Molecular characterization of clinical isolates of Cyclospora cayetanensis from patients with diarrhea in India.

Purpose: Cyclospora cayetanensis is an intestinal coccidian protozoan that has emerged as an important cause of both epidemic and endemic protracted diarrhea worldwide. Though humans appear to be the only natural hosts; the role of animals as natural reservoir is uncertain but of increasing concern. The present study aimed to study the prevalence of coccidian in different groups such as immunocompromised, clinically apparent immunocompetent and healthy individuals. Also, the study isolates were assessed for heterogeneity among the sequences. Materials and Methods: Stool samples from different groups of patients were collected. The parasite was detected in stool by different diagnostic tools such as light microscopy and nested PCR‑restriction fragment length polymorphism using 18S ribosomal RNA as the target gene. Results: The prevalence of C. cayetanensis was 2.4% (19/800) in the present study. The PCR assay amplified Cyclospora cayetanensis DNA in only 89% (17/19) isolates. Further, sequencing revealed no significant difference among the study isolates and the non‑primates. Phylogenetic analysis of the study isolates however, formed two clusters. While one cluster showed close evolutionary association with the C. cayetanensis strains, the other cluster showed evolutionary association with the two non‑primate species. Conclusion: The methods described here for detection of C. cayetanensis oocysts are simple, efficient, specific, and sensitive and therefore can be effectively applied for laboratory diagnosis and environmental assessment of fresh produce and water sources. Clinicians should include Cyclospora infection in the differential diagnosis of prolonged or relapsing diarrheal illness even in clinically apparent immunocompetent individuals.

Molecular characterisation of Giardia intestinalis assemblages from human isolates at a tertiary care centre of India.

Purpose: The aim of the study was to determine the genetic heterogeneity of Giardia intestinalis isolates detected in stool samples of the study population using polymerase chain reaction assay and restriction fragment length polymorphism. We also tried to correlate the association/differences between the clinical symptomatology and infection by different assemblages (genotypes) of G. intestinalis. Materials and Methods: This cross-sectional study was conducted from April 2008 to June 2010. A total of 40 adults (n = 40) and 42 children (n = 42) below the age of 12 years with the clinical suspicion of giardiasis and with the onset of one or more of the following fi ve symptoms, i.e., loose stool, nausea, weight loss, fatigue and foul smelling faeces and confi rmed laboratory diagnosis of giardiasis at least once during the current episode of diarrhoea were included in this study. Results: Of the 82 patients (males 66) enrolled in the study, 70 (85%) presented with diarrhoea (56 males) and 12 (15%) without diarrhoea (10 males). Out of 70 diarrheic patients, 61 (87%) had chronic diarrhoea, 8 (11.5%) had acute diarrhoea and 1 (1.5%) had persistent diarrhoea. Of the total patients, 63 (77%) were clinically assessed and were apparently immunocompetent, whereas, 19 (23%) immunocompromised patients had different underlying conditions besides giardiasis. Genotyping identifi ed all 82 (100%) isolates as assemblage B. Conclusion: We found that assemblage B of G. intestinalis presents with all kinds of clinical features ranging from asymptomatic carriage to acute, persistent or chronic diarrhoea.

Radiofrequency ablation of hepatic metastasis: results of treatment in forty patients.

AIM: To evaluate the local control of hepatic metastasis with radiofrequency ablation treatment. MATERIALS AND METHODS: We did a retrospective analysis in 40 patients treated with radiofrequency ablation for hepatic metastasis. The tumors ablated included up to two metastatic liver lesions, with primaries in breast, gastrointestinal tract, cervix, etc. Radiofrequency ablation was performed under general anesthesia in all cases, using ultrasound guidance. Radionics Cool-Tip RF System was used to deliver the treatment. RESULTS: The median age of patients treated was 49 years. There were 13 female and 27 male patients. The median tumor size ablated was 1.5 cm (0.75-4.0 cm). A total of 52 radiofrequency ablation cycles were delivered. Successful ablation was achieved in all patients with hepatic metastasis less than 3 cm in size. Pain was the most common complication seen (75%). One patients developed skin burns. At 2-year follow-up 7.5% of patients had locally recurrent disease. CONCLUSIONS: Radiofrequency ablation is a minimally invasive treatment modality. It can be useful in a select group of patients with solitary liver metastasis of less than 3 cm size.

Rational antibiotics therapy in bacterial meningitis.

Acute bacterial meningitis is one of the most important causes of morbidity and mortality in developing countries. Though a wide range of antibiotics is available for therapy, judicious and rational use of antimicrobial agents needs to be ascertained. The choice of antimicrobial agents depends mainly on the age of the patient and its CSF penetrability. Neonatal meningitis is commonly caused by Gram Negative organisms such E. coli, Klebsiella and Pseudomans;Group B streptococciand Listeria, though other organisms like Staphylococcus sp. also contribute. The neonatal meningitis is best treated with a combination of amplicillin and a third generation cephalosporin given for 14-21 days. Post-neonatal meningitis usually occurs due to S. pneumoniae, N. meningitidis and H. influenzae and is best treated with third generation cephalosporins used with or without crystalline penicillin or ampicillin depending on the clinical situation. The therapy should be modified, if necessary, on availability of culture sensitivity report. The use of dexamethasone in meningitis due to the organisms other than H. influenzae still remains controversial.

Inflammatory pseudotumour of lung.

Inflammatory pseudotumour of lung is a rare benign lung tumour of uncertain aetiology. It is difficult to distinguish clinically as well as histologically from inflammatory lesions, hamartomas and neoplasms. Only two such cases have been reported from India earlier. We report one such case, that was clinically misdiagnosed as neuroblastoma.

Serological diagnosis of celiac disease.

In developing countries like India, unlike in the West, diagnosis of celiac disease is a dilemma because the histological changes consistent with celiac disease may not be pathognomonic of the disease. We need clarity on how to use one or more of the serological antibodies, namely IgG and IgA anti-gliadin and IgA anti-endomysial antibodies as independent disease markers or as adjuncts to clinico-histological diagnosis. In this review, various possible algorithms have been discussed. The serological antibodies can be used as reliable screening tests to decide whom to biopsy and to interpret histological changes in our settings where malnutrition and intercurrent enteric infection are common.

Cost of infant feeding in exclusive and partially breastfed infants.

OBJECTIVE: To compare the costs incurred on infant feeding between the mothers who exclusively breastfed their infants and those who introduced supplements up to 6 months of age. DESIGN: Longitudinal follow up. SETTING: Urban slums of south Delhi. METHODS: One hundred normal mother infant pairs fulfilling the prelaid criteria were recruited at the time of birth and followed up for determining the feeding practices. The cost of feeding was estimated at prevalent market prices in terms of food supplement and medical treatment of infant and additional nutritional intake of mothers. The differences in costs in exclusively and partially breastfed groups were analyzed at 3, 4, 5 and 6 months of age. RESULTS: There was a sharp decline of exclusive breastfeeding from birth to six months. The mean cost of infant feeding was Rs. 204/- per month in partially breastfed as compared to Rs. 106/- in exclusively breastfed at 6 months of age. The increased cost was largely attributable to supplementary food and the cost of feeding bottles. (83% of mothers used bottles). CONCLUSIONS: The mean cost of infant feeding is substantially higher in partially breastfed children.

Epidemiology & management of persistent diarrhoea in children of developing countries.

Diarrhoea that begins acutely but lasts longer than two weeks is defined to be persistent. Revised estimates in developing countries including India showed that acute diarrhoea accounts for 35 per cent, dysentery 20 per cent and non-dysenteric persistent diarrhoea (PD) for 45 per cent of total diarrhoeal deaths. PD also often changes marginal malnutrition to more severe forms. Factors that increase the risk of acute diarrhoea becoming persistent have been identified in India and other developing countries. These include antecedent malnutrition, micronutrient deficiency particularly for zinc and vitamin A, transient impairment in cell mediated immunity, infection with entero aggregative Escherichia coli and cryptosporidium, sequential infection with different pathogens and lack of exclusive breast feeding during the initial four months of life particularly use of bovine milk. Several issues regarding the management of persistent diarrhoea in hospitalized children in India have been resolved. Diets providing modest amounts of milk mixed with cereals are well tolerated. In those who fail on such diets providing carbohydrate as a mixture of cereals and glucose or sucrose hasten recovery. The role of antimicrobial agents and individual micronutrients in PD is currently being investigated. A management algorithm appropriate for India and other developing countries has been developed and found to substantially reduce case fatality in hospital settings to about 2-3 per cent. Recent epidemiological and clinical research related to persistent diarrhoea is also reviewed.

Signal-averaged electrocardiography in survivors of first acute myocardial infarction: a pre-hospital discharge study.

Ninety one consecutive survivors of a first acute myocardial infarction (MI) were studied prior to hospital discharge, in order to observe the relationship of signal-averaged electrocardiography (SAECG) to thrombolytic therapy, site of infarction and left ventricular function. Sixty six patients received thrombolytic agents and the remaining had conventional therapy. The overall incidence of abnormal SAECG was 27 percent and 16 percent with high-pass 40 Hz and 25 Hz filters respectively. The SAECG (40Hz) was abnormal in 12 of 25 patients (48%) who did not receive thrombolytic therapy and in 13 of 66 (20%) who were thrombolysed (p < 0.01). When patients were classified according to the site of myocardial infarction, 6 out of 10 patients (60%) with anterior MI who were not thrombolysed had abnormal SAECG as compared to 10 of 51(20%) who received this treatment (p < 0.01), with no significant difference among inferior myocardial infarction patients. The mean (+/- SEM) ejection fraction (EF%) of anterior myocardial infarction patients was 31 +/- 3 percent in those with abnormal SAECG when compared to 39 +/- 2 percent in patients with normal SAECG (p < 0.05). Similarly, in patients with inferior myocardial infarction, the mean EF among these respective groups was 41 +/- 2 and 47 +/- 2 percent (p < 0.05). The mean echocardiographic score, which reflected regional LV wall motion abnormality, was not different between patients with anterior infarction when the groups with abnormal and normal SAECG were compared (9.1 +/- 0.6 versus 6.4 +/- 0.4), but differed significantly between inferior infarction patients (5.8 +/- 0.7 versus 4.6 +/- 0.4 respectively; p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)