Pulmonary function tests in compressed natural gas pump workers in Surat city

Background: Various studies have known abatements in lung function and several other health problems associated with longstanding air pollution exposure. One of the most cost-effective and environmental alternative of conventional fuels (petrol and diesel) is compressed natural gas (CNG). The increasing use of CNG as a fuel (as it is safe and cheap as compare to the conventional fuels) can add one more bug to the list of work-related disease. Aims and Objectives: This study is to evaluate the respiratory functions of CNG pump workers. Materials and Methods: The present study was held on 82 male subjects. The study group included of non-smoking healthy adult males, age group of 20–40 years working in different CNG stations in Surat city for >6 months and 8 h per day. The control group included of non-smoking healthy adult males, age group of 20–30 years working or studying in the Surat Municipal Institute of Medical Education and Research (SMIMER). Results: Out of 82 male subjects, 30 subjects were control and 52 subjects were CNG station workers. The study group comprised of 52 healthy non-smokers in the age group of 20–40 years working in different CNG station in Surat city for >6 months and 8 h/day. The control group comprised of 30 healthy non-smokers males between the age group of 20–30 years working or studying in the SMIMER. Conclusion: In this study, we have not found statistically significant deterioration in pulmonary functions of CNG pump workers when compared to controls.

Allergic Drug Reactions: How Do The Dermatologists Of Vadodara City Perceive And Contribute To Pharmacovigilance Program?

Background:The pharmacovigilanceisimperativein defining safety profile of the drug.As cutaneous Adverse Drug Reactions (ADRs) are very common, dermatologists’ contribution to pharmacovigilanceprogram of India (PvPI) is important. This study was conducted to know dermatologists’ perception about ADRs; their awareness and participation inPvPI. Material and Methods:A Prospective, cross-sectionalsurvey was conductedamongst dermatologists, approaching via Whatsappor during academic meetings. Pre-validated questionnaire including their demographic details, perception of risk of allergic reactions, awareness of PvPI and ADRs reporting was utilized. Data analysis was done with Microsoft Excel and Graph Pad prism software. Results:Out of 73 dermatologists, 44 responded the survey (Coverage rate 60%).Highest and lowest risk amongstantimicrobials for ADRswas perceived for sulphonamides and cephalosporins respectively. Amongstnon-antimicrobials, it was Non-steroidal anti-inflammatory drugs (NSAIDs) and local anaesthetics respectively. Awareness about PvPI was seen in 94% and 38% of dermatologists working in an institute and in a private set up respectively. Amongst them, 78% and 18% had ever reported ADRs to PvPI. Conclusions:Sulphonamides and NSAIDs were perceived to have higher risk ofADRs. Limited number of dermatologists have contributed to national ADR database amongst the ones who are aware of PvPI.

Left-sided giant adrenal myelolipoma secreting catecholamine.

Adrenal myelolipoma (AML) is a rare benign tumor composed of mature adipose and hematopoietic tissue. Most of these patients are asymptomatic and the tumors are non-secreting. We present a case with a large functional adrenal myelolipoma, wherein the patient was hypertensive and biochemistry revealed increase in 24 hours urinary Vanillylmandelic Acid (VMA), a metabolite of catecholamine. The mass was removed surgically and diagnosed as adrenal myelolipoma on histopathological examination. Both his blood pressure and urinary VMA returned to normal following surgery, which suggested that the mass was functioning and was secreting catecholamine. To the best of our knowledge, a catecholamine secreting adrenal myelolipoma has been reported in the literature only once previously. The association of hypertension and adrenal myelolipoma may not be entirely coincidental, as it may be associated with secreting catecholamine, as seen in our case. We also review the literature on functioning adrenal myelolipoma.

A Clinical Review on a Polyherbal Formulation, Renalka Syrup in Urinary Tract Infection.

Urinary tract infections (UTIs) are common bacterial infections in general practice and are responsible for considerable morbidity in certain groups. UTI can be defined as a condition wherein bacteria multiply within the urinary tract. Numerous antimicrobial agents are used to treat UTIs with mixed clinical response. Recurrent UTI, despite antimicrobial treatment is a cause of clinical concern due to their adverse effects on long-term and also because of rising incidence of drug resistance. Hence alternative agents, other than antimicrobial drugs, that are beneficial in treating UTI are required. Recently, there has been emphasis on the search for herbal preparations that can be helpful in the management of urinary disorders. In the Indian medical literature, many drugs have been advocated for this indication. Renalka syrup is a well-balanced, multi-ingredient formula with proven value in a variety of urinary disorders. It is a natural and effective alkalizer. The potent herbs possess analgesic, anti-inflammatory and diuretic activity without increasing excretion of electrolytes such as sodium, chloride and bicarbonate. Renalka syrup not only relieves burning micturition, but also soothes inflamed urinary mucosa. It restores normal urinary pH and normalizes the frequency of micturition. It is effective for long-term prophylaxis of UTI. Several clinical trials were conducted to evaluate the efficacy of this herbal urinary alkalizer in bacteriologically-proven UTIs. It was found to be safe and effective in relieving the symptoms of UTI. Five clinical studies conducted with Renalka syrup on substantial sample size are discussed in the review.

Clinical Profile of Leukocyte Adhesion Deficiency Type I.

Leukocyte adhesion deficiency type I (LAD-I) is a rare, inherited immunodeficiency with defect in the recruitment of leukocyte to the site of inflammation. Patients with severe LAD-I have absent or markedly reduced expression of CD18 and CD11. Here we report clinical profile of 7 cases of LAD-I diagnosed at our center over a period of 3 years. Recurrent skin and mucous membrane infections were the major presenting manifestations. All children had a history of delayed cord separation.

Over prescribing and resistance to chloroquine.

Malaria is a major health concern in the developing world including India. Overdiagnosis and overprescribing of malaria may lead to increase morbidity, mortality and increases risk of resistance to antimalarial drugs and hence increase the economical burden to health care system. The present study was carried out to determine the actual cases of malaria and extent of chloroquine resistance at Civil Hospital Ahmedabad, a tertiary care teaching hospital in Gujarat, India. After Institutional Ethics Committee approval, adult patients of either gender, presenting with a history of fever at the Out Patient Department (OPD), diagnosed to be suffering from malaria and prescribed chloroquine were included in the study. Peripheral thick blood smear test and OptiMAL-rapid diagnostic test (RDT) were carried out. RDT was performed in these patients on day 0 before the start of chloroquine treatment and after completion of the 3 day chloroquine treatment. They were again subjected to RDT on day 4. The positive cases on RDTon day 4 were considered as resistant to chloroquine. During the study period of 12 months, out of the 250 clinically suspected cases of malaria who were prescribed chloroquine, 80 (31%) cases (35 cases of P. vivax and the 45 of P. falciparum ) were positive for malaria (by the peripheral smear and the Rapid Diagnostic Test (RDT) OptiMAL test). Thirty out of the 35 cases of P. vivax malaria, responded to the three- day chloroquine treatment. Out of the 45 cases of P. falciparum malaria, 30 responded to chloroquine while 15 patients (35%) continued to be OptiMAL positive on 4th day and required change of treatment. It suggests that an early diagnosis, definitive treatment and avoiding overprescribing could delay drug resistance and reduce the morbidity and mortality due the disease.

Ocular lesions in disseminated candidiasis.

AIM: To assess the prevalence and patterns of ocular involvement in disseminated candidiasis in intensive care setting. MATERIALS AND METHODS: Institutional review board approved case review of intensive care admissions. These were patients of septicemia who had undergone ocular examination as part of their initial assessment. The records of patients in whom Candida spp. was detected in two sites or had a clinical diagnosis of candidemia were analyzed. RESULTS: Twelve patients (nine male, three female) were diagnosed with candida-induced sepsis during this period. Their ages ranged from 26 to 97 years (mean 52.7 years). Six patients (50%) had ocular lesions. The commonest lesion was chorioretinitis, seen in seven eyes of six patients followed by Roth spots seen in one eye. There was no evidence of vitritis or endophthalmitis in any eye. Systemic immunosuppression was present in three of six (50%) patients with ocular changes. Incidental findings included two eyes with non-proliferative diabetic retinopathy. CONCLUSIONS: Any suspicion of disseminated candidiasis should prompt an ocular evaluation which may help in the early diagnosis and in the institution of early antifungal therapy. This may reduce ocular morbidity and patient morbidity.

Terrible triad of the elbow: a case report of a new variant.

The usual terrible triad of the elbow consists of posterior dislocation of the elbow, radial head fracture and coronoid fracture. We describe a new variant of the terrible triad of the elbow consisting of fracture of the capitellum involving the full length of the trochlea and posterolateral dislocation of the elbow associated with coronoid fracture (type 1 Regan-Morrey). A 25-year-old girl was brought to the emergency ward with the history of having jumped from the third floor with an intention of committing suicide. She sustained multiple fractures, i.e, fracture ribs, bilateral intra-articular fracture of the lower end of the radius, left-side elbow injury, left subtrochanteric fracture femur and left zygomatic fracture with head injury. The elbow was stable after stabilization of the capitellum fracture through a collateral approach. Coronoid fragment was left alone, as it was a very small fragment.

Transphyseal spread of benign tumors and infections in pediatric patients: a series of six cases.

Epiphyseal extension of benign pathology is regarded as an infrequent occurrence. This observation has been attributed to anatomical and biochemical phenomenon unique to physeal cartilage. We report a retrospective series of six patients over a period of 4 years, diagnosed with benign pathologies that showed crossing of an open physeal plate by the disease. Four of these cases were infections and two were benign tumors. The patients were aged between 5 and 11 years, all of them were treated at a tertiary referral centre and followed up for a minimum period of 6 months to evaluate the progress of disease. The findings are more than just a pathological curiosity as they alter the management and surgical procedure that needs to be performed for these conditions. The recognition of the fact that benign tumors may occasionally present with transphyseal spread will prevent unjustified radical procedures that are best reserved for aggressive malignant conditions.

Oportunidades perdidas para la prevención y el diagnóstico precoz de la infección por HIV en Niños / Missed opportunites for prevention and early disgnosis of HIV infection in children

La transmisión vertical es el modo de adquisición más frecuente de la infección HIV en los niños. Desde el año 1997 se encuentra en vigencia en nuestro país el programa de prevención de la transmisión perinatal. Con el objetivo de analizar las características de los niños con diagnóstico reciente de infección HIV y evaluar factores relacionados con el fallo de la prevención realizamos el presente estudio. Estudio retrospectivo. Población: niños expuestos al virus HIV en forma vertical que concurrieron al hospital para descartar el diagnóstico. Período enero 2002- julio 2003. Se analizaron los datos demográficos, estadío clínico-inmunológico, lugar de procedencia y antecedentes maternos. Se incluyeron 222 niños, en 64 de ello se confirmó la infección. La edad en el momento del diagnóstico fue 38 meses (mediana) en los niños con infección HIV versus 2 meses en aquellos no infectados. El 64 por ciento de los infectados nació en el período 1998-2003, luego de la incorporación de las recomendaciónes para la prevención de la transmisión vertical y tuvieron en promedio 1.6 internaciones previas con diagnósticos relacionados con la infección HIV. El 78 por ciento de las madres infectadas recibió atención prenatal. Sin embargo solo el 18% de la madres de niños infectados conocía el diagnóstico de HIV en el embarazo. Se observó que 27/64 (42 por ciento) de los niños infectados se encontraban en un estadio clínico inmunológico avanzado en el momento del diagnóstico. El diagnóstico en los niños fue tardio aunque tenían internaciones previas por enfermedades relacionadas al HIV. Es fundamental: implementar acciones para optimizar el programa de prevención de transmisión vertical y mejorar la sospecha diagnóstica de infección HIV en pediatría.

Carcinomatous meningitis mimicking Creutzfeldt-Jakob disease.

We report a case of carcinomatous meningitis diagnosed at autopsy that was clinically diagnosed as a case of Creutzfeldt-Jakob disease (CJD) because of rapidly evolving dementia. Pathological study revealed diffusely spreading carcinomatous meningitis, infiltrating into cortex along Virchow Robin space. Immunostaining for Prion protein was negative. Despite advances in clinical diagnosis, tissue diagnosis remains a pre-requisite for confirmation of CJD.

McCune Albright Syndrome (MCAS): a case series.

McCune Albright Syndrome (MCAS) is an association of, Café-au-lait macules, polyostotic fibrous dysplasia and autonomous hyperfunctioning endocrinopathy. This is a rare disorder seen more commonly in females. We evaluated 7 (6F & 1M) cases under six years of age (4 months to 5.5 yrs) presenting with Café-au-lait spots, polyostotic fibrous dysplasia and/or sexual precocity. All the 7 cases had large Café-au-lait spots, radiologic features of polyostotic fibrous dysplasia were seen in 5 cases. Six girls had precocious puberty with large ovarian follicles and elevated S. Estradiol levels (14-65 pg/dl) with prepubertal gonadotropin levels in 5 of them. Medroxy-progrestrone acetate was used to treat the sexual precocity. Five girls on follow up for 6 months (6mo-16mo) showed cessation of menstrual episodes and regression of ovarian follicles in three, regression in breast size in one, and three girls continued to grow at a height velocity >95th centile for age. Skeletal lesions and skin features did not show any change. No other endocrinopathy was noted. Gonadotropin independent precocious puberty was the only endocrine affection seen in this series.

Polymerase chain reaction for the rapid diagnosis of tuberculous meningitis.

(i) AIM OF THE STUDY: The study was carried out with the aim to evaluate a polymerase chain reaction (PCR) based on the amplication of a 169 bp DNA fragment specific for the Mycobacterium tuberculosis complex for the rapid diagnosis of tuberculous meningitis (TBM). (ii) METHODOLOGY: A total of 105 CSF specimens from clinically suspected cases of TBM were studied. Clinical details of the cases and cytochemical parameters of the CSF specimens were recorded. In addition to the 105 specimens, 10 CSF specimens from cases other than TBM, 4 non-mycobacterial culture isolates (1 strain of E. coli, 1 strain of Proteus species and 2 strains of Salmonella species) and 1 sample of sterile distilled water were processed as negative controls. For positive control standard culture of Mycobacterium tuberculosis H37Rv was processed with every batch of specimens. Besides PCR, smear for AFB by the Ziehl Neelsen Carbol Fuchsin (ZNCF) and the fluoro chrome method and culture on LJ medium was also carried out. (iii) RESULTS: By PCR, 31.42% specimens were found positive, whereas by conventional culture on LJ medium only 3.8% specimens were positive. Only 1.9% specimens were found to be smear positive by the fluorochrome staining method, while none was positive by the ZNCF method.The PCR results showed complete correlation with the clinical findings of the patients. (iv) CONCLUSION: The PCR was found to be superior to the currently available techniques for the diagnosis of tuberculous meningitis in terms of sensitivity, specificity and rapidity and could play a critical role in the diagnosis of suspected cases.

Evaluation of a novel, two component, two step AFB cold staining method.

AFB smear is a clinically useful and a cost effective test for screening of sputum samples for Mycobacterium tuberculosis. Routinely, Ziehl Neelsen stain, using the traditional hot staining procedure is the mainstay of sputum smear AFB tests. We have evaluated a novel two components, two step cold AFB stain to establish its sensitivity, simplicity and reproducibility as compared to the traditional 'ZN Hot' stain still regarded as the standard AFB stain in routine laboratory practice. This study was conducted over a period of four months at the TB Hospital, Taleigao Goa. Comparatively the two components, two step AFB stain was easy to use, time, labour and cost saving. It gave reproducible results during the study period. The most important characteris tics were that it nearly doubled (~91%) the detection rate of AFB positive sputum in our hospital.

Hyperthyroidism in children.

This study was done to characterize the clinical features, laboratory parameters and response to therapy and outcome of childhood hyperthyroidism. The evaluation included history, examination, laboratory investigations: serum T3, T4, TSH, free T3, free T4 by RIA or immunochemiluminescence (IC), antithyroid antibodies by standard techniques, bone age (BA) by Greulich and Pyle's method, clinical and laboratory response to treatment, and follow-up of 15 children with hyperthyroidism seen in past eight years. Age of onset, presentation, nature and duration of symptoms, family history, anthropometry and signs of hyperthyroidism were recorded. There were 10 girls and 5 boys (2:1). Three families had a history of thyroid disorders. Mean ages of onset and presentation were 8.25 +/- 3.4 and 9.27 +/- 3.2 years respectively. Clinical features included weight loss, heat intolerance and sweating, diarrhoea, behavioral problems, ophthalmopathy and tachycardia. BA was advanced. Serum T3 (mean = 4.29 +/- 1.77 ng/mL), T4 (18.75 +/- 5.64 micrograms/dL), FT3 (7.11 +/- 4.58 pg/mL) and FT4 (2.93 +/- 0.29 ng/mL) were markedly elevated. TSH was suppressed. Anti-microsomal antibodies (AMA) and anti-thyroglobulin antibodies (ATG) were positive in five. They were started on standard treatment with carbimazole 0.5-0.7 mg kg-1. Clinical and biochemical euthyroidism was achieved within 2.5 to 6 months in all, after which the drug was tapered, however, they required treatment for 2 years to 7.5 years. Four children were retreated for relapse and are now euthyroid and off treatment. Childhood hyperthyroidism requires long term treatment and careful monitoring. This study shows a remission rate of 67%.

Autoimmune thyroid disease in childhood: a study of children and their families.

OBJECTIVE: To study the clinical and laboratory profile of children with autoimmune thyroid disease (AITD) and its familial prevalence. DESIGN: Clinical and investigative evaluation of 96 children and adolescents 5 to 16 years old suspected of having AITD based on clinical and family data and similar assessment of parents and siblings of 30 confirmed cases of AITD. SETTING and SUBJECTS: Of these 96 cases, 66 were from a private clinic and 30 were institution based thyroid antibody positive with confirmed AITD. On initial testing 36 (55%) of 66 clinic cases were thyroid antibodies (ab) positive and 30 were (ab) negative. In 12 of 30 ab -ve cases retesting for antibodies by newer technique or FNAC confirmed AITD. Clinical and laboratory evaluation of 90 of a total of 106 parents and siblings of the 30 institution based cases. METHODS: Clinical evaluation with goiter grading by WHO criteria was done in all. Family history of thyroid disease was inquired for in all. Clinical examination and thyroid antibody status was assessed in 90 family members as stated above. Thyroid antimicrosomal (AMA) and antithyroglobulin (ATG) antibodies were tested by standard hemogglutination kits. Titers of > 1:100 considered +ve for children and >1:400 for adults. Thyroid (ab) could be tested in ten of the ab-ve cases by ECI technique on follow up.Bone age was assessed. Ultrasonographic or TCM 99 scanning of thyroid gland and FNAC were done as indicated. RESULTS: Of the 96 children suspected to have AITD, thyroid antibodies were positive in high titers in 66 (36+30) cases (69%) on initial testing but with more sensitive ECI technique significant antibody titres were detected in 10 more cases (79%) and FNAC confirmed AITD in 2 more subjects (total 78 - initial 66 + 12). F:M ratio was 2.9:1. Sixty one per cent of children were between 6 to 12 years of age; mean age 10.12+/-2.9 years. Seventy seven per cent had hypothyroidism, 10% had thyrotoxicosis and only 13% were euthyroid. Family history of thyroid disease was elicited in 33% of the series. Survey of 90 parents and siblings of the institution based group revealed, euthyroid goiters in 17%, subclinical hypothyroidism in 10% and significant AMA titers in 43% (65% of mothers, 30% siblings and 43% fathers). CONCLUSION: Juvenile AITD is a common cause of acquired thyroid disease in children above 5 years of age with a 3-fold higher prevalence in girls. The manifestations are heterogeneous. Hypothyroidism was most common (77%), euthyroid goiters (13%) and thyrotoxicosis (10%) were less frequent. Familial aggregation was noted in adult family members (33%) with positive thyroid antibodies in 65% of mothers. Sibling affection was less frequent. The familial and genetic implications of AITD are important; diagnosis of AITD in children may also help detect subclinical disease in adult family members.