Rising trend of antimicrobial resistance among Neisseria gonorrhoeae isolates and the emergence of N. gonorrhoeae isolate with decreased susceptibility to ceftriaxone.

Context: Gonorrhoea is one of the most common sexually transmitted infections (STI) in developing countries and is a global health problem. Aims: To analyze the trend of antimicrobial susceptibility of Neisseria gonorrhoeae isolates over the years, in a tertiary care hospital of North India. Settings and Design: The study population comprised males with urethritis and females with endocervicitis attending STI clinic of our hospital. Materials and Methods: In our STI laboratory, all gonococcal isolates are subjected to antimicrobial susceptibility testing by disc diffusion method as per CLSI guidelines. ß-lactamase production is determined by chromogenic cephalosporin test. Minimum Inhibitory Concentration (MIC) for ceftriaxone is determined by E-test. Statistical Analysis Used: Data were expressed as percentages. The differences in percentages were tested for statistical signifi cance by using χ2 test and P values were determined. Results: The percentage of penicillinase producing N. gonorrhoeae (PPNG) increased from 8% in 1995-96 to 20% in 2004-05 and 88% in 2011-2013. Quinolone-resistant N. gonorrhoeae (QRNG) showed a signifi cant increase from 12% in 1995-96 to 98.3% in 2004-05, while 84% isolates were found to be QRNG by 2011-2013. In January 2013 we detected our fi rst gonococcal isolate with decreased susceptibility to third-generation cephalosporins; Ceftriaxone, Cefi xime and Cefpodoxime (MIC for ceftriaxone = 0.19 μg/ml). Conclusions: The results of our study highlighted an alarming increase in the percentage of PPNG and QRNG strains over the years. Emergence of N. gonorrhoeae isolates with decreased susceptibility to third-generation cephalosporins is a cause of concern and thus emphasises the importance of antimicrobial susceptibility testing.

Therapeutic trials for systemic sclerosis: an update.

The pathogenesis of systemic sclerosis (SSc) is complex, and the final story is yet to be elucidated. The clinical heterogeneity of the disease, its various autoimmune and antibody profiles, its long course and tendency for spontaneous cure makes the design of clinical trials difficult. The overwhelming need in this disease is to diagnose it early and identify those patients who will benefit most from early, aggressive treatment. We attempt to review data from recent clinical trials and the lessons derived.

Borderline tuberculoid leprosy--an unusual presentation: a case report.

A twenty-six year old lady presented herself with multiple erythmatous, scaly, well-defined, hypo-esthetic plaques over bilateral soles, face and left leg. Histopathology revealed features consistent with borderline tuberculoid leprosy.

Exchangeable sodium induced changes in yield, water relation and cation composition of fennel (Foeniculum vulgare Mill).

A pot experiment was conducted with the objectives to assess the adaptation potential of fennel crop grown at 10, 20, 25, 35 and 40 ESP (exchangeable sodium percentage) levels. Results showed that the rate of seed germination, plant growth including branching pattern, umbels per plant and 1000 test seed weight were adversely affected by sodic soils. Assuming that fifty percent reduction in seed yield and Na+/K+ ratio in leaf tissue as an index of alkali tolerance revealed that fennel was tolerant up to 25 ESP. The cell sap pH and EC reflected optimum osmoticum maintenance to withstand sodicity stress at this level and beyond this leaf water potential decreased (negatively) more to impede water uptake.

Ground water contamination in the area adjoining zinc smelter effluent stream.

A preliminary survey of the area adjoining to zinc smelter effluent stream was undertaken to assess ground water contamination. Twenty-five ground water samples from the wells located in the study area were collected and grouped into nine groups based on their lateral and longitudinal position from the stream carrying the effluent discharged from zinc smelter, Debari- Udaipur. The study indicate that waters of wells situated in the vicinity of effluent stream (255m radius) were of medium salinity having higher levels of Ca and Mg and lower values of pH as compared to the waters of the reference wells situated far away from the effluent stream. The Fe, Zn, Cd, Cl, F and SO4 contents ofthe water from the wells located within 80m vicinity of the effluent stream were above the permissible limits for drinking purposes. Furthermore the Zn, Cl and SO4 levels in these waters were so high that they were even not suitable for irrigation, indicating a gradual encroachment of effluent into the native ground water.

Oral zinc therapy in diabetic neuropathy.

The present double blind randomized study was conducted on 50 subjects; 20 age and sex matched healthy controls (Group--I); 15 patients of diabetes mellitus with neuropathy who received placebo for 6 weeks (Group--IIA); and 15 patients of diabetes mellitus with neuropathy who were given supplemental zinc sulphate (660 mg) for 6 weeks (Group--IIB). Serum zinc level, fasting blood sugar (FBS) and post prandial blood sugar (PPBS) levels and motor nerve conduction velocity (MNCV) were estimated on day 0 and after 6 weeks in all subjects. Serum zinc levels were significantly low (p < 0.001) in group IIA and IIB as compared to healthy controls (Group--I) at baseline. After 6 weeks the change in pre and post therapy values of FBS, PPBS and MNCV (median and common peroneal nerve) were highly significant (P = < 0.001) for group IIB alone with insignificant change (P = > 0.05) in group IIA. No improvement (P = > 0.05) in autonomic dysfunction was observed in either groups. Therefore, oral zinc supplementation helps in achieving better glycemic control and improvement in severity of peripheral neuropathy as assessed by MNCV.

Hypozincemia in diabetes mellitus.

The present study was conducted on 20 age and sex matched healthy controls and 30 patients of diabetes mellitus. Serum zinc levels in diabetics were found to be significantly (p < 0.001) reduced as compared to healthy controls. There was no significant sex difference (P > 0.05) in serum zinc levels amongst diabetic patients and healthy controls. Hypozincema in diabetes mellitus may be due to altered zinc metabolism and oral zinc may have a role in therapy.

Ultrasonic evaluation of pleural opacities.

Fifty patients of pleural effusion were subjected to radiological and ultrasonic examinations. The results of both examinations were compared and presented here. The study was undertaken to assess the comparative efficacy of ultrasonography in diagnosing pleural effusion.

Airway obstruction in bronchiectasis and its reversibility--a study of 38 patients.

Thirty-eight patients (20 males and 18 females) with bronchiectasis were studied for the evidence of airway obstruction and its reversibility in response to subcutaneous terbutaline. There was an improvement in VC (8.56%), FEV1 (6.36%), PEFR (15%) and PEF 25-75% (18%) respectively. The difference being statistically significant in VC and highly significant in FEV1, PEFR and FEF25-75 as compared to initial values and in 6 patients the improvement in FEV1 was more than 15%. The improvement in airway obstruction was not related to the character of expectoration. It is suggested that all the patients of bronchiectasis should be assessed for the reversibility of airway obstruction and those showing a reversible pattern be treated accordingly.