A clinical observational study on second-trimester abortion

Background: Second-trimester abortion is an important component of the comprehensive women’s health care. Data’s regarding second-trimester abortion is still under-reporting. Though the percentage of induced second-trimester abortion is low, its morbidity is higher than the first-trimester induced abortion. The abortion related mortality usually increases with the age of gestation.Methods: A retrospective observational study was conducted in the department of obstetrics and gynecology at Sree Balaji Medical College and Hospital, Chennai, over a period of one year. The data were collected from the medical case records and we have analyzed on the epidemiology, etiologies, complications and the methods of second- trimester abortion using statistical analysis.Results: In this study, there was no standard regimen of mifepristone and misoprostol were used for second-trimester abortion.  The dosages were varied based on the gestational age of pregnancy. As the gestational age progresses, the amount of misoprostol required for the induction of second trimester abortion decreases and the difference is statistically significant. There was no reported case of rupture uterus, but varied complications such as post-abortal hemorrhage, retained placenta, need for blood transfusion, uterine perforation and one maternal death were reported during the study period.Conclusions: In order to reduce the morbidity and mortality of second trimester abortion, more policies and monitored services have to be rendered by the health system. Data regarding the second trimester abortion have to be improved.

A rare case of pulmonary nocardiasis in an AIDS patient.

Nocardia infections are rare among normal individuals. Mostly they occur in immuno-compromised individuals. Here, we report a case of pulmonary nocardiosis in a person who was diagnosed as having pulmonary tuberculosis and was treated with anti-tuberculous treatment for 6 months. But the sputum smear was positive even after a complete course of treatment. The patient was seropositive to HIV-1 antibodies.

Bird-headed dwarf of Seckel.

Seckel syndrome is an extremely rare inherited disorder characterized by growth delays prior to birth resulting in low birth weight. Growth delays continue after birth resulting in short stature (dwarfism). This syndrome is associated with an abnormally small head, varying degrees of mental retardation and unusual "beak like" protrusion of nose. Other facial features may include abnormally large eyes, a narrow face, malformed ears and an unusually small jaw. This syndrome has an autosomal recessive pattern of inheritance. A case of the Seckel syndrome is presented.

Trichophyton violaceum: a rare isolate in 18-day-old neonate.

Trichophyton violaceum, a less common and geographically restricted infection is reported in a 18-day-old neonate. The diagnosis was made by potassium hydroxide of skin scraping examination and confirmed by culture. The patient was treated successfully with miconazole nitrate application. A large family with crowded living was considered the main predisposing factor.

Diagnostic role of stool culture & toxin detection in antibiotic associated diarrhoea due to Clostridium difficile in children.

BACKGROUND & OBJECTIVE: Mere diagnosis of Clostridium difficile by culture does not help in the diagnosis of antibiotic associated diarrhoeae (AAD) due to C. difficile. Detection of toxins A and B form the mainstay in the diagnosis of AAD due to C. difficile. This study was undertaken to find out the role of stool culture and toxin detection in the diagnosis of AAD due to C. difficile. As there are very few documented reports from India about AAD due to C. difficile in children in the age group of 5-12 yr, this age group was selected. METHODS: Faecal samples were collected from 250 hospitalized children in the age group of 5-12 yr who developed diarrhoea on receiving antibiotics for different medical problems for more than five days duration. Also faecal samples of 250 age and sex matched controls were collected. Culture for C. difficile was done on cycloserine cefoxitin fructose egg yolk agar (CCFA) and colonies were identified by standard laboratory techniques. ELISA for toxins A and B detection and tissue culture on HeLa cells for toxin B detection were also done. RESULTS: Overall positivity was 18 per cent in this study group compared to the controls (P<0.001). Maximum positive cases were in 5-8 yr age group (84.4%). Severe diarrhoea, liquid stool with mucus and blood, faecal leucocytes >5/high power field, altered flora and presence of Gram-positive bacilli with oval subterminal spores on Gram stain were sensitive predictors for diagnosis of AAD due to C. difficile. Amongst positive cases, 68.9 per cent responded to discontinuation of antibiotics and 31.1 per cent to metronidazole therapy. INTERPRETATION & CONCLUSION: C. difficile was an important pathogen responsible for antibiotic associated diarrhoea (AAD) in children of 5-12 yr age group. Conservative use of antibiotics would be beneficial to decrease the incidence of AAD.

Vibrionaceae from cases of acute diarrhoea and their antimicrobial sensitivity pattern - A five year prospective study.

Over a five year period, stool samples were screened for Vibrionaceae from cases of acute diarrhoea, to study their isolation rate and their antimicrobial sensitivity pattern. All the isolates were identified by standard laboratory techniques. A total of 323 species belonging to Vibrionaceae were isolated from 4492 stool samples tested over five year period (1996-2000), giving a positivity rate of 7.2%. Maximum isolation was during the months of May to August (62.5%). Out of 323 isolates, Vibrio spp. comprised 252 and 93.3% of them were Vibrio cholerae O1 biotype El Tor. Aeromonas spp. were isolated from 71 samples and 64.8% of them were A.hydrophila. V.cholerae showed 86.8% sensitivity to amikacin followed by 73.8% to cefotaxime. Tetracycline sensitivity was only 39.6%. Aeromonas spp. also showed maximum sensitivity to amikacin (70.4%). Isolation of Vibrio spp. have increased over the years, whereas Aeromonas spp. have decreased. Amikacin sensitivity has remained within 70-80% over the years, cefotaxime sensitivity has increased and tetracycline sensitivity has decreased.

Helicobacter pylori in duodenal ulcer disease and its eradication.

Antral biopsy specimens were processed for Helicobacter pylori by Gram staining, rapid urease test (RUT) and culture from 25 patients with symptoms of duodenal ulcer, amongst whom the positivity rate was 84%. Follow up of 16 patients after appropriate therapy showed complete regression of the disease in 87.5% of cases whereas in 12.5% of cases a decrease in the extent of duodenal ulceration was noted.

Aeromonas species isolated from cases of acute gastroenteritis.

A total of 67 Aeromonas strains were isolated as the sole bacterial pathogen from1485 patients with acute gastroenteritis. A. hydrophila (64.2%) was the predominant isolate followed by A. sobria (28.4%) and A.caviae (7.4%). Majority of the isolates were sensitive to gentamicin, nalidixic acid but were resistant to ampicillin. Minimum inhibitory concentration (MIC) of resistant strains of Aeromonas to ampicillin ranged from 80-1280 microg/mL.

Regional odontodysplasia (Ghost teeth). A case report.

Regional odontodysplasia is a rare development anomaly affecting the teeth with an unknown etiology. This dental abnormality involves the hard tissues of the teeth that are derived from both epithelial (enamel) and mesenchymal (dentine & cementum) components of the tooth forming apparatus. Teeth in a region or quadrant of maxilla or mandible are affected to the extent that they exhibit short roots, wide open apical foramen and large pulp chamber, the thinness and poor mineralisation qualities of th enamel and dentine layers have given rise to a faint radiolucent image, hence the term "Ghost teeth". Both the permanent teeth and the deciduous teeth are affected. Females are more commonly affected than males. There is a maxillary predominance (2.5:1) with a predilection for the anterior teeth. Eruption of the affected teeth is delayed or does not occur. Because of the poor quality of the affected teeth, they cannot be rehabilitated for functional use therefore the treatment of choice is extraction with prosthetic replacement. However, necrosis and facial cellulitis appear to be a complication if these teeth are retained. A unique case of regional odontodysplasia affecting the entire right quadrant of mandible is reported here.

Salmonella enteritidis meningitis - A case report.

A male infant admitted with pyogenic meningitis with protein energy malnutrition developed fatal infection due to Salmonella enteritidis. The same organism was isolated from CSF and blood cultures.

Anaerobic bacteraemia: a review of 17 cases.

Of 93 blood cultures received with a suspicion of anaerobic bacteraemia over a period of two years, only 17 (18.3%) showed anaerobic growth. Twelve grew anaerobes alone while five had a polymicrobial flora. Seven of these patients (4.3%) had pre-existing heart disease while others had history of prior surgery, diabetes mellitus or urinary tract infection. Oropharynx was the commonest portal of entry, followed by gastrointestinal tract. The anaerobes isolated were anaerobic streptococci, Bacteroides fragilis group and Bilophila and Eubacterium species. Fifteen patients developed major complications such as congestive cardiac failure, systemic embolisation, and perforative peritonitis. The mortality rate among the cases with anaerobic bacteraemia was 23.5% in this study.

C-reactive protein and buffy coat smear in early diagnosis of childhood septicemia.

Out of 200 cases of septicemia in children (age group 0-14 years), 111 had positive C-Reactive Protein (CRP > 12 mg/l) and 84 were buffy coat smear positive. Blood culture was positive in 98 cases, with predominant organism being Klebsiella pneumoniae, followed by Staphylococcus aureus. CRP test showed 100% sensitivity and 87.3% specificity, while buffy coat smear showed 76.5% sensitivity and 91.2% specificity. As blood culture reports are not available before 48-72 hours, combination of CRP test and buffy coat smear examination will be very helpful in early diagnosis of childhood septicemia.

Serogroup prevalence of Shigellae in Bombay.

Prevalence of Shigellae serotypes in Bombay was studied from June 1988 to May 1991. A total of 2758 faecal specimens were collected from paediatric patients (< 12 yrs) with acute gastroenteritis. A total of 90 Shigella were isolated giving the isolation rate of 3.2%. Shigella flexneri was the predominant serogroup (73.3%) followed by Shigella dysenteriae (16.6%). All the isolates were sensitive to nalidixic acid. Eighty percent of the Shigellae were multidrug resistant. Present data were compared with the study carried out during the period of 1983-87 from the same institute. A change in the serogroup prevalence was noted wherein Shigella flexneri dominated over Shigella dysenteriae since 1985. Increase in resistance to ampicillin and cotrimoxazole was seen in Shigella flexneri strains as compared to previous years.

A study of V. cholerae strains isolated in Bombay.

Of 935 faecal samples studied over a period of one year, V. cholerae 01 was isolated from 102 samples (10.9%). All the strains were found to be E1 Tor Ogawa. The strains belonging to the phage types 2 and 4 were encountered in our study, type 2 being the highest (76.5%). The sensitivity pattern of all strains to the commonly used antibiotics was determined. Strains sensitive to gentamicin (92.2%), nalidixic acid (85.3%), kanamycin (83.3%), cotrimoxazole (80.4%) and chloramphenicol (75.5%) were observed. Out of the total, 36.3%, 29.4% and 28.4% of V. cholerae strains were found to be resistant to ampicillin, streptomycin and tetracycline respectively. V. cholerae was isolated throughout the year indicating the endemicity of cholera in Bombay.