A Comparative Study of Laboratory Diagnosis ofGenital Chlamydial Infections InWomen By Immunofluorescence And By Conventional Staining Method.

Objective: The major objective of this study was to carry out concurrent testing of cervical swab samples with both conventional and fluorescent staining method using Giemsa stain & direct fluorescent antibody stain (DFA) respectively. The study would enable us to establish an appropriate, effective and sensitive method of diagnosis of genital chlamydial infections within the present set-up.Material & methods: The study “A Comparative Study of laboratory Diagnosis of Genital Chlamydial Infections in Women by Immunofluorescence and Conventional Staining Method” was conducted on 50 patients attending the OPD of a tertiary care hospital of Ahmedabad. Results: Out of the total 50 cases tested, four samples were found positive containing dark-purple inclusion bodies of Chlamydia trachomatis surrounding the nuclei of the host cells in Giemsa and the same were positive for elementary bodies of C. trachomatis by the DFA staining. Based on these samples, the prevalence of is 8% only.Conclusion: The present comparative study of Giemsa and DFA staining for Chlamydia trachomatis infections in females showed that both methods are equally sensitive for the detection of the microorganism.

Seroprevalence of sporadic acute viral hepatitis with their co-infection at tertiary care hospital.

Background: Viral hepatitis is one of the major causes of mortality & morbidity in developing countries. Present study was aimed to know the seroprevalence and co infection of the acute viral hepatitis caused by hepatitis A, hepatitis B, hepatitis C and hepatitis E virus from patient attending one of the largest tertiary care hospitals. Material and Methods: Study was carried out from May 2009 to June 2010 at our hospital. A total of 556 serum samples were tested for HBsAg, antibody for HCV, IgM antibody of HAV and HEV by ELISA method from the patients having clinical signs & symptoms of acute viral hepatitis. Statistical analysis: Chi square test was done and the association was considered to be statistically significant if p < 0.05. Results: Out of 556 suspected cases of acute hepatitis 281 were positive. Among the total positive cases, IgM anti HAV antibodies was 70 (24.91%), IgM anti HEV antibodies was 141 (50.18 %), HBsAg was 65 (23.13%) and HCV was 5 (1.78 %). Dual infection was seen in 14 (4.98 %) cases with 6 children cases. Among the HAV positive patients, 80% were children, In contrast to that HEV infection (63.1%) and HBsAg infection (61.5%) was common in young adult. HCV infection was found common in adults more than 20 years of age. Overall male was affected more than female. Conclusion: Sporadic HEV infection constitutes significant cause of the acute viral hepatitis. In the light of this result a nationwide survey is recommended to confirm this pattern in the other areas. As vaccine for HEV is not available, prevention in form of improvement of socio - economic and hygienic standards of the population is the better option.

Comparison of two doses of oral clonidine as a premedicant for attenuation of pressor response to laryngoscopy.

Background: The present study compared oral clonidine 0.3mg with 0.2 mg to attenuate hemodynamic response to laryngoscopy and intubation and also to evaluate the optimal dose of oral clonidine as premedication. Methods: A prospective, randomized, double blind trial performed on 40 patients of ASA Grade I & II, scheduled for planned ENT surgeries under general anaesthesia. Patients were divided into 2 groups depending on oral clonidine dose given 90 mins prior to induction. Group A received 0.3 mg while group B received 0.2 mg clonidine. Heart rate, SBP, DBP, MAP were monitored at various time intervals e.g. before premedication, before induction, at laryngoscopy, intubation, immediately after intubation and post intubation for 30 minutes. Patients were anesthetized with sodium thiopentone (2.5%) 5-7 mg/kg followed by suxamethonium 2 mg/kg i.v. Results: We observed a significant decrease in mean HR,SBP,DBP,MAP in both the groups (clonidine 0.2 and 0.3mg ) as compared to baseline and preinduction level. Tablet Clonidine 0.3 mg proved to be significantly effective in checking the rise in SBP. A highly significant (p < 0.01) fall in DBP was observed in Group A at 1, 3, 15, 30 mins post intubation as compared to Group B. At 3 min, 15 min and 30 min interval, highly significant (p <0.01) decrease in MAP observed with clonidine 0.3mg as compared to 0.2mg. In this study, no patient encounter complications like bradycardia, hypotension. Conclusions: Oral clonidine 0.3 mg premedication in adult patients 90 mins prior to induction is safe, convenient and more effective in suppressing the hemodynamic response to laryngoscopy & intubation as compared to clonidine 0.2 mg.

Pericardial tamponade after left posterolateral thoracotomy for left upper lobectomy for pulmonary aspergilloma.

Pericardial tamponade limits diastolic filling of the heart; therefore, a high venous pressure is required to fill the ventricle. In presence of cardiac tamponade, therapeutic agents and manoeuvres that results in venodilation or vasodilation can severely compromise diastolic filling of the heart and might result in rapid cardiac decompensation. Equalization of central venous pressure and pulmonary artery diastolic pressure or equalization of pressures in all four chambers during diastole confirms cardiac tamponade. Transthoracic echocardiography can detect the site of tamponade and assist in pericardiocentesis. We describe acute pericardial tamponade in a young man who underwent left posterolateral thoracotomy for left upper lobectomy. Intraoperatively, mobilization of the left upper lobe was frequently associated with hypotension. Postoperatively, the patient suffered two more episodes of hypotension. The episodes of hypotension were attributed to surgical manipulation and epidural blockade. Hemodynamics normalized after discontinuing epidural infusion, volume resuscitation and lobectomy. On third postoperative day, the patient developed cardiovascular collapse; arterial blood pressure and central venous pressure were 70/50 and 12 mmHg. Investigations showed haziness of left lung, and severe respiratory acidosis. On opening of the left thoracotomy wound, pericardial tamponade was diagnosed. A pericardial window was created and tamponade was released with that the hemodynamics normalized. Episodes of unexplained hypotension after left upper lobectomy suggest a cardiac etiology and acute pericardial tamponade is a possibility which should be released immediately otherwise it can result in fatal outcome.

Efficacy of PercuSurge in acute myocardial infarction patients undergoing revascularization with a special emphasis on procedural time.

AIM: To evaluate the efficacy of the PercuSurge Guardwire(R) Plus Temporary Occlusion and Aspiration System, the actual procedural time involved and long-term follow-up in acute MI patients undergoing primary/rescue percutaneous coronary intervention (PCI). METHODS & RESULTS: It was a single centred, prospective study in 67 prospective AMI patients undergoing PCI. They were divided randomly into two groups depending on whether PercuSurge was used (n=30) or not used (control n=37) during PCI. Final TIMI flow, TMP grade and the time involved in or necessary for various steps of the PCI were recorded. PercuSurge showed significantly greater achievement of TIMI III flow and TMP III grade (p<0.01). Its use was associated with less total procedural time (p<0.05). The time required from guidewire crossing to stent placement; from guidewire crossing to TIMI III flow and from predilatation/stent placement to optimal TIMI flow was significantly reduced with its use (p<0.05 for all). Slow/no-reflow was significantly reduced (p<0.001), thus reducing intracoronary vasodilators and GP IIb/IIIa antagonists requirements. A 2 years' follow-up revealed four deaths in control and one death in PercuSurge group. CONCLUSION: PercuSurge reduced the total procedural time with better and faster optimal TIMI flow and TMP grade in primary/rescue PCI and was associated with less long term events.

Tuberculous abscess of rectus abdominis muscle.

Tuberculosis of skeletal muscle is very rare. A case of tuberculous abscess in rectus abdominis muscle is described in a seven year old male child. The patient presented with an abscess in the anterior abdominal wall, which subsequently ruptured. The diagnosis was made by histological examination of the excised tissue following local debridement.

Isolated tuberculous epididymo-orchitis.

Isolated epididymo-orchitis is an unusual presentation of tuberculosis. We report a case of bilateral epididymitis with right sided orchitis and scrotal involvement due to tuberculosis in a young male patient who had infertility. The diagnosis was suspected on ultrasonography of scrotum and confirmed by histological examination of scrotal and testicular tissue biopsy.