High prevalence of class 1 integrons in clinical isolates of methicillin‑resistant Staphylococcus aureus from India.

Introduction: Class1 integrons are one of the prevalent mechanisms of antibiotic resistance gene transfer in Gram‑negative organisms, but their prevalence and role in the spread of antibiotic resistance genes in methicillin‑resistant Staphylococcus aureus (MRSA) is unexplored. The purpose of this study was to investigate the prevalence of class 1 integrons in clinical isolates of MRSA. Materials and Methods: Total 143 MRSA isolates obtained from two different cities in India (Pune and Mumbai) were characterized by biochemical tests, and the antibiotic sensitivity was performed using the Clinical and Laboratory Standards Institute (CLSI) guidelines. The presence of class 1 integrons, sul1/qacEΔ1 region of class 1 integron and mecA gene among these isolates was determined by polymerase chain reaction (PCR). Results: All 143 isolates were mecA positive and coagulase‑positive. Overall, 71% of the MRSA isolates carried class 1 integrons; 58% (45/77) of the isolates obtained from Mumbai and 85% (56/66) of the isolates from Pune carried class 1 integrons. In all, 39% of these isolates carried sul1/qacEΔ1 region, thus confirming the association of class 1 integrons with antibiotic resistance genes. Along with ‑lactam antibiotics the MRSA isolates were resistant to several other antibiotics, with resistance to erythromycin, ciprofloxacin and trimethoprim‑sulfamethoxazole being observed in 75%, 66% and 60% of the isolates, respectively. Conclusion: To the best of our knowledge, this is the first report of class 1 integrons in MRSA isolates from India. The study provides insights into the prevalence of a novel mechanism adapted by MRSA for the propagation of antibiotic resistance genes.

Variability in platelet response to a single daily dose of 150 mg enteric coated aspirin in a high risk population.

PURPOSE: Previous studies have reported inadequate anti-platelet effect in 0.4-35% of patients taking aspirin. Such studies have arbitrarily defined the terms "semi-responders", "non-responders" or "resistant" to variable doses of aspirin on the basis of absolute values derived from different ex-vivo platelet aggregation (PA) methods. Our objective was to define response to 150-mg dose of aspirin in terms of normally distributed values using an ex-vivo measure of PA in a population at high risk for vascular events. METHODS: We prospectively studied high risk patients with either established coronary artery disease (CAD) or stroke or transient ischemic attack (TIA) or peripheral vascular disease or with multiple atherothrombotic risk factors like diabetes plus one of the following-- hypertension, increased total cholesterol, cigarette smoking, micro-albuminuria, low-high density lipoprotein (HDL), family history of CAD and receiving single 150 mg dose of aspirin daily. PA was assessed by chronolog lumi-aggregometer (490-2D) using arachidonic acid (AA) reagent. RESULTS: 130 patients were studied. The response of subjects to aspirin followed a normal, bell shaped distribution curve with a mean and standard deviation (S.D.) of 13.1 +/- 4.4%. 3.1% patients had PA values more than 2 S.D. of the mean, hence termed as hypo-responders to aspirin while another 3.1% patients had PA values less than 2 S.D. of the mean, hence termed as hyper-responders to aspirin. CONCLUSION: There is minimal inter-individual variability in the response to aspirin when tested with AA as the reagent. The response to aspirin follows a normal Gaussian distribution. The prevalence of hypo-responders to aspirin in high risk population is only 3.1%. This is the first study to document "hypo" and "hyper-responders" to single daily dose of 150 mg aspirin. The clinical relevance of these findings remains to be determined.

Indo Heart Survey on latent abnormal glucose regulation in patients with coronary artery disease without diabetes across India.

BACKGROUND: The Euro Heart Survey on diabetes and heart has demonstrated high prevalence of latent glucose abnormalities in non-diabetic patients with coronary artery disease (CAD) in the European population. The aim of our survey was to assess the prevalence of latent abnormal glucose regulation in adult non-diabetic CAD patients in India. METHODS AND RESULTS: Seven centers distributed across India recruited 350 patients. The diagnosis of CAD was done by coronary angiography showing >50% stenosis in any major epicardial coronary artery or its branches. Oral glucose tolerance test (OGTT) and fasting glucose levels were used to characterize glucose metabolism. Venous plasma glucose was measured before (fasting) and 2 hours after ingestion of glucose. Impaired fasting glucose (IFG) was defined as OGTT (0 minute)>or=100 mg/dl but <126 mg/dl and OGTT (2 hours)<140 mg/dl. Impaired glucose tolerance (IGT) was defined as OGTT (0 minute)<126 mg/dl and OGTT (2 hours)>or=140 mg/dl but <200 mg/dl. Of the 350 patients studied, 176 (50.28%) had impaired glucose regulation (IFG-28 [8%]; IGT-148[42.28%]) and 75 (21.42%) had newly detected Diabetes. In all 251 (71.7%) patients with CAD had previously undetected abnormal glucose regulation. CONCLUSION: This survey demonstrates the presence of abnormal glucose regulation in almost three quarters of the non-diabetic Indian CAD patients. OGTT should be recommended as routine screening test for detecting latent glucose abnormalities in all CAD patients.

Placenta in PIH.

A variety of changes in placental villi are known to occur in Pregnancy Induced Hypertension. In this study an attempt is made to study 49 placentae from PIH and its correlation to perinatal outcome. Quantification of villous lesions was carried out. The striking villious changes were cytotrophoblastic proliferation, paucity of vasculosyncytial membrane, trophoblastic basement membrane thickening and fibrinoid necrosis of villi. The changes were directly proportional to the severity of disease and perinatal outcome was worse with advancing grades of PIH.

Papillon Lefevre syndrome.

Papillon Lefèvre syndrome is a rare disease characterized by skin lesions caused by palmar-plantar hyperkeratosis, and severe periodontal destruction involving both the primary and permanent dentitions. It is transmitted as an autosomal recessive condition and consanguinity of parents is evident in about one-third of cases. Pyogenic liver abscess is an increasingly recognized complication. We report a new case of this association and review the current literature.

Gonadoblastoma with unusual mixed germ cell overgrowth--a case report.

Gonadoblastoma is an uncommon tumour of ovary occurring exclusively in patients with inter sex disorders. We are presenting an unusual case of gonadoblastoma with distinctly rare pattern of germ cell overgrowth on the other side in an eighteen year old girl.

Kasabach-Merritt syndrome: a case report.

Kasabach-Meritt syndrome is a combination of thromobocytopenia, hemolytic anemia, and acute or chronic consumptive coagulopathy in association with rapidly enlarging hemangioma. A male infant of 5 days was admitted in paediatric ward with this syndrome. The baby had ecchymotic patches over face and extremities and bleeding through umbilical stump. The child expired due to severe thrombocytopenia with consumptive coagulopathy leading to precipituous hemorrhage superimposed by septicemia. An autopsy was performed which confirmed retroperitoneal lesion as kaposiform hemangioendothelioma.

Early diagnosis of neonatal septicemia by sepsis screen.

A study of 100 neonates with clinical suspicion of septicemia, admitted in neonatal intensive care unit of SCSM General Hospital, Solapur was carried out to assess the utility of various indices of sepsis screen. Bacterial and hematological profile of these neonataes was studied. Parameters of sepsis screen such as leukocyte count, band form to neutrophil ratio, neutrophils with toxic granulations, micro ESR and test for C-reactive protein were analysed to know their sensitivity and specificity.

Histopathological study of endometrium in infertility.

A study of 200 cases of primary and secondary infertility was carried out in the department of pathology, Dr. V.M. Medical College, Solapur. Endometrial specimens were evaluated in the light of menstrual history to find out the incidence of various endometrial changes in cases of infertility. All cases underwent endometrial biopsy premenstrually. Haematoxylin and eosin staining was done for dating of endometrium and diagnosis of corpus luteal defect and anovalutory cycles. PAS stain was done in 50 cases of infertility with control of 25 cases to detect the amount of glycogen. Menstrual problems were seen in 38.2% of patients. Anovulatory infertility was present in 28.2% cases. Luteal phase defect was seen in 20% cases. Cystoglandular hyperplasia was seen in 1.7% cases & tuberculous endometritis was present in 2.6% cases. Glycogen deficiency was seen in 30% cases of luteal phase defect.

Behavioural disturbances in dementia.

OBJECTS: To assess the frequency of behavioural disturbances in patients suffering from dementia and their relation to dementia severity. METHODS: The study evaluated 75 patients referred to the Memory Clinic at our hospital. Patients meeting DSM-IV criteria for dementia were included in the study. Activities of daily living (ADL) and cognitive functioning were also assessed. Patients were then rated for dementia severity using the Clinical Dementia Rating scale. Clinical data regarding behavioural disturbances was obtained from the patient (where possible) and an informant (usually the primary caregiver) who had contact with the patient at least thrice a week. RESULTS: Results showed that behavioural disturbances were present in more than 60% of the sample. Psychotic and activity associated disturbances were most common, and that these were seen more frequently in Alzheimer's disease than any other type of dementia. Further, these disturbances occurred most frequently in dementias of moderate severity but reduced as the dementia progressed further. CONCLUSION: Our results indicate that behavioural disturbances are a prominent part of dementia and that judicious use of psychiatric medication should form an important aspect of management.

A comparative study of platelets behaviour in controls and acute myocardial infarction patients.

Acute myocardial infarction is one of the leading vascular diseases. Platelet-endothelium plays a crucial role in its etiopathogenesis. The present study was undertaken to compare the platelet aggregability in controls and acute myocardial infarction patients along with its effect on the peripheral platelet count. The work was conducted in five patients from ICCU and 5 controls between the age group of 40-60 years by using Chronolog Dual Channel Aggrometer with ADP and epinephrine as agonists. The platelets were counted by hemocytometry. The results were statistically analysed by Student's 't' test which was found to be significant. There was increase in the aggregation index in patients compared to controls. It was also observed that the degree of increase was more with ADP than epinephrine. Relatively, there was tendency of low platelet count. The increase in the aggregation index can be attributed to the hyperreactiveness of the platelets to ADP than epinephrine. The relative thrombocytopenia can be accounted to the sequestration of platelets in the coronary microvasculature. In conclusion, balance between EDRF and EDCF determines the platelet activation.