UTI in Pregnancy: Incidence and Antimicrobial Profile

Introduction: Urinary tract infection in pregnancy isassociated with significant morbidity for both the motherand the baby. The aim of this study was to determine thebacterial profile and antibiotic resistance pattern of the urinarypathogens isolated from pregnant women at Mata GujriMemorial Medical College and Hospital, Kishanganj.Material and methods: A total of 267 pregnant womenwith and without symptoms of urinary tract infection wereenrolled as a study subject from October 2016to october2017.Organisms were identified from mid-stream clean catch urinesamples and antibiotic susceptibility was performed usingbacteriological standard tests. Data were collected usingstructured questionnaires and were processed and analyzedusing SPSS for Windows version 16.Results: Out of 267 pregnant women, 37 were symptomaticand the rest 230 asymptomatic. Bacteriological screening ofurine samples revealed growth of bacteria in 8.5% (7/37) and18.9% (28/230) for symptomatic and asymptomatic pregnantwomen respectively with overall prevalence of 9.5%.The most common isolates detected were E.coli (45.7%)followed by coagulase negative Staphylococcus (17.1%).Gram-negative bacteria showed resistance rates in the rangeof 56.5%-82.6% against trimethoprim/sulfamethoxazole,amoxicillin and ampicillin. Gram positive isolates showedresistant rate ranging from 50-100% against trimethoprimsulphamethoxazole, amoxicillin and ampicillin. Both Grampositive and gram negative bacteria showed high sensitivityagainst Nitrofurantoin with a rate of 82.3% and 87%,respectively. All isolated Gram positive bacterial uropathogenswere sensitive for Amoxicillin-clauvlanic acid.Conclusion: The isolation of bacterial pathogens both fromsymptomatic and asymptomatic pregnant women that areresistance to the commonly prescribed drug calls for an earlyscreening of all pregnant women to urinary tract infection.

Sequential C-reactive protein: a cheap and a valuable biomarker in patients with sepsis

Background: C-reactive protein (CRP) is a valuable biomarker of sepsis. Levels of CRP increase very rapidly in response to infection, and decrease just as rapidly with the resolution of the condition. The aim of the research was to study, C-reactive protein levels in patients of sepsis and to study the pattern of CRP levels in patients of Sepsis with hypertension, diabetes, smokers and alcoholics.Methods: This prospective observational cohort study was conducted from December 2016 to September 2018 in 100 cases of sepsis. Patients presenting in emergency with sepsis were included as subjects. C- reactive protein was measured in every patient at the time of admission and after 72 hours.  Facts related to history, clinical examination and biochemical parameters were recorded in a pretyped proforma. Data were analyzed using SPSS software.Results: Males outnumbered females. Most of the patients40(40%)  were in the age group of  less than 30 years  age group. CRP levels were markedly elevated in patients with diabetes mellitus (92.2±102.63) as compared to patients with hypertension (36.66±26.97) or both (24.20±12.87). CRP levels were higher in alcoholics (60.59±44.20) as compared to smokers (13.37±10.96).  CRP levels decreased significantly after 72 hours compared to CRP levels at the time of admission (p <0.001) across all patients suggestive of acute infection.Conclusions: Serial CRP measurement, rather than a single determination at the time of admission, is cheap and valuable in the diagnosis of sepsis and in monitoring the response to therapy.  CRP levels shows exaggerated response in diabetes mellitus and alcoholics with sepsis in this study.

Paint thinner ingestion-induced stroke in a young male.

Previous reports of paint thinner ingestion were suggestive of rhabdomyolysis, polyneuropathy, chemical pneumonia and coma. Reports of cerebral stroke following thinner ingestion have almost never been reported. A healthy male presented to us with unconsciousness and hemiplegia following deliberate ingestion of paint thinner. Magnetic Resonance Imaging (MRI) of head revealed cerebral infarct and multifocal oedema.

An electromyographic and enzymatically confirmed case of inflammatory myopathy in hairdye poisoning.

Reports on electromyographic changes in poisoning with hairdye containing paraphenylenediamine are scant. In view of the number of cases of hairdye ingestion presenting with severe pain in the limbs, it was planned to record the electromyogram and observe the pattern. This is a report on electromyographically and enzymatically proved case of systemic poisoning with hairdye (paraphenylenediamine) ingestion, resulting in quadriparesis and acute renal failure.

Hair dye poisoning: An emerging epidemic.

In view of the increasing number of case reports of hair dye poisoning it is important to sensitise medical professionals and toxicologists about its potentially lethal toxicity, and guidelines pertaining to management. Most permanent hair dyes contain paraphenylenediamine, which is nephrotoxic. The main aim of this communication is to create awareness amongst the medical fraternity regarding hair dye poisoning, so that cases of accidental or deliberate ingestion can be readily diagnosed and effectively treated.

Myocardial damage in hair dye poisoning--an uncommon presentation.

A 22-year-old female presented to us after consuming hair dye with features of angio-neurotic edema, asphyxia and irregular pulse. Serial ECGs revealed presence of ST segment elevation and T wave inversion in anterior chest leads. Strongly positive c-troponin-T test further confirmed the myocardial damage. This is a rare manifestation of para-phenylene diamine poisoning mentioned in literature. Patient also had elevated liver enzymes and oliguria.

Outcome of sixty four cases of ethylene dibromide ingestion treated in tertiary care hospital.

BACKGROUND AND AIMS: In view of high incidence and mortality due to ethylene dibromide poisoning, a prospective study was planned to assess demographic, toxicological, clinical profile and outcome. MATERIAL AND METHODS: Prospectively collected data of sixty four patients with ethylene dibromide poisoning were reviewed. All the patients were from Gwalior and neighbouring districts. RESULTS: Majority were males in the age group 21-30 years. Out of sixty-four cases 26 patients (40.6%) survived and 38 patients (59.4%) expired. Nausea vomiting and pain abdomen were most common symptoms at presentation. Diarrhoea, drowsiness, palpitations and oliguria were other features. Pulse rate was normal (< 100) in 22 (84.6%) survived patients whereas it was > 100 in 24 (63.1%) of expired patients at the time of admission (p value = 0.0004199). Half ampoule (1.5ml.) of ethylene dibromide was sufficient as fatal dose. Mortality was 20% and 46.15% with half and one ampoule respectively. Best outcome was when the patient presented to the hospital within six hours. Death occurred anywhere between twelve hours and five days. Gastrointestinal toxicity was predominant at presentation. Nausea, vomiting and abdominal pain was present in all the patients. Nephrotoxicity 32 (50%), hepatotoxicity 28 (43.8%), cardiotoxicity 28 (43.8%), central nervous system 8 (12.5%) toxicity and hypoglycemia 24 (37.5%) were also observed. CONCLUSION: Ethylene dibromide is highly toxic. Patients who consumed half to one ampoule usually survived with supportive care provided they presented to the hospital within six hours. Pulse rate more than 100 at presentation was a poor prognostic factor. Patients with normal pulse and blood pressure at admission had better prognosis.