Effectiveness of Training for Teachers in Early Identification of Skin Disorders Among Primary School Attending Children - A Quasi-Experimental Study Protocol

Skin diseases are the leading cause of morbidity in children. As children spend most of their time in schools, training teachers on the detection of skin changes and timely referral will prevent or reduce the complications. Hence, we propose a quasi-experimental study to evaluate the effectiveness of training for teachers in the early identification of skin disorders among primary school children in a rural area of southern India. The teachers of government and government-aided schools in the field practice area of Model Rural Health Research Unit, Tirunelveli, will be the intervention group. The same schools in the nearby village will be the control group. The investigators and the National Institute of Epidemiology, ICMR, Chennai will develop and validate the training manual. Using the manual, the principal investiga-tor will train the teachers on identifying and referring skin changes and provide a training manual, model register and referral slip to each teacher. The investigators will review the schools quarterly and collect the number of children identified and referred from both groups before and after the intervention. Thus, the trained teachers will be a resource to achieve the objectives of the school health program, comple-menting the health services.

Trichoblastic carcinoma arising in trichoepithelioma in Brooke–Spiegler syndrome

Brooke–Spiegler syndrome (BSS) is a rare autosomal dominant disease characterized by the development of multiple cutaneous adnexal neoplasms namely cylindroma, trichoepithelioma and spiradenoma. The neoplasms associated with this syndrome are generally benign, but rarely they may undergo malignant transformation. A 63-year-old male presented with an ulcerated nodular lesion over glabella and multiple asymptomatic nodular lesions over face, scalp, chest and limbs. His father, grandfather and paternal cousins had history of similar lesions. Histopathological examination revealed trichoblastic carcinoma arising from trichoepithelioma over glabella and cylindroma on the chest. With these findings we arrived at a diagnosis of BSS with malignant transformation of trichoepithelioma. Trichoblastic carcinoma arising in trichoepithelioma in a patient with BSS is extremely rare with only a single case reported in literature.

Susceptibility profile, resistance mechanisms & efficacy ratios of fosfomycin, nitrofurantoin & colistin for carbapenem-resistant Enterobacteriaceae causing urinary tract infections

Background & objectives: The escalation in carbapenem resistance among Enterobacteriaceae has resulted in a lack of effective therapeutic alternatives. Older antimicrobials, fosfomycin, nitrofurantoin and colistin for urinary tract infections (UTIs) caused by carbapenem-resistant Enterobacteriaceae (CRE) may be effective treatment options. The objectives of this study were to evaluate the utility of fosfomycin, nitrofurantoin and colistin in treating UTI caused by CRE and molecular characterization of the plasmid-mediated carbapenem resistance mechanisms. Methods: Consecutive, non-duplicate isolates of CR Escherichia coli and Klebsiella spp. from urine cultures were included (n=150). Minimum inhibitory concentrations (MIC) were determined by E-test (fosfomycin and nitrofurantoin) and broth microdilution (colistin). Efficacy ratios were derived by dividing susceptibility breakpoints by observed MIC values of the drugs for the isolates. Isolates were screened for genes coding for carbapenemases using multiplex PCR. Fosfomycin, nitrofurantoin and colistin-resistant isolates were screened for plasmid-borne resistance genes fos A3, oqx AB and mcr-1, respectively using PCR. Results: Among E. coli, 98.9, 56 and 95 per cent isolates were susceptible to fosfomycin, nitrofurantoin and colistin, respectively, while 94 and 85 per cent of Klebsiella spp. were susceptible to fosfomycin and colistin, respectively. The efficacy ratios indicated fosfomycin as the drug of choice for UTI caused by CR E. coli and Klebsiella spp., followed by colistin. The blaNDM gene was most common, followed by blaOXA48-like. Plasmid-borne genes encoding resistance to fosfomycin, nitrofurantoin and colistin were absent. Interpretation & conclusions: With increasing resistance against the current treatment options, older drugs may emerge as effective options. Molecular screening of resistant isolates is essential to prevent the spread of plasmid-borne resistance against these drugs.

Evaluation of endocrine parameters and glucose tolerance status in obese subjects with polycystic ovary syndrome.

BACKGROUND: Severe insulin resistance is a key abnormality in obese women with polycystic ovary syndrome (PCOS). The purpose of this study was to evaluate the sex steroid hormone levels and glucose tolerance status in obese PCOS patients. METHODS: 104 obese patients with PCOS (BMI≥23Kg/m3) and 95 healthy control subjects were included in this study. Body mass index (BMI), waist-to-hip ratio (WHR), plasma sex steroid hormones, fasting insulin, fasting glucose were measured. Oral glucose tolerance test was also performed according to WHO criteria. Hirsutism score and acne were recorded. Insulin resistance was evaluated by using homeostasis model assessment for insulin resistance (HOMA-IR), Quantitative insulin sensitivity check index (QUICKI) and fasting glucose / fasting insulin ratio (Fasting G:I ratio). RESULTS: plasma LH, LH/FSH ratio, total Testosterone, adrostenedione and dehydroepiandrostenedione sulphate (DHEA-S) were higher where as SHBG was lower in patient with obese PCOS compared to controls (P<0.05). Compared with healthy women, those with obese PCOS had significantly elevated fasting insulin, HOMA-IR, and significantly decreased QUICKI and fasting G:I ratio. CONCLUSION: The results of the present study indicates, elevated androgen levels, high degree of glucose intolerance and insulin resistance in obese PCOS patients when compared with healthy control subjects.

Evaluation of insulin resistance and oxidative stress in obese patients with polycystic ovary syndrome.

BACKGROUND : Patient with Polycystic ovary syndrome (PCOS) are known to have high incidence of Insulin Resistance (IR) and oxidative stress and most of the patients are obese. The aim of this study was to evaluate the insulin resistance and oxidative stress in obese PCOS patients. METHODS : 104 obese patients with PCOS [BMI ≥23 Kg/m2] and 95 healthy control subjects were included in this study. Plasma sex steroid hormones, fasting insulin, fasting glucose, were measured in both the groups. Oral glucose tolerance test was also performed. Total antioxidant status (TAS), malonyldialdehyde (MDH), protein carbonylation (PC), erythrocyte reduced gluthathione (GSH) and antioxidant enzymes like erythrocyte catalase and erythrocyte glutathione peroxidase (GPx) activity were measured. Insulin resistance was evaluated by using homeostasis model assessment for insulin resistance (HOMA-IR), quantitative insulin sensitivity check index (QUICKI) and fasting glucose / fasting insulin ratio (fasting G:I ratio). RESULTS : Compared with healthy women, those with obese PCOS had significantly elevated HOMA-IR, plasma MDA, protein carbonylation, erythrocyte glutathione peroxidase activity and significantly decreased QUICKI, fasting G:I ratio, plasma TAS, GSH, catalase activity. CONCLUSION: The result of the present study indicates, high level of insulin resistance and significantly increased oxidative stress were observed in obese PCOS patients when compared with controls.