Idiopathic sudden sensorineural hearing loss – A 12-month review

Background: Idiopathic sudden sensorineural hearing loss (ISSNHL) is a condition which is difficult to define and treat. Sensorineural hearing loss being a situation where rehabilitation therapy with hearing aids is the only treatment option, ISSNHL is an exception which can be treated medically if identified early enough. Objectives: The objectives of the study were as follows: (i) To study the recovery of hearing and other symptoms in patients diagnosed of ISSNHL treated with medical management as per institutional protocol and (ii) to study the association between recovery with medical management and factors such as time of presentation and comorbidities in patients with ISSNHL. Materials and Methods: In the Department of ENT, MCH, Kottayam, a protocol for the management of ISSNHL was worked out as per guidelines from standard otology textbooks. All patients with suspected ISSNHL were admitted. Hearing assessment was done using pure tone audiometry during inpatient care and on discharge of the patient. Patients were discharged after completion of the treatment and followed up for a period of at least 6 months. Results: The inference of our study is that cases who presented early in the first 24–48 h of onset of symptoms have maximum chance of recovery irrespective of associated comorbidities. Conclusion: The study highlights the fact that ISSNHL is and should be considered as a medical emergency.

Methicillin-resistant staphylococcus aureus : prevalence and risk factors among healthcare workers :.

Background & Objectives: Awareness of Methicillin-resistant Staphylococcus aureus (MRSA) is still lacking in various regions of developing countries. The present study was carried out to assess the prevalence and to establish significant risk factors for colonization with MRSA in health care workers. Methods: A cross sectional study was carried out. Ninety one health care workers and were screened for MRSA by nasal swabbing. MRSA strains were detected by disc diffusion and chromogenic agar. The D test was also carried out to detect inducible clindamycin resistance. Hand hygiene practices were surveyed. Results:Twenty MRSA carriers were identified among the 91 health care workers (21.98%; CI95:13.97-31.88 %). A high prevalence was found in emergency ward (62.5 %; CI95: 24.49 -91.48 %) (p <0.05) .The surgical and orthopedic departments also showed high prevalence (54.55% and 75% respectively) (p< 0.001). Inducible clindamycin resistance was found in 20.45% samples. Chromogenic agar was found to have high sensitivity and results were similar to those of disc diffusion (p<0.001). Interpretation & Conclusion: The presence of significant risk factors aids in identification of high risk groups among hospital staff. Selective surveillance and effective lab techniques implemented in these groups will reduce the burden of MRSA in hospitals.

Glutaraldehyde cross-linking of lectins to marker enzymes: protection of binding site by specific sugars.

The role of bound specific sugars in protecting the sugar binding activity of several galactose binding proteins during their covalent conjugation to horse radish peroxidase by glutaraldehyde-mediated cross-linking was examined by: a) affinity matrix binding of the conjugate, b) enzyme linked lectin assay and c) hemagglutination assay. During conjugation using 1% glutaraldehyde, protection of jack fruit (Artocarpus integrifolia) lectin (jacalin) activity depended on concentration of specific sugar present during conjugation; optimum protection was offered by 50 mM galactose. This indicated the presence of one or more primary groups at the binding site of jacalin, which is (are) essential for sugar binding. On the other hand, such essential amino group(s) was not indicated at the sugar binding site of the peanut lectin, bovine heart galectin or of the human serum anti alpha-galactoside antibody, since exclusion of sugar during their conjugation to HRP did not diminish sugar binding activity. The differential behavior is discussed in the light of reported differences in sugar specificities. Results indicated that sugar mediated blocking of active site may be used in characterization of the latter in lectins.

Compatibility problems after intravenous immunoglobulin--a case report.

Serious incompatibility was noted in a patient diagnosed as acute Guillain Barre syndrome treated with intravenous immunoglobulin. Patient had positive direct and indirect antiglobulin test and the auto control was negative. There was no clinical signs of hemolysis. Patient's blood group was O D positive and cross matched several units of ABO compatible D positive and D negative blood. Only one unit was compatible. These findings suggest that the particular intravenous immunoglobulin contained a mixture of saline and immune antibodies having different specificity. As the number of patients getting treated with intravenous immunoglobulin is on the rise more and more compatibility problems should be anticipated and should be borne in mind during serological testing and evaluation.

Para Bombay phenotype--a case report.

Bombay phenotype is peculiar in that red cells are not agglutinated by antisera A, B or H; while serum contains anti A, B and H. Existence of modifying genes at independent loci with variable expression of ABO genes is postulated. We report here a case of partial suppression where antigens could be detected by elution tests and unlike classical Bombay type, normal amount of appropriate blood group substances were present in saliva. This case of para Bombay phenotype was detected as a result of discrepancy in cell and serum group ng. This highlights the importance of both forward and reverse grouping in ABO testing.

Effect of temperature on functional response of platelet concentrates stored in PVC bags.

Haemostatic efficacy of platelet concentrates prepared and stored in locally available PVC triple bags was compared against a Japanese bag. In vitro functional parameters studied included shape change, aggregation and secretion in response to ADP. We have observed remarkable difference in the aggregatory response of platelets stored at slightly varying temperatures. The stimulatory responses of platelets stored with constant agitation at 70 strokes per min and 23 +/- 2 degrees C, deteriorated drastically by the time platelets were stored for 48 h. Both the rate and the extent of aggregation were affected showing no response to ADP at 72 h. However, when platelets were stored in a BOD incubator, thermostated at 22 +/- 0.5 degrees C, with continuous horizontal agitation at 70 strokes per min, 50 per cent functional response was retained till 72 h. We also demonstrated fragmentation of platelet membrane during storage. The membrane fragments collected by high speed centrifugation, expressed PF3 activity. Shedding of microvesicles indicates alterations at the membrane level that possibly cause functional lesion during storage. Our data suggest the significance of controlling the storage temperature steadily, to get maximum post transfusion efficacy.

Morphological & ultrastructural changes of platelet concentrates stored in PVC bags.

To assess the effect of storage bags on platelets, we studied the morphological and ultrastructural changes of samples drawn from platelet concentrates (PC) prepared and stored in triple, poly vinyl chloride (PVC) bags, manufactured in India. Using the scanning electron microscopy, we demonstrate formation of long pseudopods, and interaction through these to form aggregates. When platelets were stored at 23 +/- 2 degrees C, morphological changes were severe compared to the deleterious effects when kept at 22 +/- 0.5 degrees C. Ultrastructural analysis also showed that maintenance of discoid shape and prevention of granule secretion could be improved by storing the platelets at 22 +/- 0.5 degrees C. Significant degree of platelet fragmentation took place when the storage temperature was high. The morphology score done for platelets stored at both 22 +/- 0.5 degrees C and 23 +/- 2 degrees C showed that preservation of discoid shape was better with the former.

Biochemical lesions of platelets stored as concentrates in PVC bags.

Acid-base status of platelet suspension during storage is a measure of the gas permeability of the bag material. To assess the efficacy of the bags available in our market to store platelets, we compared biochemical lesions of platelets stored in an Indian polyvinyl chloride (PVC) triple bag against a Japanese PVC bag standardized for 5 days platelet storage. Platelet concentrates prepared in both control and test PVC bags were stored for 72 h. Two ml samples were drawn 1 h after preparation, and then at 24 h intervals, for analysis. Our data show that the mean pH value in the test bags was maintained above 6.5. However, the CO2 tension was high and O2 tension was low. We also analyzed malondialdehyde (MDA) formation which is a measure of arachidonic acid metabolism, and seemed to be unaffected in stored platelets. Lactate dehydrogenase (LDH) was not released into the plasma excessively and hence significant platelet lysis was absent during storage. Hypotonic shock response (HSR) of platelets stored in both test and control bags was comparable, indicating the possibility of satisfactory post-transfusion recovery.

Neonatal citrobacter sepsis: clinical and epidemiological aspects.

Fourteen neonates were diagnosed to have Citrobacter sepsis during 1986-89, representing 4.6% of all cases with bacteriologically proven sepsis. Most of these infants were low birth weight (mean 2046 gm, +/- 750) and preterm (mean 34.8 weeks, +/- 3.8). Mean age at onset of sepsis was five days. In 10 cases the hematological profile was suggestive of sepsis. Infants had clinical evidence of multisystem infection; 2 with septic arthritis and 3 meningitis. The case fatality rate was 61%. Resistance to antibiotics was frequent. Citrobacter species were also cultured from other sites: umbilical stumps, eye swabs, urine, skin pustules and umbilical catheter tips. The epidemiological features and virulence of this organism call for vigilance and strict control measures.