Corneal endothelial cell changes in diabetics versus age group matched nondiabetics after manual small incision cataract surgery

Purpose: To assess and compare the endothelial cell changes after manual small incision cataract surgery (SICS) in diabetic patients versus age group matched non-diabetic patients. Methods: This comparative prospective observational follow-up study included 54 diabetic patients and 52 control patients without diabetes who underwent manual SICS. Preoperative, one day, one week, one month and three months post-surgery assessments of corneal endothelial cell changes were done using specular microscopy. Data analysis was performed using SPSS software (version 20.0, SPSS, Inc.). Mann朩hitney U test was used to compare the data between the test group and control group. Results: There was drop in the endothelial density in both the groups postoperatively, with the mean percentage of endothelial loss at three months post- surgery being 27.5% in diabetics and 18.3% in controls. There was also a significant increase in central corneal thickness and coefficient of variance in diabetics as compared to controls at every follow up one day, one week, one month and three months. The percentage of hexagonality was statistically significant at post-operative three months. Conclusion: The diabetic endothelium was found to be under greater metabolic stress and had less functional reserve after manual SICS than the normal corneal endothelium.

Quality of Sleep in Association with Relapse in Patients with Bipolar Affective Disorder

Introduction: Bipolar Affective Disorders is an episodic mooddisorder with significant global morbidity. Sleep deprivationin addition to being a core symptom and early warning sign ofimpending mood episodes can also trigger relapse. Individualswith Bipolar Affective Disorder in specific, differ in theirtendency for sleep loss to trigger relapse depending on theirsociodemographic and clinical factors.Current study objective was to evaluate the frequency andquality of sleep as a trigger for relapse of mood episode inpatients with bipolar affective disorders and to correlate itwith socio-demographic profile and clinical variables.Material and methods: This observational cross sectionalclinical study was conducted on 62 patients with ICD10diagnosis of bipolar affective disorders presenting with relapseof mood episode. Presence of acute sleep deprivation andchronic sleep insufficiency according to American academy ofsleep medicine criteria was considered. Young Mania RatingScale (YMRS) and Hamilton Depression Rating Scale (HAMD) were administered. Pittsburgh Sleep Quality Index (PSQI)Scale was used to assess quality of sleep. Written Informedconsents were taken from all the subjects. The data wasanalyzed with appropriate statistical methods.Results: Of the 62 patients assessed with diagnosis of bipolaraffective disorders presenting with mood episode, 58.1% havepoor quality of sleep and 41.9% have good quality of sleep.No statistically significant association noted in any domains ofsocio demographic profile. Statistically significant associationis noted with triggers in the present episode of relapse with94.4% of individual were noted to have sleep deprivation(p<0.001). 52.8% individuals with current episode manic,16.7% with depression, 27.8% with hypomania and 2.8% withcurrent episode mixed is noted to have poor quality of sleepand statistically significant association is noted with polarityof current episode. No statistically significant associationnoted between quality of sleep with other clinical variables.Conclusion:Poor quality of sleep may trigger relapse ofmood episode in patients with bipolar affective disorders.Our finding substantiates the need for careful assessment andmanagement of sleep disturbances during maintenance phasefor bipolar disorders

Rapid detection of the commonly encountered carbapenemases (New Delhi metallo-?-lactamase, OXA-48/181) directly from various clinical samples using multiplex real-time polymerase chain reaction assay

Background: Resistance due to New Delhi metallo-?-lactamase (NDM) and OXA-48/181 continues to emerge as a threat which is associated with nosocomial outbreaks and is a serious healthcare concern. Phenotypic detection being laborious and time-consuming requires rapid detection of NDM and OXA-48/181, which is achieved through real-time polymerase chain reaction (RT-PCR). Materials and Methods: In this study, RT-PCR assay was developed to simultaneously detect NDM and OXA-48/181. The assay was validated on 102 non-duplicate, phenotypically characterised clinical samples. Results: The assay showed a sensitivity and specificity of 97% and 100% for the detection of carbapenemases in comparison to conventional PCR. The in-house developed multiplex RT-PCR would help to rule-in the presence of NDM and OXA-48/181. Conclusions: Rapid detection of these carbapenemases would be assist in better patient management, in terms of accurate antimicrobial treatment, help in cohorting infected from uninfected patient to prevent spread.

Effect of electron‑beam irradiation on antimicrobial, antibiofilm activity, and cytotoxicity of mouth rinses.

Background: Oral health diseases are common in all regions of the world. Mouth rinses are widely used generally by population as a port of daily oral care regimen. In addition to antimicrobial activity, mouth rinses possess certain cytotoxic effects. Electron‑beam (E‑beam) radiation is a form of ionizing energy known to induce structural, physical, and chemical changes in irradiated products. In this study, the modulatory effects of E‑beam in irradiated mouth rinses were evaluated for its biological activities. Materials and Methods: The antimicrobial activities of nonirradiated and irradiated mouth rinses were evaluated for its antimicrobial and antibiofilm activities against oral pathogens, Enterococcus faecalis, Streptococcus mutans, Staphylococcus aureus, and Candida albicans. The antimicrobial activity was evaluated by disc diffusion method and antibiofilm activity was evaluated by O’Toole method. The cytotoxicity was evaluated against human gingival fibroblast (HGF) cells by 3‑(4, 5 Dimethythiazol‑yl)‑2,5‑Diphenyl‑tetrazolium bromide assay. Results: Colgate Plax (CP) exhibited the antimicrobial activity against the tested pathogens, and a significant (P < 0.05) increase was observed against S. aureus at 750 Gy irradiation. Further, CP significantly (P < 0.05) suppressed S. mutans, S. aureus, and C. albicans biofilm. Listerine (LS) inhibited S. mutans and C. albicans biofilm. Whereas irradiated CP and LS significantly (P < 0.05) suppressed the biofilm formed by oral pathogens. The suppression of biofilm by irradiated mouth rinses was dose‑ and species‑dependent. There was no significant (P > 0.05) difference in the cytotoxicity of irradiated and nonirradiated mouth rinses on HGF cells. However, an increased percentage viability of HGF cells was observed by mouth rinses irradiated at 750 Gy. Conclusion: The E‑beam irradiation enhanced the antibiofilm activity of mouth rinses without modifying the cytotoxicity.

Prevalence of adhesive genes among uropathogenic Escherichia coli strains isolated from patients with urinary tract infection in Mangalore.

The study was carried out to detect the adhesive genes pap (pyelonephritis associated pili), sfa (S fimbrial adhesin) and afa (afimbrial adhesin) from Escherichia coli strains isolated in patients diagnosed with urinary tract infection (UTI). A total of 23% of the isolates were positive for pap, sfa and afa genes with a prevalence of 60.87% (14/23), 39.1% (9/23) and 39.1% (9/23), respectively. Prevalence of multiple adhesive genes was 8.7% (2/23) for pap and afa, 30.43% (7/23) for pap and sfa. Significant numbers of isolates were positive for Congo red binding (80%) and haemolysin production 60%. The prevalence of multiple adhesive genes indicate the potential to adhere and subsequently cause a systemic infection among UTI patients.

Comparative evaluation of biofilm suppression by plant extracts on oral pathogenic bacteria.

Microbial colonization as biofilm is one of the reasons for the emergence of drug resistant strains. In the oral cavity, drug resistant strains limit the efficacy of oral hygiene practices. Enterococcus faecalis and Staphylococcus aureus have been reported as drug resistant bacteria and producing oral biofilms in oral cavity. In this study we demonstrate the efficacy of aqueous extract of Azadirachta indica, Mangifera indica, Piper betel and Pepper nigrum for antibiofilm activity against E. faecalis and S. aureus. The aqueous extracts were obtained by cold percolation method. The antibiofilm activity of plants extract was evaluated at 30, 15 and 7.5 mg/ml concentration. The percentage yield of extract was maximum in P. nigrum. The aqueous extract of A. indica significantly suppressed E. faecalis and S. aureus biofilm at 7.5 mg/ml at p<0.01 and p<0.001 significance level. P. betel significantly (p<0.001) disintegrated the E. faecalis biofilm at 30 mg/ml and S. aureus at 15 mg/ml (p<0.01). P. nigrum disintegrated E. faecalis and S. aureus biofilm significantly (p<0.05 and p<0.001) at 30 and 15 mg/ml respectively. M. indica significantly (p<0.05) suppressed S. aureus biofilm at 30 mg/ml. These results clearly demonstrate the antibiofilm activity of plants extract against oral pathogens.

Standardization of fungal polymerase chain reaction for the early diagnosis of invasive fungal infection.

Background: An early initiation of antifungal therapy in invasive fungal infections (IFIs) is critical in reducing the high mortality rate. Current diagnosis of fungal infection relies on microscopy, culture, antigen, antibody specific tests and histological diagnosis. However, these tests either lack sensitivity or specificity. There is thus the need for a rapid, specific and accurate diagnostic method. Objective: The aim of our study was to establish PCR for the rapid detection of Candida and Aspergillus species in clinical specimens with improved sensitivity and specificity. Materials and Methods: A total of 71 proven cases of IFI (confirmed by culture) were collected. A total of 15 healthy, 15 patients suffering from bacterial sepsis and 15 patients with HIV, HBV viral infections were included as controls. Clinical specimens were subjected to a standardized nested amplification to produce Round I (504 bp) and Round II (150 bp) amplicons. Restriction digestion was performed on these products for further identification. Results: Analytical sensitivity was determined using 10 6 -10 CFU/ml of cell suspension. The lower detection limit of the assay was 10 CFU/ml of blood. This test was 100% sensitive and specific with a positive predictive value of 100% and a negative predictive value of 96.7%. Conclusion: The assay was found to be effective for the rapid detection of Candida and Aspergillus in clinical specimens.

Incidence of poisoning deaths in and around Belgaum, Karnataka: A retrospective autopsy survey.

A five-year retrospective study was undertaken to ascertain the incidence of poisoning deaths in and around Belgaum district of Karnataka state, which were autopsied at KLE's Prabhakar Kore Hospital and Research Centre, Belgaum, a referral hospital catering to the needs of the general public within a radius of 100 km. Out of 600 autopsies conducted, 150 were deaths due to poisoning. The commonest age group of affected victims was 21 to 30 years. Males outnumbered females in a ratio of 2.2:1. The most commonly used poison was an organophosphorus compound. Most victims died within 1 to 6 hours of admission to the hospital. Most of the cases were suicidal in nature.

Food poisoning due to Salmonella enterica serotype Weltevreden in Mangalore.

An outbreak of food poisoning due to Salmonella enterica serotype Weltevreden ( S.weltevreden ) involving 34 students has been reported from a tertiary care hospital in Mangalore. The symptoms developed 8-10 hours, after consuming a non- vegetarian dish, probably fish, from an outside caterer. The identity of the organism was confirmed at Central Research Institute, Kasauli. This report emphasizes the geographical distribution of this organism in the Coastal Karnataka region. S.Weltevreden may be overlooked due to the biochemical similarity to S. Paratyphi B & S. Typhimurium.

Giant cystic thymoma with haemorrhage and necrosis: An unusual case.

Extreme degree of cystic, haemorrhagic and necrotic changes in a thymoma is rare. A 22-year-old male presented with cough, grade 2 dyspnoea, and occasional chest pain for the past six months. Radiological investigations revealed a large cystic lesion in the anterior mediastinum. A benign cystic tumour was suspected. Surgical resection of the tumour was done. Grossly, the almost entirely cystic and haemorrhagic dumb-bell shaped encapsulated tumour showed a subcapsular residual nodule. Histopathological examination was suggestive diagnosis of benign thymoma (World Health Organization [WHO] Type A, medullary type) associated with the rare features of cells with dendritic processes containing melanin pigment seen singly scattered throughout the tumour.

Child friendly school initiative at Karkala Taluk, Karnataka.

We conducted a cross-sectional study in 40 schools in Karkala Taluk, Karnataka to evaluate whether they met the 10 criteria of Child Friendly School Initiative as recommended by Indian Academy of Pediatrics. Data were collected using a predesigned proforma by talking to the headmaster and school teachers and inspection of the premises for various facilities. We found that none of the schools met all the criteria; 90% of the schools did not have adequate toilet facilities, 90% did not have safe transportation for the students, children in 82% schools had excess baggage, 72% did not have access to safe drinking water, 57% did not have properly ventilated and illuminated classrooms, and physical punishment was being administered in 45% of schools. 72% of schools did have periodic health checkup, 60% of schools had clean kitchen/ dining room, 60% had adequate facilities for games, and 57% had facilities for first aid facility at school.

Mysterious death in a bathroom: Case report.

A young, married Muslim female was brought dead to casualty with a history of being found unconscious in the bathroom. The information furnished by the police and interaction with the relatives revealed that the deceased had been in good health prior to the incident which the suspicion of foul play. Meticulous autopsy ruled out natural disease and trauma. Findings were however highly suggestive of asphyxia without any demonstrable external or internal cause for the same. The case was finally solved by taking into consideration various causes for bathroom deaths, and ruling out each one by one. At the end, it was concluded that the cause of asphyxia was inhalation of vitiated air, associated with inadequate ventilation.

Primary pulmonary Hodgkin's disease: a distinct entity.

A 30-year-old lady presented with fever, dry cough and weight loss for the preceding five months. Radiological investigations revealed a solitary nodular lesion in the lingula of the left lung. Guided fine needle aspiration cytology failed to yield any diagnostic material. Bronchoscopic cytology was also not contributory. As a last resort open lung biopsy was done and a diagnosis of Hodgkin's disease was made. Hilar and pre aortic lymph node biopsies showed only reactive change. The final diagnosis was primary pulmonary Hodgkin's disease.

Blood utilisation in elective general surgery cases: requirements, ordering and transfusion practices.

AIMS: For elective surgeries, over ordering of blood is a common practice. This can be decreased by simple means of changing the blood cross matching and ordering schedule depending upon the type of surgery performed. The principle aim of the study was to improve the efficacy of ordering system for maximum utilisation of blood and formulation of maximum surgical blood order schedule (MSBOS) for procedures where a complete cross-match appears mandatory. MATERIAL AND METHODS: We evaluated blood ordering and transfusion practices in 500 elective general surgical procedures at our institute. With the help of different indices such as cross-match to transfusion ratio (C/T ratio), transfusion probability (% T) and transfusion index (TI), blood ordering pattern was changed in the next 150 patients. RESULTS: Out of 1145 units of blood crossmatched for the first 500 patients only 265 were transfused with non-utilisation of 76.86% of ordered blood. With the help of the indices the wastage was reduced in next 150 patients, i.e. from 76.86% to 25.26% and improved the utilisation of blood, i.e. from 23.14% to 74.74%. CONCLUSIONS: Change of blood ordering patterns with use of MSBOS can avoid the over ordering of blood.

A comparison of continuous infusion of vecuronium and atracurium in midline and paramedian laparotomies.

This was a study to compare continuous intravenous infusion of atracurium with continuous intravenous infusion of vecuronium for intraoperative muscle relaxation in 62 ASA I / II patients. Scheduled for laparotomies and pelvic surgeries under general anaesthesia. They were randomly allocated in two groups to receive either vecuronium infusion of 50 microg/kg/hour following a bolus dose of 0.1 microg/kg, or atracurium infusion of 400 microg/kg/hour following a bolus dose of 0.5 microg/kg. The mean infusion dose of atracurium was 478 +/- 44.11 microg/kg/hour and that of vecuronium was 63.2 +/- 74 microg/kg/hour for adequate muscle relaxation. The depth of neuromuscular blockade was monitored by using peripheral nerve stimulator so that only one twitch of train of four was present, resistance to ventilation, surgical relaxation and haemodynamic changes. Vecuronium infusions produced more haemodynamic stability than atracurium infusions. Vecuronium produced lesser change in systolic blood pressure (mean change of 3. 46 +/- 3.33%) from baseline values as compared to atracurium (mean change of 5.81 +/- 3.73%) from baseline values ( p < 0.01) which was statistically significant. The difference in mean pulse rate change from baseline value in the atracurium group (4.78 +/- 2.745%) was less than that in the vecuronium group (5.99 +/- 2.67%), which was not statistically significant. Spontaneous recovery was faster with vecuronium (540.94 +/- 76.46 seconds) as compared to atracurium (596. 33 +/- 72.48 seconds). 84.4% of patients who received vecuronium fell within good to very good category of muscle relaxation as compared to 63.3% in atracurium group. There were no cost benefits when either agents were used in infusion form.

Proximal femoral focal deficiency (PFFD).

A 1-year-old child with proximal femoral focal deficiency (PFFD) is presented. The clinical spectrum and associated abnormalities is described and the diagnosis and management of this entity is discussed.