Clinical Profile of Co-Infections and Bacterimia in Adults with Malaria – An Experience from a Tertiary Care Hospital in Northeastern India.

Bacterial co-infection associated with malaria is potentially important but poorly documented. Published reports are mainly from African children while data from adult Indian population are limited. To determine the spectrum of concurrent bacterial infection in malaria the present study was conducted in department of Medicine at Tripura Medical College. Out of eighty patients, 58 had falciparum, 15 had dual infection and 7 had vivax malaria. Blood culture failed to confirm bacteraemia in any sample with the exception of one case of complicated malaria showing the growth of Escherichia Coli. Urine culture also grew Escherichia Coli in 2.5% of enrolled patients. Anti salmonella IgM antibody was detected in 7.5% of the study population. Sputum culture was positive of streptococcus pneumoniae in single patient with radiological evidence of consolidation. CSF culture was sterile in cases with cerebral malaria. Thus the present study shows that bacteraemia is uncommon in adults with malaria compared to children of endemic areas. Presence of other co-existent infections should be sought in clinically suspected cases only. We propose a restrictive antibiotic policy in the setting of malaria.

A Study of Cerebro Vascular Accident Patients.

To find out the proportion of different types of strokes among the CVA patients and to examine the correlation between stroke and various risk factors. Patients and Methods: Sixty CVA patients who attended the department of Medicine of TMC & Dr.BRAM Teaching hospital comprised the material for this study. Detailed history, clinical examination especially CNS examination, different biochemical and radiological investigations including CT Scan were performed to establish the diagnosis of CVA and to confirm the type of CVA. Various risk factors then correlated in causation of CVA. Result: Out of 60 CVA patients 42(70%) had ishaemic and 18(30%) had haemorrhagic stroke. Among the 42 ischaemic stroke patients 12 (20%) had lacunar stroke. 38 patients (63.3%) had hypertension, out of which only 4 (15%) had regular follow up showing that hypertension is a definite risk factor. Serum Cholesterol (213.52 ± 32.97) and Serum Triglyceride (176.25 ± 41.97 ) were statistically significant (p<0.01) along with Serum LDL (117.88 ± 27.18) and VLDL (49.11 ± 13.76),t value 5.096 and 5.128 respectively. In this study 14 (23.3%) patients had diabetes mellitus, 31 (51.6%) smokers, 14 (23.3%) alcoholics and 15 (25%) overweight, but none of them could be established as a statistically significant risk factor.

Primary orbital lymphoma.

Primary orbital lymphoma is a rare condition involving primarily the lacrimal glands. We present the second Indian case of right-sided primary orbital lymphoma in an elderly male who presented with the typical features and showed a good response to chemotherapy.

Effect of tri-ortho-cresyl phosphate on hen nervous system.

Correlation of tri-ortho-cresyl phosphate (TOCP) toxicity with clinical symptoms and inhibition patterns of neurotoxic esterase (NTE) in different regions of the central nervous system was studied in hens. The total content of NTE in spinal cord and peripheral nerves was relatively much lower than that of the brain, about 29 and 4.8 per cent respectively. Brain and spinal cord NTE was inhibited to 75 and 67 per cent respectively on day 1 post-TOCP treatment, and 91 and 84 per cent respectively on day 2, while the activity of the enzyme in peripheral nerve was inhibited to 92 per cent on day 1. However, the clinical manifestations of paralysis appeared after 7-8 days of TOCP treatment. It can be concluded that the presence of NTE in very low quantities in the peripheral nerves and its almost complete inhibition as compared to that of brain and spinal cord, could be of great significance in the development of neurotoxicity.

Kwashiorkor and marasmus: changing hospital incidence of syndromic presentation (1957-88).

This clinico-epidemiological study was undertaken to substantiate the impression that the pattern of clinical presentation of protein-energy malnutrition causing kwashiorkor-marasmus syndrome (KMS) is changing over time. An analysis of data for the period 1964-88, obtained from the specialised Pediatric Clinic of the Calcutta School of Tropical Medicine serving mostly the city slums showed decrease (p less than 0.01) in the incidence of chronic edematous forms of severe KMS, less decrease (p less than 0.05) in the incidence of mild-moderate KMS and increase (p less than 0.01) in the incidence of nutritional marasmus and of chronic very severe forms of KMS characterised by extreme retardation in growth and development. Incidentally, a rising incidence of rickets was observed. In the hospitalised cases (1957-88) these observations were corroborated. Data for 1985-88 of NRS Medical College Hospital, Calcutta, a general hospital serving the city as well as the neighbouring rural areas, showed that among the hospitalised city children edematous KMS was proportionately fewer than marasmus. The situation was reverse in the children from the rural areas. The observations suggested that the syndromic presentation of KMS is changing over the last three decades with some rural-urban differences for which only some recent data could be available.

Cyclic changes in salivary lactate dehydrogenase, peroxidase and leucine aminopeptidase during menstrual cycle.

Salivary lactate dehydrogenase (LDH), peroxidase (Px) and leucine aminopeptidase (LAP) activities were scanned in both normally ovulating and anovulating women during entire menstrual cycle. In ovulating women, all the three enzymes exhibited significant increase in the activity on or before the onset of ovulation which was monitored by the shift of the basal body temperature (BBT) as well as the ferning pattern of the cervical mucus. The peak maximum at the midcycle was several times higher than the previous day value in all the six normal women. In anovulatory women, no such remarkable change in the enzyme activities was found throughout the cycle. Salivary LDH and LAP showed peak at the midcycle and at the same time required short time for assay, so the present results are strongly suggestive that the determination of salivary enzyme content may be a convenient method for detecting the day of ovulation.

Glycerylphosphorylcholine levels in the coagulational groups of human ejaculates.

The amount of coagulum present in fresh ejaculates of men (among infertile couple) varied directly with the levels of seminal glycerylphosphorylcholine (GPC; P less than 0.001), which is secreted predominantly by the epididymis. GPC concentrations (mg/ml) of the normally and poorly coagulating ejaculates revealed close similarities with those of the presumably fertile (1.72 +/- 0.10) and infertile semen (1.13 +/- 0.08) respectively. The study suggests that the degree of coagulation of human ejaculates may be correlated with epididymal function.

Structural changes in human cervical mucus.

The crystallization phenomenon of human cervical mucus was investigated with the help of scanning electron microscope. Changes in the conformation of crystals and ferning patterns were studied on different days of the menstrual cycle in both normally ovulating women and those using oral contraceptives. No crystalline structure was found on day 5 in both categories of women, whereas square crystals were observed on day 21 in normal woman. Nature and type of ferning pattern changes seen from days 11 to 14 in normal women were not seen during this period in women who were on oral contraception, instead a thick, viscous mucus was found during the entire period of the cycle.