitus. Indirect costs (63%) were higher than direct costs. Drug costs were high. The main brunt of financial burden was borne by the family. Total treatment costs in schizophrenia were significantly higher in those who were unemployed, those who visited the hospital more often, and were more severely ill and disabled.

CONCLUSION

Schizophrenia is an expensive illness to treat even in developing countries. Costs of care are similar to those of chronic physical illness, such as diabetes mellitus. Costs are higher in severely ill and disabled patients.

Substance-dependent women attending a de-addiction center in North India: sociodemographic and clinical profile

BACKGROUND

Treatment-seeking is limited in women substance abusers. Studying the sociodemographic and clinical profile of treatment-seeking substance-dependent women can help us to understand the problem better and respond appropriately in terms of primary and secondary prevention strategies.

AIM

To study the sociodemographic and clinical profile of women attending a de-addiction centre in North India.

DESIGN AND METHODOLOGY

Retrospective structured chart review of 35 women substance abusers.

RESULTS

The results indicated that a typical subject was urban (86%), married (63%), nuclear family (60%), based housewife (57%), educated up to school completion (54%), and having poor social support (57%). The common substances were opioids (60%), followed by alcohol (17%), and tobacco and benzodiazepines (11.5% each). The mean age at onset of substance use was 30.5 years, the mean duration of use was 9 years and mean duration to develop dependence was 5.5 years. The common reasons for initiating use were medical (63%) and curiosity (34%). Comorbidity profile was: physical illness (34%), psychiatric illness (23%) and dependence on another substance (14%). Only 20% had a family history of substance dependence. The social impairment ranged from 77% for social to 40% for financial and none for legal aspects. A typical subject had followed up 4.2 times in 8.4 months, while 54% were abstaining, 40% were continuing their substance dependence at the last follow up.

CONCLUSIONS

The results suggest that the development of substance dependence in women is a combination of genetic, personal, and social vulnerability factors, including the drug culture of the social milieu and the poor social support. Comorbidity and impairment are common features.

Bovine chymosin: production by rDNA technology and application in cheese manufacture

Bovine chymosin, an aspartyl protease extracted from abomasum of suckling calves, is synthesized in vivo as preprochymosin and secreted as prochymosin which is autocatalytically activated to chymosin. Chymosin is bilobular, with Asp 32 and Asp 215 acting as the catalytic residues. Chymosin A and chymosin B have pH optima of 4.2 and 3.8, respectively, and act to initiate milk clotting by cleaving kappa-casein between Phe 105 and Met 106. The gene encoding chymosin has been cloned and expressed in suitable bacteria and yeast hosts under the control of lac, trp, trp-beta, gly A genes, and serine hydroxymethyl-transferase promoters. Protein engineering of chymosin has also been attempted. A number of companies are now producing recombinant chymosin for commercial use in cheese manufacture.

Point surveillance of Staphylococcus aureus carriage among medical staff in Infectious Diseases Hospital, Kuwait

OBJECTIVE

To investigate the carriage of Staphylococcus aureus among doctors and nurses in Infectious Diseases Hospital, Kuwait, following the detection of 3 cases of methicillin-resistant S. aureus (MRSA).

MATERIALS AND METHODS

A total of 260 nasal and throat swabs were obtained from 19 doctors and 111 nurses and cultured for the carriage of S. aureus. Forty-three S. aureus were identified based on their growth characteristics on mannitol-salt agar, catalase and tube coagulase and DNA hydrolysis. The isolates were tested for susceptibility to antibacterial agents and typed by phage typing; plasmid analysis and pulsed-field electrophoresis were carried out to determine their relatedness.

RESULTS

Of the 19 doctors, 4 (21%) had nasal carriage while only 1 of them had a throat carriage. Sixteen (14.4%) nurses carried S. aureus in their noses and 20 (18%) in their throats. The combined nasal carriage rate for both doctors and nurses was 15.8%, and combined throat carriage was 16.6%. None of them carried MRSA. The isolates were resistant to penicillin G (90%), tetracycline (23.3%), erythromycin (9.3%) and cadmium (100%). Typing of the isolates showed a variety of phage types, plasmid and pulsed-field gel electrophoresis patterns.

DISCUSSION

None of the doctors or nurses carried MRSA. Typing of the methicillin-susceptible strains that they carried demonstrated that the S. aureus were different, indicating an absence of a dominant clone capable of spreading. It is important to maintain a low carriage of S. aureus among health-care workers.

Clinico-mycological evaluation of onychomycosis at Bangalore and Jorhat

INTRODUCTION

Clinical and mycological features of onychomycosis show variation with time and place.

MATERIAL AND METHODS

A study to analyze the morphological variants and mycological isolates of onychomycosis was carried out in 50 patients attending the dermatology out-patient departments at the Air Force Hospitals at Bangalore and at Jorhat. Nail clippings were subjected to direct microscopy and cultured on Sabouraud's Dextrose Agar.

RESULTS

The commonest age group affected (56%) was the 20-40 year age group. The fingernails alone were involved in 24 (48%) patients, the toenails alone in 15 (30%) patients, and both in 11 (22%) patients. Distal and lateral subungual onychomycosis was encountered in 41 (82%) patients, proximal superficial onychomycosis and total dystrophic onychomycosis in 3 each (6%), paronychia in 2 (4%) and superficial white onychomycosis in 1. Of the 59 samples cultured, dermatophytes were grown in 14 (23.7%), non-dermatophyte moulds (NDM) in 13 (22.0%), candida in 10 (16.8%) and no growth in 22 (37.2%) samples.

CONCLUSION

Among the dermatophytes, Trichophyton rubrum, and among the NDM, Aspergillus spp., were the commonest isolates.

Retrospective, longitudinal, and cross sectional study of visual acuity impairment in choroideraemia

BACKGROUND/AIMS

Few studies have reported on the change in visual acuity (VA) in patients with choroideraemia. In order to determine the degree and rate of VA impairment associated with this disease, the central VA was analysed in a large group of patients with choroideraemia.

METHODS

The authors completed a retrospective, cross sectional review of 115 patients with choroideraemia from three tertiary care centres. A longitudinal analysis was performed on 45 of these patients who met the inclusion criteria of at least three visits over a minimum period of 4.5 years. Multiple linear regression analysis was used to explore the 5 year rate of VA change while controlling for initial VA and initial age. Multiple logistic regression was also used to investigate VA impairment.

RESULTS

In the cross sectional group (n = 115), 84% (87/103) of patients under the age of 60 had a VA of 20/40 or better while 33% (4/12) of patients 60 years of age or older had a VA of 20/200 or worse at their most recent visit. The majority of the patients (93%) in the longitudinal subgroup of 45 patients had a VA of 20/30 or better at their initial visit. The mean 5 year rate of VA change was 0.09 logMAR equivalent (approximately one line on the Lighthouse chart).

CONCLUSION

In this cohort of patients with choroideraemia, there was typically a slow rate of VA loss and the prognosis for central VA retention was, as a group, favourable until the seventh decade.

Changing trends in sexually transmitted diseases in North Eastern India

A retrospective data analysis was carried out to find the trends in frequency and distribution of different STDs in North Eastern (NE) India during 1995-1999. The commonest STD was chancroid (25.7%) followed by condylomata acuminata (CA), nongonococcal urethritis (NGU), lymphogranuloma venereum (LGV), syphilis, gonorrhoea (GONO), herpes genitalis (HG), mixed infection (MI) and balanoposthitis (BP). Interestingly no case of donovanosis (Dono) was seen. HIV infection accounted for 9.62% of the total STD patients. A comparison of the present data with that reported a decade back (1986-1990) revealed a sharp decline in the incidence of syphilis, chancroid, GONO, whereas a conspicuous upward trend in CA and NGU. Factors responsible for these variations are analysed briefly.

Auditory function following spinal analgesia. Comparison of two spinal needles

BACKGROUND AND OBJECTIVE

Auditory impairment is among the lesser known complications of spinal analgesia. The aim of the present study was to determine the degree of vestibulocochlear dysfunction in patients undergoing spinal analgesia for lower abdominal surgery.

METHODS

Eighty patients who had received spinal analgesia for lower abdominal surgery were studied. Males were undergoing inguinal herniorraphy and the females tubectomy. Audiograms were performed before operation and on the second and seventh postoperative days. Hearing levels were measured from 250 Hz-8 kHz. In Group 1 (n = 40) a 22-gauge, cutting type of spinal needle (Howard Jones) was used. In Group 2 (n = 40) a 25-gauge, non-cutting spinal needle (Whitacre) was used.

RESULTS

Hearing loss >10 dB was noticed in three patients in Group 1 and none in Group 2. The mean hearing level was more reduced in Group 1 patients.

CONCLUSIONS

Use of cutting type spinal needle is associated with a greater decrease in mean hearing levels compared to the non-cutting type.

Invasive amebiasis: challenges in diagnosis in a non-endemic country (Kuwait)

Invasive zymodemes of the enteric protozoan Entamoeba histolytica infect the large intestine and cause extra-intestinal lesions such as amebic liver abscess (ALA). The clinical manifestations of ALA are protean, particularly in patients presenting in a non-endemic, desert country such as Kuwait, and diagnosis becomes problematic. In this study, we present cases of ALA to illustrate the clinical and diagnostic challenges. For serodiagnosis of ALA, we compared the sensitivity and specificity of the indirect hemagglutination assay (IHA) with the ImmunoTab assay and an enzyme-linked immunosorbent assay (ELISA) for this geographic region. We tested sera of 110 patients with ALA, 1,224 patients suspected of having invasive amebic infection, and 50 Europeans with no travel history to an amebic-endemic area. The IHA was simple, rapid, easy to perform, and reliable (sensitivity = 99%, specificity > 95%). The performance of the IHA in detecting ALA in suspected cases was significantly better than that of the ELISA and the ImmunoTab test. Compared with the IHA, both the ELISA and ImmunoTab assay detected relatively higher numbers of false-positive cases (4.7% and 3.6%, respectively). With the availability of ultrasound and computed tomography scans, the serology correlates excellently with the clinical presentation. In chronic cases where fibrosis may be present around the abscess, the IHA has limitations, as in the follow-up of treated patients. Pitfalls in diagnosis are highlighted by discussing the differential diagnosis of ALA from bacterial hepatic abscesses and infected hydatid cysts. Most importantly, the IHA in such cases was invariably at a titer that is considered not significant.

Purification and characterization of a bacteriocin-like compound (Lichenin) produced anaerobically by Bacillus licheniformis isolated from water buffalo

AIMS

To characterize a bacteriocin-like factor from Bacillus licheniformis 26 L-10/3RA isolated from buffalo rumen.

METHODS AND RESULTS

The culture supernatant exhibited the antibacterial activity against a number of indicator organisms in a cut-well agar assay under anaerobic conditions. The inhibitory component was purified by following ammonium sulphate precipitation, gel filtration and ion exchange chromatography and confirmed to be a single peptide. A single band on tricine-sodium dodecyl sulphate-polyacrylamide gel electrophoresis confirmed that the peptide was purified to homogeneity and having an estimated molecular mass of approximately 1400 dalton. Complete amino acid sequence of the peptide yielded 12 amino acids from the N-terminal end (ISLEICXIFHDN). No homology with previously reported bacteriocins was observed and has been designated as Lichenin. Lichenin was found to be hydrophobic, sensitive to atmospheric oxygen, retained biological activity even after boiling for 10 min and was active over a pH range of 4.0-9.0.

CONCLUSIONS

The Lichenin represents the first anaerobiosis specific expression of bacteriocin-like compound isolated from Bacillus licheniformis 26 L-10/3RA of buffalo rumen origin.

SIGNIFICANCE AND IMPACT OF THE STUDY

Lichenin could be a potential candidate for manipulating the rumen function at molecular level intended for improving the productivity of the ruminant.

Retinal findings in melanoma-associated retinopathy

PURPOSE

To report unusual fundus findings in two cases of melanoma-associated retinopathy.

METHODS

Observational case reports. The histories of two patients with melanoma-associated retinopathy were reviewed. Sera from both patients were examined for antibodies against retinal bipolar cells. Immunofluorescence was performed on cryostat sections of unfixed normal human retinas. Sera and IgG from both patients were tested against a known melanoma-associated retinopathy patient as well as a control subject.

RESULTS

Our patients had metastatic, cutaneous melanoma and a clinical syndrome consistent with melanoma-associated retinopathy. Both patients had serum antibodies that were reactive against retinal bipolar cells. They had unusual fundus changes not previously described in association with melanoma-associated retinopathy. One patient also developed vitiligo.

CONCLUSION

Patients with metastatic cutaneous melanoma and melanoma-associated retinopathy may present unusual fundus lesions that may be caused by autoimmunity which is part of the clinical picture of melanoma-associated retinopathy or metastatic melanoma.

Generalised recessive dystrophic epidermolysis bullosa in two sisters

Two female siblings of a family presented with a mechanobullous disorder since birth. Both had retarded physical development, flaccid bullac, extensive cutaneous erosions and scars, mucosal erosions, milia, corneal haziness, deformed and carious teeth, dystrophic nails, cicatricial alopecia of scalp and positive Nikolsky's sign. Skin biopsy revealed subepidermal bulla. They were diagnosed as generalized recessive dystrophic epidermolysis bullosa. They were given oral phenytoin but failed to show significant response.

A study of dengue imported to Kuwait during 1997-1999

This study was carried out on sera from 210 patients in Kuwait in 1997-1999. All of the patients were suffering from febrile illness and had recently visited dengue- (DEN) endemic areas. The sera were screened for DEN virus by inoculation into cultures of the Aedes albopictus cell clone C6/36 (virus isolation) and by IgM capture ELISA (detection of DEN virus-specific IgM antibodies). In the cell cultures, DEN virus could not be isolated from any of the patients' sera. However, sera from 19 patients were positive for DEN virus-specific IgM antibodies. All these 19 sera were tested for the presence of DEN virus-specific RNA by reverse transcription-PCR (RT-PCR) using DEN virus types-common (consensus) primers. In addition, the type of DEN virus was identified by using type-specific primers in a semi-nested PCR. The results showed that two of the 19 patients were infected with DEN virus type 2. This report of 19 patients with serological evidence of DEN infection indicates that imported DEN is a real threat to Kuwait, a country non-endemic for DEN but with a large portion of the population vacationing in DEN-hyperendemic areas during the peak DEN season and then returning to Kuwait.