ABSTRACT
Peutz-Jeghers Syndrome (PJS) is a rare inherited autosomal dominant disorder characterized by pigmented mucocutaneous melanotic macules and hamartomatous polyps. PJS arises due to mutations in STK11 gene located on chromosome 19q 13.3 and predisposes the patients to a multitude of malignancies with an estimated cumulative risk of 81% - 93%. Breast, gastrointestinal tract, pancreas, reproductive system and lung are common sites of development of malignancies in these patients. Anemia, rectal bleeding, abdominal pain, obstruction and intussusception are the usual complications in patients with PJS leading to multiple interventions. Upper GI endoscopy and Double Balloon Enteroscopy (DBE) allows screening of the gastrointestinal tract. Polypectomy of hamartomas more than 1 cm carried out at the time of surveillance endoscopy, abates the complications like bleeding, obstruction and intussusception. When DBE is not feasible, intraoperative endoscopy (IOE) is helpful to evaluate the entire gastrointestinal tract during surgery. IOE is also crucial for removal of all small intestinal polyps. Imaging techniques like magnetic resonance enterography and computed tomography enterography and video capsule endoscopy are non-invasive options for evaluation and screening in these patients. Sixty eight percent of the patients require emergency surgery during their lifetime. Regular cancer screening protocols should be instituted for early detection of malignancies. Genetic counseling and screening of other first degree family members helps in their preemptive identification and management. Chemoprevention using mTOR inhibitors, COX-2 inhibitors could be helpful in polyp reduction.
ABSTRACT
Background: Extracranial head and neck schwannomas are rare tumors which are often clinically misdiagnosed. Preoperative diagnosis of these tumors is challenging but imperative for surgeons so as to avoid nerve damage during excision. Materials and Methods: Sixteen patients diagnosed with extracranial head and neck schwannomas over a period of 2 years were retrospectively analyzed. Clinical details including preoperative fine-needle aspiration cytology (FNAC) and/or computed tomography (CT)/magnetic resonance imaging (MRI) findings were retrieved. FNAC smears and formalin-fixed paraffin-embedded sections were evaluated. Results: Among these 16 tumors, 6 (37.5%) were located in the lateral aspect of neck, 4 (25%) in scalp, 2 (12.5%) in orbit, and one each (6.25%) in palate, tongue, submandibular gland and parotid gland. The mean patient age was 31.3 years. FNAC was performed in 14 cases, of which 8 cases (58.3%) showed features of benign nerve sheath tumor (BNST), two cases (14.2%) were inconclusive with possibility of mesenchymal lesion, two cases (14.2%) were inadequate, one case (8.3%) showed features suggestive of schwannoma, and a diagnosis of nerve sheath tumor inconclusive for malignancy was rendered in a single case. The sensitivity of FNAC in diagnosis of BNST was 71.4%. CT or MRI was performed in five cases, of which an accurate diagnosis was rendered only in one case of orbital schwannoma. Conclusion: Imaging has a limited role in the preoperative diagnosis of head and neck schwannomas owing to nonspecific radiological features. Cellular aspirate smears are helpful in accurate diagnosis even at unusual locations
ABSTRACT
Background: Patients infected with HIV have an increased risk of nasal Staphylococcus aureus carriage as well as consecutive staphylococcal infections and is a major reservoir for MRSA which is potential risk factors for community acquired MRSA. Knowing the Nasal carriage status of Staphylococcus aureus and their Antibiogram will be beneficial for effective management of these patients.Methods: Nasal swab sample were collected from all the participants and processed for culture and identification of Staphylococcus aureus and their antimicrobial sensitivity. All the Staphylococcus aureus isolates were tested for Methicillin resistance by Oxacillin screen agar test, cefoxitin disc diffusion test and further confirmed by mecA gene PCR.Results: In this study out of 220 HIV seropositive patients, 43.64% isolates were confirmed to be S. aureus, 18.75% MRSA and 81.25% were MSSA. Cefoxitin disc diffusion showed 100% specificity (95% CI; 97.05%-100.00%), 100% sensitivity (95% CI; 83.89-100.00%) and 100% accuracy (95% CI; 97.47% to 100.00%) while comparing with gold standard mecA gene PCR. Among the nasal carriers; males (60%) ware dominant on females (40%). 31-50 years age group was strongly associated with MRSA nasal carriage. None of the isolates were resistant against lenozolid, teicoplanin and vancomycin while ampicillin (75%), ciprofloxacin (62.5%), clindamycin (59.38%) and cotrimoxazole (53.13%) showed increased resistance against S. aureus nasal carriage.Conclusions: Resistance among HIV positive persons for all antibiotics showed statistically significant while compared to control group. Cefoxitin disc diffusion can be used as surrogate agent for mecA gene detection.
ABSTRACT
Background & objectives: Extended spectrum β-lactamases (ESBLs) have emerged as a major threat worldwide with limited treatment options. The genotypes of ESBL producing strains largely remain unknown in India; hence the present study was aimed to determine the occurrence of ESBLs in Escherichia coli and Klebsiella pneumoniae, their molecular types and associated risk factors in a tertiary care hospital. Methods: Total 200 consecutive clinical isolates of E. coli (n=143) and K. pneumoniae (n=57) collected between February and July 2006 at Sanjay Gandhi Postgraduate Institute of Medical Sciences, a tertiary care hospital in north India, were examined phenotypically for ESBL production. ESBL strains were further typed for the blaTEM/SHV/CTX-M genes by PCR using specifi c primers. The blaCTX-M cluster was identifi ed by restriction analysis and genotype by sequencing of PCR product. Resistance to other antimicrobial agents was also studied. Various risk factors associated with ESBL infections were analyzed by logistic regressions. Results: ESBLs were found in 63.6 per cent E. coli and 66.7 per cent K. pneumoniae isolates. Majority of the typeable isolates harboured two or more ESBL genes (57.3%). Overall blaCTX-M was the commonest genotype (85.4%) followed by blaTEM (54.9%) and blaSHV (32.9%) either alone or in combination. All CTX-M enzymes in E. coli and 87.5 per cent in K. pneumoniae belonged to the CTX-M-1 cluster. Sequencing was done for randomly selected 20 blaCTX-M PCR products and all were identifi ed as CTXM- 3. Resistance of ESBL isolates to other antibiotics was amikacin 14.7 per cent, gentamicin 66.7 per cent, trimethoprim/sulphamethoxazole 79.1 per cent and ciprofl oxacin 93.8 per cent. Prior antibiotic exposure, use of intravenous device and urinary catheter, renal insuffi ciency and ICU admission were associated with ESBL infection on univariate analysis. On multivariate, antibiotic exposure (P=0.001) and use of urinary catheter (P<0.001) were identififi ed as risk for ESBL infection. Interpretation & conclusions: Our study showed high ESBL occurrence with CTX-M as the emerging type in our hospital and CTX-M-3 being reported for the fi rst time in India. High co-resistance to other non-β-lactam antibiotics is a major challenge for management of ESBL infections.