Thrombus in transit – A case series on dilemma in management

Thrombus in transit (TIT) is a rare but potentially fatal condition. Transthoracic echocardiography is the diagnostic modality of choice. The major complications of TIT are pulmonary embolism, right ventricular dysfunction, obstructive shock, and paradoxical embolism through patent foramen ovale. We hereby present a case series of four patients with TIT and the challenges faced while managing them

Study of metallo-beta-lactamase production in clinical isolates of Pseudomonas aeruginosa.

A study of metallo-beta-lactamase (MBL) production was done in clinical isolates of Pseudomonas aeruginosa. Isolates resistant to ceftazidime and imipenem were screened for MBL production by double disc synergy test (DDST) and minimum inhibitory concentration reduction test. There was complete correlation between two methods for imipenem. For ceftazidime, there was correlation between the two methods in all except four strains. In the screening test for MBL, ceftazidime-EDTA combination was better than imipenem-EDTA combination. 8.05% strains were MBL producers. Presence of MBL producer P. aeruginosa is a cause of concern. Simple DDST can be helpful for monitoring of these emerging resistant determinants.

Hepatopulmonary syndrome.

Hepatopulmonary syndrome (HPS) is defined as clinical triad of advanced liver disease, arterial deoxygenation and intra pulmonary vascular dilatation. It is a rare complication of liver disease of varied etiology and indicates a poor prognosis. Many theories have been put forward to throw light over its pathogenesis. The major clinical manifestations are arterial hypoxemia, clubbed fingers and spider navei. Orthodeoxia and platypnea are usual clinical features. A simple non invasive method to screen HPS is desirable. Contrast enhanced 2D ECHO cardiography is the preferred screening test. No effective medical treatment has been found. Although liver transplant seems feasible to reverse (at least partially) this situation, however it is associated with increased post operative morbidity and mortality.

Prediction model for peak expiratory flow in North Indian population.

OBJECTIVE: To establish a model for predicting peak expiratory flow rate (PEFR) in North Indian healthy population. Study subjects. Eight hundred and ninety-seven healthy, non-smoker individuals (681 males and 216 females) in the age group of 10-60 years. METHODS: The study was carried out at a health exhibition organised by the Government of Uttar Pradesh, at King George's Medical University, Lucknow. Only healthy, non-smoker individuals were enrolled for the study. Age was noted in completed years and weight in kg and height in cm were taken without shoes. PEFR was measured by Mini Wrights peak flow meter in standing position after prior instructions and demonstration of technique to each individual. The test was performed three times on each subject and best of the three attempts was selected for data computation. The statistical solftware SPSS was used to fit the model and perform residual analysis. RESULTS: The highest reading for males was recorded in the age group of 20 to 24 years and for females in the age group of 25 to 29 years. Using age, height and weight, we established a regression model for predicting PEFR values for males and females separately in the age group 19-60 years. In the age group 10-18 years, the model for predicting PEFR was same for both the sexes. PEFR values were found to be more in males as compared to females. The predictive power of the model as described by explained variation was found to be 80 and 82 percent for males and females, respectively. CONCLUSIONS: Prediction model for north Indian subjects was drafted for age range 10-60 years. While separate models were required for males and females because of sex related differences in the age group 19-60 years, a common model sufficed for age group 10-18 years.

Emergence and re-emergence of Vibrio cholerae 0139: an epidemiological study during 1993-2002 at Nagpur, Central India.

The pattern of Vibrio cholerae 01 and 0139 isolates at Indira Gandhi Medical College and Mayo General Hospital, Nagpur from 1993 to 2002 is presented. Emergence of the novel serotype 0139 in 1993 was followed by periods of quiescence and re-emergence. For the first time after 1993, the 0139 isolates out numbered 01 isolates in 2001. The peculiar epidemiological pattern is compared with other reports.

An unusually high occurrence of Salmonella enterica serotype paratyphi A in patients with enteric fever.

BACKGROUND & OBJECTIVES: Salmonella enterica serotype Paratyphi A has been reported less frequently as a causative agent of enteric fever. Reports on the antimicrobial susceptibility of this pathogen are few and varied. An unusually high occurrence of S. Paratyphi A was noted in a tertiary care hospital at Nagpur, Maharashtra during April 2001-September 2002. An effort was made to study the antimicrobial susceptibility pattern and phage types of the isolates. METHODS: Blood cultures of patients suspected to have enteric fever admitted to the Indira Gandhi Medical College and Hospital, Nagpur were processed by conventional methods. Antimicrobial susceptibility was tested by Kirby-Bauer disc diffusion method and the minimum inhibitory concentration (MIC) to chloramphenicol was determined. RESULTS: Eighteen (46.15%) of 39 Salmonella isolates were S. Paratyphi A and all were sensitive to ciprofloxacin and cephotaxime. Twelve (66.67%) strains were sensitive to ampicillin and 13 (72.22 %) to chloramphenicol. Two strains (11.11%) were resistant to three drugs (ampicillin, chloramphenicol and cotrimoxazole) simultaneously. The prevalent phage type in the local population was phage type I. INTERPRETATION & CONCLUSION: The high occurrence of S. Paratyphi A found in the present study indicated the emergence of this rare pathogen of enteric fever in the local population. Though some degree of resistance was encountered with ampicillin and chloramphenicol, all the isolates were sensitive to ciprofloxacin, currently a drug of choice for enteric fever. Multidrug resistance was rare.

Occult breast carcinoma: a report of four cases and review of literature.

We report four occult carcinoma breast cases in which extensive axillary node metastases was the first manifestation. Upper outer quadrentectomy with axillary dissection was done in three patients while modified radical mastectomy was done in one. Primary tumor could be found in three patients, one had squamous cell carcinoma (SCC) & two had infiltrating duct carcinoma (IDC). However primary tumor was not detected in breast tissue of the fourth patient. Extensive lymph node metastases were found in three out of 14,15 out of 15(SCC), 24 out of 24 and 1 out of three axillary nodes respectively. Results of immunohistochemical staining for estrogen and progesterone receptors on three cases were negative. All patient received postoperative radiotherapy and chemotherapy. We have reviewed the literature and discussed the approach to diagnosis and management in female patients presenting with metastatic carcinoma in the axillary nodes with emphasis on the appropriate pre-treatment evaluation.

Squamous cell carcinoma of thyroid gland.

We present the clinical manifestation, management and outcome in two cases of squamous cell cancer arising in the thyroid gland which is a rare entity. Both cases had advanced disease invading adjacent structures. At the followup of three to six months, one patient developed recurrence and died.

Bone changes in leprosy. A study of 50 cases.

The radiological bone changes have been studied in 50 patients comprising of lepromatous, tuberculoid, mixed (borderline lepromatous, borderline tuberculoid, dimorphous) and polyneuritic (neural) types of leprosy of which the former formed the largest group. The overall incidence of non-specific bone changes is higher as compared to specific bone changes. These were found to have highest incidence in the lepromatous type of leprosy, in the occupational group of manual workers and from 3rd to 6th decade of life. With the longer duration of the disease, the incidence of non-specific bone changes is also more.