Comparative evaluation of rapid diagnostic test and real-time PCR in clinically suspected malaria

Background: India represents 3% related to the global malaria problem. Early diagnosis and treatment that are complete alongside preventive measures are modalities essential to managing the situation. Rapid diagnostic tests (RDTs) and polymerase chain reaction (PCR) that are malaria that is real-time be used to obtain an exceedingly really very early diagnosis in acutely febrile customers. Aims and Objectives: This study aims to gauge the effectiveness of RDT bloodstream that is utilized entire from clients clinically suspected of malaria and compare it with real-time PCR. Materials and Methods: The cross-sectional study is observationally done and made up of 158 patients admitted to Index Hospital, Indore, having a serious illness that is febrile and medical suspicion of malaria. RDT for malaria antigen and PCR that are real-time done in the bloodstream that is whole examples depending on kit guidelines. Results: There exists a difference that is significant the nice and examples which are negative by both techniques. RT-PCR is diagnostic PCR that is real-time RDT has been good in 62 (44%) clients, whereas, real-time PCR detected the parasite in 136 (91%) customers. RDT was in reality negative for malaria antigen in 16 (12.8%) consumers, in whom RT-PCR was good. RDT failed to identify Plasmodium falciparum antigen in RT-PCR samples that can be good. RT-PCR indicates basic greater sensitiveness (82.4–95% CI 79.2–84.5%) in diagnosing malaria set alongside the quick test is an antigen. The sensitiveness of RT-PCR in detecting P. falciparum had been also high (74.2%, 95% CI 71.4–77.2). This has greater specificity than RDT in detecting P. falciparum disease (91.3%, 95% CI 89.4–95.4) in detecting P. falciparum than RDT. Conclusion: RT-PCR has better efficacy to look for the presence of malaria parasites in acutely clients being febrile remain undiscovered by RDT. Therefore, it might be helpful for the verification of diagnoses and studies which are epidemiological.

Giant hyperplastic gastric polyp: A diagnostic dilemma!!

Gastric hyperplastic polyps (GHP) account for a majority of benign gastric polyps. Most of the GHPs are <2 cm, asymptomatic, and incidentally detected on endoscopy or radiologically. With increasing size, these polyps manifest as upper gastrointestinal bleeding, iron deficiency anemia, and gastric outlet obstruction (GOO). We report an unusual case of giant GHP simulating gastric carcinoma and posing as a diagnostic challenge for the surgeons emphasizing the diagnostic role of histopathology. A 46-year-old female presented with clinical features of progressive GOO for 1 year. Endoscopy revealed an eccentric proliferative lesion in the antrum. Computed tomography showed a polypoidal, enhancing mural thickening involving distal body and antro-pyloric region measuring 8.4 cm × 6.6 cm × 1.8 cm. Subtotal gastrectomy was done in view of clinical features of GOO and having a clinical suspicion of malignancy. Gross examination showed a giant sessile hyperplastic polyp with lobulated surface. Microscopy revealed features of a large, sessile hyperplastic polyp without any evidence of dysplasia. The patient was symptomatically relieved and is on follow-up. To conclude, giant GHPs can mimic gastric carcinoma on endoscopy and radiology. The possibility of giant GHP should be kept in mind in the presence of an intensely contrast-enhancing polypoidal lesion in the gastric antrum. Long-term endoscopic follow-up is recommended.

A Retrospective Observational Study of Neurological Manifestations in COVID-19 (SON-CoV)

Objectives: Coronavirus disease 2019 (COVID-19) has neurologic manifestations associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study aimed to retrospectively analyze SARS COVID-19 patients with neurological manifestations and identify patterns of presentation including the site of neuroaxis involvement, neuroimaging, and associated systemic involvement. Methods and subjects: This retrospective observational study was conducted at two tertiary care hospitals in western Rajasthan. Data on age, sex, presenting symptoms, and comorbidities (hypertension, diabetes, cardiac, cerebrovascular disease, and cancer) were collected from 28th February 2020 to 31st December 2020 through medical records, discharge summaries, and radiological studies. Verbal/written patient consent was obtained due to the prevailing COVID-19 norms at the time of the first wave. Major inclusion criteria were as follows: age >18 years, consent from patient/surrogate, positive RT-PCR report in case of active COVID cases, or positive COVID antibody test in case of post-COVID neurological sequelae. All neurological manifestations were reviewed by at least two neurologists and were divided into central nervous system (CNS) and peripheral nervous system (PNS) manifestations. Systemic features and their temporal relationship with neurological features were recorded. Various other specialized assessments and therapeutic interventions were conducted. Statistical analysis was performed using the SPSS software. A Chi-square test was performed to determine the association between variables. Student’s t-test and one-way analysis of variance were used to determine differences in mean values. Statistical significance was set at p < 0.05. Results: The mean age was 57.32 years for the CNS group and 40 years for the PNS group (p = 0.025). Age was significantly lower in the PNS group than in the CNS group (p = 0.025). Anemia, leucocytosis, and elevated serum creatinine were more commonly seen in the CNS group, although the difference was not statistically significant. The most common CNS manifestations were stroke (41.8%), of which ischemic stroke constituted 83% of cases, followed by seizure (22%), encephalopathy (20.9%), headache (15.1%), and vertigo (3.8%). The most common PNS manifestation was neuropathy (57%), which included Guillain–Barré syndrome (GBS), critical illness neuropathy, and autonomic neuropathy Conclusion: CNS symptoms of COVID-19 are more common than PNS symptoms. Stroke is the most frequent (46%) COVID-CNS symptom, which occurs in people of age above 35 years and is associated with high mortality.

An Unusual Presentation Of Erythema Ab Igne And The Role Of Occupational History In Unveiling It - A Case Report

Erythema ab igne is a characteristic reticular telangiectatic and pigmented dermatosis, resulting from repeated or prolonged exposure to heat or infrared radiation insufficient to cause burns. Occupational history has played a pivotal role in dermatological diagnosis, and its importance cannot be overstated. It could lead to the provisional or final diagnosis in many instances.Over the course of time, the site and cause of erythema ab igne has evolved. From commonly being found on knees shins and palms due to tapnas (a practice in Indian villages to sit in front of fire); the disease is now observed on other sites such as on thighs and trunk after the discovery of heating pads and laptops.In thisparticular case, a 26-year-old male presented with erythematous to light brown patches on his right arm. The site of presentation was quite unusual, thus making occupational history the key to diagnosis.

An Evaluation Of The Retention Property Between Cream Type And Strip Type Denture Adhesive With And Without Salivary Substitutes: An In Vitro Study

Background:Patients with xerostomia complain of not only dryness of mouth but also discomfort during routine normal oral functions like speaking and swallowing. These complainis worse in individuals wearing removable intraoral dental prosthesis. In such situations, when salivary flow decreases, denture adhesives and salivary substitutes are recommended; which aid in denture retention and improve patient comfort.Material & Method:A total 150 samples were prepared using heat-cure acrylic resin of 30mm×30mm×5mm. All samples were equally divided in A,B,C,D,E groups,wherein Group A was control group with salivary substitutes.Group B was denture adhesive cream without salivary substitutes.Group C was denture adhesive cream with salivary substitutes.Group D was denture adhesive strips without salivary substitutes.Group E was denture adhesive strips with salivary substitutes.The retentive force was measured for all samples usinguniversal testing machine.Results:Data was collected and statistical analysis was done by one-way ANOVA test followed by post hoc test. The significant difference was found between the retentive forces of cream type and strip type denture adhesives withor without salivary substitutes.Conclusion:From this study, it is concluded that denture adhesive will definitely increases the denture retention. The cream type denture adhesive with salivary substitutes has the most retention than among all groups.

Direct immunofluorescence findings in cicatricial alopecia: A retrospective study of 155 cases

Objectives: To study the direct immunofluorescence (DIF) in cicatricial alopecia (CA) patients. Materials and Methods: Approximately, 155 skin biopsies from CA patients examined over 7 years (2009–2015). Special stains and Hematoxylin and Eosin were performed, and final histopathological diagnosis was made. DIF (against anti-IgG, IgM, C3, IgA, and fibrinogen) on all these cases and patterns were noted. The descriptive statistics were applied along with ANOVA test. Results: Approximately, 155 patients with Male: Female = 1.24:1, age 7–65 years. In total, 57 cases were of Lichen planopilaris (LPP; 36.7%), 22 Lichen planus (LP; 14.2%), 22 Psuedopalade of Brocq (PPB; 14.2%),16 discoid lupus erythematosus (DLE; 10.3%), 8 end-stage scarring alopecia (ESSA; 5.2%), 2 cases each of Fungal folliculitis (FF), and Folliculitis decalvans (FD; 1.3% each), and in 26 cases, no specific diagnosis could be reached were collectively kept in the category of non-specific findings (NSP; 16.7%). On DIF: LPP positive for IgG = 4 cases (7%), IgM = 26 (45%), IgA = 11 (19.3%), C3 = 16 (28.1%), and fibrinogen = 11 (19.3%). LP positive for IgG = 2 (9%), IgM = 18 (81%), IgA = 2 (9.1%), C3 = 10 (45%), and fibrinogen = 1 (4.5%). DLE positive for IgG = 6 (37%), IgM = 8 (50%), IgA = 1 (6.3%), C3 = 9 (56%), and fibrinogen = 1 (4.5%). Limitations: Because this was a retrospective study, clinical follow-up and treatment history of the patient could not be retrieved. Conclusions: IgG positivity helps significantly in differentiating LPP from DLE (P 0.004) and NSP from DLE (P 0.005). IgM positivity helps significantly in differentiating LPP from LP (P 0.04), LP from PPB (P 0.00) and NSP (P 0.00). C3 positivity helps significantly in differentiating PPB from DLE (P 0.02).

"The Chennai declaration" Recommendations of "A roadmap- to tackle the challenge of antimicrobial resistance" - A join meeting of medical societies of India.

"A Roadmap to Tackle the Challenge of Antimicrobial Resistance - A Joint meeting of Medical Societies in India" was organized as a pre-conference symposium of the 2 nd annual conference of the Clinical Infectious Disease Society (CIDSCON 2012) at Chennai on 24 th August. This was the first ever meeting of medical societies in India on issue of tackling resistance, with a plan to formulate a road map to tackle the global challenge of antimicrobial resistance from the Indian perspective. We had representatives from most medical societies in India, eminent policy makers from both central and state governments, representatives of World Health Organization, National Accreditation Board of Hospitals, Medical Council of India, Drug Controller General of India, and Indian Council of Medical Research along with well-known dignitaries in the Indian medical field. The meeting was attended by a large gathering of health care professionals. The meeting consisted of plenary and interactive discussion sessions designed to seek experience and views from a large range of health care professionals and included six international experts who shared action plans in their respective regions. The intention was to gain a broad consensus and range of opinions to guide formation of the road map. The ethos of the meeting was very much not to look back but rather to look forward and make joint efforts to tackle the menace of antibiotic resistance. The Chennai Declaration will be submitted to all stake holders.

Hepatic calcification following dengue virus-induced fulminant hepatic failure.

Hepatic calcification can be seen with various infectious and neoplastic conditions. We report a 32-year- old man who developed massive calcification in the right lobe of liver following recovery from dengue virus-associated fulminant liver failure.

An epidemiological study of road traffic accident cases attending emergency department of teaching hospital.

Several studies have shown that road traffic injuries are a major cause of death and disability globally, with a disproportionate number occurring in developing countries. The growth in numbers of motor vehicles is a major contributing factor in the rising toll of fatalities and injuries from road traffic crashes in poor countries. In this study, we reviewed medical records of all the victims of road traffic accidents attending the emergency department of Kathmandu Medical College Teaching Hospital within a year. A total of 757 road traffic victims were reported which accounted for 6.66% of all the cases attending the emergency. 49.93% cases belonged to 21-40 years age group. The most common victim group comprised the pedestrians (56.54%) with motorcycle (55.09%) being the most commonly involved vehicle. 44.65% accidents occurred in evening (12-6 pm). The lower limbs (in 42.0% cases) were the most common body region injured with superficial injuries (bruise/abrasion) accounting for the most common injury pattern followed by soft tissue injuries, incised/lacerated wounds and fractures and dislocations. Most accidents occurred in the April-June trimester.

Patterns of organophosphorous poisoning attending a teaching hospital.

The objective of this was to study the pattern of patients of organophosphorous (OP) poisoning attending Kathmandu Medical College Teaching Hospital (KMCTH). This is a retrospective study of OP poisoning from hospital records were analyzed meticulously and data extracted. Data collected were: patient's demographics, motive for poisoning, type of OP poison, arrival time, time since ingestion, patient's vitals, predisposing factors, serum cholinesterase levels, treatment given, duration of hospital stay and mortality. A total of 47 patients of OP poisoning attended KMCTH from Aug 2003 to July 2005. 22(46.8%) cases were male and 25(53.2%) were female. The maximum number of patients were between the age of 20-40 (33-70.2%). Married patients outnumbered the unmarried (35/74.5% vs 12/25.5%). The most common motive for poisoning was suicidal, 41 cases (87.2%). Metacid (methyl-parathion) was the most commonly used OP compounds in 32 (68%) patients. Interpersonal marital relationship seemed to be the commonest predisposing factor, 23 cases (48.9%).The commonest time of presentation was between 6 pm-12 midnight. 7(57.4%) cases presented within 2 hours of ingestion of the poison. Serum cholinesterase level measured after full atropinisation was >50% of normal level in 17 cases (36.2%). 10 cases (21.3%) required respiratory support. Intermediate syndrome (IMS) was observed in 3 cases. Overall mortality occurred in 3 cases (6.4%). This study highlights the problem of OP poisoning in our region. Establishment of strict policies against the sale and availability of insecticides and pesticides which are freely available in the market is an effective way to control OP poisoning.

Two cases of severe falciparum malaria in KMCTH.

Malaria is the most important parasitic disease of man. It is the protozoan infection of RBCs transmitted by bite of blood feeding female anopheline mosquito. Until the 19th century malaria was found throughout Europe, North America and Russia. Since then, it has been eradicated from these areas but in tropics though initial efforts of eradication had been successful, there has been resurgence of disease accompanied by increasing resistance of the anopheline vector to insecticide and of the parasite to antimalarial drugs. We report two cases of falciparum malaria in which there was co-existent vivax malarial infection. These two cases were both exposed to highly endemic zone for malaria.

Study of clinical profile and antibiotic sensitivity pattern in culture positive typhoid fever cases.

OBJECTIVES: The present study was designed to analyze the clinical profile and antibiotic sensitivity pattern in the cases of culture positive typhoid fever. METHOD: The study was conducted over a period of 1 year. Total of 46 culture positive cases of Typhoid fever were included in the study. The sensitivity pattern of isolates from blood culture was recorded. The modes of presentation, clinical course, lab investigation reports were also recorded. RESULTS: Out of 46 cases, 33 (71.7%) were males and 13 (28.3%) were females. Average age of presentation was 26.17 years. Fever was present in all patients. Resistance of S .typhi to amoxycillin, chloramphenicol and co-trimoxazole were significantly high. Ciprofloxacin showed resistance in 2 (4.3%) cases. Sensitivity to ceftriaxone was 100% in our study. CONCLUSION: Typhoid fever is one of the most common health problem in Nepal. Various drugs are being used in the treatment of typhoid fever, in the mean time resistance to many of them are emerging. An appropriate antibiotic has to be initiated only after culture sensitivity in typhoid fever.

Ancient cystic pelvic schwannoma presenting as a right iliac fossa mass.

Schwannoma is rare in pelvis. Ancient schwannoma is rarer histological subtype of schwannoma. We report a very rare case of pelvic schwannoma presenting with right sciatica and right iliac fossa pain. Clinical and imaging findings were suggestive of Peritoneal Hydatid cyst. The tumour was resected completely with marked clinical improvement. Histopathological examination showed Ancient cystic schwannoma.