Molecular and Clinical Features of Heterogeneous Vancomycin-Intermediate Staphylococcus aureus in Tertiary Care Hospitals in South India

Objectives

This study aimed to detect heterogeneous vancomycin-intermediate Staphylococcus aureus (hVISA) among methicillin-resistant S. aureus (MRSA) isolated from healthcare-associated infections and identify staphylococcal cassette chromosome mec (SCCmec) types.

Methods

This study was conducted from February 2019 to March 2020 and included patients admitted in 4 tertiary care hospitals in Karnataka, India. Isolation and identification of MRSA were done using standard bacteriological methods. Antimicrobial susceptibility testing was done using Kirby-Bauer disc diffusion; macrolide-lincosamide-streptogramin B phenotypes were identified using the D test. The minimum inhibitory concentration (MIC) of vancomycin was determined using agar dilution. hVISA were confirmed by the modified population analysis profile-area under the curve test. SCCmec types and the Panton-Valentine leukocidin (pvl) gene were detected using multiplex polymerase chain reaction.

Results

Of 220 MRSA stains, 14 (6.4%) were hVISA. None of the MRSA isolates was vancomycin-intermediate or -resistant and all hVISA were susceptible to linezolid and teicoplanin. The macrolide-streptogramin B phenotype was present in 42.9% of hVISA; 92.9% of the hVISA strains had vancomycin MIC in the range of 1-2 μg/mL. Majority of the hVISA and vancomycin-susceptible MRSA were isolated from patients with skin and soft tissue infections. SCCmec III and IV were present in 50% and 35.7% of hVISA, respectively; 14.3% of the hVISA harboured SCCmec V.

Conclusion

The prevalence rate of hVISA among MRSA was 6.4%. Therefore, MRSA strains should be tested for hVISA before starting vancomycin treatment. None of the isolates was vancomycin-intermediate or -resistant and all the hVISA strains were susceptible to linezolid and teicoplanin. The majority of the hVISA were isolated from patients with skin and soft tissue infections and harboured SCCmec III and IV.

Spondias pinnata bark extract- an ameliorator of inflammatory derangement in etoposide induced mucositis: An experimental approach

Background and Aim:

Mucositis, one of the vulnerabilities of chemotherapy, affects the physiological activities and therapeutic strategies of patients because it can affect the normal cell population. Etoposide is a commonly used chemotherapeutic agent for cancers such as oral, lung, and gastrointestinal. In addition to the abnormal metabolic processes in the body caused by tumorigenesis, new metabolic alterations can occur, such as oxidative stress, antioxidant imbalance, and inflammatory reactions, all of which can contribute to existing patient vulnerability. Therapeutic adjuvants can help overcome these toxic effects. Spondias pinnata is a tropical tree omnipresent in the coastal and Western Ghat section of India that is used for culinary purposes and as a local analgesic. Therefore, we aimed to study the anti-inflammatory effects of S. pinnata in an etoposide-induced mucositis rat model.

Materials and Methods:

Small intestinal tissue homogenates from albino Wistar rats were used to estimate the levels of glutathione (GSH) and nitric oxide (NO), and activities of total antioxidant (TAO), myeloperoxidase (MPO) and Na⁺-K⁺ ATPase. The animals were grouped into: (1) normal control, (2) etoposide-induced mucositis (65 mg/kg bodyweight, single IP dose), (3) S. pinnata control group, and (4) etoposide followed by S. pinnata bark extract (200 mg/kg bodyweight, once in a day). Animals were sacrificed after 24, 48, 72, and 96 h and compared with that of the normal control group (n=6). Statistical analysis was performed using EZR software.

Results:

We observed a significant decrease in the TAO and GSH levels with a marked increase in NO, MPO, and Na⁺-K⁺ ATPase activity in the mucositis group. A tendency to recover from the decreased TAO and GSH levels existed in the treated group, showing the protective effects of S. pinnata bark extract against mucositis. In addition, this extract also showed anti-inflammatory effects as reflected by the recovery in MPO levels at the end of 96 h. Maintenance of Na⁺-K⁺ ATPase activity in the treated group demonstrates the protective effects of the extract against the increased levels observed in the etoposide-induced mucositis group.

Conclusion:

This study revealed the protective effects of S. pinnata bark extract against the oxidative and inflammatory changes that occurred during the development ofmucositis. This would decrease the pathological burden during chemotherapy and prevent any hurdles in therapeutic modalities.

Adherence to Home-based Neuro-rehabilitation Exercise program in Stroke survivors

Background:Post discharge, Home-based exercise program (HEP), prescribed by physiotherapistis an integral part, to plan effective stroke rehabilitation, with the intended goal of maintainingfunctional motor performance and enhancing functional progress.Earlier studies have shown thatmany factors attribute to adherence and barriers for structured group based exercise program. Objective: This study was designed to identify the factors in stroke subjects, which mayinfluence the adherence and barriers to individually tailored HEP post-discharge, in strokesubjects. Method: An analytical cross-sectional study, with non-random sampling, consistingof first onset stroke subjects who had received acute stroke rehabilitation from tertiary carehospitals. Post-discharge, seventy-four participants were followed up and their responses relatedto adherence and barriers to the prescribed HEP by administering a self-reported adherence to home exercise questionnaire. Results: 63.5% were adherent and 36.5% were non-adherent toHEP, among 74 subjects. The adherent group had performed exercises for at least 5-6 times in aweek, for 31-45 minutes each day. Intrinsic factors related to self-efficacy and perceived level ofanticipated recovery had found an association with adherent and non-adherent groups.The mostcommon barriers for adherence to HEP were fear of fall or injury and fatigue for both adherent and non-adherent subjects. Conclusion: This present study helped to put an insight, onto sociodemographicand intrinsic factors, with the level of adherence and to identify the barriers foradherence to individually tailored HEP. Bangladesh Journal of Medical Science Vol.20(1) 2021 p.145-153

Comprehensive Review on Diabetes Associated Cardiovascular Complications - The Vitamin D Perspective

Vitamin D, a steroid hormone is primarily known for its role in calcium and bone mineral homeostasis. Over the years, vitamin D has been implicated in various non-skeletal diseases. The extraskeletal phenomenon can be attributed to the presence of vitamin D receptors (VDRs) in almost all cells and identification of 1-α hydroxylase in extrarenal tissues. The vitamin D deficiency (VDD) pandemic was globally reported with increasing evidence and paralleled the prevalence of diabetes, obesity and cardiovascular diseases (CVDs). A dependent link was proposed between hypovitaminosis D glycemic status, insulin resistance and also the other major factors associated with type 2 diabetes leading to CVDs. Insulin resistance plays a central role in both type 2 diabetes and insulin resistance syndrome. These 2 disorders are associated with distinct etiologies including hypertension, atherogenic dyslipidemia, and significant vascular abnormalities that could lead to endothelial dysfunction. Evidence from randomised clinical trials and meta-analysis, however, yielded conflicting results. This review summarizes the role of vitamin D in the regulation of glucose homeostasis with an emphasis on insulin resistance, blood pressure, dyslipidaemia, endothelial dysfunction and related cardiovascular diseases and also underline the plausible mechanisms for all the documented effects.

Effects of Task Oriented Exercises with Altered Sensory Input on Balance and Functional Mobility in Chronic Stroke: A Pilot Randomized Controlled Trial

Background: Stroke subjects presented with greater postural instability which lead to challenge their balance control in sensory conflict conditions. Studies have shown that deficits of sensorimotor integration and an inability to select the appropriate sensory input are associated with balance measures following stroke.However, limited studies have been focused to sensorimotor integration in balance rehabilitation.Objective: Our study aimed to evaluate the Task Oriented Training (TOT) with sensory manipulation to enhance balance and functional mobility in chronic stroke subjects.Design: Randomized controlled pilot study.Setting: Department of Physiotherapy in a Tertiary care Hospital.Subjects: A convenience sample consisting of 26 hemi paretic subjects at least 6 months post stroke duration with Brunnstrom’s recovery stage ?5 for the lower limb and Berg Balance Score of 40 or above were randomly assigned control group (n=13) and in experimental group (n=13).Interventions: Control group received the conventional physical therapy and in the Experimental group received TOT with manipulations of sensory inputs and provision of sensory conflict for the trunk and lower limb focusing on balance and mobility were implemented for 15 sessions, 5 days a week for 3 weeks with each session of 45-60 mints duration.Outcome measures: Dynamic Gait Index (DGI), Timed Up and Go Test (TUGT) and Fall Efficacy Scale (FES) were analyzed before and after the training.Results: Post training there was a significant improvement in all the outcome measurements for both the groups. However components 3, 4 and 5 of DGI, TUGT and FES of experimental group had a highly significant statistical difference between-group analysis with p<.05.Conclusion:Task oriented exercises with altered sensory input was found to be effective in improving functional mobility in terms of dynamic balance and reduction in their fear of fall levels after a 3 week training program.Bangladesh Journal of Medical Science Vol.16(2) 2017 p.307-313

Clinical manifestations of lead workers of Mangalore, India

Objective: To correlate blood lead levels and clinical manifestations. Participants: Battery workers and painters (occupationally exposed to lead in and around Mangalore, India) and occupationally unexposed controls. Main outcome measures: We measured the blood lead levels by anodic stripping voltammetry, and a clinical examination was carried out on all participants. Results: There was a statistically significant difference between the lead-exposed group and controls with respect to clinical manifestations. The prominent findings among the lead-exposed group were fatigue, abdominal colic, abdominal discomfort, backache, muscular exhaustability, myalgia and paresthesia, at a blood lead level ranging from 0.4 to 116.6 μg/dL. Conclusions: Such a study on battery workers and painters has not been reported in India. Several attempts have been made over the years to relate blood lead levels to adverse health effects. It was not possible to determine a precise blood lead level below which symptoms never occur or a blood lead level at which symptoms are always reported. Toxicology and Industrial Health 2006; 22: 405-413.

Healthcare-Associated Methicillin-Resistant Staphylococcus aureus: Clinical characteristics and antibiotic resistance profile with emphasis on macrolide-lincosamide-streptogramin B resistance

OBJECTIVES

Healthcare-associated methicillin-resistant Staphylococcus aureus (MRSA) is a common pathogen worldwide and its multidrug resistance is a major concern. This study aimed to determine the clinical characteristics and antibiotic susceptibility profile of healthcare-associated MRSA with emphasis on resistance to macrolide-lincosamide-streptogramin B (MLSB) phenotypes and vancomycin.

METHODS

This cross-sectional study was carried out between February 2014 and February 2015 across four tertiary care hospitals in Mangalore, South India. Healthcare-associated infections among 291 inpatients at these hospitals were identified according to the Centers for Disease Control and Prevention guidelines. Clinical specimens were collected based on infection type. S. aureus and MRSA isolates were identified and antibiotic susceptibility tests performed using the Kirby-Bauer disk diffusion method. The minimum inhibitory concentration of vancomycin was determined using the Agar dilution method and inducible clindamycin resistance was detected with a double-disk diffusion test (D-test).

RESULTS

Out of 291 healthcare-associated S. aureus cases, 88 were MRSA (30.2%). Of these, 54.6% were skin and soft tissue infections. All of the isolates were susceptible to teicoplanin and linezolid. Four MRSA isolates exhibited intermediate resistance to vancomycin (4.6%). Of the MRSA strains, 10 (11.4%) were constitutive MLSB phenotypes, 31 (35.2%) were inducible MLSB phenotypes and 14 (15.9%) were macrolide-streptogramin B phenotypes.

CONCLUSION

Healthcare-associated MRSA multidrug resistance was alarmingly high. In routine antibiotic susceptibility testing, a D-test should always be performed if an isolate is resistant to erythromycin but susceptible to clindamycin. Determination of the minimum inhibitory concentration of vancomycin is necessary when treating patients with MRSA infections.

Motor Imagery Training on Muscle Strength and Gait Performance in Ambulant Stroke Subjects-A Randomized Clinical Trial

INTRODUCTION

The ultimate goal of physiotherapy in stroke rehabilitation is focused towards physical independence and to restore their functional ability during activities of daily living (ADLs). Motor imagery (MI) is an active process during which a specific action is reproduced within working memory without any actual movements. MI training enhances motor learning, neural reorganization and cortical activation in stroke. The efficacy of MI training involving lower extremity mobility tasks need to be assessed.

AIM

To evaluate the effects of combining motor imagery with physical practice in paretic Lower Extremity Muscles Strength and Gait Performance in Ambulant Stroke subjects.

MATERIALS AND METHODS

A Randomized Clinical Trial was conducted in Department of Physical Therapy, Tertiary Care Hospitals, Mangalore, India which includes 40 hemi paretic subjects (>3 months post-stroke) who were ambulant with good imagery ability in both KVIQ-20 ≥ 60 and Time dependent MI screening test were recruited and randomly allocated into task-oriented training group (n=20) and task-oriented training group plus MI group (n=20). Subjects in both groups underwent task orientated training for lower extremity 45-60 minutes, 4 days per week for 3 weeks. In addition, the experimental group received 30 minutes of audio-based lower extremity mobility tasks for MI practice. Isometric muscle strength of Hip, Knee and Ankle using a hand-held dynamometer and self-selected 10 m gait speed were assessed before and after 3 weeks of intervention.

RESULTS

Both the groups had found a significant change for all the outcome measures following 3 weeks of interventions with p <.05. The experimental group had shown a significant improvement in paretic hip muscles (both flexors and extensors), knee extensors and ankle dorsiflexors and gait speed compare to control group with p < .05 between group analyses.

CONCLUSION

Additional task specific MI training improves paretic muscle strength and gait performance in ambulant stroke patients.

Community-Acquired Methicillin Resistant Staphylococcus aureus Bacteremia: Case Series

Community-acquired methicillin resistant Staphylococcus aureus (MRSA) usually causes skin and soft tissue infections. However, community-acquired methicillin resistant S.aureus has been identified as a causative agent of many invasive infections like necrotizing fasciitis, pneumonia and bacteremia. Risk factors such as immunodeficiency and skin and soft tissue infections have been identified for acquiring bacteremia. We present four cases of bacteremia caused by community-acquired methicillin resistant S.aureus, risk factors and outcome.Kathmandu University Medical Journal Vol.13(1) 2015; 77-79

Hemophagocytic lymphohistiocytosis secondary to infections: a tropical experience!

Hemophagocytic lymphohistiocytosis (HLH) is a potentially fatal hyper inflammatory condition, if not recognized and treated in time. A high index of suspicion can help identify the condition early. This condition can occur in the primary or secondary form. Secondary HLH or hemophagocytic syndrome (HPS) secondary to infections is an important clinical entity especially in tropical world. In this article, we share our experience with this entity and make an attempt to explore literature about ravenous macrophages which occurs secondary to infections. It is a series of six cases of HLH secondary to infectious disease in our center in a coastal city in South India over last one year with follow up.

Iatrogenic Perforation of Stomach--A Case Report

Gastric lavage is a routine procedure done in many cases of poisoning and it has been advocated by many as a lifesaving procedure. There may be some instances, where it might be unnecessary, ineffective or even detrimental to life. A 35 year old man walked into a casualty, 2 hours after having ingested 15 benzodiazepine tablets. Lavage was done by an unqualified person using Ewald's tube, leading to iatrogenic perforation. The unwarranted use of the procedure proved to be fatal.

Scrub typhus, a reemerging zoonosis – An Indian case series

Background: Rickettsial diseases are reemerging in many parts of our country. Scrub typhus is a rickettsial disease caused by Orientia tsutsugamushi. It is difficult to diagnose Scrub typhus because of nonspecific clinical presentation and lack of availability of specific tests (ELISA) in all centres. Aim: Our aim was to study the clinical features, lab parameters and outcome of patients diagnosed with Scrub typhus. Materials and Methods: A retrospective hospital based study was done in Mangalore (Karnataka) to identify cases of scrub typhus. Patients who had an acute febrile illness and IgM antibodies against O. tsutsugamushi were included in our study. Results: 10 cases of Scrub typhus were identified. Among them 7(70%) patients were females and 3(30%) were males. Major symptoms on admission were fever10(100%), dyspnea or cough-2(20%), rashes1(10%), altered sensorium1(10%). The major signs were fever10(100%), eschar 2(20%), and signs of meningial irritation in 1(10%). Lab parameters showed leukocytosis in 4(40%), thrombocytopenia in 3(30%), raised liver enzymes in 3(30%) and renal failure in 3(30%). Chest X-ray showed consolidation in 2(20%) patients. There was no mortality in our study. Conclusion: Scrub typhus can present with varying clinical manifestations and eschar can be absent in majority of cases as shown in our study. Therefore diagnosis should be based on a high index of suspicion and empirical treatment with doxycycline must be started whenever there is a strong suspicion of Scrub typhus. Asian Journal of Medical Science, Volume-5(3) 2014: 108-111 http://dx.doi.org/10.3126/ajms.v5i3.9213  

Effectiveness of mirror therapy on lower extremity motor recovery, balance and mobility in patients with acute stroke: A randomized sham-controlled pilot trial

OBJECTIVE

To evaluate the effectiveness of mirror therapy on lower extremity motor recovery, balance and mobility in patients with acute stroke.

DESIGN

A randomized, sham-controlled, assessor blinded, pilot trial.

SETTING

Inpatient stroke rehabilitation unit.

SUBJECTS

First time onset of stroke with mean post-stroke duration of 6.41 days, able to respond to verbal instructions, and Brunnstrom recovery stage 2 and above were enrolled.

INTERVENTION

Mirror therapy group performed 30 minutes of functional synergy movements of non-paretic lower extremity, whereas control group underwent sham therapy with similar duration. In addition, both groups were administered with conventional stroke rehabilitation regime. Altogether 90 minutes therapy session per day, six days a week, for two weeks duration was administered to both groups.

OUTCOME MEASURES

Lower extremity motor subscale of Fugl Meyer Assessment (FMA), Brunnel Balance Assessment (BBA) and Functional Ambulation Categories (FAC).

RESULTS

Amongst the 22 patients included, equal number of patients participated in mirror group (N = 11) and control group (N = 11). Baseline variables were similar in both groups, except for Brunnstrom recovery stage. There was no statistical difference between groups, except for FAC. (FMA: P = 0.894; BBA: P = 0.358; FAC: P = 0.02). Significance was set at P < 0.05.

CONCLUSION

Administration of mirror therapy early after stroke is not superior to conventional treatment in improving lower limb motor recovery and balance, except for improvement in mobility.

Study of home-monitored night blood pressure and its correlation with left ventricular hypertrophy in treatment-naive hypertensive patients

INTRODUCTION

24-hour ambulatory blood pressure (BP) monitoring is a well-validated tool that can reveal the patient's nocturnal dipping pattern. However, to the best of our knowledge, the role of home BP monitoring in identifying nocturnal dipping has not been studied.

METHODS

We evaluated the nocturnal BP of 30 treatment-naive subjects using a home BP monitoring device. BP measurements were taken once during the daytime and once at night (three hours after sleep) by a blinded observer. Readings were correlated with left ventricular mass index.

RESULTS

Night BP measurements were significantly lower in subjects without left ventricular hypertrophy (LVH) as compared to those with LVH, while the daytime readings were not significantly different between the two. The mean dips in nocturnal systolic and diastolic BP were 1.92% ± 6.89% and -0.55% ± 14.31%, respectively, in subjects with LVH. The corresponding values were 12.96% ± 6.16% and 11.36% ± 11.90% in those without LVH. The correlation between left ventricular mass index and night BP readings was statistically significant (systolic r = 0.66, p < 0.001; diastolic r = 0.496, p < 0.005).

CONCLUSION

Nocturnal BP measurement using a home BP monitoring device may be a reliable and cost-effective method for detecting early signs of end-organ involvement such as LVH in hypertensives, especially in a resource-limited setting.

Acute cholestatic hepatitis along with agranulocytosis: a rare side effect of carbimazole

Antithyroid drugs have been used for more than 50 years for the management of hyperthyroidism. Most patients tolerate treatment well but some may develop life-threatening side effects such as agranulocytosis, aplastic anemia and cholestatic hepatitis. A 45-year-old female was diagnosed with severe hyperthyroidism. Treatment with Carbimazole 30 mg/day was initiated. Within six weeks following the start of therapy, patient developed potentially life-threatening acute cholestatic hepatitis and agranulocytosis as adverse effects to carbimazole. The patient's symptoms and laboratory abnormalities resolved following withdrawal of offending drug. Agranulocytosis and cholestatic hepatitis together is an extremely rare idiosyncratic side effect of Carbimazole treatment and considered to be dose and age-related. Antithyroid drugs are deceptively easy to use, but because of the variability in the response of patients and the potentially serious side effects, all practitioners who prescribe the drugs need to have a working knowledge of their complex pharmacology.

Rare association of papillary carcinoma of thyroid with adult T-cell lymphoma/leukemia

Papillary carcinoma is the most common malignant tumor of the thyroid, especially in countries with adequate or excess iodine in diet. Many studies indicate that a sizable number of papillary cancer cases occur in a setting of chronic thyroiditis. But the tumor that arises more frequently in thyroiditis is malignant lymphoma. We report a rare association of papillary carcinoma of thyroid in an elderly lady with adult T-cell lymphoma/leukemia. Fine needle aspiration of the thyroid, neck nodes and evaluation of the bone marrow and peripheral blood helped in the diagnosis of papillary cancer coexisting with adult T-cell lymphoma/leukemia.

A rare case of brucine poisoning complicated by rhabdomyolysis and acute renal failure

Brucine is the predominant alkaloid present in the bark of the tree Strychnos nux vomica and is a weaker alkaloid when compared to strychnine. However, its toxicological property is akin to strychnine. We report a rare case of brucine poisoning complicated by acute renal failure and rhabdomyolysis. A 24-year-old male presented with a history of consumption of a decoction made from the bark of the Strychnos nux vomica tree. Soon after, he developed widespread muscle spasms and convulsions, which were promptly treated. On the fifth day of admission, he developed features of rhabdomyolysis and acute renal failure. Investigations revealed elevated creatine phosphokinase levels and elevated blood urea and serum creatinine. The patient was managed with hemodialysis and recovered gradually. There are many reports of strychnine poisoning producing rhabdomyolysis and renal failure. In this case report, attention is drawn to the fact that brucine, although a weaker alkaloid, can also produce life threatening complications like rhabdomyolysis and acute renal failure.

Tuberculosis mimicked by melioidosis

BACKGROUND

In regions endemic for tuberculosis (TB) such as India, presumptive anti-tuberculosis treatment is often prescribed. Melioidosis, caused by Burkholderia pseudomallei, is underdiagnosed in India, due to lack of awareness and a low index of suspicion.

SETTING

A tertiary care hospital in south India.

OBJECTIVE

To present our analysis of a series of 22 cases of suspected TB that was later confirmed as melioidosis.

DESIGN

Twenty-two patients with culture-proven melioidosis, who were initially given empirical anti-tuberculosis treatment, were retrospectively analysed regarding clinical presentation, laboratory findings and epidemiological features, with a view to determining any significant discriminatory parameter/s that would help distinguish the two diseases.

RESULTS

Eight cases mimicked pulmonary TB, five tubercular arthritis, three tubercular spondylitis, two tubercular lymphadenitis, two splenic abscess, and one each mimicked tubercular pericarditis and parotid abscess. Fever was the chief presenting complaint; all had high erythrocyte sedimentation rate (ESR) values (mean 111 mm +/- 23.7 SD); 15 (68.2%) had neutrophilic leuco-cytosis, 20 (90.9%) had diabetes mellitus. Subsequent to laboratory culture reports confirming melioidosis, appropriate treatment was instituted.

CONCLUSION

Fever in a diabetic patient with high ESR and neutrophilic leucocytosis should raise suspicion of melioidosis while instituting presumptive anti-tuberculosis treatment in areas where both diseases are prevalent.

Epidemiological shift, seasonal variation and antimicrobial susceptibility patterns among enteric fever pathogens in south India

SUMMARY

Between January 2005 and December 2006, a higher incidence of paratyphoid fever (53.8%) compared to typhoid fever (44.9%) has been observed at a tertiary hospital in South India. A definite seasonal pattern of incidence is seen in paratyphoid fever (peak incidence during October–December, i.e., post monsoon period) but not in typhoid fever. Decreased fluoroquinolone susceptibility is much higher in S. Paratyphi A (98.8%) as compared to S. Typhi (46.5%). These findings are of importance in therapeutic decision making, development of vaccination strategies and implementing public health measures for disease control.

Preferential accumulation of Aβ(1−42) on gel phase domains of lipid bilayers: An AFM and fluorescence study

Peptide-membrane interactions have been implicated in both the toxicity and aggregation of beta-amyloid (Abeta) peptides. Recent studies have provided evidence for the involvement of liquid-ordered membrane domains known as lipid rafts in the formation and aggregation of Abeta. As a model, we have examined the interaction of Abeta(1-42) with phase separated DOPC/DPPC lipid bilayers using a combination of atomic force microscopy (AFM) and total internal reflection fluorescence microscopy (TIRF). AFM images show that addition of Abeta to preformed supported bilayers leads to accumulation of small peptide aggregates exclusively on the gel phase DPPC domains. Initial aggregates are observed approximately 90 min after peptide addition and increase in diameter to 45-150 nm within 24 h. TIRF studies with a mixture of Abeta and Abeta-Fl demonstrate that accumulation of the peptide on the gel phase domains occurs as early as 15 min after Abeta addition and is maintained for over 24 h. By contrast, Abeta is randomly distributed throughout both fluid and gel phases when the peptide is reconstituted into DOPC/DPPC vesicles prior to formation of a supported bilayer. The preferential accumulation of Abeta on DPPC domains suggests that rigid domains may act as platforms to concentrate peptide and enhance its aggregation and may be relevant to the postulated involvement of lipid rafts in modulating Abeta activity in vivo.

Role of multiple induced sputum examination in the diagnosis of Pneumocystis carinii pneumonia

We evaluated the usefulness of repeated nebulized saline induced sputum examinations among 60 HIV infected patients clinically suspected to have Pneumocystis carinii pneumonia (PCP). We found that the first sample was positive for 15 episodes (21.4%); the second sample was positive in 33 episodes (47.1%); the third sample was positive in 22 episodes (31.4%). Repeated nebulized saline induced sputum examination imporved the yield of Pneumocystis carinii and enhanced the sensitivity of a positive result. This technique is simple, cost-effective, non-invasive, and reliable. We recommend the examination of multiple induced samples of nebulized saline induced sputum in all HIV infected patients with suspected PCP. This recommendation may decrease the need for invasive procedures.

Portable lead analyzer to locate source of lead

OBJECTIVE

To investigate the sources of lead in the environment in children with elevated blood, with the help of a Field Portable X-Ray Fluorescence Analyzer.

METHODS

One hundred and seven school children were chosen for this study on a random basis, from Mangalore and Karnataka. Their blood lead was analyzed. Of the cases analyzed, 10 students whose blood lead level was more than 40 microg/dl were investigated using a field portable X-Ray Fluorescence Analyzer. This is the first time such a device has been available for this purpose in India.

RESULTS

The 'likely' source of lead exposure could be determined in eight cases which was from the immediate environment of the children like 'lead-based' paint on surfaces in the house, on playground and other exterior equipment; lead storage batteries, contaminated dust and soil and other lead-containing substances.

CONCLUSION

The use of an X-Ray Fluorescence Analyser appeared to be useful in determining the source of lead.

Seasonal variation in the incidence of hyponatremia

AIM

To study the seasonal variation in the incidence of hyponatremia and to correlate it with the rainfall pattern.

METHOD

Retrospective analysis of patients having serum sodium of less than 120 meq/L was done during the 24 months from March, 1995. Patients with fever, renal failure, cardiac failure, cirrhosis, hyperlipidemia, hyperproteinemia, patients taking diuretics and postoperative patients were also excluded. Average inpatient number and rainfall for each month was noted. Daily incidence of hyponatremia was expressed as percentage of total inpatients for each day and was compared with the rainfall.

RESULTS

A total of 353 patients had hyponatremia during the two years from March, 1995; 174 cases during the first year and 179 during the second year. Average inpatient strength was 302.17 +/- 21.41 during the first year and 313.67 +/- 12.94 during the next year. The incidence of hyponatremia was 0.24 +/- 0.096% between June and August and 0.1 +/- 0.04% between December and February (95% confidence interval 0.045-0.235, p < 0.01). Statistically significant correlation was observed between rainfall pattern and hyponatremia, r = 0.711, 95% confidence interval 0.478-0.913, p = 0.01 during 95-96 and r = 0.825, 95% confidence interval 0.478-0.949, p < 0.001, during 96-97.

CONCLUSION

Incidence of hyponatremia is higher during the peak southwest monsoon season with similar pattern for the study period of two years. Humidity and temperature may have important role in the manifestation of hyponatremia.

Blood sugar profile in diabetics receiving plain insulin

Blood sugar profile was studied by checking multiple plasma venous samples at 1/2 hr interval after porcine plain insulin. Mean blood sugar was the highest (198.8 +/- 24.6 mg%) at 1 1/2 hrs and the lowest (86.3 +/- 18.4) at 4 1/2 hrs after breakfast. 52% of the patients had hypoglycemias between 4 and 5 hrs. It is recommended that pre-lunch blood sugar be checked in those receiving plain insulin.