A study of clinico-epidemiological profile of patients of snake bite and their outcome in a tertiary care centre in central zone of Himachal Pradesh

Background: The aim of this study was to assess clinico-epidemiological profile, prevalent treatment practices and outcome of snake bite patients in a tertiary care hospital in a hilly North central region of Himachal Pradesh. Methods: A hospital record based retrospective descriptive study was done which included demographic data, clinical profile, prevalent traditional treatment methods of snake bite, treatment given at hospital and outcome among 144 patients. Results: The 123 (83%) patients were young (age group of 17-50 years) and number of female patients was 89 (62%), 29 (38%) more than male patients. Most of snake bite cases recorded, presented in the months of July to September 56 (72.7%). The most frequently bitten sites were the upper limbs particularly left hand. 61 (42%) of patients presented without any features of envenomation. Hematotoxicity was the commonest presentation in 68 (82%) of patients followed by neuroparalysis in 26 (18%) of the symptomatic cases. Green snake (Green pit viper) was the commonest snake seen. Cure rate in our study was more than 80%. Major reason for delayed presentation was consultation of traditional healers. Conclusions: In the tropics and subtropics, snake bite is a life threatening health hazard especially in poor rural people who usually waste precious time by indulging in harmful activities. This needs public as well as health care workers’ awareness and prompt intervention in a health care facility.

Performance of rapid influenza diagnostic tests (QuickVue) for Influenza A and B Infection in India.

Background: Rapid point-of-care (POC) tests provide an economical alternative for rapid diagnosis and treatment of infl uenza, especially in public health emergency situations. Objectives: To test the performance of a rapid infl uenza diagnostic test, QuickVue (Quidel) as a POC test against a real-time polymerase chain reaction (RT-PCR) assay for detection of infl uenza A and B in a developing country setting. Study Design: In a prospective observational design, 600 patients with infl uenza-like illness (ILI) or with severe acute respiratory illness (SARI) who were referred to the Infl uenza Clinic of a tertiary care hospital in Srinagar, India from September 2012 to April 2013, were enrolled for diagnostic testing for infl uenza using QuickVue or RT-PCR. All infl uenza A-positive patients by RT-PCR were further subtyped using primers and probes for A/H1pdm09 and A/H3. Results: Of the 600 patients, 186 tested positive for infl uenza A or B by RT-PCR (90 A/ H1N1pdm09, 7 A/H3 and 89 infl uenza B), whereas only 43 tested positive for infl uenza (infl uenza A = 22 and infl uenza B = 21) by QuickVue. Thus, the sensitivity of the QuickVue was only 23% (95% confi dence interval, CI: 17.3-29.8) and specifi city was 100% (95% CI: 99.1-100) with a positive predictive value (PPV) of 100% (95% CI 91.8-100) and a negative predictive value (NPV) of 74.3% (95% CI: 70.5-77.9) as compared to RT-PCR. Conclusions: The high specifi city of QuickVue suggest that this POC test can be a useful tool for patient management or triaging during a public health crisis but a low sensitivity suggests that a negative test result need to be further tested using RT-PCR.

Family burden in opioid dependence syndrome in tertiary care centre.

This is a cross-sectional, hospital based study conducted in De-Addiction centre under department of psychiatry, AIIMS, New Delhi, India. Patients and their spouses fulfilling inclusion criteria were enrolled in the study after taking informed consent. A diagnosis of Opioid Dependence Syndrome (ODS) was made based on ICD-10 criteria and the assessment of severity of ODS was determined by Addiction Severity Index (Hindi version). Subsequently the family burden, perceived by spouses was assessed using Family Burden Interview Schedule (FBIS). Most of the subjects were from urban or semi-urban areas, mostly from around the service facility. The maximum number of subjects was of age group 31-40 years with majority of having below high school level education. Both subjective and objective family burden was perceived as "severe" by subjects' spouses. The relationship between spouses' perceived burden and socio-demographic variables including duration of substance abuse were not correlated. Hence it was found that opioid dependent subjects cause considerable amount of distress to their care providers.

Alcohols and other substance use/abuse among junior doctors and medical students in a teaching institute.

Substance related disorders have become matters of global concern because of its negative impact on individual health, familial, social and professional life. This study aims to assess prevalence of alcohol and other substance use among students and junior doctors at teaching institute. This descriptive study conducted on medical students, following convenient sampling method. Results revealed the prevalence rates of 'ever used', 'last year used' and 'last month used' were 63.5%, 56.5% and 42.5% respectively. The most preferred substance was alcohol (90.9%) and only 32.2% females 'ever used' substance. Cannabis use was seen exclusively among male (15.0%) students and opioid use was not found. Alcohol is most prevalent substance of use/abuse and was common among house officers and medical students.

Tubercular pancreatic abscess: A case report.

Primary involvement of the pancreas in bacterial and parasitic diseases is exceptional. Infection of the pancreas is usually secondary to necrosis and inflammation after serious necrotizing pancreatitis. Although a rare manifestation of a common disease, pancreatic tuberculosis can present to a clinician as a difficult diagnostic dilemma. The clinical manifestation may vary from painless obstructive jaundice to fever of unknown origin. Here, we report a case of pancreatic tuberculosis in a young alcoholic patient.

Scorpion bite and multiple cerebral infarcts.

Multiple cerebral infarcts, bilateral optic neuropathy with limb ischemia, following scorpion bite is documented. Vasospasm and autonomic storm due to envenomation is a plausible explanation for this symptom complex.

Neuropsychiatric manifestations in patients of primary hyperparathyroidism and outcome following surgery.

BACKGROUND: A wide variety of psychiatric symptoms ranging from mild personality changes to severe depression and psychosis have been described in patients of PHPT. However, the psychiatric profile in Indian patients remains a mystery. It remains to be seen if surgery can alleviate the psychiatric morbidity and improve the quality of life of patients. Although, the pathophysiology remains largely unknown, we attempted to see if psychiatric morbidity correlated with serum calcium values. OBJECTIVE: a) To study the nature and severity of neuropsychiatric manifestations in patients of hyperparathyroidism before surgery and their outcome after surgery b) To study their correlation with levels of serum calcium. MATERIAL AND METHODS: This prospective study documented the occurrence of psychiatric symptoms among 14 patients of primary hyperparathyroidism (group I). 13 patients of gall stone disease (group II) and 12 patients of thyromegaly, undergoing total thyroidectomy (Group III) constituted the control groups. The relationship between such symptoms and degree of hypercalcemia was also studied. Assessment of psychologic symptoms, using the CPRS scale (validated in Hindi) and the scale for Memory and Intelligence for use in Hindi speaking population was carried out preoperatively and at 1 wk, 6 wk, 3, and 6 months postoperatively. OBSERVATIONS: The hyperaparathyroid group had significantly higher levels of total serum calcium and PTH preoperatively, with biochemical normalization postoperatively. The preoperative CPRS rating of the 14 patients with primary hyperparathyroidism revealed pronounced psychiatric symptoms, with a mean total CPRS score of 20 +/- 8.7, compared with 10.5 +/- 6.9(II) and 12.7 +/- 5.6 (III) in the control groups. Statistically significant improvement was seen in the CPRS score, maximally at 6 weeks post operatively for the following symptoms: Sadness, lassitude, ache and pains, and fatigability. There was no memory and intelligence impairment in any of the groups pre or post operatively. No correlation was found between the serum calcium levels and the psychiatric morbidity. CONCLUSIONS: The psychologic symptom distress is multidimensional and symptoms significantly improved by 6 weeks post parathyroidectomy. There was no memory and intelligence impairment in any of the groups pre or post operatively. No correlation was found between serum calcium levels and psychiatric morbidity.

Substance abuse in children and adolescents.

Consumption of licit and illicit substances has increased all over the world and the age of initiation of abuse is progressively falling. The common drugs of abuse amongst children and adolescents in India are tobacco and alcohol. Use of illicit drugs like cannabis and heroin have also been reported. A high prevalence of drug use and even intravenous use among street children and working children is a matter of concern. Although initiation to drug use usually occurs during adolescence, the adolescent drug users are seldom seen in various treatment centres. Thus community based programmes are beneficial for prevention and treatment of substance abuse among children and adolescents.

Urinary continence following posterior urethral valves treatment.

This retrospective study discusses the incidence of symptomatic voiding dysfunction, the etiological factors and the changes with age and with increasing duration of follow up in 67 boys treated for posterior urethral valves and followed up for a period ranging from 1-21 years. Twenty three of the 67 patients (34.3%) had symptomatic voiding dysfunction; the commonest symptom being nocturnal enuresis with diurnal urgency and frequency. Data in this study suggests a definite decrease in the incidence of urinary incontinence as the patient grows older or as the duration of follow up after valve fulguration increases. A Tc-99m DRCG based uroflowmetry was available in 31 of the 67 patients at the time of this review and evidence of detrusor dysfunction was identified in 9 of the 31 patients on the basis of uroflowmetry. Of significance was the detection of detrusor dysfunction on uroflowmetry in 3 patients with a history of normal urinary control and urinary stream with persistent post treatment hydroureteronephrosis eventually culminating into renal failure. Imipramine therapy was given to 10 of the 17 patients with symptoms of urinary frequency, urgency and nocturnal enuresis with a significantly symptomatic improvement in 9 of these patients. Urinary incontinence, detrusor dysfunction and its effect on the upper tracts and renal function is a significant determinant of the long term outcome of the boys treated for posterior urethral valves and this paper emphasises on the need to carefully evaluate and treat this aspect of all valve patients.

Experience with roxithromycin in visceral leishmaniasis in north Bihar.

In search of an oral drug for Visceral Leishmaniasis, 54 cases of Kala-azar were treated with roxithromycin, an orally administrable drug at a dose of 300 mg twice daily for 21 days. Thirty-nine (86.7%) were responsive (cured), 11 (28.2%) relapsed. The results appeared equally or even more effective when compared to the sodium antimony gluconate in two recent trials in Kala-azar in almost same demographic pattern. A possible synergistic action of roxithromycin and SAG was explored. Toxicities of SAG and roxithromycin are compared and discussed. Further controlled trials are needed before it can be widely used as first line drug for Indian Kala-azar in the present epidemic.

Spread of lymphatic filariasis, re-emergence of leishmaniasis & threat of babesiosis in India.

The impact of unabated population growth and consequent ecological changes is felt in the spread of vector-borne diseases also. Filariasis, once considered to be more associated with urban areas and urbanization, is rapidly emerging as a major problem in rural areas. The need to delimit the endemic areas through a new rapid assessment procedure and the possible control methods of rural filariasis are discussed. Leishmaniasis has re-emerged with a vengeance in some parts of the country and the reasons for this are analyzed. Babesiosis, though zoonotic, has the potential to invade the domain of man in India.

A study of spectrum of iodine deficiency disorders in rural area of Uttar Pradesh.

In the present study, attempt has been made to study the spectrum of the iodine deficiency disorders (IDD) in a sub Himalayan hyperendemic area. Iodine deficiency has been found to enhance the conditions like abortion, still birth, higher infant mortality, neonatal chemical hypothyroidism, congenital anomalies, retarded growth, hypothyroidism, endemic goitre and endemic cretinism.

Hepatic artery aneurysm.

A 25-year-old man who presented with recurrent attacks of acute abdominal pain was diagnosed to have recurrent attacks of acute pancreatitis with pseudocyst formation. Laparotomy revealed aneurysm of the hepatic artery which was successfully managed with endoaneurysmorraphy.

Renal cell carcinoma in a child: case report and brief review of literature.

Renal cell carcinoma is common malignancy in the older age but extremely uncommon in childhood. Here in is reported a case of renal cell carcinoma in a eight year old female because of its rarity in children.

Effect of blockade of transdiaphragmatic absorption of bacteria on survival in peritonitis: an experimental study in rats.

An experimental rat model of established peritonitis was used to test the effect of intraperitoneal injection of platelet rich plasma (PRP) on blood and peritoneal fluid culture positivity and survival rates. Thirty animals divided into two groups of 15 each were studied. The first group served as control while animals in the second group received intraperitoneal injection of PRP. The use of PRP in established. Peritonitis was of no significant benefit.

Serodiagnosis of gut tuberculosis.

The efficacy of enzyme-linked immunosorbent assay (ELISA) in the diagnosis of gut tuberculosis was evaluated. The study included 95 patients with gut tuberculosis, 40 with pulmonary tuberculosis, 25 with non-tubercular intestinal diseases and 40 healthy controls. Mantoux response and antibody titre against PPD using ELISA were studied. The ELISA sensitivity in gut tuberculosis was 80% and in pulmonary tuberculosis 90%. It was also positive in 12% of patients with non-tubercular intestinal diseases and 5% of healthy controls. The sensitivity of Mantoux test in gut (77%) and pulmonary (84%) tuberculosis was comparable to that of ELISA. However, Mantoux test lacked diagnostic significance due to high positivity in non-tubercular disease patients (55%) and healthy controls (56%), whereas ELISA was highly specific (93%) for the diagnosis of gut tuberculosis.

Differentiation antigen on murine B lymphocytes defined by monoclonal antibodies.

Spleen cells from an AKR/J X DBA/2J F1 mouse immunized with NZB/BIN spleen cells were fused with SP2/0-Ag14. Two hybrid cell lines, B220-1 and B220-2, were established that secreted antibody to the B-lineage specific B220 antigen. B220-1 and B220-2 are present on 45-55% of splenic and bone marrow lymphocytes and absent from thymus. By flow cytometry, all immunoglobulin-bearing cells were stained by these monoclonal antibodies. Although these monoclonals do not stain thymocytes, they do react weakly with Lyt-2+ peripheral T cells. Dual parameter analysis of B lymphocytes using RA3-3A1 or 14.8 show that these monoclonals recognized the same population. Prior incubation with RA3-3A1 or 14.8 was unable to completely block the binding of B220-1 or B220-2, implying that the epitopes recognized are different from the previously described monoclonal antibodies. Immunoprecipitation of the splenic lymphocyte reveals a molecule which migrates on SDS-PAGE as a single band with MW of 220,000 daltons. Expression of the distinct antigens recognized by B220-1 and B220-2 varied among mouse strains, indicating previously unappreciated polymorphism of the B220 molecule. These monoclonals are useful for cytotoxic elimination of B cells and for three-color flow cytometry.