Biodiversity of phosphate solubilizing bacteria in rhizosphere of chickpea, mustard and wheat grown in different regions of Haryana

The native population of phosphate solubilizing bacteria (PSB) was studied in the rhizosphere of chickpea, mustard and wheat grown in different regions of Haryana. A total of 193 PSB were isolated from 245 rhizospheric samples collected from south-west and north-east zones. The PSB count showed large variations (3-67 × 10(5)cfu/g) and biodiversity within the crop and place of sampling. Using biochemical analysis, the isolates were tentatively identified as belonging to four genera, Pseudomonas, Aeromonas, Klebsiella and Enterobacter. Phosphate solubilization of these isolates varied from 5.9 to 123.8% and 2.2 to 227.2 μg/ml in solid and liquid Pikovskaya's medium, respectively. Based on their morphological traits, all the isolates were placed into 20 groups, majority of them falling in the group having white, round and gummy colonies, irrespective of the crop or the region. The intrinsic antibiotic resistance pattern showed large variations among the isolates and most of the isolates were resistant to streptomycin, ampicillin and penicillin. The highest PSB number and greatest variability were found in the rhizosphere of chickpea, followed by wheat and then mustard.

High-resolution computed tomography features in patients with chronic obstructive pulmonary disease

INTRODUCTION

In recent years, there has been increasing interest in diagnosing various components of chronic obstructive pulmonary disease (COPD) using high-resolution computed tomography (HRCT). The present study was undertaken to evaluate HRCT features in patients with COPD.

METHODS

40 male patients with COPD (age 40 years or older) and with a significant smoking history (20 pack-years or more) were included in the study. They were evaluated for HRCT features including vascular attenuation and distortion, mosaic attenuation pattern, directly visible small airways, low attenuation areas of emphysema and measures of hyperinflation of the lungs: tracheal index, sterno-aortic distance, thoracic cage ratio and thoracic cross-sectional area.

RESULTS

The tracheal index ranged from 0.46 to 0.94; Saber-sheath trachea was found in 14 patients. The mean thoracic cage ratio at two levels, carina and 5 cm below carina, were 0.69 (range 0.61-0.78) and 0.73 (range 0.62-0.83), respectively. Sterno-aortic distance at carinal level ranged from 1.43 to 4.55 cm, with a mean of 3.00 cm. Directly visible small airways was the commonest finding (36 patients), followed by vascular attenuation (25 patients), mosaic attenuation pattern (16 patients) and vascular distortion (8 patients). Among various subtypes of emphysema, centriacinar emphysema was commonest (16 patients), followed by paraseptal (13) and panacinar emphysema (11).

CONCLUSION

There are certain specific HRCT features of emphysema and it is possible on HRCT to identify the subtypes of emphysema, such as centriacinar, panacinar and paraseptal emphysema. Various features of hyperinflation can also be well identified and quantified on HRCT.

Annual risk of tuberculosis infection among tribal population of central India

OBJECTIVE

To estimate the annual risk of tuberculosis infection (ARTI) among tribal children of Madhya Pradesh, central India.

METHODS

Community-based, cross-sectional tuberculin survey among children aged 1-9 years in the tribal population of Madhya Pradesh. Multistage stratified cluster sampling was used to select a representative random sample of villages predominated by tribal population from selected districts. A total of 4802 children were tuberculin-tested with 1TU of PPD RT 23 and the reaction sizes read after 72 h.

RESULTS

A total of 3062 (64%) children had no BCG scar. The frequency distribution of children by reaction sizes indicated a fair mode at 18 mm in the right hand side of the distribution. By mirror-image technique, the prevalence of infection among children with no recognizable BCG scar was estimated as 6.8% (95% CI: 4.8-8.9%). The ARTI was computed as 1.3% (0.9-1.7%). The corresponding figures for children irrespective of scar status were 7.1% (95% CI: 5.5-8.8%) and 1.3% (1.0-1.7%) respectively.

CONCLUSIONS

The risk of tuberculosis infection in tribal population of Madhya Pradesh, central India is not different from other areas of the country. There is, however, a need to further intensify tuberculosis control measures on a sustained and long-term basis.

Carotid intimomedial thickness in type 2 diabetic patients and its correlation with coronary risk factors

AIMS

To compare the carotid intimal-medial thickness in type 2 diabetics with and without coronary artery disease (CAD), and to correlate the intimal-medial thickness (IMT) with known coronary risk factors.

METHODS

One hundred and eleven patients of type 2 diabetes were recruited for the study. History and physical examination were recorded. Laboratory investigations included fasting and 2-hour post-prandial blood sugar, blood urea, serum creatinine, lipid profile, glycated haemoglobin, and microalbuminuria. Ultrasonographic scanning of the carotid arteries was performed to measure the carotid IMT. For identification of cases of silent ischaemia, treadmill test (TMT) was performed.

RESULTS

The study group was divided into a non-CAD group (n=40), and a CAD group (n=71). The mean carotid IMT of the group as a whole, was 0.840 +/- 0.2 mm. The mean carotid IMT was significantly higher (p<0.0001) in type 2 diabetics with CAD (both overt and silent) than in those without CAD. In diabetics with CAD, the systolic blood pressure, diastolic blood pressure and triglycerides were found to be predictors of high mean carotid IMT. On subgroup analysis of the cases with silent ischaemia, the variables affecting carotid IMT were serum creatinine, total cholesterol, microalbuminuria/proteinuria, serum triglyceride levels, and diastolic blood pressure.

CONCLUSION

A high carotid IMT is a surrogate and reliable marker of higher risk of CAD amongst type 2 diabetic patients, even in those without overt CAD. The study underlines the utility of carotid IMT as a simple, non-invasive, safe, and cheap screening test for the assessment of risk/prognosis of CAD in type 2 diabetics. We have also demonstrated the usefulness of measuring IMT, as a means to detect silent CAD among type 2 diabetics.

Travel-associated Legionnaires’ disease in Europe: 2006

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Travel-associated Legionnaires disease in Europe: 2006

Twenty countries reported 921 cases of travel-associated Legionnaires' disease to EWGLINET (the European Surveillance Scheme for Travel-Associated Legionnaires' Disease) with onset during 2006; 875 confirmed and 46 presumptive. Thirty three cases died, giving a case fatality rate of 3.6%. Of the 124 new clusters detected in 2006, 43 would not have been identified without the EWGLINET scheme. A total of 146 investigations were conducted at cluster sites according to the standards of the EWGLINET investigation guidelines; 111 of these investigations were associated with the new clusters while 35 investigations were associated with re-offending sites (where additional cases had onset after a report was received to say that investigations and control measures had been satisfactorily conducted). The names of four accommodation sites were published on the EWGLI website. Overall, there has been an upwards trend in case numbers since the scheme was founded, which has implications for the work load of public health authorities across Europe and for the tour industry. Despite this increasing pressure on public health authorities, environmental investigations are being conducted in a timely manner.

Tuberculous infection in Saharia, a primitive tribal community of Central India

A cross-sectional tuberculin survey was carried out to estimate the prevalence of tuberculous infection and the annual risk of tuberculosis infection (ARTI) among children of Saharia, a primitive ethnic group in Madhya Pradesh, Central India. A total of 1341 children aged 1-9 years were subjected to tuberculin testing with 1 TU of PPD RT 23 and the reaction sizes were read after 72 h. The proportion of BCG scar-positive children was 34.6%. The frequency distribution of children by reaction sizes indicated a clear-cut anti-mode at 11 mm and a mode at 18 mm at the right-hand side of the distribution. The prevalence of infection among children irrespective of BCG scar was estimated as 20.4% (95% CI 18.2-22.5%) and the ARTI was 3.9% (95% CI 3.5-4.3%). The corresponding figures were 21.1% (95% CI 18.3-23.8%) and 3.9% (95% CI 3.4-4.5%) among BCG scar-negative children and 19.0% (95% CI 15.4-22.5%) and 4.0% (95% CI 3.2-4.8%) among BCG scar-positive children. The findings of the present study show a high prevalence of tuberculous infection and high ARTI in this primitive ethnic group. There is an urgent need to further intensify tuberculosis control measures on a sustained and long-term basis in this area.

Anaesthetic Management of Tracheal Agenesis

Tracheal agenesis is a rare but uniformly fatal congenital condition that obstetricians, neonatologists or anaesthesiologists may encounter as an unexpected emergency. Ventilation with bag and mask or through an endotracheal tube placed in the oesophagus may be the only options left for immediate survival and evaluation. Ventilation and maintenance of adequate oxygenation can be difficult during surgical interventions. We report a case of neonate in which ventilation and anaesthesia were maintained through an endotracheal tube in the oesophagus and frequent episodes of drop in oxygen saturation were observed during surgery. Anaesthetic management, airway and other issues are discussed.JNMA J Nepal Med Assoc. 2008 Jul-Sep;47(171):142-144.

Anaesthetic management of tracheal agenesis

Tracheal agenesis is a rare but uniformly fatal congenital condition that obstetricians, neonatologists or anaesthesiologists may encounter as an unexpected emergency. Ventilation with bag and mask or through an endotracheal tube placed in the oesophagus may be the only options left for immediate survival and evaluation. Ventilation and maintenance of adequate oxygenation can be difficult during surgical interventions. We report a case of neonate in which ventilation and anaesthesia were maintained through an endotracheal tube in the oesophagus and frequent episodes of drop in oxygen saturation were observed during surgery. Anaesthetic management, airway and other issues are discussed.

Prevalence and predictors of pulmonary artery hypertension in systemic sclerosis

INTRODUCTION

Development of pulmonary artery hypertension (PAH) worsens the prognosis of systemic sclerosis (SSc). There is paucity of data on PAH in patients with SSc in India. We have attempted to determine the prevalence and predictors of pulmonary artery hypertension in systemic sclerosis using noninvasive cardiopulmonary evaluation.

OBJECTIVES

(1) To study the prevalence of PAH in SSc (2) To study the predictors of PAH in SSc (gender, age of onset of disease, duration of disease, extent of skin involvement, digital infarcts/ulcer, interstitial lung disease.

MATERIAL AND METHODS

Clinical and functional characteristics of 100 patients of systemic sclerosis who had undergone screening echocardiography to detect pulmonary artery hypertension were studied.

RESULTS

PAH was found in 32% patients on 2D-echocardiography. Prevalence of PAH did not differ between patients with limited cutaneous SSc (lcSSc) and patients with diffuse cutaneous SSc (dcSSc). On multiple logistic regression analysis, none of the studied variables was found to be independent predictor of PAH in SSc.

CONCLUSION

PAH in SSc occurs in significant proportion of patients without any "red flag signs" in early stages. Non-invasive screening of patients with SSc for PAH will help in early diagnosis and appropriate timely therapeutic intervention before significant end-organ damage occurs.

Feasibility of community neonatal death audits in rural Uttar Pradesh, India

OBJECTIVE

Medical audit is a widely promoted strategy in hospitals, but experience within community settings is scant. Community neonatal death audit is a form of audit, which involves a systematic analysis of the quality of care provided in the home, danger sign recognition and care seeking decision making for neonatal illness. This research was conducted in Uttar Pradesh, India, to investigate the feasibility and cultural acceptability of community neonatal death audits.

STUDY DESIGN

During November-December 2004, we conducted three in-depth interviews with family members of deceased neonates, and six focus group discussions with family and community members. Three approaches were evaluated: in-depth interview with the family before engaging them in an audit with the community; preliminary meeting to build rapport with the family and community before conducting an audit; and audit with the family and community in a single focus group. Approaches were interactive processes, involving the community, to identify avoidable factors in a particular death and discuss solutions.

RESULT

Carried out in a culturally sensitive and non-punitive manner, community neonatal death audit was found to be acceptable and feasible. All approaches provoked formal investigation by community members, and stimulated sharing of views, leading to the self-discovery that community perception was a cumulatively amplified effect of individual perceptions. Presence of an educated/experienced community member or health worker served as a catalyst. No one optimal approach was identified.

CONCLUSION

Community neonatal audit is an acceptable approach that shows promise as an effective intervention for improving neonatal health outcomes.

Spontaneous acute subdural haemorrhage, cerebral and pulmonary metastases in a complete mole

Complete and partial moles remit spontaneously in most cases, following evacuation of the uterine cavity. However, either persistent trophoblastic disease or a frank trophoblastic tumour can follow a complete hydatidiform mole. To our knowledge, acute subdural haematoma, as a complication of cerebral metastases, following treatment for hydatidiform mole has not been reported. We describe a 29-year-old woman who presented with spontaneous acute subdural haemorrhage and pulmonary metastases, eight months after evacuation of a complete hydatidiform mole, with a fatal outcome.

Introduction of community-based skin-to-skin care in rural Uttar Pradesh, India

OBJECTIVE

Two-thirds of women globally give birth at home, yet little data are available on use of skin-to-skin care (STSC) in the community. We describe the acceptability of STSC in rural Uttar Pradesh, India, and measured maternal, newborn, and ambient temperature in the home in order to inform strategies for introduction of STSC in the community.

STUDY DESIGN

Community-based workers in intervention clusters implemented a community mobilization and behavior change communication program that promoted birth preparedness and essential newborn care, including adoption of STSC, with pregnant mothers, their families, and key influential community members. Acceptance of STSC was assessed through in-depth interviews and focus groups, and temperature was measured during home visits on day of life 0 or 1.

RESULTS

Incidence of hypothermia (<36.5 degrees C) was high in both low birth weight (LBW) and normal birth weight (NBW) infants (49.2%, (361/733) and 43% (418/971), respectively). Mean body temperature of newborns was lower (P<0.01) in ambient temperatures <20 degrees C (35.9+/-1.4 degrees C, n=225) compared to > or =20 degrees C (36.5+/-0.9 degrees C, n=1450). Among hypothermic newborns, 42% (331/787) of their mothers had a lower temperature (range -6.7 to 0.1 degrees C, mean difference 0.4+/-1.2 degrees C). Acceptance of STSC was nearly universal. No adverse events from STSC were reported. STSC was perceived to prevent newborn hypothermia, enhance mother's capability to protect her baby from evil spirits, and make the baby more content.

CONCLUSION

STSC was highly acceptable in rural India when introduced through appropriate cultural paradigms. STSC may be of benefit for all newborns and for many mothers as well. New approaches are needed for introduction of STSC in the community compared to the hospital.

Percutaneous transvenous mitral commissurotomy in patients with severe mitral stenosis and acute rheumatic fever

There is a concern that percutaneous transvenous mitral commissurotomy (PTMC) performed during acute rheumatic fever (ARF) may result in adverse outcomes. We performed a retrospective study at a tertiary care center. Ten patients (ages 8-12 years) with severe symptomatic mitral stenosis and ARF who underwent PTMC (ARF group) were compared with 10 controls with similar mitral valve area (MVA). The procedure was successful in all patients. The median MVA increased from 0.7 to 1.5 cm2 following PTMC in the ARF group and from 0.7 to 1.8 cm2 in the control group [p = not significant (NS)]. The median MVA was 1.2 cm2 in the study group compared to 1.6 cm2 in the control group (p = 0.02) over a mean follow-up of 17.5 +/- 11.7 months. Echocardiographic restenosis occurred in 4 patients (40%) in the ARF group compared to 1 patient (10%) in the control group (p = NS). The improvement in the New York Heart Association functional class was maintained in 8 patients of the ARF group and 9 patients of the control group. PTMC can be performed in children with ARF without an increase in procedural complications. However, the restenosis rates appear to be higher.

Neutrophil chemorepulsion in defined interleukin-8 gradients in vitro and in vivo

We report for the first time that primary human neutrophils can undergo persistent, directionally biased movement away from a chemokine in vitro and in vivo, termed chemorepulsion or fugetaxis. Robust neutrophil chemorepulsion in microfluidic gradients of interleukin-8 (IL-8; CXC chemokine ligand 8) was dependent on the absolute concentration of chemokine, CXC chemokine receptor 2 (CXCR2), and was associated with polarization of cytoskeletal elements and signaling molecules involved in chemotaxis and leading edge formation. Like chemoattraction, chemorepulsion was pertussis toxin-sensitive and dependent on phosphoinositide-3 kinase, RhoGTPases, and associated proteins. Perturbation of neutrophil intracytoplasmic cyclic adenosine monophosphate concentrations and the activity of protein kinase C isoforms modulated directional bias and persistence of motility and could convert a chemorepellent to a chemoattractant response. Neutrophil chemorepulsion to an IL-8 ortholog was also demonstrated and quantified in a rat model of inflammation. The finding that neutrophils undergo chemorepulsion in response to continuous chemokine gradients expands the paradigm by which neutrophil migration is understood and may reveal a novel approach to our understanding of the homeostatic regulation of inflammation.