An adult worm in the eye.

We report a case of ocular loiasis in a 9 yrs old girl. Very few case reports of ocular loiasis have published from India to date. Loa loa is a subcutaneous filarial parasite of man and known to be transmitted to humans by Chrysops flies. Patient presented with visual disturbances due to worm in her eye. A live adult worm was extracted and identity was confirmed by gross and microscopic examination to be Loa loa. Patient was treated with albendazole, gentamicin and steroids.

Subdural empyma due to Mycobacterium fortuitum in a non-HIV patient.

A 14‑year‑old male child presented with high grade intermittent fever with altered sensorium since 5‑6 days and generalised seizures. On examination neck stiffness noticed with normal haemogram and chest X‑ray. CSF microscopy was normal and no growth seen in aerobic culture. CT scan showed loculated lesion. Drained pus showed acid fast organism and culture on Lowestein Jensen medium showed pale‑coloured growth on 3rd day. Organism identified as Mycobacterium fortuitum by biochemical test. Interesting aspect of this case was there is no history of trauma or injection and patient was negative for HIV antibody.

Study of Cryptococcal Meningitis in HIV Seropositive Patients.

Cryptococcal meningitis is an emerging opportunistic fungal infection among HIV infected patients and important risk factors for the morbidity and mortality of these patients. A total of 8 specimens of CSF out of 45 from known HIV positive patients samples yielded Cryptococcus neoformans during the period of one year. The prevalence of cryptococcal meningitis among HIV seropositive patients in this region is 17.78%.

Effect of passive smoking on endothelial function in: healthy adults.

BACKGROUND: Active smoking predisposes to atherosclerotic vascular disease but recent evidence that inhalation of environmental tobacco smoke (passive smoking) may also have deleterious cardiovascular effects, has enormous public health implications. Endothelial dysfunction is an important early feature of atherogenic process, which may occur due to passive smoking. OBJECTIVE: To assess the effect of passive smoking on endothelial function (measured by flow-mediated dilatation, a marker of endothelium-dependent arterial dilatation) and compare it with non-smokers. STUDY DESIGN: Case control study. SETTING: Out-Patient Department of Medicine, Government Medical College, Nagpur. PARTICIPANTS: Seventy-five young, healthy, male adults between 15-30 years age were studied. There were three groups: (a) Non smokers (n = 25) (b) Passive smokers (n= 25) and (c) Active smokers (n = 25). Subjects with diabetes mellitus, hypertension and ischemic heart disease were excluded. Lipid profile was measured in all. Endothelial function was tested non-invasively by using high frequency linear vascular probe on brachial artery. Resting brachial artery lumen, flow at rest and after hyperemia, flow-mediated dilatation and nitroglycerine-induced dilatation were measured. RESULTS: The mean brachial artery lumen dilatation and flow at rest were similar in all the three groups. Flow-mediated dilatation (FMD%, a marker of endothelium-dependent dilatation and endothelial function) was significantly higher in non-smokers than passive smokers (8.9 +/- 4.8 Vs 5 +/- 2.3, p < 0.01) and also as compared with active smokers (8.9 +/- 4.8 Vs 6.6 +/- 2.2, p < 0.05). Nitroglycerine-induced dilatation, (a marker of endothelium-independent dilatation ) was similar in all the three groups. Serum lipids (mean cholesterol, LDL, and mean LDL/HDL ratio) were statistically significantly higher in passive and active smokers as compared with non-smokers (p < 0.05). CONCLUSION: Like active smoking, passive smoking was also associated with impaired endothelial function, (a key early event in atherogenesis) and altered lipid profile, in healthy young adults.

Seroprevalence of anti-HCV and hepatitis B surface antigen in HIV infected patients.

Human immunodeficiency virus (HIV) is known to influence the natural history of infections with certain hepatitis viruses and interactions between HIV and hepatitis viruses may potentiate HIV replication. There is high degree of epidemiological similarity between hepatitis B virus and HIV as regard to high-risk group and route of transmission. Transmission of hepatitis C virus (HCV) through blood transfusion and intravenous drug abuse is well documented. Present study deals with the study of concurrent infection of HBV and HCV with HIV infection. In the study of 110 HIV seropositive patients, 34(30.4%) were positive for HBV and 8(7.27%) for HCV. The difference of concomitant infection was highly significant compared to controls. (p value < 0.0001). Heterosexual high risk behaviour was observed in 89(80.91%) of 110 HIV positive patients, out of which 23(25.8%) and 5(5.62%) were HBsAg and anti-HCV positive respectively. History of transmission was unclear in remaining patients. Concomitant infection of HIV and HBV was found to be significantly more in the symptomatic group (40.68%) compared to asymptomatic group (19.6%). As HIV infection is known to affect the natural history of both HBV and HCV infection, screening of their concurrent association is necessary.

Concurrent infection with S.typhi and V. cholerae--a case report".

An eight year old male child presented with symptoms of diarrhoea, vomiting & fever with signs of moderate dehydration. He was treated with tetracyline and fluid replacement therapy. Inspite of treatment and control of diarrhoea and vomiting patient developed gastrointestinal bleeding and tenesmus with continued fever. Deterioration in patient's condition to suspicion of another infection. High level of suspicion and appropriate microbial investigations revealed dual infection with S. typhi and V. cholerae.

An unusually high occurrence of Salmonella enterica serotype paratyphi A in patients with enteric fever.

BACKGROUND & OBJECTIVES: Salmonella enterica serotype Paratyphi A has been reported less frequently as a causative agent of enteric fever. Reports on the antimicrobial susceptibility of this pathogen are few and varied. An unusually high occurrence of S. Paratyphi A was noted in a tertiary care hospital at Nagpur, Maharashtra during April 2001-September 2002. An effort was made to study the antimicrobial susceptibility pattern and phage types of the isolates. METHODS: Blood cultures of patients suspected to have enteric fever admitted to the Indira Gandhi Medical College and Hospital, Nagpur were processed by conventional methods. Antimicrobial susceptibility was tested by Kirby-Bauer disc diffusion method and the minimum inhibitory concentration (MIC) to chloramphenicol was determined. RESULTS: Eighteen (46.15%) of 39 Salmonella isolates were S. Paratyphi A and all were sensitive to ciprofloxacin and cephotaxime. Twelve (66.67%) strains were sensitive to ampicillin and 13 (72.22 %) to chloramphenicol. Two strains (11.11%) were resistant to three drugs (ampicillin, chloramphenicol and cotrimoxazole) simultaneously. The prevalent phage type in the local population was phage type I. INTERPRETATION & CONCLUSION: The high occurrence of S. Paratyphi A found in the present study indicated the emergence of this rare pathogen of enteric fever in the local population. Though some degree of resistance was encountered with ampicillin and chloramphenicol, all the isolates were sensitive to ciprofloxacin, currently a drug of choice for enteric fever. Multidrug resistance was rare.

Bacteriological study of pyogenic meningitis with special reference to C-reactive protein.

Seventy five clinically, biochemically and microscopically diagnosed cases of pyogenic meningitis including 28 adults and 47 paediatric patients were studied. Gram positive isolates in adults and gram negative bacilli in paediatric age group were the predominant organisms. Estimation of C-reactive protein (CRP) in cerebrospinal fluid (CSF) and serum was done in all cases as an early marker for rapid diagnosis of pyogenic meningitis. Simultaneous estimation of CRP levels in serum and CSF was found to have a significant diagnostic utility as compared to culture.

Effect of H37Ra on PHA-induced migratory inhibition of leucocytes in patient of tuberculosis.

Eighty nine cases of active pulmonary tuberculosis were classified into four stages depending on the clinical extent of disease. Leucocyte migration inhibition test (LMIT) was done using mitogen phytohaemagglutinin (PHA) and H37Ra specific antigen. Normal PHA responses were observed in all clinical stages while specific immune response in relation to inhibition of leucocyte migration decreased from stage I to stage IV. Effect of H37Ra on PHA induced release of lymphokine was studied by mixing the two and comparing the percentage migratory inhibition of the mixture with that of PHA alone. Increased or decreased values with mixture compared to those with PHA alone were regarded as enhancement or inhibitory effect respectively. Median percentage effect of H37Ra on PHA induced migratory inhibition was found to be inhibitory in first three stages and controls while enhancement effect was observed in stage IV. A total of 22 cases in all stages showed enhancement effect while 48 cases showed inhibitory effect. The possible mechanism of enhancement or inhibitory effect are discussed.

Short PR interval and abnormal systolic time interval as a method of carrier detection in maternal relations of patients with muscular dystrophy.

Seventeen relatives of patients with Duchenne's muscular dystrophy (Group A) and 6 relatives of patients with adult type of muscular dystrophy (Group B) were studied. Short PR interval on electrocardiogram and abnormal systolic time interval (STI) were consistent findings in 14 of 15 female relatives (93.35%) in group A, while these criteria were lacking in group B. Myopathic pattern (i.e. tachycardia, short PR interval, R/S ratio in V1 greater than 1.5, significant Q wave in V4, V5, V6 on electrocardiogram) was present in two (13.35%) of 15 female relatives from group A. It was absent in group B. Male relatives in both the groups had normal electrocardiogram and normal systolic time interval.

Single dose therapy of ascariasis--a randomized comparison of mebendazole and pyrantel.

A multicentre, randomized trial was carried out to compare the efficacy of two single-dose treatments for ascariasis: mebendazole 200 mg, and pyrantel 10 mg/kg. Each centre enrolled 200 patients with a suspected diagnosis of ascariasis, 100 for each treatment, and the treatments were randomized for each centre. To confirm the diagnosis, stools were examined for eggs of Ascaris lumbricoides by Kato's thick smear method. Efficacy was evaluated by stool examination repeated three weeks after treatment by a "blind" technician using two methods, viz. Kato's thick smear method and the zinc sulfate flotation method. Cure was defined as absence of ascaris eggs in the stools by both methods. Of the 600 enrolled patients, 32 were excluded from analysis as their initial stool examination was negative, and 568 completed the trial: 284 on each treatment. The cure rate was 80 per cent in the mebendazole group and 90 per cent in the pyrantel group (P less than 0.01). Thus pyrantel was found to be significantly more efficacious than mebendazole for single-dose treatment of ascariasis.