Chrysosporium: A rare cause of allergic fungal rhinosinusitis

Allergic fungal rhinosinusitis (AFRS) forms a significant group of patients presenting with the commonest health problem encountered in rhinology. Patients commonly present with typical symptoms of sinusitis, and the diagnosis is often made after imaging and/or intraoperatively. Infections caused by Chrysosporium species are very rare and are very rarely been reported to cause sinusitis in humans. Usually, human chrysosporial infections are mild and unmarked by symptoms. We report a rare case of allergic fungal sinusitis (AFS) caused by Chrysosporium species in a 41-year-old male with the history of diabetes mellitus.

The Effect of Intravenous Ketamine After Spinal Anesthesia on the Duration of Postoperative Analgesia and Analgesic Requirement

Objective: To evaluate the impact of ketamine following spinal anesthesia on the duration of postoperative analgesia and the need for analgesics. Methods: This was a prospective, randomized, double-blinded placebo-controlled study done over a period of two years. A total of 60 participants undergoing elective surgeries under spinal anesthesia were randomized into two groups. After 10 min of spinal anesthesia and achieving the required level of sensory and motor blockade, both groups were given Inj. Midazolam 1 mg intravenously, followed by Inj. Ketamine 0.25 mg/kg, volume made up to 10 mL with normal saline, given intravenously for Group K and Inj. Normal Saline 10 mL was given intravenously for Group N. Hemodynamic monitoring was done intraoperatively, and the postoperative visual analog score (VAS), sedation score, the mean time for the first rescue analgesia, and the total dose of postoperative analgesic required in 24 h were tabulated. Results: There was no statistical difference between the two groups in terms of age, weight, ASA grade, and duration of surgery. In Group K, the VAS scores were significantly lower and patients were comfortable when compared to Group N (P value <.01). The mean time to first rescue analgesia was longer in Group K (6.4 ± 1.69 h) when compared to Group N (2.9 ± 1.01 h), and the total dose of postoperative analgesia (Tramadol) required in 24 h was also significantly less in Group K (143.33 ± 56.83 mg) when compared to Group N (236 ± 49.01 mg). Changes in hemodynamic parameters (heart rate and mean arterial pressure (MAP)) were statistically and clinically not significant in both the intraoperative and postoperative periods between the groups. Conclusion: Patients in Group K were more comfortable, had a longer duration of postoperative analgesia, and required less dose of rescue analgesia in the postoperative period. Ketamine is a safe drug that is readily available, and it decreases the use of opioids and opioid-related side effects. Therefore, ketamine can serve effectively as an adjunctive analgesic drug.

Drug utilization study in ophthalmology outpatient department of a tertiary care teaching hospital

Background: Drug utilization studies (DUS) provide insight into recent trend of drug usage and facilitate rationality of prescribed drugs. Few DUS have been conducted in ophthalmology. Aim and Objective: To analyse the prescription pattern in outpatients of the ophthalmology department at a tertiary care teaching hospital. Materials and Methods: A prospective, observational and cross-sectional study was conducted at GCS Medical College Hospital and Research Centre, Ahmedabad. All patients who visited ophthalmic outpatient department were enrolled and necessary data were recorded regarding drugs prescribed in pre-defined case record form. Data analysis was carried out using Microsoft Excel. Results: A total of 388 prescriptions were analysed. Average number of drugs and fixed-dose combinations (FDCs) per prescription were 2.47 (95% CI, 2.29–2.64) and 0.44 (95% CI, 0.36–0.51), respectively. Drugs were prescribed in different dosage forms with eye drops being the most common (95.1%) followed by tablet (12.3%), ointments (8.5%), capsules (2.8%), syrup (1.1%), and injections (0.3%). One or more dosage forms were seen per prescription. Total 957 drugs were prescribed, out of which drugs with brands name and generic name were 88.4% and 11.6%, respectively. Total FDCs prescribed were 17.5%. Overall, 43.5% of prescriptions had antibiotics ranging from 1 to 5 per prescription and 25% of antibiotics were seen out of total drugs. Conclusion: Most of the drugs prescribed were in the form of drops. FDCs and antimicrobial use have been increasing in the management of ophthalmic diseases. Less numbers of drugs were prescribed by generic names.

Reading And Texting While Walking: Effect On Gait Indices In Healthy Young Females

Background: Mobile phones are becoming one of the necessities now a day. Divided attention leads to affected performance in one or both tasks. Effects of such dual tasking using mobile while walking needs to be explored as the use of mobile phones during walking/stair climbing etc. are very common. Methods: 132 female students of age 18 yrs to 21 yrs were made for walking under three conditions (walking, walking and reading on mobile, walking and texting). Gait indices (step and stride length, toe out angle) were compared in all conditions using the paired t-test. Results: Step length, stride length reduced and angle of toe out increased significantly in reading during walking and texting during walking as compared to only walking (p<0.0001). Parameters during texting while walking showed maximum affection. Conclusion: Reading or texting during walking can affect walking performance adversely. You are texting while walking is most deleterious in the above three conditions.

Development and validation of an LC-MS/MS method for tyrphostin A9 / 药物分析学报

Here we have presented a sensitive and selective LC-MS/MS method for the quantification of tyrphostin A9, which is a selective inhibitor for platelet derived growth factor receptor tyrosine kinase and has been investigated in vitro as a potent oxidative phosphorylation uncoupler. The murine analytical method was developed for three biological matrices: cell culture media, 3T3-L1 cell lysate, and murine plasma. For each matrix the limit of detection and the limit of quantification were found to be 0.5 ng/mL and 1.0 ng/mL, respectively. The range of standard curve for each matrix was 1.0-100 ng/mL, linearity was >0.99, and the precision and accuracy were within 20％. 3-(3,5-di-tert-butyl-4-hydroxyphenyl) propanoic acid was found to be the most suitable internal standard. The validated LC-MS/MS method was used to investigate stability and in vitro pharmacokinetics of tyrphostin A9. It was found that tyrphostin A9 is susceptible to hydrolysis, and the degradation product was identified as 3,5-di-tert-butyl-4-hydroxybenzaldehyde. Tyrphostin A9 was not stable in biological matrices, and the rate of its degra-dation in murine plasma was faster than that in cell culture media. In vitro pharmacokinetic studies revealed that tyrphostin A9 concentrations in the cell culture media declined in a bi-exponential manner and the concentrations inside the adipocytes remained constant, suggesting tyrphostin A9 has an intracellular binding site and is retained within the cell. The LC-MS/MS method presented here paves the way for further quantitative investigations involving tyrphostin A9.

Prevalence of anemia and dyslipidemia in patients with Diabetes Mellitus Type 2

Introduction: Diabetes is the leading cause of dyslipidemia and is associated with excessive cardiovascular morbidity and mortality. Anemia is common among those with diabetes and greatly contributes to patient outcomes. Observational studies indicate that low hemoglobin levels in such patients may increase risk for progression of kidney disease and cardiovascular morbidity and mortality in diabetic patients. Aim: The aim of the study was to find prevalence of anaemia and dyslipidemia in our population of patients with diabetes. Materials and methods: This was a descriptive analytical cross-sectional study carried out in GMERS Medical College and Hospital, Valsad. Total 100 consecutive patients with diabetes were enrolled and serum lipid profile, blood sugar estimation and complete blood count of all patients were done. All the results were noted and analysed statistically. Results: Anemia was present in 44% diabetic patients and 53% of the patients were dyslipidemics out of 100 patients in our study. Anemia and dyslipidemia were significantly higher in patients with diabetes, chronic kidney disease and diabetes with chronic kidney disease. Conclusion: Anemia and dyslipidemia was more prevalent in patients with diabetes and diabetes associated with chronic kidney disease. Correction of anemia may have a significant role in prevention of other diabetic complications.

Wilms tumor in 3 years old female patient – A case report

Nephroblastoma or Wilms' tumor is an embryonic tumor derived from primitive renal epithelial and mesenchymal components. It is the most common abdominal malignant tumour of young children. Overall, Wilms' tumor incidence is 7.8 cases per million children. Peak age of incidence is 2 to 3 years of age, or 99% occurring less than six years of age. Here, we are presenting a case of 3 years old female patient with diagnosis of Nephroblastoma.

Characterization of Methicillin resistant Staphylococcus aureus (MRSA) from various clinical samples at tertiary care centre of Dhiraj Hospital, Piparia, Vadodara, Gujarat

Background: Over the past decades, the emergence of Methicillin resistant S. aureus (MRSA) has changed the landscape of S. aureus infections around the globe. Aim: Present study was aimed to find out the prevalence of MRSA strains, and evaluate its antibiogram to other common antibiotics. Materials and methods: Total 120 samples were collected from various patients of Dhiraj Hospital, Vadodara, Gujarat. All spec C. After overnight incubation, suspected S. aureus colonies were confirmed by gram staining, catalase test and coagulase (slide and tube) tests, which were performed as per standard guidelines. Disk diffusion method was performed as per Clinical and Laboratory Standards Institute (CLSI) guidelines. A peptone water suspension equivalent to 0.5 McFarland standard was prepared from isolates. A swab was dipped in suspension and streaked over surface of a Mueller- . S v f x 0 μ . Results: Out of 120 samples, 73 strains (60.8%) were found to be MRSA with the prevalence higher in males (52/73) compared to females (21/73). Strains were mainly isolated from the pus samples Passi K, Hemachander SS, Shah K, Khara R. Characterization of Methicillin resistant Staphylococcus aureus (MRSA) from various clinical samples at tertiary care centre of Dhiraj Hospital, Piparia, Vadodara, Gujarat. IAIM, 2016; 3(9): 74-78. Page 75 (70%), followed by sputum (11%), blood and urine samples (8%) each. Highest rate of isolation of MRSA was from the orthopedics ward (23%), followed by surgery (22%), medicine (16%), recovery (12%), ICU (11%), pediatrics (10%), obstetrics (5%). Majority of the MRSA strains were resistant to erythromycin (76.7%), Co-trimoxazole (71%) and (61.6%) resistance with Gentamycin and Clindamycin. All strains were resistant to penicillin (100%). The optimistic finding was its 98.6% sensitivity to Linezolid and Vancomycin. Conclusion: The results of the present study showed a high prevalence of (60.8%) MRSA during April to September 2015. The treatment options for MRSA strains have been restricted to potentially toxic antimicrobials like vancomycin, clindamycin. This poses a serious problem for antibiotic therapy of S. aureus infections and leads to high morbidity and mortality. To prevent MRSA infection control measures like hand washing and other aseptic techniques have been implemented strictly

Antibiotic susceptibility pattern of Pseudomonas aeruginosa at the tertiary care center, Dhiraj Hospital, Piparia, Gujarat

Background: Infections with pseudomonas have been an important cause of Morbidity and Mortality throughout the history, which makes the treatment challenging every year. The present study was intended to find out the drug resistance pattern of Pseudomonas aeruginosa from various clinical specimens. Materials and methods: The study was conducted during April 2015 to September 2015. One hundred and one strains of Pseudomonas aeruginosa were subjected to antimicrobial susceptibility test by modified Kirby-Bauer disk diffusion method as per CLSI guidelines with Pseudomonas aeruginosa ATCC 27853 as control strain. Results: One hundred and one Strains were isolated from 83 males and 28 females. Majority of the Pseudomonas strains were isolated from ICU (30.63%), followed by Orthopedics (14.41%) and Pediatrics wards (13.51%), Strains were mainly isolated from pus samples (48.65%) followed by urine (20.72%) and sputum sample (13.51%). Majority of the strains were resistant to Aztreonam (70.27%) followed by Ciprofloxacin (54.95%), Amikacin (53.15%), Piperacillin (51.35%), Cefoperazone-sulbactam (50.45%), Gentamycin (49.55%), Cefepime and ceftazidime at 45.95% Lakum S, Anita, Pandya H, Shah K, Lakhani SJ. Antibiotic susceptibility pattern of Pseudomonas aeruginosa at the tertiary care center, Dhiraj Hospital, Piparia, Gujarat. IAIM, 2016; 3(5): 133-137. Page 134 respectively. While with Piperacillin - Tazobactam we got sensitivity of 63.97% and with Imipenem and Imipenem –EDTA we got sensitivity of 78.38% and 81.08% respectively. Conclusion: We concluded that drug resistance of Pseudomonas was mainly isolated from pus samples of ICU patients, which is therefore an urgent call for the physicians to limit the indiscriminate use of antibiotics. The encouraging finding was its sensitivity to Imipenem and PiperacilinTazobactum as an effective antibiotic for the treatment

Acute de Garengeot Hernia Masquerading as a Recurrent Inguinal Hernia – A Diagnostic Dilemma.

A de Garengeot hernia is a femoral hernia in which the sac contains the vermiform appendix. herein, we report an interesting case of a de Garengeot hernia with secondary appendicitis presenting acutely in a male patient with previous history of inguinal hernia repair. We discuss the diagnostic dilemmas involved and present a review of current literature.

Disseminated multiple hydatidosis at unusual location: Two rare case reports.

Hydatid disease, a parasitic infection is caused by cestode tapeworm Echinococus granulosus which is endemic in cattle grazing areas including India. Dogs are the definitive host. In human, commonly involved organs are liver and lungs. Peritoneal hydatidosis secondary to liver hydatid diseases is not uncommon but peritonial hydatidosis herniating to inguinal canal mimicking irreducible inguinal hernia is rare. Patient on clinical examination appears normally with complain of progressive abdominal pain and distention and irreducible cystic swelling in the inguinal region. Patients also gave history of contact with animals. Laboratory findings were not constant. Imaging and investigation necessary for establishing diagnosis were done. There always choice between ultrasound and computed tomography. Treatment includes conservative and surgical intervention. In case of single, symptomatic and large cyst was surgically treated. Small asymptomatic cysts, some daughter cysts, and peritoneal secondary cysts and splenic cysts may also be effectively conservatively treated. We reported here two cases of multiple hydatidosis at unusual location. In all patients large and symptomatic cyst was excised and all patient recover clinically. This case series emphasized that current understanding of disseminated multiple hydatidosis etiology still very little known. Study for additional risk factor may be necessary.

Response of Hirayama disease to surgical intervention: case report.

Hirayama disease also known as monomelic amyotrophy, primarily involves distal upper limb extremities. It differs from the known types of motor neuron diseases because of its nonprogressive behavior and pathologic findings of focal ischemic changes in the anterior horn of the lower cervical cord. We present a young male with Hirayama disease who had a left upper extremity involvement which was progressive in nature. He didn’t respond with initial treatment of cervical collar. Consequently surgical intervention improves muscle weakness and decrease the neurological deficit.

Radiological age estimation from sternum.

Introduction: Verification or determination of the age is prerequisite for personal identification in living as well as dead and age estimation is one of the important tasks for a medico-legal practice. Skeletal examination is important for identification of an individual either living or dead especially for the estimation of age. Material and Method: In the present study, authors have tried to work out the criteria for determination of age of the deceased with the help of sternum. Authors have studied 109 sterna procured from the cadavers with known age brought for post-mortem examination at the civil hospital, ahmedabad. Fusion of manubrium and xiphoid process with the body of sternum was studied radiologically. The data thus collected, were analysed statistically and conclusion was drawn. Result: According to the present study, for males, the age of fusion between xiphisterum and body of the sternum is at 42 years, for females, the age of fusion between xiphisterum and body of the sternum is at 44 years. In males, the fusion at manubrio-sternal starts at the age of 50 years and it completes after the age of 59 years but the exact age for complete fusion at manubrio-sternal joint could not be defined. Amongst females, the cases showing first degree fusion are seen increasing from the age of 54 years and complete fusion after the age of 64 years. But here also the exact pattern could not be defined. Conclusion: Estimation of age by radiology will be of very much helpful to the medicolegal experts in determining the age of unknown deceased as well as skeletonised remains.

Profile of pedestrian deaths in road traffic accidents.

Introduction: Pedestrians deaths in automobile road accidents in frequently encountered. Pedestrian deaths constitute a high percentage of all road fatalities. Material & Method:Out of total 367 accident death postmortem examinations,87(23.70%) were pedestrians. The present study aimed at analyzing pattern of 87 pedestrian deaths; out of these 73 were male victims. Results: Majority of pedestrian accidents occurs at 10AM-2PM (27 cases) followed by 6 PM-10PM(25 cases). The pedestrians were hit by heavy vehicles in 31 cases, two wheelers in 20 cases, car &jeep in 16 cases Head injury is responsible in 67 pedestrian death cases followed by chest injury in 40 cases, abdominal injury in 28 cases.

Tel hashomer camptodactyly syndrome a case report / El síndrome de camptodactilia de tel hashomer un reporte de caso

Tel Hashomer camptodactyly syndrome (THCS) is a rare autosomal recessive camptodactyly with muscular involvement. The manifestations of THCS other than camptodactyly are clubbed feet, thenar and hypothenar hypoplasia, abnormal palmar creases and dermatoglyphic ridges, spina bifida and mitral valve prolapse. The syndrome was first described by Goodman et al in 1972 and thereafter two further cases with similar phenotype were seen. Herein, we present another case report and review of the literature of other syndromes associated with camptodactyly and mitral valve prolapse. Further cases with this syndrome need to be reported for mapping of the candidate loci. This will help in planning management and genetic counselling.

El síndrome de camptodactilia de Tel Hashomer (SCTH) es una camptodactilia autosómica recesiva rara con compromiso muscular. Las manifestaciones de SCTH, aparte de la camptodactilia, son: pies equinovaros (zambos), hipoplasia tenar e hipotecar, pliegues palmares anormales, y dermatoglifos, espina bífida, y prolapso de la válvula mitral. El síndrome fue descrito por primera vez por Goodman et al en 1972, tras lo cual se vieron otros dos casos con fenotipos similares. Aquí presentamos otro reporte de caso, y revisamos la literatura de otros síndromes asociados con camptodactilia y el prolapso de la válvula mitral. Se necesitan reportes de otros casos con este síndrome para hacer el mapa de los locus candidatos. Esto ayudará a planear el tratamiento y a decidir el asesoramiento genético.

Anti-tubercular activity of aqueous extract of l.inermis leaves and its comparison with ethambutol.

Background: Tuberculosis holds one of the top places on the list of the main cause of death in India. At times the patients fail to respond to treatment with anti tubercular drugs, drug resistance being one of the reasons. The increasing incidence of MDR- and XDR-TB worldwide highlight the urgent need to search for newer anti-tubercular drugs. Objectives: The present study was carried out to assess the antitubercular activity of Lawsonia inermis, and if any, to compare it with ethambutol by "in vitro" method. Materials and Methods: From sputum samples of patients of pulmonary tuberculosis, who had not received any antitubercular drug earlier, the acid-fast bacilli were cultured and identified. Resistance ratio method was followed. For each isolate, (originally from the sputum samples) two sets of L-J slants containing ethambutol, in serially doubling concentration ranging from 1mcg/ml to 16 mcg/ml and L-J slants containing L.inermis leaves aqueous extract (2%) in serial doubling concentration ranging from 3 mcg/ml to 48 mcg/ml were prepared. One set for inoculating with test strain and the other with standard H37Rv strain. Each set had a drug/extract free L-J slant (control). All the L-J slants were labeled with appropriate drug concentrations and incubated at 37° C for 8 weeks for growth. Result & Conclusion: The MIC for ethambutol for both test as well as standard H37Rv strain was 4 mcg/ml by Resistance ratio method. The number of colonies (test and standard H37Rv) on all the L-J slants containing L.inermis extract were more than 100. Thus the aqueous extract of L.inermis leaves used, did not show antitubercular activity in the concentrations of 3 to 48 mcg/ml in the Lowenstein – Jenson media in the present laboratory set up. It is suggested that further studies may be undertaken to confirm the results of the present study.

Study of hanging cases in Ahmedabad Region.

In spite of advancement in medical facilities, the natural end of life is inevitable. But for some persons, the death is destined earlier in an un-natural way. A few choose to make their own way by committing suicide. The major reasons are personnel problems, stress of life, family problems and financial problems. There are many methods for committing suicide like poisoning, hanging, self-immolation, drowning etc. Hanging provides painless death so it is one of the commonly adopted methods for suicide. However, in a few instances false allegations are made claiming that the ligature mark over neck is of strangulation rather than hanging. Vice versa cases are also likely. In such cases, the post-mortem findings are very helpful to differentiate between the two. Present prospective study was carried out at the mortuary of Civil Hospital, Ahmedabad over 2 years period ranging from December 2008 to November 2010 with a view to study to incidence, ligature materials, and post-mortem findings in hanging cases. The place of hanging, manner of death and reason for death were also studied in the study.

Pharmacognostical Potential of Capparis deciduas Edgew.

Capparis decidua (Family, Capparidaceae) is commonly known as ‘Kair’. It is distributed throughout the arid regions of India and other countries. Kair is a caducous plant, so in the foliage condition mainly stem and fruits are common. It is also known as Capparis aphylla. Since the plant is xerophytic, it is generally found in dessert area and is highly draught resistant plant which can survive for long. Tribal people prepare pickle from the fruits of Kair. Some of the communities use Kair fruits as vegetables and food additives. The plant is used traditionally as anti-inflammatory, laxative, anti-diabetic, anthelmintic, antibacterial, astringent, digestive, diaphoretic and anodyne. It is reported to possess beneficial effects in various ailments, like rheumatism, asthma, diabetes, liver disorders, hypercholesterolemia, hypertension and microbial infections. Studies have revealed the presence of various phytoconstituents especially spermidine alkaloids, glucosinolates and other glycosides, β-sitosterol, rutin, l-stachydrine, hydrocarbons and terpenolides. The present review is an attempt to highlight the traditional uses, pharmacognostical, phytochemical and pharmacological reports on Capparis decidua.

Causative agents of urinary tract infections in children and their antibiotic sensitivity pattern: a hospital based study.

A retrospective study was conducted to find out the causative agents of urinary tract infection (UTI) in children and their antibiotic sensitivity pattern among Nepalese children. This was done at Kanti Children's Hospital in Kathmandu (Nepal) by analyzing the records of urine samples collected for culture and sensitivity tests over a period of six months (April to November, 2007). Of the total 1878 mid-stream urine samples collected from suspected cases of UTI, 538 (28.6%) were positive for pathogenic organisms. There was no significant difference in growth positive rate in two genders (M: 51.7% and F: 48.3%). Of the various pathogenic organisms isolated, Escherichia coli constituted for 93.3% followed by Proteus sp, Klebsiella sp, Citrobacter sp, Staphylococcus aureus and others. E. coli was found to be most sensitive to amikacin, chloramphenicol, nitrofurantoin and ofloxacin and least sensitive to most commonly used drugs like cephalexin, nalidixic acid, cotrimoxazole and norfloxacin.