Granulicatella adiacensinfective endocarditis

Infective endocarditis is an unconventional infectious disease nonetheless life-threatening. A roundabout of 3% to 5% cases of Streptococcalinfective endocarditis is caused by nutritionally variant Streptococci (NVS). Granulicatella species is one of the atypical causes of infective endocarditis. In this context, the authors are disclosing a case of infective endocarditis in an underlying rheumatic heart disease patient, caused by Granulicatella adiacens. The patient had breathlessness for the past four months, on and off fever for two months anew and mid-diastolic murmur with vegetation in aortic valve as appeared by echocardiogram. The blood cultures were tested positive for Granulicatella adiacens. The patient was successfully treated with intravenous vancomycin for a period of six weeks.

A STUDY ON THE POLICYHOLDERS SATISFACTION IN TERM INSURANCE POLICIES IN LIFE INSURANCE CORPORATION OF INDIA - A STUDY WITH REFERENCE TO KARAIKUDI TOWN

Human life is a most important asset and life insurance is the most important type of insurance which provides financial protection to a person and his family at the time of uncertain risks or damage. LIC of India plays a vital role in the welfare of human well-being by providing insurance to millions of people against life risks such as uncertain death or accident. The present exploratory and descriptive based study was selected with an objective to identify that satisfaction level of LIC policyholder in the selected area. This study is based on primary data which is collected through questionnaire among 100 policyholders in karaikudi town and data were analyzed with multi variety statistical tools like percentage, ANOVA and factor analyses were used to identify the factors responsible for satisfaction towards LIC. there is no significant mean variation between reasons for select the LIC with their gender. The proportion of total variance explained by all these three factors in the actual data is 76.27 percent

Assessment of liver involvement in type 2 diabetes mellitus using fibroscan® and correlation with risk factors

Background: Non‐alcoholic fatty liver disease (NAFLD) is one of the most common causes of chronic liver injury. The most important predictor of mortality in NAFLD is the extent of liver fibrosis. Advanced liver fibrosis is associated with overall and liver related mortality. The upcoming non-invasive imaging modality for the evaluation of liver fibrosis is transient elastography (TE) (Fibro scan®). The aim of this study is to assess hepatopathy among diabetics using TE and to correlate the degree of hepatopathy with the associated risk factors.Methods: Type 2 diabetes mellitus patients were assessed for liver stiffness using TE. Liver stiffness was correlated with the associated risk factors. Authors recruited 100 patients from diabetic clinic in tertiary care teaching hospital.Results: About 55% of males and 39% of females had increased liver stiffness. 14% of males and 11% of females had severe fibrosis(F3-F4). Body mass index, waist circumference, fasting blood sugar levels, and liver enzymes, had significant positive correlation with liver stiffness whereas triglyceride levels, high-density lipoprotein levels, and duration of diabetes mellitus did not correlate with liver stiffness.Conclusions: Diabetic patients have high prevalence of NAFLD and advanced fibrosis. Those with obesity and dyslipidaemia are at particularly high risk. Type 2 diabetes mellitus patients with hepatopathy can be easily identified using TE scan eliminating the need for liver biopsy. The establishment of a national program for the recognition of NAFLD is essential to reduce the risk of liver disease progression.

Incidence and Factors Affecting Subclinical and Clinical Mastitis in Selected Organised Dairy Farms Located in Tamil Nadu

The study is undertaken in five organised dairy farms located in Chennai, Trichy and Karur districts of Tamil Nadu to assess the incidence of clinical and sub clinical mastitis and predisposing factors such as Herd, Breed, Parity, stage of lactation and the efficiency of two screening tests for the diagnosis of sub clinical mastitis (SCM) in the dairy farms. A total of 159 cows with 636 quarters samples screened for clinical mastitis signs and SCM by modified California mastitis test (mCMT) and somatic cell count (SCC).The results showed that 9.4 per cent of animals had clinical mastitis, 66.7 per cent had SCM by mCMT and 77.4 per cent by SCC. The quarter wise incidence of SCM was 47.6 per cent as screened by mCMT and 51.7 per cent by SCC. There are no significant differences observed in the incidence of clinical mastitis and SCM in farm and breed wise. Parity (p<0.01), Stage of lactation by SCC method (p<0.05), Quarter-wise (p<0.05) incidence have significant differences of occurrence. SCM as screened by mCMT and SCC were compared for agreement by Cohen’s Kappa statistics and the per cent agreement for the two methods of screening SCM was 54.7 per cent with a P-value of 0.000. The study conclude that the higher SCM incidence in organised dairy farms as 66.7 per cent by mCMT and 77.4 per cent by SCC and necessitate the need of effective mastitis control program to be implemented at the farm level

Determinants of dysphagia following stroke

Background:Swallowing is affected following stroke. Many studies focus on various aspects of swallowing difficulties (dysphagia) following stroke. However, there are not many studies on the determinants of dysphagia following stroke. The aim of the present study is to establish the association between various factors with the severity of dysphagia. Methods: After screening for Mann Assessment of Swallowing Ability (MASA),110 patients, post-stroke were selected using consecutive sampling to assess the common risk factors, namely the presence of diabetes mellitus, dyslipidemia, hypertension, alcohol usage and smoking habits. Additionally, other variables such as age, gender, type of lesion, side of lesion, tobacco chewing, speech disorders, arterial dysfunction, lobe involvement and Brunnstrom's stages, were also evaluated using a structured interview method. 2 (chi-squared) analysis was carried outto find out the association between the selected determinants and severity of dysphagia following stroke.Results: It was found that age and Brunnstrom's stages are the determinants of dysphagia, as analysis showed a strong association with a p value < 0.001. A marginal association between post-stroke dysphagia and type of lesion with a p value of 0.056 was also observed.Conclusions: Among15 factors evaluated, age, type of lesion and Brunnstrom's stages showed a significant association with the severity of dysphagia following stroke. This study advocates early dysphagia management for elderly patients with high Brunnstrom's grading, for those who are not expected to spontaneously recover following stroke, and for earlier and better community rehabilitation

Human brucellosis in a non-susceptible host: a case report

Clinical human brucellosis is quite rare in India, that too in an non susceptible host. This report describes a case of clinical human brucellosis in India. This case involved a 36 years old male, a professor in an Engineering college. He presented with complaints of fever for 4 months with myalgia, generalized tiredness, loss of weight and loss of appetite. On evaluation, total counts and ESR was elevated and all other investigations were normal. Based on history, common causes like occult tuberculosis or autoimmune diseases were considered. But, blood cultures grew Brucella melitensis in all 2 samples and a diagnosis of brucellosis was made. He was treated with Rifampicin and Doxycycline. Suspicion of brucellosis in this patient is low because the patient has no history of contact with animals, consumption of unpasteurized milk or occupational exposure. So, the health care practitioners should be aware of this possibility of this zoonotic infection as a differential diagnosis in patients with nonspecific symptoms and unexplained prolonged fever.

Massive left atrial appendage aneurysm presenting as supraventricular tachycardia.

Left atrial appendage aneurysm is a rarely reported condition. Symptoms are absent in childhood and diagnosis is usually incidental. Systemic embolization or arrhythmia can bring these cases to medical attention. We report the case of a 12-year-old male with massive left atrial appendage aneurysm who presented with effort intolerance and supraventricular arrhythmia. The diagnosis was made by transthoracic echocardiography. Magnetic resonance imaging and left atriogram were also done before surgical resection.

Percutaneous transluminal mitral commissurotomy--experience with inoue balloon and over the wire technique.

OBJECTIVE: To compare the immediate and long-term results, safety and complication profile of inoue balloon technique (IBT) and over the wire technique (OWT) in the treatment of rheumatic mitral stenosis. METHODS: We have compared the IBT in 104 patients and OWT in 40 patients. Preprocedural, immediate post-procedure and follow-up echocardiograms of both groups of patients were done. RESULTS: There was no statistically significant difference in the success rates between IBT and OWT (97% vs. 95%; p > 0.05), nor was there a difference in reduction in mean left atrial pressure, mean pulmonary artery pressure, the occurrence of significant mitral regurgitation, or mortality (p > 0.05). The cost per procedure was cheaper with OWT but the occurrence of sustained ventricular tachycardia (VT) during the procedure was more common with OWT. OWT uses a stiff guidewire for positioning the balloon across the mitral valve, which is not done in IBT, hence there is the possibility of left ventricular perforation--which in fact occurred in one of our patients. During a mean follow up period of 12.9 months for IBT and 13.5 months for OWT, there was no significant restenosis in both the groups. The advantage of the OWT was the cheaper cost of the balloon and comparable results with IBT despite longer fluoroscopy and procedural times and the increased incidence of arrhythmias during the procedure. CONCLUSION: In a third world country like ours where escalating cost may be a deterrent in performing interventions, the OWT is a comparable alternative to IBT.

Isolated congenital left ventricular diverticulum in adults.

Isolated congenital ventricular diverticulum or aneurysm is rare and usually arises from the left ventricle. The presentation of this condition is diverse. We report three cases of isolated congenital left ventricular diverticula. The age range was 17-30 years. Chest X-ray provided the earliest clinical suspicion in these three cases of a cardiac anomaly which was diagnosed by echocardiography and confirmed by angiocardiography. The location of the congenital left ventricular diverticulum was the left ventricular apex in two cases and basal in the other. We conclude that congenital left ventricular diverticulum is a disease of protean presentations. A high index of suspicion is necessary while interpreting chest X-rays and echocardiographs to diagnose congenital left ventricular diverticulum. A contractile accessory chamber of the left ventricle with a narrow neck with or without midline defects and an electrocardiogram without Q waves is consistent with the diagnosis of congenital left ventricular diverticulum.

Valvuloplasty balloon detaching from the stem of a catheter.

A 12-year-old boy underwent pulmonary balloon valvotomy for isolated critical pulmonary stenosis. Following valvotomy, blood was found to be drawn into the syringe during deflation of the balloon, so a provisional diagnosis of a burst balloon was made. However, when the balloon catheter was withdrawn, the balloon got detached from the stem of the catheter at the level of the right atrium and was retained over the exchange guidewire. The balloon, when retrieved with a snare, was found to be intact. The balloon may have been partially detached at the junction of the proximal end of the balloon and the catheter; hence, blood was drawn from the catheter during deflation. In our institution balloons are reused following sterilization with ethylene oxide gas. We conclude that any balloon presumed to have burst inside the heart must be removed with great caution. In a third world country like India, where cost is an important factor, balloons can be reused, but with caution, keeping in mind complications such as in this case.

Dorsal cavoatrial bypass graft for coarctation of inferior vena cava-trial of aortic occlusion technique.

Male aged 28, presented with coarctation of inferior vena cava (IVC) causing chronic Budd-Chiari syndrome (CBCS). The coarcted IVC was exposed by transthoracic, transdiaphragmatic, retroperitoneal approach. There was no evidence of inflammation or compression. Venotomy was done immediately below the coarctation after clamping the descending aorta above the diaphragm. Distal IVC was occluded with a Fogarty balloon catheter passed through the venotomy. There was no flow through hepatic veins. But a dry field was not obtained because of bleeding from the systemic collaterals draining into IVC above the venotomy. Hence the veno-tomy was sutured. Dorsal cavoatrial bypass (DCAB) was done anastomosing the graft, end to side of IVC at a lower level, after partial clamping of IVC. Cross clamping the descending aorta appears to be a useful technique for surgery of retrohepatic IVC to arrest blood flow from distal IVC and hepatic veins.