Circumscribed choroidal hemangioma: An overview of clinical manifestation, diagnosis and management

Circumscribed choroidal hemangioma is a benign vascular tumor which presents in middle-aged adults with progressive diminution of vision, metamorphopsia, floaters, and visual field defects. Diagnosis is based on the characteristic clinical features. It is an orange-red, usually solitary, tumor situated in the posterior pole. The visual symptoms are because of the associated subretinal fluid, cystoid macular edema, and, in long-standing cases, retinal pigment epithelium changes, subretinal fibrosis and retinoschisis. It must be distinguished from the more ominous amelanotic melanoma and choroidal metastasis. Diagnostic tools such as ultrasound, fundus fluorescein angiography, indocyanine green angiography, and optical coherence tomography are helpful in cases with diagnostic dilemma. Treatment is indicated in symptomatic cases. The management of choroidal hemangioma has evolved over the years beginning with laser photocoagulation to transpupillary thermotherapy, photodynamic therapy, plaque brachytherapy and external beam radiotherapy. No one therapeutic option holds superiority over the other. In this article, we review the epidemiology, clinical manifestations and treatment of the circumscribed variant of choroidal hemangioma.

Coats disease: An overview of classification, management and outcomes

Coats disease is an idiopathic retinal vascular disorder with retinal telangiectasia with intraretinal and/or subretinal exudation without appreciable retinal or vitreal traction. The condition is sporadic with no associated systemic abnormalities. Unilateral involvement in young males is the typical presentation with most cases being diagnosed in the first and second decade of life. Younger the patient, more severe is the presentation and poorer the visual outcome. The management varies with the stage of the disease. Over the years, we have shifted from enucleation to a more conservative approach for the treatment of Coats disease with laser photocoagulation, cryotherapy and surgery for retinal detachment achieving good outcomes. The anti-VEGF agents have come into the scene as important form of adjuvant treatment along with the traditional management options. This article describes the clinical features, underlying pathology, classification and staging, the complications and the management of Coats disease and gives an overview of the changing trends in treatment and outcomes spanning across five decades.

A study to determine patient safety awareness and attitudes among medical students in a Malaysian University

OBJECTIVE:Over the last decade, various methods to improve patient safety and to reduce medical errors are being implemented. Medical students should look into and participate in patient safety during their education. The objective of the study was to study the personal awareness, attitudes, and knowledge of patient safety measures in use in a Malaysian Medical College after implementation of the patient safety study module in the curriculum.MATERIAL AND METHODS:This was a cross-sectional analysis using a validated World Health Organization questionnaire (“Patient Safety – Curriculum Guide, Topic 1 questionnaire on patient safety”) on 4th-year medical students. The students’ awareness, attitudes, and knowledge of patient safety measures were assessed.RESULTS:One hundred and thirty-four years four undergraduate students of the Faculty of Medicine were recruited for the study using a convenience sampling method. The majority of study participants were females (65.4%). The median age of study participants was 24 years of the interquartile range = 1. On analysis, a majority of study participants had a medium level of knowledge about errors and patient safety. There was a significant positive correlation between the safety of the health-care system and personal influence over safety and attitudes toward patient safety (P < 0.05). There was also a positive correlation between personal influence over safety and safety at the workplace (P < 0.05).CONCLUSIONS:Our study indicates that student attitudes toward patient safety measures are positive, and knowledge and awareness are fair.

Co-existence of Pseudomonas-derived cephalosporinase among plasmid encoded CMY-2 harbouring isolates of Pseudomonas aeruginosa in north India.

Context: In Pseudomonas aeruginosa, AmpC β-lactamases are often responsible for high-level resistance to β-lactam antibiotics. The co-production of plasmid-mediated AmpC along with chromosomal Pseudomonas-derived cephalosporinases thus remain a serious clinical concern owing to high resistance spectrum towards antibiotics. Aim: The present study was performed to investigate the co-existence of both chromosomally-encoded and plasmid-mediated AmpC β-lactamase among clinical isolates of P. aeruginosa. Setting and Design: It is a cross-sectional study carried out in the Department of Microbiology in a tertiary referral hospital of northern India. Methods and Methods: A total of 329 consecutive, non-duplicate clinical isolates of P. aeruginosa, were selected for the detection of AmpC β-lactamases and confirmed for AmpC production by modified three dimensional (M3D) test. Ceftazidime -imipenem antagonism test was used to detect inducible AmpC producers. Molecular characterisation of chromosomally-encoded blaPDC and plasmid-mediated AmpC gene was studied by performing polymerase chain reaction (PCR). Result: A total of 214 (65%) isolates were confirmed for AmpC production by M3D test. On performing multiplex PCR, 27 isolates were detected posessing blaCMY type of plasmid-mediated AmpC gene. While 48 isolates were found to harbour chromosomally-encoded blaPDC gene co-production of both chromosomal and plasmid-encoded AmpC was reported in eleven isolates. Conclusions: Although these chromosomally-encoded cephalosporinases might spread more slowly than mobilised AmpC, but it is likely that in the present scenario of intense antibiotic pressure, this will become an increasing problem and may further limit our antibiotic choices.

Association of dietary fiber with high sensitivity C-reactive proteinin type 2 diabetes mellitus.

Introduction: Hs-CRP is a nonspecific marker of the inflammatory response has been associated with development of type 2 diabetes mellitus. Cardiovascular disease is a major consequence of diabetes. DM confers a 2-4 fold rise in cardiovascular risk compared with general population. One of the many modifiable risk factors for both cardiovascular disease and diabetes is diet. Fiber is an important dietary factor that may modify the risk of both diseases. Material & methods: The current study is an attempt to explore the association of dietary fiber on inflammatory marker, hs-CRP in type2 diabetic subjects. Total 80 diabetic subjects were included in this study of which 40 were taking more dietary fiber and 40 were taking relatively low dietary fiber. Serum hs-CRP was measured by chemiluminescent immunometric assay (DPC Biermann Gmbh., Germany). Nutrient information was calculated using a pretested food recall questionnaire prepared by nutritionists for usual Bangladeshi food articles. Results: Hs-CRP was significantly higher in subjects taking low dietary fiber. There was significant negative correlation between CRP of subjects taking high and low intake of dietary fiber. Conclusion: So, low dietary fiber consumption maybe a possible causal factor of raised CRP. Type 2 diabetic patients who took less dietary fiber in their diets had elevated blood CRP levels.

Observation on integron carriage among clinical isolates of Klebsiella pneumoniae producing extended-spectrum β-lactamases.

Purpose: Klebsiella pneumoniae is considered an important pathogen causing nosocomial and community-acquired infections and is often associated with the production of extended-spectrum β-lactamases (ESBL) belonging to SHV and CTX-M families, which are frequently described as a part of complex integrons, facilitate their horizontal transfer to other related as well as unrelated microbes. The present study was undertaken to investigate the occurrence and characterization of integrons among K pneumoniae isolates producing ESBL in a tertiary referral hospital. Materials and Methods: A total of 136 clinical isolates of K pneumoniae were investigated for the presence of ESBL. Their ESBL genes were characterized by multiplex polymerase chain reaction (PCR). Integrase gene PCR was performed to detect the presence of integron. The isolates were further typed by random amplification of polymorphic DNA (RAPD). Result: Out of 136 K pneumoniae isolates, 63 (46%) were confirmed to be ESBL producers. SHV (68%) and CTX-M (67%) ESBL genes were the most common in our study. Of the 63 ESBL-positive isolates, 58 (92%) strains carried integrons; 52 strains (82%) carried only class 1 integron, whereas 6 (9%) isolates harboured both class 2 integrons and the class 1 gene. However, in ESBL negatives, only 29 (40%) strains were positive for class 1 integron and none for class 2 integron. Conclusion: The presence of class 2 integron amongst ESBL-producing K pneumoniae is being described for the first time in this part of the world. The findings of this study strongly suggest that integrons have a role in the dissemination of ESBL-mediated resistance among the nosocomial isolates of K pneumonia.

Increased prevalence of extended spectrum beta lactamase producers in neonatal septicaemic cases at a tertiary referral hospital.

Emergence of extended spectrum beta lactamases (ESBLs) producing strains of gram negative bacteria, as one of the leading cause of septicaemia often complicates the clinical and therapeutic outcome. The present study was undertaken to investigate the prevalence of ESBLs in bacteria isolated from neonatal septicaemic cases along with their antimicrobial sensitivity pattern. Blood samples were collected from 243 suspected cases of neonatal septicaemia. Apart from susceptibility testing, all the gram negative isolates were subjected to phenotypic tests for ESBL production. Amongst the positive test samples (n = 115), 84 were gram negative rods. ESBL was detected in 26 (32%) isolates. Results indicate that routine ESBL detection should be made imperative and empirical use of third generation cephalosporins must be discouraged.

Prevalence of Chlamydia trachomatis/Neisseria gonorrhoeae and human papilloma virus among women-at risk in the Aegian region of Turkey, and their knowledge about HIV/AIDS / Prevalencia de Chlamydia trachomatis/Neisseria gonorrhoeae y el virus del papiloma humano entre las mujeres en riesgo, y sus conocimientos sobre la VIH/SIDA, en la región egea de Turquía

BACKGROUND: The aim of this study was to determine the prevalence of selected sexually transmitted diseases (STDs) and the level of knowledge and attitudes regarding HIV/AIDS among Turkish brothel based sex-workers (SWs). SUBJECTS AND METHODS: A pre-designed questionnaire was administered to 199 SWs to obtain their sexual behaviours and their level of knowledge of HIV/AIDS. The specimens collected for C trachomatis/N gonorrhoeae and human papillomavirus (HPV) were tested using Gen-Probe PACE 2 and HPV-screening assays, respectively. RESULTS: Aproximatelly sixty-seven per cent of the SWs knew that condoms afforded protection against HIV/AIDS and 62% reported continued use of condoms. Although most of the SWs had heard about HIV/AIDS, thorough knowledge of transmission and prevention was lacking. The overall estimated rates for C trachomatis/N gonorrhoeae and HPV were 18.6% and 9.7%, respectively. CONCLUSION: There is a need for further studies to generate more data on the prevalence of STDs and the knowledge of STDs in this population.

ANTECEDENTES: El objetivo de este estudio es determinar la pevalencia de las enfermedades de trasmisión sexual (ETS) seleccionadas, y el nivel de conocimientos y actitudes en relación con el VIH/SIDA entre las trabajadoras sexuales (TS) en burdeles turcos. SUJETOS Y MÉTODOS: Se aplicó un cuestionario prediseñado a 199 trabajadoras sexuales a fin de revelar sus comportamientos sexuales y su nivel de conocimientos acerca del VIH/SIDA. Las muestras de C trachomatis/N gonorrhoeae y virus del papiloma humano (VPH) recogidas, fueron analizadas mediante la sonda genética conocida como Gen-Probe PACE 2 y ensayos de pesquisaje de VPH, respectivamente. RESULTADO: Aproximadamente sesenta y siete por ciento de las TS sabían que los condones daban protección contra el VIH/SIDA, y el 62% reportó uso continuado de condones. Aunque la mayor parte de las TS habían oído acerca del VIH/SIDA, les faltaban conocimientos cabales sobre la trasmisión y prevención de ETS. Las tasas generales estimadas de C trachomatis/N gonorrhoeae y VPH fueron 18.6% y 9.7%, respectivamente. CONCLUSIÓN: Es necesario realizar estudios ulteriores a fin de generar más datos acerca de la prevalencia de las ETS y los conocimientos acerca de ellas en esta población.

Evaluation of different tests for detection of Staphylococcus aureus using coagulase (coa) gene PCR as the gold standard.

A total of 288 staphylococcal specimens isolated from different clinical specimens were selected for the evaluation of tests used to detect Staphylococcus aureus. The coagulase (coa) gene PCR was preformed, which confirmed 288 specimens as S. aureus and 51 specimens as coagulase negative staphylococci (CONS). All the specimens were subjected to slide coagulase test, Slidex Staph plus test and tube coagulase test. Sensitivity, specificity, positive predictive value and negative predictive values of were calculated using coa gene PCR as gold standard for the detection ofS. aureus. The tube coagulase test showed very good sensitivity (98.7%), specificity (98.1%), PPV (99.5%) and NPV (94.4%) than other methods. Slidex Staph plus test showed fairly good sensitivity and specificity. Slide coagulase test has good specificity but poor sensitivity. Therefore we recommend that tube coagulase test be done routinely for the detection ofS. aureus in microbiology laboratory.

Antimicrobial resistance profile of bacterial isolates from Intensive Care Unit: changing trends.

The incidence of antimicrobial resistance has increased over the years resulting in limitation of therapeutic options. Strategies such as appropriate infection control measures and surveillance of resistance pattern are necessary to address the problem of resistance. Knowledge of the pattern of resistance in Intensive Care Units (ICUs) can help to determine antibiotic prescribing policy. A retrospective study has been carried out to determine the bacterial spectrum and the antibiotic resistance pattern of clinical isolates collected from patients admitted to the ICU. The data was compared with a similar study conducted during 1996-97. Amongst the gram-positive organisms Staphylococcus aureus (23%) was the predominant isolate, while Pseudomonas (23%), Acinetobacter (20.8%), Citrobacter (11.7%) accounted for the majority of the gram-negative organisms. Both gram positive and gram-negative organisms exhibited high resistance to most antimicrobial agents used for testing susceptibility. The frequency of resistance has markedly increased as compared to the previous study.

Prevalence of methicillin resistant staphylococcus aureus in a tertiary referral hospital in eastern Uttar Pradesh.

We report the prevalence of methicillin resistant Staphylococcus aureus (MRSA) infections and their antibiotic susceptibility pattern in our hospital located in eastern Uttar Pradesh. Out of total 549 strains of Staphylococcus aureus isolated from different clinical specimens 301 (54.85%) were found to be methicillin resistant. More than 80% of MRSA were found to be resistant to penicillin, cotrimoxazole, ciprofloxacin, gentamicin, erythromycin, tetracycline, 60.5% to amikacin and 47.5% to netilmicin. However, no strains were resistant to vancomycin. Many MRSA strains (32.0%) were multi-drug resistant. To reduce the prevalence of MRSA, the regular surveillance of hospital associated infection, monitoring of antibiotic sensitivity pattern and formulation of definite antibiotic policy may be helpful.

Antibiotic sensitivity pattern of the bacteria isolated from nosocomial infections in ICU.

The incidence of nosocomial infections in ICU is 4-5 times greater than in general ward. Critically ill patients are always at higher risk of developing nosocomial infections with resistant strains. This study is an attempt to know the antibiotic sensitivity pattern of the common isolates in ICU. Samples comprising urine, blood, endotracheal secretions and throat swabs were collected from 102 ICU patients of them, 56 patients showed evidence of nosocomial infection (54.9%), from whom 120 different organisms were isolated. Antibiotic sensitivity test was done according to Kirby Bauer method. Klebsiella pneumoniae were the most prevalent isolates from respiratory tract infections followed by Proteus spp, Escherichia coli, Staphylococci spp. and Acinetobacter spp. The gram negative enteric bacilli were uniformly resistant to betalactam antibiotics as well as betalactam-betalactamase inhibitors. Resistance to Ciprofloxacin and Ceftriaxone ranged from 50-100% and 25-83.3% respectively. Staphylococci were 100% resistant to penicillin and tetracycline, 80% to cotrimoxazole, 60% to erythromycin and gentamicin and 40% to amikacin. Acinetobacter spp. were highly resistant to most of the antibacterial agents except gentamicin while Pseudomonas spp. showed 75% resistance to it. The increased prevalence of resistant organisms in ICU probably reflects lack of proper antibiotic policy resulting in prolonged and indiscriminate use of antimicrobial agent.

Vocal cord dysfunction presenting as refractory asthma.

Vocal cord dysfunction is a rare variety of upper airway obstruction characterized by typical laryngoscopic features and may mimic an acute asthma attack. The case presented in this report pertains to a 15-year-old girl who had repeated acute episodes of dyspnoea and wheezing and remained non-responsive to corticosteroids and inhaled bronchodilators requiring endotracheal intubations for adequate control. Laryngoscopic findings were consistent with vocal cord dysfunction. She was treated with a tracheostomy and psychological support.

Therapeutic bronchoscopy.

Endoscopic therapy has been used extensively in every field of medicine. The bronchial tree is no exception. The rigid bronchoscope was mainly used for foreign body extraction and hemostasis from and in the bronchial tree. With the evolution of flexible fiberoptic bronchoscope, the scope of therapeutic bronchoscopy has widened. The principles of therapeutic bronchoscopy, the various indications and brief description of such procedures like laser-bronchoscopy, endo-bronchial brachytherapy, management of airway strictures, its role in management of hemoptysis and foreign body removal have been reviewed.

Tracheal duplication as a cause of congenital stridor.

A six-week-old child with tracheal duplication presenting with congenital stridor is being reported. To the best of our knowledge, a tracheal web or tracheal duplication (as the present condition may be named) has not been described as a causative factor of infantile stridor.

A case of motor neurone disease with sleep apnoea syndrome.

A case of a 63-year-old patient with motor neurone disease (amyotrophic lateral sclerosis) with central sleep apnoea syndrome is being reported. His sleep architecture was fragmented with a high apnea-hypopnea index of 65 per hour and maximum oxygen-desaturation of 78 percent. Total correction of sleep pattern with nasal non-invasive ventilation (BiPAP-ST) was demonstrated.