Neonatal listeriosis: A case report from sub-Himalayas.

Perinatal listerial infection is the most common clinical syndrome caused by Listeria monocytogenes and includes abortion, still birth, neonatal sepsis, and meningitis. Reports of listeriosis from India are limited. Sub Himalayan . We report a case of neonatal listeriosis from Himachal Pradesh. A two-day-old full term male baby was referred from a peripheral hospital with fever listlessness, skin rash and non-acceptance of feed. Ceftriaxone was already started as an empirical therapy. Listeria monocytogenes was isolated from cerebrospinal fluid (CSF) and blood of the baby, and also from the genital tract of the mother. Unfortunately, the baby died before the preliminary report could be communicated.

Primary amoebic meningoencephalitis due to Naegleria fowleri.

Primary amoebic meningoencephalitis (PAM) due to Naegleria fowleri was detected in a 36-year-old, Indian countryman who had a history of taking bath in the village pond. He was admitted in a semi comatosed condition with severe frontal headache, neck stiffness, intermittent fever, nausea, vomiting, left hemiparesis and seizures. Computerized tomography (CT) scan of brain showed a soft tissue non-enhancing mass with erosion of sphenoid sinus. However CSF findings showed no fungal or bacterial pathogen. Trophozoites of Naegleria fowleri were detected in the direct microscopic examination of CSF and these were grown in culture on non-nutrient agar. The patient was put on amphotericin-B, rifampicin and ceftazidime but his condition deteriorated and was taken home by his relatives in a moribund condition against medical advice and subsequently died. A literature review of 7 previous reports of PAM in India is also presented. Four of theses eight cases were non lethal. The mean age was 13.06 years with male: female ratio of 7:1. History of contact with water was present in four cases. Trophozoites could be identified in all 8 cases in this series.

Transcutaneous bilirubinometer in assessment of neonatal jaundice in northern India.

This study was undertaken from April 2002 to March 2003 to find out the correlation of transcutaneous bilirubinometer index with serum bilirubin levels in term, pre-term, small for gestation age babies, with and without phototherapy in neonates with jaundice. Another aim was to evaluate the transcutaneous bilirubinometer as a screening device for neonatal hyperbilirubinemia by finding the action levels for TcBI at forehead and sternum at which sample for serum bilirubin estimation should be taken. A total of 104 neonates were evaluated. Mean (SD) age (hours), birth weight (grams) and gestational age (weeks) were 100.4 (37.90), 2264.9 (634.4) and 36.8 (2.9) respectively. Mean serum bilirubin was 16.6 (6) mg/dL. Overall a correlation coefficient of 0.878 at forehead and 0.859 at sternum was observed. On excluding infants receiving phototherapy coefficients of 0.900 at forehead and 0.908 at sternum were noted. Correlation coefficient over forehead and sternum was found to drop from 0.85 to as low as 0.33 with duration of phototherapy exceeding 48 hrs. Lastly the determined action levels had a sensitivity of 77.8 to 100 % in assessing the need for serum bilirubin estimation in various groups.

Role of C-reactive protein in deciding duration of antibiotic therapy in neonatal septicemia.

In this study serum C-reactive protein (CRP) levels were used to evaluate the duration of antibiotic therapy in 50 consecutive neonates with suspected septicemia. In 44 percent of cases therapy was stopped on 3rd day, as CRP was normal. In 8 percent antibiotics could be stopped within 5-7 days as CRP values returned to normal and in 48 percent therapy was extended beyond 7th day, as CRP values were high or rising persistently. Negative predictive value of serial CRP was 100 percent in deciding duration of antibiotic therapy in suspected neonatal septicemia up to 7 days. The correlation between positive CRP, raised micro ESR and positive blood culture was significant (p < 0.005).

Childhood trichobezoar.

Two cases of trichobezoar with unusual presentation in rural female children are described. The first one in a healthy asymptomatic child with no abnormal psychological behaviour and other one in an emotionally disturbed child with history of trichotillomania. Both were treated surgically with no recurrence. A physical sign of indentibility is discussed and literature is also reviewed.

Cysticercus immunoblot assay in patients with single, small enhancing lesions and multilesional neurocysticercosis.

A single, small (< 20 mm), ring or disc shaped contrast enhancing lesion located at the cortical-subcortical junction with minimal or no surrounding edema on computed tomography is the commonest mode of presentation of neurocysticercosis in the Indian subcontinent. Serum samples of 37 patients with these single, small enhancing lesions (SSEL's) and five patients with typical multilesional parenchymal neurocysticercosis were tested by the electro-immunoblot transfer (EITB) assay and the enzyme linked immunosorbent assay (ELISA). EITB was positive in 18 patients (48.64%) and ELISA was positive in 21 patients (56.76%) with SSEL's. On the other hand EITB was positive in all five patients (100%) and ELISA was positive in four patients (80%) with multilesional neurocysticercosis. The low sensitivity of the EITB in the SSEL's is probably linked to an insufficient immune stimulation provided by a single cysticercus cyst.

Synchronous oesophageal carcinoma with non Hodgkin's lymphoma, problems with management.

A case of synchronous malignancy of oesophagus with Non Hodgkin's lymphoma is presented and the rarity of such an association is discussed. The inherent difficulties encountered were initial planning of therapy keeping in view of the general condition of the patient. The patient received three cycles (every 21 days) of CHOP regimen for Non Hodgkin's lymphoma and to maintain a static state of oesophageal cancer. The patient showed more than 75 percent response to NHL counterpart, and for carcinoma oesophagus counterpart short course high dose loco-regional radiation therapy was given and the tumor was found to be resectable.

Interaction of technical hexachlorocyclohexane and oxydemeton methyl 25 EC to female rats after dermal application.

Technical hexachlorocyclohexane (HCH, 100 mg/kg/day) and oxydemeton methyl 25 EC (125 mg/kg/day) to female rats for 7, 15 and 30 days individually and in combination through skin application caused pathomorphological changes in vital organs and significant enzymatic changes in liver and serum. However changes produced by the two compounds in combination were not suggestive of potentiation effect at the tested dose level in female rats.

Effect of B-HT 920 on cardiotoxic effects of ouabain in guinea pigs.

Effect of B-HT 920, a selective alpha 2 adrenoceptor agonist, was studied on ouabain induced cardiac arrhythmias and cardiac arrest in guinea pigs. Ventricular premature beats, ventricular tachyarrhythmias and cardiac arrest were induced in anaesthetized guinea pigs by slow infusion of ouabain. B-HT 920 accorded significant protection to guinea pigs against ouabain induced arrhythmias. Yohimbine inhibited the antiarrhythmic effect of B-HT 920 significantly. It is concluded that the protective effect of B-HT 920 against ouabain induced cardiac arrhythmias and cardiac arrest is mediated through the stimulation of alpha 2 adrenoceptors.

Carcinoma of the esophagus presenting with esophagocutaneous fistula--a case report.

An interesting manifestation of carcinoma of the esophagus, hitherto undescribed is reported. The patient at the time of diagnosis had presented with an esophagocutaneous fistula. He was treated by feeding jejunostomy and local palliative radiotherapy and showed good clinical improvement. The extreme rarity of such a presentation is highlighted.

Occult carcinoma esophagus metastatic to spine producing paraplegia--a case report and review of literature.

An extremely rare case of asymptomatic squamous cell carcinoma of the esophagus metastatic to the spine leading to paraplegia is reported. The rarity of such an event signifies the relationship between hypercalcaemia and carcinoma of the esophagus. Its occurrence as a second silent primary neoplasm and its association with a negative esophagogram is highlighted.

Dermal toxicity of hexachlorocyclohexane (HCH) in rabbit.

Application of HCH (25 mg/kg) on dorsal, ventral and thigh regions of the skin of male rabbits resulted in poisoning and mortality of animals. Morphological changes in skin, liver, kidney, testes and cerebellum together with highly significant alterations in serum and liver enzymatic activity and residue in blood suggested that absorption of HCH and its toxicity could be severe when the pesticide comes in contact with the skin of thigh region of body.