Study of Urinary Tract Infection in Patients with Diabetes Mellitus

Introduction: Urinary tract infection is one of the most common types of bacterial infection in patients with diabetes mellitus.Aim: The aim of the study was to assess the prevalence of urinary tract infection among hospitalized diabetic patients.Materials and Methods: A hospital-based prospective study was carried out from June 2018 to May 2019. A total of 100 patientsof diabetes mellitus with urinary tract infection were included in this study.Results: Of 100 patients, 54 were male and 46 were female, the most common age group was 46–55 years. Most patientshad a fever with rigor (48%) followed by dysuria (22%), suprapubic pain (20%), increased frequency of urine (18%), flank pain(10%), pyuria (6%), and hematuria (4%). Urine culture analysis revealed that Escherichia coli (29%) was the most commonorganism responsible of urinary tract infection. The majority of isolated organisms were sensitive to antimicrobial agents suchas amikacin, nitrofurantoin, and levofloxacin.Conclusion: Urinary tract infection is frequent in diabetic patient and the urine culture should be performed in all hospitalizedpatients with diabetes mellitus. Early diagnosis, knowledge of common predisposing factors, and appropriate clinical managementare important to improve prognosis.

Differential diagnosis of non-small cell lung carcinoma by circulating microRNA

Introduction: More than 70% of lung cancer comprises nonsmall-cell lung carcinoma and is associated with poor survival outcome owing to late diagnosis. Identification of lung cancer in early stages when no clinical signs or symptoms are evident, can drastically improve the prognosis. To this end, we aimed to evaluate the changes occurring at tissue level by assessing the expression of six microRNAs (miRNAs) in lung adenocarcinoma (AC) and squamous cell carcinoma (SCC). Materials and Methods: Peripheral blood of histopathologically proven cases of lung AC and SCC was collected and processed for the isolation of miRNAs using commercially available kit. Primers against mir-2114, mir-2115, mir-2116, mir-2117, mir-449c, and mir-548q with loading control Caenorhabditis elegans were used. Screening was carried out in thirty cases of both AC and SCC, whereas twenty healthy controls were included. Results:Real-time polymerase chain reaction data revealed that the expression of mir-2114 and mir-449c in AC and mir-2115 in SCC was significantly upregulated. The expression of these miRNAs was also confirmed in lung AC cell line. The differential pattern of expression of these miRNAs can be used for precise diagnosis of lung carcinoma Conclusions: We have used a noninvasive technique to identify the subtype of lung cancer based on molecular genetic signatures. The results suggest that through molecular profiling of miRNA, we can screen high-risk cases for cancer interception

Study of Surgical Infection in a Tertiary Care Hospital

Introduction: Surgical site infection is a common postoperative problem causing significant post-operativemorbidity and mortality, prolonged indoor stay and addsbetween 10% and 20% to hospital cost. In India, rate ofsurgical site infections in various set-ups had been reportedto be 4.2-21%. Current study aimed to record the incidenceof surgical site infection in present set up in both elective andemergency cases and to assess the possible risk factors andanalyze the measures to prevent surgical site infection.Material and Methods: The present prospective study wasconducted in the post graduate Department of General Surgery,Rohilkhand Medical College, Bareilly, from 1 November 2017to 31 October 2018 to determine the incidence of surgical siteinfections and to assess the risk factors associated with thesurgical site infections. Samples were processed for microbialflora and antibiotic sensitivity.Results: Incidence of surgical site infections in present studywas 13%. In elective surgeries it was 7.1% while in emergencysurgeries it was 26.7%. Incidence was higher in patients withdiabetes, smokers and obese patients. Highest incidence waspresent in dirty wounds. Incidence was lower in patientswho have shorter pre operative hospital stay and underwentsurgery for shorter duration. In most of the cases surgical siteinfections occured on post-operative day 7. Patients with SSIhad longer mean duration of hospital stay as compared tothose who did not have SSI. Staphylococcus aureus was themost common organism isolated followed by E. Coli.Conclusion: We reported a significant association of SSIwith type of procedure (open and emergency), diabetes,obesity, smoking, duration of preoperative hospital stays,ASA physical grade, duration of surgery, duration of drainsand type of wound according to wound classification.

Evaluation of Dengue and Malaria co-infection in Rohilkhand Region of Northern India

Introduction: Both dengue and malaria are mosquito bornediseases, which are associated with high morbidity andmortality thus posing a worldwide public health problem.Both infections are endemic in tropical regions, leading to coinfections. Concurrent infections of malaria and dengue arewhen both the diseases occur simultaneously in an individual.Because of the similar clinical presentation between these twoinfections, the diagnosis of malaria and dengue co-infectionsmight be either misdiagnosed or misinterpreted as monoinfections. This study was aimed to evaluate the dengue andmalaria co-infection from this region.Material and methods: A total number of 994 patientssuffering from acute febrile illness were included in thestudy and screened for malaria and dengue infection.Blood sample from each febrile patient was collected inplain and EDTA vacutainer and were sent to the laboratory.The screening for malarial parasite was done by both rapidimmunochromatographic test and microscopic examination ofperipheral blood films (both thin and thick). Dengue screeningwas done by rapid immunochromatographic test as well as bydengue MAC ELISA.Results: 295 (29.67%) were found to be infected withdengue infection. Malaria parasite was found in 685 (68.91%)patients. Among them 430 (62.77%) cases were infected withPlasmodium vivax while 255 (37.22%) of cases were due toPlasmodium falciparum infection. Dengue and malaria coinfection was present in 30 (3.40%) patients with Plasmodiumfalciparum (53.33%) in most of the cases.Conclusion: The finding of this study indicates that denguemalaria co-infection is not uncommon. Both the infectionspresents clinically indistinguishable clinical features, earlydiagnosis of concurrent infection can be lifesaving.

Epidemiological Correlates and Treatment Outcomes among Patients with MDR Tuberculosis in Northern India

Introduction: Multi drug resistant-TB (MDR-TB) threatens global TB control and is a major public health concern in several countries. The present study was undertaken to detect the epidemiological correlates and treatment outcomes among patients with MDR-TB previously or currently admitted in Department of Respiratory Medicine and Pulmonary and Critical Medicine, KGMU, Lucknow. Material & Methods: This retrospective study included 2370 TB patients admitted in the Department of Respiratory Medicine and Pulmonary and Critical Medicine, KGMU, Lucknow between years 2012 to 2015. Treatment outcomes were observed. SPSS software was used for data analysis. Results: The total number of MDR-TB cases enrolled were 2370. There were 772 (32.6%) males (95% CI: 30.7 % -34.5%) and 1598 (67.4%) females (95% CI: 65.5% -69.3%) registered for MDR-TB treatment. The treatment outcomes were as follows: majority (77.1%) were under treatment, 279 (11.8%) patients were declared cured, 10 (0.4%) were failure cases, while 64 (2.7%) were defaulters, 149 (6.3%) had died and 41(1.7%) were transferred out. Conclusion: Emergence of MDR-TB has the potential to be a serious public health problem in Northern India and this necessitates strengthening of TB control and improved continuous monitoring of therapy.

Histological Study- The Effects Of Various Fixatives On Kidney

Fixation is the critical step in processing tissues. Following tissue removal from the body, autolysis begins and proceeds more or less quickly depending on many factors, including the level of enzymes or microorganism present in the tissue. We studied effect of five different types of fixatives. An essential part of all histological and cytological techniques is preservation of cells and tissues as they naturally occur. The aim of the current study is to see the effect of following fixatives namely 10% formalin, Buffered 10% formalin, Bouin’s fluid, Zenker’s fluid, Carnoy’s fluid on liver tissues and to observe the optimum result in a particular fixative in H&E sections. There is no single fixative which can be considered as best fixative for all purposes. Best fixatives for architectural preservation are Carnoy’s fluid and Zenker’s fluid. Best fixative for study of nuclear details is Bouin’s fluid.

A Study of Prevalence of Etiological Agents of Dermatophytosis in a Tertiary Care Hospital.

Background: Dermatophytoses are commonly encountered fungal diseases prevalent in most parts of the world especially in tropical countries. It is a superficial mycotic infection affecting hair, skin and nails. The present study was carried out to determine the incidence of dermatophytoses and their etiological agent in different age groups attending the Dermatology department. Methods: A total of 200 samples were taken from skin department and processed by direct KOH preparation & fungal culture methods. Identification of the species was done by Lactophenol Cotton Blue mount from colony. Results: Our study shows that males 60 (68.41%) are more infected than females 40 (31.59%) Tinea corporis was the commonest clinical type 59 (55.75%). The commonest fungal isolate is Trichophyton species (51.72%), followed by Micro-sporum 38 (36.92%) and Epidermophyton species 11(9.31 %). Conclusion: Male have higher fungal infection rate than females. Trichophyton rubrum is the common isolate in our geographical area. KOH preparation has higher positivity rate than culture.

A comparison of toxicity profi le of gemcitabine monotherapy versus etoposide/cisplatin in the treatment of locally advanced or metastatic non-small cell lung cancer.

Background: Lung cancer is the leading cause of cancer deaths globally in which about 40% patients reporting in advanced stage disease. Both platinum and non platinum combinations have been shown to be equally effi cacious as initial fi rst-line treatment of advanced non-small cell lung cancer (NSCLC), however because of the toxicity of cisplatin, combination treatment can only be administered to a minority of patients in good general health. Gemcitabine could be combined with one of the other new agents to create novel non-platinum-doublet combinations with effi cacy and/or toxicity profi le superior to that of standard platinum based combinations. Hence, this study was conducted to compare the toxicity profi les of gemcitabine monotherapy and the cisplatin/etoposide combination therapy. Methods: This was a randomized prospective study, which included 96 patients selected on the basis of histologically or cytologically confi rmed Stage III B or IV of NSCLC. Study was divided into two arms-Arm A received gemcitabine monotherapy in a dose of 1000 mg/m2 on day 1 and 5 of the cycle and repeated after every 3 weeks while Arm B received cisplatin (25 mg/m2 on day 1, 2 and 3) + etoposide (100 mg/m2). Patient were evaluated for adverse events by following World Health Organization grading of toxicity. Results: Out of the 96 patients enrolled in the study, 74 (77.0%) patients were eligible and were analyzed. Of these, 36 (37.5%) patients belonged to Arm A and 38 (39.5%) to Arm B. Transient vomiting (45.8% vs. 37.5%), leukopenia (33.3% vs. 8.3%) were seen more in Arm A, while thrombocytopenia (33.3% vs. 12.5%), patchy hair loss (68.4% vs. 16.6%) was seen more in Arm B. Nephrotoxicity was seen almost similarly in both the groups. Conclusions: Single-agent gemcitabine appears to have a safer toxicity profi le than the combination cisplatin-etoposide in the fi rst-line chemotherapy of advanced NSCLC. With less toxic anticancer drugs like gemcitabine, the physician now has greater choice in choosing treatment, which can have better effect on the patients concerned.

Increasing incidence of multidrug resistant Pseudomonas aeruginosa in inpatients of a tertiary care hospital.

Background: Pseudomonas aeruginosa is an important pathogen isolated from various clinical infections. The occurrence of multidrug-resistant (MDR) Pseudomonas aeruginosa strains is increasing worldwide and limiting our therapeutic options resulting in high mortality. We aim to study the incidence of multidrug resistant Pseudomonas aeruginosa in inpatients from various departments along with rate of nosocomial infections. Methods: A cross sectional study from January 1, 2013 to December 31, 2013. A total of 167 Pseudomonas aeruginosa were isolated from 764 clinical specimens. The isolates were identified by standard microbiological techniques. The antibiotic susceptibility was done by Kirby Bauer method. Results: The highest number of isolates were from pulmonary samples n=90 (53.89%) followed by pus n=48 (28.74%). Overall, 39 (23.36%) isolates were nosocomial. The nosocomial isolates were mainly isolated from department of surgery, orthopaedics, obstetrics & gynaecology followed by others. Among 167 isolates screened, 53 (31.73%) were found to be MDR (resistant to ≥3 classes of antipseudomonal agents). The resistance was most against cephalosporins [Cefepime (65.26%), cefotaxime (60.47%)], fluoroquinolones [Ciprofloxacin (46.1%), levofloxacin (31.87%)] aminoglycosides [Amikacin (37.72%), gentamicin (31.13%)] followed by ureidopenicillins and carbepenems. About 56.75% isolates were suspected Metallo β lactamases producers. Conclusion: The study suggests that the incidence of nosocomial infection by multidrug resistant Pseudomonas aeruginosa is increasing globally especially the Metallo Beta lactamases producing strains. So there is a continuous need of conduction of surveillance programmes to formulate rational treatment strategies to combat this emerging challenge.

Role of MTHFR C677T polymorphism in ischemic stroke.

BACKGROUND: Homozygosity for MTHFR C677T polymorphism can lead to significantly high homocysteine levels and hyperhomocysteinemia is an important risk factor for thrombotic events. AIMS: The aim was to determine role of MTHFR C677T polymorphism in North Indians with ischemic stroke. SETTINGS AND DESIGN: In a prospective study, the subjects of stroke were recruited from the neurology clinic of the hospital. Controls were healthy individuals from the Hematology clinic without any history of stroke. MATERIALS AND METHODS: Plasma homocysteine levels were measured by enzyme immuno assay method after 3 months of acute episode. Serum folate and Vitamin B12 levels were estimated by competitive inhibition radioassay. MTHFR polymorphism was detected by PCR-RFLP using Hinf I enzyme. Statistical analysis: The analysis of significance of results was done using SPSS software package. A p-value. RESULTS: Thirty-two acute ischemic stroke patients (aged 1-44 years) were studied. Fourteen (43.8%) had recurrent stroke. Nine (28%) had multiple infarcts. Four of 32 patients (12.5%) had high homocysteine levels. Three out of these 4 hyper-homocysteinemia patients were homozygous ( TT ) for MTHFR polymorphism (2 with recurrent stroke). Two of three homozygous cases with TT genotype had low serum folate. Five of 32 stroke cases (18.8%) were heterozygous ( CT ) genotype. CONCLUSIONS: Primary hyper-homocysteinemia appears to be an important risk factor for ischemic stroke in North Indians, most due to MTHFR C677T homozygosity. Folate levels may modify the presentation of the MTHFR TT genotype.

Invasive Aspergillosis in an Immunocompetent Host

Invasive aspergillosis is a disease known to manifest in immunocompromised hosts. It is a opportunistic disease which spreads by air and occurs predominantly in lungs, although dissemination to virtually any organ is possible. We report an unusual case of invasive aspergillosis with invasion of lung, lymph nodes and esophagus without having any apparent immunodeficient state.