Clinicomicrobiological study of the removed intrauterine device

Background: Intrauterine contraceptive devices are one of the most efficient, cost effective long acting reversible contraceptives. But the worrying clinical symptoms, misconceptions and higher rates of genital tract infection have become a hurdle in its acceptance as the first choice of contraception. The objective of this study was to study the common reasons for removal of IUCD.Methods: An observational study was done involving 430 women who reported to the OBG Outpatient of the hospitals attached to Bangalore Medical College, over a period of 2 years, for IUCD removal. Socio-demographic details, clinical symptoms compelling IUCD removal were elicited. The removed IUCD was subjected to culture and sensitivity. Initial descriptive analysis was used and statistical tests of significance like chi-square were used to know the relation between genital infections and IUCD.  P value <0.05 was considered significant.Results: Of the 430 women, 46.9% were between 21-25 years of age, 49.3% were primipara, and 71% used IUCD for 1-3 years. Most common reason for removal in the first 2 years was heavy menstrual bleed followed by pain abdomen. 15.3% culture reports showed growth of bacteria, with maximum cultures positive in <5 years of usage, the association was statistically significant.Conclusions: Present study shows a lower risk of bacterial infections among IUCD users. Hence, effective counseling regarding the safety of IUCD over other spacing methods is essential to increase its acceptance.

Medical problems in children with Down syndrome

Background: Down syndrome (DS) is a major cause of mental retardation of prenatal origin and has several associated co-morbidities involving cardiovascular system, respiratory, endocrine system, hematological, gastrointestinal, musculoskeletal, eye and ear defects, immunological changes and neurological system. This study was conducted to identify the common medical problems in children with Down syndrome and the morbidity associated with these conditions. The objective of the present study was to find out the occurrence of different medical problems in children with DS.Methods: 42 children with a phenotype of Down syndrome in the age group of 0-12 years attending the outpatient, inpatient and Down syndrome Clinic of the Institute of Child Health, Kottayam during the study period were included in the study by purposive sampling. Demographic details were entered, and Pediatric Clinical Examination was performed by the investigator himself to identify the medical problems. Old medical reports were reviewed, and data entered into a proforma and statistically analysed.Results: Out of the 42 children with DS, 22 were males. 15 (35.7%) were less than 1 year, 20 (48.3%) children 1-5 years and 7 (16.1%) children 5-12 years of age. Mean age of the study group was 1.78±0.51 years. Mean age of their mothers at the time of conception was 30.6±5.8 years. 26 (57%) children with Down syndrome had a medical problem during the neonatal period which required hospitalization. Almost all systems are affected and craniofacial features, developmental delay and hypotonia were universal. Various forms of congenital heart diseases were observed in 67% and hypothyroidism in 23.8%.Conclusions: Down syndrome is a common genetic disorder with multisystem involvement. Congenital heart diseases, hypothyroidism and recurrent respiratory infections were the common medical problems identified in this study.

A study of anti-inflammatory activity of the benzofuran compound (3,4-dihydro 4-oxo-benzofuro [3,2-d] pyrimidine-2-propionic acid) in chronic model of inflammation.

Background: Benzofuran compounds are shown to have pharmacological properties such as antiarrhythmic, antidepressant, antifungal, and antibacterial activity. Some studies conducted on them have revealed that they are having anti-inflammatory property also. Hence, we carried out this study to know whether the benzofuran compound 3, 4-dihydro 4-oxo-benzofuro (3, 2-d) pyrimidine-2-propionic acid has got anti-inflammatory activity against chronic inflammation. Methods: Wistar albino rats were treated with benzofuran compound under study and phenylbutazone in the dose of 100 mg\kg, orally with 2% gum acacia as suspending agent and the effects were observed in chronic experimental model of inflammation namely, cotton pellet induced granuloma model. Results: In the present study, it was shown that the benzofuran compound under study has got significant anti-inflammatory activity against the chronic model of inflammation. Conclusion: Our experiment shows that the benzofuran compound under study has got significant anti-inflammatory activity and may, as well become an additional anti-inflammatory drug if further studies are conducted in this direction involving human beings.

Single‑walled and multi‑walled carbon nanotubes based drug delivery system: Cancer therapy: A review.

Carbon nanotubes (CNTs) are advanced nano‑carrier for delivery of drugs especially anti‑cancer drugs. In the field of CNT‑based drug delivery system, both single‑walled carbon nanotubes (SWCNTs) and multi‑walled nanotubes (MWCNTs) can be used for targeting anticancer drugs in tissues and organs, where the high therapeutic effect is necessary. Benefits of the carbon nanotubes (CNTs) in drug delivery systems are; avoiding solvent usage and reducing the side effects. Therefore, the present review article described about achievement of SWCNTs and MWCNTs to deliver the anticancer drugs with different cancerous cell lines.

Creation of Public Health Cadre in Karnataka State, India.

Background: Public Health is the science and art of promoting Health, preventing diseases and prolonging life through organized efforts of Society. The Government of Karnataka constituted a committee to revive the Public health system in state of Karnataka to provide recommendations for creation of Public health ca-dre. Objectives: To provide recommendations for creation of efficient public health system through creation of public health cadre. Methods: We reviewed several documents for studying the history and current struc-ture of the department regarding creation of public health cadre/department. We conducted 35 brainstorm-ing sessions involving in-depth discussions. We also conducted field visits and administered a pre-designed format for collecting the feedbacks from the officials of different levels. Results: The reviewed documents had a common finding of implementing public health cadre. Our analysis of current human resources in health department indicates that there is shortfall of qualified public health professionals in the department to opt and continue in public health cadre. Among the existing staff, 51% of the respondents wanted to up-date their skills through continued professional education. Our results from the study demonstrated to create a Public health directorate and public health cadre in Karnataka state. Conclusions: We recommend that there can be three levels in Public Health Cadre namely, Taluk level officers, District level officers and State level officers. We recommend time bound promotions of medical officers in accordance with published and updated common seniority list, which is the basis for all service matters.

An in vitro comparison of resistance to second and third order archwire activations of three different varieties of esthetic brackets.

Background: When ceramic brackets were introduced as an esthetic alternative to the stainless steel brackets, it was a step ahead in the use of esthetic appliances for orthodontic treatment. Although ceramic brackets had overcome the drawbacks of the initial polycarbonate brackets such as staining and bracket slot distortion, they posed an altogether different problem. This was on account of the physical properties of the ceramic material, namely brittleness. Purpose of the Study: The purpose of this study is to investigate the physical properties of three different varieties of esthetic brackets, i.e., “MXI” ceramic bracket, “Spirit MB” bracket (Ormco), a composite bracket with metal slot reinforcement and the third one fiber bracket, with silicious copolymer, Natura (Leone Co.). Aims and Objective of the Study: The objective of this study is to compare the torsional resistance of the brackets and resistance of brackets to second order archwire activations. Conclusion: The strength of the selected brackets was more than sufficient to withstand orthodontic load without any fracture or deformation.

Albumin-adjusted calcium: Are previously published regression equations reliable for your laboratory? - A pilot study.

Background: Most of the laboratories use previously published regression equations for estimation of calcium which may not fit for their population. So deriving locally a regression equation for albumin-adjusted calcium (CaAd) is a mainstay to avoid population-based differences. Aims & Objective: To derive regression equation for albumin-adjusted calcium in our laboratory and validate it for the local population. Material and Methods: Total 575 normal healthy individuals of 35-65 years were included in the present study and were estimated for serum total calcium (CaT), ionized calcium (Ca2+), and albumin. The linear regression equation for the binding of calcium and albumin was derived in a cohort of 450 normal healthy individuals of 35-65 years, and the albumin-adjusted calcium equation was internally validated in a separate cohort of 125 subjects. The performance of this equation was compared with a previously published equation: CaAd (mmol/L) = CaT (mmol/L) + 0.02 (40 - [albumin] (g/L). Results: The local adjustment equation obtained from the derivation subset was expressed by the relationship; CaAd (mmol/L) = CaT (mmol/L) + 0.03 (37.33 – [albumin] (g/L)). The equation was internally validated with an adjusted r2 shrinkage value of 0.0009 in a validation subset. Bland-Altman plot showed statistically significant difference (Mean = 0.13 mmol/L) when both formulae were compared for the population. Conclusion: A locally derived and internally validated albumin-adjusted calcium equation differed significantly from previously published equations. Individual laboratories should determine their own linear albumin-adjusted regression equation for calcium rather than relying on published formulas.

Urinary Albumin Excretion Rate: Diagnostic and Prognostic Utility in Essential Hypertension.

Context : To evaluate the usefulness of urinary albumin excretion rate (UAER) i.e. Albumin/Creatinine Ratio (ACR) in diagnosis and prognosis of essential hypertension (EHT). Objectives : To find out the association of urinary albumin excretion rate with the pathophysiology of essential hypertension. Study Design : A cross-sectional analytical study. Materials & Methods : Urinary albumin excretion (UAE), urinary creatinine (UC) and UAER were analyzed and compared between hypertensive cases and age & sex matched normotensive controls of age group 30-65 years using unpaired two-tailed Student ‘t’ test. All statistical analyses were done with PASW (SPSS) v.18.0. Results : Systolic BP (SBP) and diastolic BP (DBP) of cases were found to be significantly higher (p < 0.001) than controls. Urine MAlb level (p < 0.001) and ACR (p < 0.001) in cases were significantly higher compared to controls. Correlation studies showed that SBP and DBP was significantly positively correlated with urine MAlb (SBP: r = 0.859, DBP: r = 0.733; p < 0.001) and ACR (SBP: r = 0.830, DBP: r = 0.739; p < 0.001). Sex-wise comparison in cases revealed that males had statistically non-significant (p > 0.05) lower levels of urine MAlb as compared to females but had significantly higher (p < 0.001) levels of urine creatinine and lower (p < 0.001) ACR compared to females. Conclusion: Urinary MAlb levels and ACR are seen to be increased in hypertensive subjects compared to normotensive subjects. ACR was significantly higher in female hypertensives than males which can be credited to the physiologically observed lower urine creatinine levels compared to males. Both Microalbuminuria and ACR can serve as specific and well-established marker of cardiovascular and renal damage in EHT.

Successful treatment of peritonitis by C. bertholletiae in a chronic kidney failure patient on continuous ambulatory peritoneal dialysis after kidney rejection

Peritonitis is a common problem in patients undergoing peritoneal dialysis. However, peritonitis due to Cunninghamella (C.) bertholletiae, a fungus of the class Zygomycetes, is rare. We present a case of fungal peritonitis in a patient on continuous ambulatory peritoneal dialysis due to kidney rejection. Direct examination of the patient's peritoneal fluid showed fungal hyphae, and the culture was identified as C. bertholletiae. A cumulative dose of 1,600 mg fluconazole was given to the patient intraperitoneally over a one-week period. When his condition had stabilised, oral antifungal treatment was administered for two weeks. After removal of the Tenckhoff catheter, the patient was discharged with arteriovenous fistulation for haemodialysis. Zygomycosis due to C. bertholletiae is often fatal and non-responsive to systemic antifungal therapy. This case is the first from India with a successful outcome, and highlights the importance of early detection and intervention for successful outcome of peritonitis caused by C. bertholletiae.

Malignant nodular hidradenoma of the eyelid: a rare sweat gland tumor

We report a case of malignant nodular hidradenoma in a middle-aged man, who presented with a nodular swelling in the eyelid. The tumor was similar to its benign counterpart but had additional features such as surface ulceration, numerous mitiotic figures, and an infiltrative growth pattern. Malignant forms of hidradenomas are unusual and the possibility this variant should be considered in the differential diagnosis of eyelid tumors

Effect of industrial effluent on the morphological parameters and chlorophyll content of green gram (Phaseolus aureus Roxb).

A pot culture experiment was conducted to study the effect of biomass power plant effluent on seed germination, seedling growth and chlorophyll content of green gram (variety LGG 460) have been estimated at different effluent concentrations and time intervals. The effluent is alkaline in nature (pH 8.5), odorless, and comprises of heavy metals such as Cr (0.071 mg l-1),Cu (0.014 mg l-1), Mn (0.036 mg l-1), Fe (0.05 mg l-1),Co (0.31 mg l-1), Ni (0.041 mg l-1),Cd (0.028 mg l-1), Pb (0.108 mg l-1) and Zn (6.73 mg l-1). The germination percentage of seed, seedling growth and chlorophyll content showed a gradual decline with increase in effluent concentration. It has been observed that at 25% effluent concentration, there is growth in the root length (3.50 cm seedling-1), an increase in shoot length (23.90 cm seedling-1) and total chlorophyll content (4.467 mg g-1 fresh weight) up to 20 days. After 20th day there is decline in all the parameters observed. However, at higher concentrations of the effluent, toxic effects were observed from 20th day. This suggests that the effluent can be used safely for green gram cultivation, only after proper treatment and dilution.

Cadmium induced changes on proline, antioxidant enzymes, nitrate and nitrite reductases in Arachis hypogaea L.

The groundnut, Arachis hypogaea seedlings, when grown in pot cultures for 10–25 days at 25, 50, 100 "M CdCl2 , showed a marked decline in growth compared to control. Similar trend was observed for nitrate reductase (NR) and nitrite reductase (NiR) activities whereas proline, peroxidase (POD) and catalase (CAT) showed increasing trend when observed on the 10th day of the experiment. Changes have occurred in the physiological and biochemical activities which are observed even at low Cd levels (25 "M). At 100 "M concentration, with increase in experimental days, Cd has imposed drastic decrease in leaf and stem respectively, where nitrate reductase has varied from 20.87 – 79.41 and 29.11 – 72.91 % and nitrite reductase 21.66 – 79.41 and 43.58 – 75.92% respectively. Contrastingly Cd treated plant tissues showed an increase in proline 111.2 – 159.87 % (percentage changes) and 131.23 – 212.16 % for leaves and stems respectively, In addition cadmium caused significant changes in the activity of antioxidative enzymes, peroxidase 48.12 – 72.19 % in leaf and 37.71 – 75.25 % in stem and catalase 64.86 – 143.92 % in leaf and 129.13 – 214.74 % in stem as compared to control. The study concludes that the activities of NR, NiR, proline, POD, CAT are inhibited suggesting that Arachis hypogaea seedlings are under Cd stress affecting their growth.

Scapulothoracic dissociation--A case report.

Scapulothoracic dissociation (SCTD) is a rare clinical entity with fewer than 70 cases reported in English literature. The mechanism of injury is severe rotational force, which causes disruption of the shoulder girdle from the rest of chest wall. Frequently, SCTD produces massive blood loss as it involves major fractures of the upper extremity, disruption of muscle, brachial plexus, and vascular damage. This case report demonstrates classical radiological findings of SCTD with brachial plexus injury but with no associated vascular damage.

Levofloxacin in enteric fever--a study.

Typhoid fever is an important cause of morbidity and mortality in patients especially in developing country. Therapy with conventional drugs is associated with increasing resistance, non-compliance to therapy and toxicity. Oral fluoroquinolones have been shown to be effective compared to parenteral broad-spectrum cephalosporins in the treatment of uncomplicated typhoid. However, there is no data available regarding the use of levofloxacin in the treatment of typhoid fever in spite of the susceptibility of Salmonella species to levofloxacin. The present study was undertaken to evaluate the efficacy, safety and tolerability of oral levofloxacin 750 mg once daily in the treatment of typhoid fever. Results indicated that levofloxacin 750 mg administered orally once daily was an effective, safe, well-tolerated and cost-effective option in the treatment of typhoid fever in adult Indian males and non-pregnant females.

Spectrum of anti-neutrophil cytoplasmic antibodies in patients with pulmonary tuberculosis overlaps with that of Wegener's granulomatosis.

BACKGROUND AND OBJECTIVES: Mycobacterial infections are known to induce the development of autoantibodies and a few of these antibodies are also known to be diagnostic markers for some other diseases and it is uncertain whether these autoantibodies play a role in the pathogenesis of autoimmune disorders. This study was undertaken to determine the prevalence of autoantibodies like anti-neutrophil cytoplasmic antibodies (ANCA), anti-nuclear antibodies (ANA), anti-double stranded antibodies (anti-dsDNA) and anti-histone antibodies (AHA)in pulmonary Tuberculosis. MATERIALS & METHODS: Seventy consecutive pulmonary TB patients, 30 patients of interstitial lung disease and 100 normal individuals were studied. ANCA and ANA were detected by indirect immunofluorescence test (IIF). Anti-dsDNA and AHA were tested by ELISA. RESULTS: ANCA was detected in 30% cases, and of these 52.4% showed perinuclear pattern (p-ANCA), 38.1% cytoplasmic (c-ANCA) and 9.5% showed an "atypical" pattern. ANCA specificities by ELISA revealed that, 47.6% had anti-Myeloperoxidase (anti-MPO), 28.6% had anti-Proteinase3 (anti-PR3) and 19.1% had anti-Lactoferrin (anti-LF) antibodies. ANA and AHA were present in 24.3% and 21.4% cases respectively whereas anti-ds DNA antibodies were absent. Normal controls showed 4% and 2% positivity for ANA and ANCA whereas disease control group of ILD showed 7% of ANA and ANCA posititivy. CONCLUSION: The presence of autoantibodies in TB patients could have a multifactorial etiology. Clinically relevant is the presence of anti-PR3 antibodies. This finding along with pulmonary and renal manifestations could lead to a false diagnosis of Wegener's granulomatosis or vice versa because these autoantibodies may be present in both diseases.

Atrioventricular septal defect--associated anomalies and aneuploidy in prenatal life.

The present study was conducted to estimate the frequency of other-cardiac, extracardiac and chromosomal anomalies in fetuses with A VSD diagnosed in a prenatal diagnosis center, analysed from the database during the 54-month period extending from November 1997 to May 2002. One hundred and three fetuses were diagnosed with A VSD. Among them other-cardiac and extra cardiac anomalies were present in 56 and 75 cases respectively. Of the 22 fetuses that had undergone karyotyping, no metaphase was seen in one case. In the remaining 21, 15 (71.4%) turned out to be normal, three (14.2%) had trisomy 18, two (9.5%) had trisomy 13 and one had trisomy 21 (4.8%). We found that AVSD almost always occurs with other-cardiac or extracardiac anomalies, though the pattern may differ between populations. It seems to be less frequently associated with chromosomal anomalies (especially trisomy 21) in South India. The genetics of AVSD underscores the importance of a thorough understanding of the target population in prenatal decision-making.

Latex allergy in children: diagnosis and management.

Latex allergy is an increasingly common condition, in both children and health care workers who provide care for them. Subpopulations at particular risk include children with spina bifida, children undergoing multiple surgical procedures, and health care workers in the operating theatre. Chemical additives in latex gloves can cause an irritant or allergic contact dermatitis. Latex proteins are responsible for most of the immediate IgE-mediated hypersensitivity allergic reactions. Symptoms range from rhinitis, conjunctivitis and urticaria to anaphylaxis and death. A latex-directed history is the primary method of identifying latex sensitivity, although both skin and serum testing is available and increasingly accurate. (Latex avoidance should be used in all individuals with a positive skin or blood test or a positive history). The most important preventive measure for patients with or at risk for latex allergy is minimizing direct patient exposure to latex products, most notably latex gloves. Recent operating room studies indicate simple preventive measures can dramatically reduce intraoperative reactions. Preoperative prophylaxis with antihistamines and steroids have not been shown to be necessary or effective. Treatment of an allergic reaction begins with immediate removal of any identified source of latex in direct patient contact. Treatment is similar to anaphylaxis from other causes, and may require the use of epinephrine. Everyone caring for the patient at risk for latex allergy must be involved in making their medical environment safe.

Ultrasonic characterisation of malignant melanoma of choroid.

An in-vitro study of wave spectral analysis in 8 enucleated eyes was conducted in order to differentiate histological subtypes of malignant melanoma. To obtain the backscattering coefficient for the tissues, we used a broadband focussed transducer with a frequency range of 7-12 MHz and a centre frequency of 10 MHz. Experimental measurement of backscattering coefficient and attenuation coefficient at various frequencies was done by substitution techniques. The backscattering coefficient, scatterer size, and root mean square velocity fluctuation were derived by the numerical method, while the attenuation coefficient at 1 MHz was derived from attenuation coefficient at different frequencies. This study revealed that backscattering coefficient and attenuation coefficient, over a frequency range of 7-12 MHz, show an increase in the spindle cell type compared to the mixed cell type of malignant melanoma. Particularly, the scatterer size was significantly higher in the spindle cell group (p = 0.013) in contrast to the mixed cell type. Spindle cells have uniform and compact histological pattern which contributes to an increase in scatterer size and root mean square velocity fluctuation. The ultrasonically obtained parameters have been shown to have a good correlation with the histology of malignant melanoma.

Sedation in pediatric patients.

Sedation is being used increasingly in children to allay anxiety and discomfort. Sedation can also increase the efficiency of performing both diagnostic and therapeutic procedures in children. There are a wide array of available sedation methods that are used by radiologists, gastroenterologists, hematologists/oncologists and emergency room physicians everyday. Indiscriminate use of sedatives has led to seizures, respiratory arrests and death in a variety of practice settings. With improved monitoring capability, more potent drugs and better understanding of the pharmacokinetics in children, it is possible to provide batter care.