Retrospective analysis of colistin-resistant bacteria in a tertiary care centre in India

The incidence of carbapenem-resistant Enterobacteriaceae has been steadily rising. The morbidity, mortality and financial implications of such patients are significant. We did a retrospective analysis of the case records of 11 patients who had culture report positive for pan drug-resistant (PDR) organisms. There were total 15 isolates of PDR organisms in 11 patients. These were associated with catheter-associated urinary tract infections (7), tracheitis (4), bacteraemia (2), meningitis (1) and soft-tissue infection (1). Average APACHE II score was 23.72 (range 7-36) indicating patients with multiple co-morbidities and organ dysfunction. The average length of hospital stay was 60.72 (25-123) days. The overall mortality rate was 81.81 per cent, while PDR infection-related mortality was 18.18 per cent. Strict implementation of antibiotic stewardship programme is essential to limit use and prevent abuse of colistin.

Anatomic characteristics of foramen vesalius.

OBJECTIVES: Foramen Vesalius is an inconstant foramen that gives passage to an emissary vein that connects pterygoid venous plexus with cavernous sinus, the importance of which lies in the fact that an infected thrombus from an extracranial source may reach cavernous sinus. This study presents some data on characteristics of foramen vesalius. METHODS: We studied 70 sides of 35 dried adult human skulls available in the Department of Anatomy, Manipal College of Medical Sciences, Pokhara, Nepal. Variation in number and incidence of foramen Vesalius were noted. Differences between the right and the left side and between the male and the female sex are discussed. MAIN FINDINGS: Foramen Vesalius was present in 23 sides (14 right, 9 left) out of the 70 sides observed, the incidence being 32.85% (20.0% right side, 12.85% left side) of all the sides observed. Incidence of bilateral and unilateral foramen vesalius was 22.85% (8 out of 35 skulls) and 20% (7 out of 35 skulls) respectively. Foramen vesalius was found in 10 sides in males and in 13 sides in females. No remarkable differences were observed in the incidence of foramen vesalius between the sides within same sex but the incidence was more in females compared to male skulls. SIGNIFICANCE OF FINDINGS: Anatomic variations of the foramen vesalius could be explained by developmental reasons. Knowledge about characteristics of foramen vesalius and its incidence is not only important for anatomists but equally essential for an operating surgeon.

Involuntary jerking of lower half of the body (spinal myoclonus).

A 55 years old, hypertensive, diabetic lady presented with sudden onset jerky movement of lower trunk and legs. It was present both in awake and sleep and got aggravated by mental stress as well as sensory stimulation. Examination revealed rhythmic jerks affecting muscles of lower abdomen and legs. The lower limbs had normal muscle bulk and power, increased tone, exaggerated deep tendon reflexes, bilateral flexor plantar response with normal sensory autonomic and cerebellar function. Investigations including CSF study, MRI of dorsal spine and NCV were normal. A combination therapy with tizanidine, baclofen and clonazepam induced gradual improvement within 6 weeks.

Anatomic variations of foramen ovale.

OBJECTIVES: Foramen ovale is of great surgical and diagnostic importance in procedures like percutaneous trigeminal rhizotomy for trigeminal neuralgia, transfacial fine needle aspiration technique in perineural spread of tumour and electroencephalographic analysis for seizure. This study presents the anatomic variations in dimensions, appearance and number of foramen ovale. METHODS: We studied 35 dried human skulls available in the Department of Anatomy, Manipal college of Medical Sciences, Pokhara, Nepal. Variations in appearance and number of foramen ovale were noted. Length and width of foramen ovale was measured. Comparison with other races and differences between right and left sides were also discussed. RESULTS: Out of 70 sides in 35 adult skulls, mean length and width of foramen ovale was 7.46+/-1.41 mm and 3.21+/-1.02 mm on right side and 7.01+/-1.41 mm and 3.29+/-0.85 mm on left side. Shape of foramen ovale was typically oval in 43, (22 on right, 21 on left) almond shape in 24 (Fig.1, arrowhead; 11 right, 13 left), round in 2(1 right, 1 left) and slit-like in 1(Fig.1, arrow). Bilateral oval foramen was observed in 15 and bilateral almond was in 7. Out of 70 sides in 35 adult skulls 3 (2 left, 1 right) sides had spine on the margin of the foramen (Fig.2, arrow), 3 (2 left, 1 right) had tubercle protruding from the margin (Fig. 3, arrow), 2 (1 left, 1 right) sides had bridge like bony spur dividing the foramen into two compartments(Fig. 2, arrowhead), 9 (5 left, 4 right) had bony plate on the margin of foramen ovale (Fig. 4, arrow). Variant foramen ovale was observed in 24.2%. CONCLUSION: Anatomical variations in size and shape of foramen ovale could be explained by developmental reasons. Considering the immense surgical and diagnostic importance of foramen ovale, this study was worthwhile.

Role of the medial preoptic area in thermal preference of rats.

This study was conducted to find out whether the medial preoptic area (mPOA) plays a role in the selection of ambient temperature by rats. Adult male Wistar rats were kept in an environmental chamber having three interconnected compartments, maintained at three different temperatures (18 degrees, 24 degrees and 30 degrees C) in which the animals could move freely from one compartment to the other. Normal rats preferred to stay at the chamber maintained at 24 degrees C for most of the time, during day and night. The temperature preference shifted to 30 degrees C after the mPOA of these rats had been lesioned by local administration of 5 micrograms of N-methyl D-aspartic acid (NMDA) in 0.2 microliter distilled water. The results of the study suggest that the mPOA acts as a fine tuning center for homeostatic regulation of thermal balance, including selection of appropriate thermal environment. It is proposed that after the mPOA lesion, the animal cannot assess properly the energy status of the body and thereby prefers a higher ambient temperature.

Regeneration of encapsulated protocorms of Phaius tankervilliae stored at low temperature.

Embryos (80 days old) developed after selfing P. tankervilliae were cultured on Nitsch medium for protocorm development. Protocorms (70 days old) thus developed were encapsulated with alginate matrix. Ninety six per cent of freshly prepared encapsulated protocorms differentiated into shoots and roots when cultured on Nitsch medium. Storage of encapsulated protocorms in sealed petri plates or by embedding in liquid paraffin at 4 degrees C showed no reduction in their regeneration frequency up to 120 days when cultured on Nitsch medium. However, 90% of encapsulated protocorms stored at room temperature in empty petri plates differentiated within 35-40 days. Regeneration frequency of encapsulated protocorms was drastically reduced when stored in liquid paraffin at room temperature.

Impact of prolactin on epididymal lipid profile in castrated rats.

Prolactin treatment to castrated rats led to accumulation of triacylglycerol and esterified cholesterol. There was no appreciable drift in epididymal cholesterol: phospholipid ratio between the prolactin treated and control animals. However, further analysis of phospholipids showed a build up of phosphatidyl inositol, phosphatidyl choline and phosphatidyl ethanolamine but a drop in the levels of phosphatidyl serine and sphingomyelin in prolactin treated castrated rats as compared to those castrated animals injected with vehicle alone. Changes in phospholipids reported above were prominently seen in the group of castrated rats that received 100 micrograms oPRL/100 g body weight but not in those animals which received either lower or higher doses of the hormone. Interestingly, bromocryptine treatment in castrated rats produced a general depletion in the levels of all lipid classes studied in the epididymis. It is suggested that this may be due to impaired synthesis and/or increased breakdown of lipids in this organ.

Infant feeding practices in a rural community of west Bengal.

A study on breast feeding and weaning practices was carried out in a sample of 57 lactating mothers of rural community. Although early start and prolonged breast feeding was an universal practise, but timely weaning was neglected and offered to 54.5% of infants only. On the contrary, introduction of artificial milk to young infants was a culturally accepted baby feeding.