Report-based antibiotic sensitivity pattern of community-acquired urinary tract infection in rural Bengal

Background: Urinary tract infection (UTI), a common bacterial infection managed in general practice, is the second most common cause for antibiotic use in primary care setting. Antibiotic prescription is mostly empirical in UTI and it is imperative to choose one highly sensitive drug against the common pathogens. Aims and Objectives: In this study, it has been tried to find out the magnitude of community-acquired UTI in a rural population of West Bengal, its causative agents, and the sensitivity pattern of urinary isolates to reduce the development of antibiotic resistance. Materials and Methods: This is an observational, cross-sectional study over 1 year in a rural tertiary care hospital in West Bengal. Culture and sensitivity reports generated from diagnosed UTI patients from the different OPDs of the hospital were analyzed. Results: Out of 603 reports analyzed, culture-positive reports were 463. Escherichia coli was identified to be the most predominant (61.7%) followed by Staphylococcus aureus (17.3%). The sensitivity report of the empirically given antibiotics shows that among the oral antibiotics, nitrofurantoin was the most sensitive one (92%) followed by ciprofloxacin (83.1%) and ofloxacin (66%). Among the injectables, amikacin (84.5%) and ceftazidime (81.8%) were the antibiotics having the highest sensitivity. Conclusion: The sensitivity among the uropathogens to the commonly used antibiotics shows higher resistance rate toward norfloxacin, cephalexin, cotrimoxazole, ampicillin, amoxicillin, co-amoxiclav, and cefuroxime. Oral antibiotics such as nitrofurantoin and ciprofloxacin and parenteral antibiotic amikacin have found to be of higher sensitivity among all organisms identified clubbed together.

Reflective writing as a learning tool for Phase II MBBS students in India

Background: Reflection is essential in training physicians mainly because it helps them to participate in collaborative teams, respond in unique and compassionate manner to clinical cases and situations and behave professionally and with empathy. Aims and Objectives: The objective of this study was to observe the reflective writing ability of the Phase II MBBS students of the institute after a structured training and to obtain student feedback about the experience. Materials and Methods: This was a prospective, observational study conducted at the Department of Pharmacology, of a Medical college. A total of 102 students were included in an interactive lecture on reflection writing. Over 3 weeks they were shown three different videos (two of them doctor patient/family member interactions and one a teacher student interaction). The students were asked to reflect about what they saw in the videos. Their reflection was under three heads - “what happened, what was your reaction, and what can be done next.” Their reflection was analyzed using a scoring system (score 1 no refection to score 6 with in depth reflection) by a single observer. Their feedback was obtained using a 5-point Likert scale. Results: Average scores of the students in the three reflection exercises were 2.85 ± 0.78, 2.98 ± 0.84, and 3.36 ± 0.57, respectively, showing improvement in reflection skills. Feedback from the students showed that most liked the experience and recommended for their peers. Conclusions: We concluded that 2nd year MBBS students, when taught the structure of a reflective exercise may be able to reflect better on their day to day experiences.

High-grade mixed neuroendocrine non-neuroendocrine neoplasm of the gastroesophageal junction: A rare case report and review of literature

Mixed neuroendocrine non-neuroendocrine neoplasm (MiNeN) is a recently described entity of the esophagus in the latest (fifth) edition of WHO Classification of Digestive System Tumors. It is often a difficult pathological diagnosis, especially in small preoperative biopsies. We herein report a case of high-grade MiNeN of gastroesophageal junction diagnosed as a squamous cell carcinoma in preoperative biopsy and subsequently as a high-grade MiNeN in esophagogastrectomy specimen comprising areas of mucoepidermoid carcinoma and large-cell neuroendocrine carcinoma (NEC). This report accentuates the importance of deeper multisite preoperative biopsies as the management is completely different in a MiNeN from esophageal squamous cell carcinoma.

Clinico-radiological profile and outcome of patients undergoing intercostal tube drainage in a tertiary care hospital in West Bengal, India

Introduction: Evacuation of empyema which was first performed centuries ago, marked the beginning of thoracic drainage. The subsequent acquisition of a greater knowledge of the anatomy, physiology, and pathology of the pleural space directed the design of thoracic catheters and drainage systems and the development of the methods by which they are used. Thoracic drainage systems are designed to remove air and liquids from the pleural space or mediastinum, which collect there as a result of injury, disease, or surgical procedures. Method: A total of 100 patients who underwent intercostal tube drainage due to various etiologies are followed up for 3 months in the study Results: In this study it was observed that pneumothorax (67%) as the most common indication for chest drain insertion followed by hydro-pneumothorax. During this period 100 patients of different pathologies related to chest underwent chest intubations. Amongst them 88(88%) were male and 12(12%) were female. Subcutaneous emphysema was found to be the most common complication followed by ICD tube blockage. Among the study population 95% patients were successfully treated & unsuccessful outcome was only 5%. Conclusion: Chest tube insertion is a common procedure usually done for the purpose of draining accumulated air or fluid in the pleural cavity. Small-bore chest tubes (≤14F) are generally recommended as the first-line therapy for spontaneous pneumothorax in non-ventilated patients and pleural effusions in general. Large-bore chest drains may be useful for very large air leaks, as well as post-ineffective trial with small-bore drains.

A clinicopathological study of pleural effusion with special reference to malignant aetiology in a tertiary care hospital in West Bengal

Background: Pleural effusion has varied aetiological factors. It constitutes one of the major causes of morbidity in India as well in other parts of world. Because of the various aetiologies that can cause pleural effusion, itoften present a diagnostic problem, even after extensive investigations. Objective: In this study, authors aimed to identify the common aetiologies causing pleural effusion and their clinical profile in a tertiary care hospital. Materials and Methods: A hospital based cross-sectional study is conducted over a period of one year in tertiary care hospital in West Bengal. 150 patients of pleural effusion above 10 yrs of age were studied. Clinico-pathological, radiological, hematological and biochemical parameters were documented. Results: The most common cause pleural effusion in this study was tuberculosis (64.67%), followed by malignancy (14.67%), parapneumonic effusion (7.33%), cardiac failure (5.33%) and other minor causes. It was commonly seen in male (70%). The occurrence of tubercular pleural effusion was maximum in the age group 31-40 years. Right-sided effusions were more common. Pleural fluid cytology and adenosine deaminase played a pivotal role in the diagnosis of tubercular pleural effusion. Conclusion: The present study highlights tuberculosis as the common causative factor for pleural effusion, labels lung carcinoma as the most common cause of malignant pleural effusion, and defines the clinico-pathological, biochemical and imaging characteristics of different aetiologies of pleural effusion.

Assessment of efficacy of Anti-IgE (Omalizumab) therapy in patients with severe allergic asthma in a tertiary care hospital of Eastern India

Introduction: Immunoglobulin E dependent mechanisms play an important role in the development of airway inflammation in allergic asthma. Atopic patients with severe asthma frequently have poorly controlled disease. Many have poor asthma control despite intensive treatment. Severe allergic asthma patients frequently treated with oral corticosteroids and therefore may develop serious side-effects. Anti-IgE antibody had been used in severe persistent allergic asthma in Western countries. However, its long-term efficacy in patients in India has not been reported. Objective: To assess the efficacy of anti IgE therapy in patients with severe allergic asthma. Method: 30 (16 male and 14 female) patients, with mean age of 49 having severe persistent allergic asthma, with recurrent exacerbations and on oral/IV steroids, received Omalizumab 150mg/300mg/450 mg for 1 year. Total dose of oral Steroids, use of rescue medications, changes in lung function (FEV1) were recorded at the baseline, 16 weeks & at end of the treatment (52 weeks) and then analyzed. Results: Significant reduction observed in total oral steroid use at 16 week & at 52 weeks. -10.5mg (p<0.003) & 22.5mg respectively. Use of rescue medications decreased by -7.90 puffs(p- <0.001) at 16 weeks and by -13.67 puffs (13.67 (p -<0.001) at 52 weeks. Improvements in lung Function (FEV1) observed with a tune of 700 ml. from Baseline after 52 weeks therapy. Conclusion: Use of anti-IgE antibody for 1 year is well tolerated and led to an overall significant improvement in patients with severe persistent allergic asthma.

Impact of hepatitis B immunization among the Nicobarese tribe - antibody titres & seroprotection five years after vaccination.

Background & objectives: A total of 237 Nicobarese subjects who had received hepatitis B vaccination as part of mass vaccination project during 2000-2001 were screened for anti-HBsAg titres by quantitative ELISA five years after vaccination. Methods: Anti-HBsAg antibody was estimated using quantitative ELISA. Proportion of the subjects with protective levels of antibody and geometric mean antibody titres were calculated. Results: Among the 237 study subjects, 213 had received three doses of vaccine, 17 had received two doses and seven had received one dose. The geometric mean titres of anti-HBs antibodies were 201.7, 31.9 and 23.1 mIU/ml among those who received three, two and one dose of vaccine, respectively. Among those who received three doses of vaccination, 85.9 per cent had anti-HBs antibody levels of 10 mIU/ml or more, indicating seroprotection. The difference in the seroprotection rates among those who received three doses of vaccination (85.9%) and those who received less than three doses (58.3%) was significant. Seroprotection rates one month after the first, second and third dose of vaccination were 49.1, 86.9 and 96.7 per cent, respectively. It then declined to 89 per cent by the end of the second year and to 85.5 per cent by the end of the third year, but there was no decline thereafter. Interpretation & conclusions: Seroprotection rate reached at the maximum one month after the third dose of HBV vaccine. Although about 15 per cent of the vaccinated persons lost seroprotection by the end of the third year, no further loss in seroprotection was observed between the third year and the fifth year.

Clinical Outcome and Echocardiographic Evaluation of Inferior Myocardial Infarction with Right Ventricular Involvement.

Background : Acute right ventricular myocardial infarction complicates inferior wall myocardial infarction with an incidence of 14-84%. ECG is the cornerstone in initial diagnosis as it is cost effective and done easily. Echocardiographic analysis of the right ventricular involvement can shed light on the severity of the disease. Hence we aimed to study right ventricular infarction in acute inferior wall myocardial infarction using right precordial lead as well as echocardiography. Methods: Present study is based on the analysis of 100 patients admitted to Coronary care unit of the National Institute of Cardiovascular Diseases & Hospital during July 2010 to June 2011, with acute inferior wall myocardial infarction. 12 lead ECG with thorough physical examination was done along with right precordial mapping. ST ³ 1mm in V4R was initial diagnostic of right ventricular involvement followed by echocardiographic assessment of RV and LV within 24 hours. Results: A total of 50 patients showed right ventricular involvement with V4R being the sensitive lead. Echocardiography showed mean RVEF of patients with 29.5 % ± 9.5 in comparison of 44.9%±12.2 without right ventricular involvement. Right ventricular involvement presented with bradycardia (40%) and hypotension, 80% Kussmaul’s sign, 14% with complete heart block. Mortality in right ventricular involvement was 6 times higher than without right ventricular involvement (12 %). Conclusion: Clinical signs and symptomatology are not fully diagnostic of RVI in inferior wall acute MI. ECG can diagnose (using right precordial mapping) this condition very early. Echocardiography help to assess the right ventricular function high-risk groups for aggressive management like primary PCI. Early diagnosis will help in careful monitoring and management of such cases.

Echocardiographic Evaluation of Left Ventricular Diastolic Function after Percutaneous Coronary Intervention in Patients with Coronary Artery Disease.

Background: Although percutaneous coronary intervention (PCI) is an excellent therapy for coronary artery disease, there is a paucity of information on the efficacy of PCI in improving diastolic function, especially in Bangladesh. Because of the high prevalence of left ventricular diastolic dysfunction in coronary artery disease patients and its probable progression to heart failure, an evaluation of the role of PCI in improving diastolic function is required. Objective of the study was to evaluate the impact of percutaneous coronary intervention on left ventricular diastolic dysfunction by Doppler echocardiography in patients with coronary artery disease. Methods: One hundred patients scheduled for elective PCI were enrolled in this study whose left ventricular systolic ejection fraction was normal or only mildly abnormal. Before PCI and 48 hours after PCI, echocardiography was done to evaluate the indices of LV diastolic function in these patients.

Expressional Evaluation of Androgen Receptor in Transitional Cell Carcinoma of Urinary Bladder Patients.

The study was undertaken to evaluate the possible role of Androgen Receptor (AR) in relation to tumor grade, age, sex and urinary bladder cancer risk. Expression of AR detected by immunohistochemistry in 125 Transitional Cell Carcinoma and 100 control cases. Expression of AR was noticed in 28.8% cases. AR increased with increasing tumor grade. Expression of AR was seen to be significantly higher in male in the age group ≥ 50 years (p < 0.05). AR expression was found to be associated significantly with the tumor grades, age and sex suggesting that AR may be used as prognostic markers in the treatment of urinary bladder carcinomas.

Evaluation of 100 cases of ascites.

This has been a descriptive cross sectional study on 100 consecutive adult cases of ascites. They were studied regarding the incidence of underlying causes, variable clinical presentations and the co-relation of investigations with clinical features during the period of September, 2006 to August, 2007 in Sher-e-Bangla Medical College Hospital, Barisal, Bangladesh. Diagnosis of ascites was based on history, clinical examination & USG examination. Among the 100 cases, male were 68 & female were 32, age range was 13-61years. Causes of ascites were cirrhosis of liver 68%, tubercular peritonitis 9%, hepatocellular carcinoma 8%, congestive cardiac failure 6%, malignancy 4%, nephrotic syndrome 3%, lymphoma 2% and others 4%. Cirrhosis of liver is the major cause of ascites in our study. Many of the patients with cirrhosis & hepatocellular carcinoma were positive for HBsAg & anti HCV implying that hepatitis B & C viruses play a positive role in this condition.

Needle sticks injury among nurses involved in patient care: a study in two medical college hospitals of West Bengal.

A hospital-based retrospective study on a sample of 228 nurses involved in patient care, in two medical college hospitals of West Bengal, showed that 61.4% of them sustained at least one Needle Stick Injury (NSI) in last 12 months. The risk of such injuries per 1000 nurses per year was found to be 3,280. Out of the most recent injuries among 140 nurses, 92.9% remained unreported to appropriate authorities; in 52.9% events hand gloves were worn by the nurses; only 5% of those nurses received hepatitis B vaccine, 2.1% hepatitis B immunoglobulin and none of them received post exposure prophylaxis for HIV.

A study on delivery and newborn care practices in a rural block of West Bengal.

A cross-sectional study was conducted in a rural block of the State of West Bengal to generate area specific data on the proportion of home deliveries and certain newborn care practices prevalent in that area. The study was done through house-to-house survey among 165 mothers who delivered in last six months. 83.6% deliveries were conducted at home and untrained persons attended 36.3% deliveries. Bath within 24 hours of delivery was given to 17.58% newborns. Birthweight was not recorded in 38.18%. High proportion of newborns, 78.5%, was given prelacteal feeding. The health system should urgently address the deficiencies in the delivery and newborn care practices in the study area.

Calcifying epithelial odontogenic tumor: report of two cases.

Calcifying epithelial odontogenic tumor (CEOT) is a rare, benign odontogenic tumor. It constitutes 0.4-3% of all odontogenic tumors. There is only a single case, which has been reported in the Indian literature that too in cytology. Microscopically, these are composed of large sheets of epithelial cells, amorphous amyloid-like material and calcification. Although these lesions are benign, they can be locally aggressive, but malignant transformation and metastasis is rare. Considering its locally aggressive nature, appropriate management and long-term follow-up is recommended. We describe two cases of CEOT involving the hard palate and leading to facial alterations.

Knowledge and practice regarding menstrual hygiene in rural adolescent girls of Nepal.

OBJECTIVE: This study was done in the adolescent girls to evaluate the knowledge and practice on different aspects of menstrual hygiene. METHODS: One hundred and fifty adolescent girls of age 13-15 years from 3 schools of Shivanagar and Patihani village development committees of Chitwan district were involved in this study. Altogether 27 questions were asked to each of them. RESULTS: During our study, we found that they were not properly maintaining the menstrual hygiene. Only 6.0% of girls knew that menstruation is a physiologic process, 36.7% knew that it is caused by hormones. Ninety-four percentages of them use the pads during the period but only 11.3% dispose it. Overall knowledge and practice were 40.6% and 12.9% respectively. CONCLUSION: Although knowledge was better than practice, both were not satisfactory. So, the girls should be educated about the process and significance of menstruation, use of proper pads or absorbents and its proper disposal. This can be achieved by giving them proper training and health education (by teachers, family members, health educators, and media) so that there won't be any misconception to the adolescent girls regarding menstrual hygiene.

Need for measurement of bone mineral density in patients of prostate cancer before and after orchidectomy: role of quantitative computer tomography.

BACKGROUND: Androgen deprivation therapy is the first-line systemic treatment of prostate cancer, orchidectomy remaining the most common mode in view of cost-effectiveness and better compliance. Accelerated bone loss is common after orchidectomy, which exacerbates osteoporosis already common in this patient-population. We studied the need of periodic measurement of bone mineral density after orchidectomy. MATERIAL AND METHODS: Fifty five patients of adenocarcinoma prostate opting for orchidectomy were prospectively studied. Follow up ranged from 6 to 18 months. Lumbar spinal (L1-L3) trabecular bone mineral density (BMD) was measured with quantitative computed tomography (QCT) at baseline and every 6 months after orchidectomy, and compared with preoperative values. RESULTS: Mean (+/- SD) age of the patients was 69.9 +/- 7.9 years and BMD 115.7 +/- 35.7 mg/cm2 with T-score -1.89 +/- 1.26 and Z-score 0.30 +/- 1.30. Thirty three percent patients were osteoporotic at baseline, as defined by a T-score <-- 2.5. Fall of BMD six months after orchidectomy was statistically significant (12.1%, p = 0.0001) increasing the proportion of osteoporotics to 49%. Twenty four patients completing 12 months follow up, were separately analyzed and showed similar fall in BMD in first 6 months of follow up (13%) and further 8% loss in next six months. Ten patients were followed up for 18 months, and these did not show significant loss of BMD beyond 12 months (p = 0.9). CONCLUSIONS: Osteoporosis is common in hormone-naive population affected by prostate cancer and orchidectomy leads to accelerated exacerbation of this bone loss. Periodic measurement of BMD using QCT after ADT would help in early detection of osteoporosis.