Genomic profile of antibiotic resistant, classical ctxB positive Vibrio cholerae O1 biotype El Tor isolated in 2003 and 2005 from Puri, India: A retrospective study.

Objectives: To examine eight strains of Vibrio cholerae O1 isolated in 2003 and 2005 from Puri, India, for antibiotic susceptibility, presence of virulence and regulatory genes, cholera toxin (CT) production, CTX arrangement and genomic profiles. Materials and Methods: Bacterial strains were tested for antibiotic susceptibility using disc diffusion assay. Polymerase chain reaction determined the presence of antibiotic resistance, virulence and regulatory genes. To determine the type of cholera toxin subunit B (ctxB), nucleotide sequencing was performed. Southern hybridisation determined the number and arrangement of CTXΦ. Ribotyping and pulsed‑field gel electrophoresis (PFGE) were used to determine the genomic profile of isolates. Results: All the eight strains, except one strain, showed resistant to nalidixic acid, sulphamethoxazole, streptomycin and trimethoprim and possessed the sullI, strB, dfrA1 and intSXT genes. All the strains carried the toxin‑co‑regulated pilus pathogenicity island, the CTX genetic element, the repeat in toxin and produced CT. Restriction fragment length polymorphism (RFLP) analysis showed that V. cholerae O1 possess a single copy of the CTX element flanked by tandemly arranged RS element. Nucleotide sequencing of the ctxB gene showed the presence of classical ctxB. RFLP analysis of conserved rRNA gene showed two ribotype patterns. PFGE analysis also showed at least three PFGE patterns, irrespective of year of isolations, indicating the genomic relatedness among them. Conclusion: Overall, these data suggest that classical ctxB‑positive V. cholerae O1 El Tor strains that appeared in 2003 continue to cause infection in 2005 in Puri, India, and belong to identical ribotype(s) and/or pulsotype(s). There is need to continuous monitor the emergence of variant of El Tor because it will improve our understanding of the evolution of new clones of variant of V. cholerae.

Incidence of Instrument Fall During Caesarean Section: An Enigma.

Objective: The aim of the study was to analyse and compare statistically the incidence of accidental fall of instruments during elective and emergency caesarean section. Material and Methods: A prospective study was carried out at (V. C. S. G. G. Medical Sciences and Research Institute) Srinagar, Pauri Garhwal, India over a period of 24 months. The instrument fall during elective and emergency caesarean sections was observed. The observer counted the number of times an instrument fell during surgery. The personnel responsible were identified. A note of the nature of instrument falling was made. Results: We observed 362 surgeries which included 242 emergency caesarean sections and 120 elective caesarean sections. There were a total of 159 falls. Falls were classified as major and minor. There were 22 falls (18.33%) during elective caesarean sections and 137 falls (56.61%) during emergency caesarean sections. There were 53 major and 106 minor falls. Two or more falls were noted in 31 surgeries. In 96 instances (60.37%) the operating surgeon was responsible for the fall. In 37 cases (23.27%) assisting surgeon and in 17 cases (10.69%) the scrub nurse was responsible for the fall of the instruments. Nine falls (5.66%) were unaccountable. Most falls in elective caesarean section were in later half of the surgery while in emergency caesarean section, they were before and during the extraction of the baby. The surgeries were delayed, on an average by 5.7 minutes after a major fall of an instrument. Conclusions: Falling of instruments in the theatre is a common problem all over the world. This leads to increase in operating time, more resources and quality compromise. The operating surgeon was mainly responsible for the fall. Ashort training programme in instrument handling should be conducted for operating surgeons which may be helpful in preventing such avoidable falls.

An Outbreak of Cholera Associated with an Unprotected Well in Parbatia, Orissa, Eastern India.

In November 2003, an outbreak (41 cases; attack rate–4.3%; no deaths) of severe diarrhoea was reported from a village in Orissa, eastern India. Thirteen of these cases were hospitalized. A matched case-control study was conducted to identify the possible exposure variables. Since all wells were heavily chlorinated immediately after the outbreak, water samples were not tested. The cases were managed symptomatically. Descriptive epidemiology suggested clustering of cases around one public well. Vibrio cholerae El Tor O1, serotype Ogawa was isolated from four of six rectal swabs. The water from the public well was associated with the outbreak (matched odds ratio: 12; 95% confidence interval 1.2-44.1). On the basis of these conclusions, access to the well was barred immediately, and it was protected. This investigation highlighted the broader use of field epidemiology methods to implement public-health actions guided by epidemiologic data to control a cholera epidemic.

Drug abusers - A new high risk population for HIV infection in Orissa.

The present study reports the prevalence of HIV infection among the drug addicts undergoing counselling and treatment in a drug deaddiction centre located in Bhubaneswar, during July 1996 to August 1997. All subjects were males. The coded serum samples were tested by ELISA and rapid spot test for the detection of HIV antibodies. The positive samples were finally confirmed by the line immunoassay for HIV infection. A high prevalence of 7% HIV infection was noticed among the drug addicts (n=100). Oral drug abusers and IDUs were positive for HIV-1 infection in 5.26% and 21.74% cases respectively. The present study reveals a high prevalence of HIV infection among the drug addicts for the first time from Orissa which needs a careful monitoring and surveillance.

Etiology and management of obscure gastrointestinal bleed--an appraisal from eastern India.

OBJECTIVES AND METHOD: Forty patients (mean age 45 years; 24 men) attending a tertiary care hospital in eastern India during the period 1996-2000 were investigated to evaluate the etiology and clinical spectrum of obscure gastrointestinal bleed. RESULTS: The patients presented to hospital after mean symptom duration of 2.5 years. They had received an average of 15 units of blood transfusion. Most patients presented with recurrent melena (85%); all had iron-deficiency anemia. A total of 230 investigations (89 gastroscopies, 54 colonoscopies, 25 double-contrast meal and follow-through studies, 14 small bowel enemas, 24 radionuclide scans, 16 mesenteric angiographies and 8 intraoperative endoscopies) yielded positive diagnosis in 87.5% of cases. The diseases encountered were small bowel and colonic angiodysplasias (32.5%), ileal Crohn's disease (20%), intestinal tuberculosis (10%), intestinal tumors (10%), nonspecific small bowel ulcers and strictures (7.5%), Meckel's diverticulum (5%) and hemobilia (2.5%). The etiology remained obscure in 5 (12.5%) cases. Overall success of surgery was 63%; in-hospital mortality was 7.5%. CONCLUSION: Though obscure gastrointestinal bleed is commonly caused by angiodysplasias, it can be an atypical presentation of Crohn's disease.

Is immunoproliferative small intestinal disease uncommon in India?

Till date only three series of immunoproliferative small intestinal disease (IPSID) describing 22 patients have been reported from India. Seven patients with IPSID in two tertiary referral centers in India are included in the study. Diagnosis was based on typical clinical features [diarrhoea (7/7), weight loss (7/7), clubbing (6/7), fever (3/7), abdominal pain and lump (3/7)], biochemical evidence of malabsorption and duodenal biopsy findings. All patients were young males (mean age 29.8 +/- 11.8 years, range 17-53). Atypical features included gastric involvement (1/7), colonic involvement (1/7) and appearance of pigmented nails following anti-cancer chemotherapy (1/7) which disappeared six months after omitting doxorubin from chemotherapy regimen. Parasitic infestation was common. Ascaris lumbricoides (1/7), Giardia lamblia and hookworm (1/7), Strongyloides stercoralis and Trichuris trichura (1/7). In the latter patient S. stercoralis became disseminated after anti-malignant chemotherapy. One patient had gastric H. pylori infection. Four of the seven patients who were misdiagnosed as tropical sprue were treated with tetracycline. This raises doubt on efficacy of tetracycline alone in treatment of IPSID. One other patient was misdiagnosed and treated as intestinal tuberculosis. Early diagnosis and administration of chemotherapy may improve survival in this disease.

Colonic mucosal changes in portal hypertension.

Forty one consecutive patients with portal hypertension (PHT) were evaluated by colonoscopy to study the prevalence, type, extent and predictors of haemorrhoids, colorectal varices, and portal hypertensive colopathy. Specific inquiry and regular follow-up assessed frequency of hematochezia. Twenty five patients with obscure gastrointestinal bleeding without PHT who underwent colonoscopy served as controls. Haemorrhoids were seen in nine of 41 (21.9%) patients with PHT and four of 25 (16%) controls (p = ns). Colorectal varices were seen in 13/41 (31.7%) patients with PHT and none of the controls (p = 0.005). Portal colopathy was present in 15/41 (36.6%) patients with PHT and none of the controls (p = 0.0005). None of the parameters (e.g. aetiology of PHT, Child's class, oesophageal variceal eradication by EST with or without EVL, history of variceal bleeding, grade of oesophageal varices, presence of portal hypertensive gastropathy or gastric varices) predicted the occurrence of colorectal varices and portal hypertensive colopathy. Detection of colorectal varices but not portal hypertensive colopathy was associated with occurrence of hematochezia.

Aetiological spectrum of chronic liver disease in eastern India.

AIM: To evaluate the aetiologic spectrum of chronic liver disease (CLD) in a tertiary referral center in Eastern India. METHODS: A total of 175 patients (cirrhosis 166, chronic hepatitis 9) diagnosed by clinical, biochemical, radiological and histopathological (42 cases) parameters were evaluated for aetiology. Investigations included: HBsAg and anti HCV (third generation) by ELISA. HBeAg and HBV DNA were tested in HBsAg positive patients. HCV RNA was tested in anti-HCV positive patients. Markers for autoimmune and Wilson's disease (anti-nuclear antibody, anti smooth muscle antibody, serum ceruloplasmin, urinary copper and slit lamp examination for KF ring) were done where clinically indicated. RESULTS: A total of 62 (35.4%) patients had HBV related CLD and 6 (9.7%) of them had pre-core mutant. HCV was present in 17/114 (14.9%) cases and none had infection with both viruses. Autoimmunity, Wilson's disease and alcohol were the aetiological factors in 5 (2.8%), 5 (2.8%) and 3 (1.7%) patients respectively. No aetilogy could be found in 18/114 (15.8%) patients. CONCLUSIONS: It is concluded that HBV is the commonest cause of CLD in Eastern India. Alcohol and HCV are uncommon in this part of the country.

Seroprevalence of HIV infection among jail inmates in Orissa.

Seroprevalence of human immunodeficiency virus (HIV) infection was carried out in three prisons in Orissa from March 1994 to December 1995. All the prisoners of Indian origin (300), housed in these jails tested negative for HIV infection. On the other hand, 33.8 per cent (26/77) of jail inmates from foreign countries (Thailand and Myanmar), serving short terms in Orissa jails were found positive for HIV infection. While all the 26 HIV positive prisoners had HIV-1 infection, five of them had antibodies for HIV-1 and HIV-2 viruses. Such a high prevalence of HIV infection and detection of HIV-2 virus is being reported for the first time from Orissa.

Response to low-dose interferon in chronic liver disease due to hepatitis B virus infection.

BACKGROUND: Interferon is at present the only effective therapy for chronic hepatitis B virus (HBV) infection. Data regarding its efficacy in India are scant. The present study was undertaken to assess the efficacy of low-dose interferon in chronic liver disease due to HBV infection. METHODS: Twenty four patients with histologic evidence of chronic hepatitis with or without cirrhosis, and persistent elevation of serum aminotransferases and persistent positivity for HBsAg and HBeAg for more than six months, were included. Fourteen patients were treated with interferon alpha-2b, 3 million units thrice weekly for 16 weeks; ten patients who could not afford the drug were followed up as controls without specific therapy. Patients were examined weekly for the first 4 weeks, followed by two weekly for 12 weeks and then every two months. Blood tests for viral markers and liver biochemistry were done at 0, 4, 8, 12, 16 weeks and then at two-month intervals for at least one year after therapy. Patients who cleared HBeAg were followed up for 2.2 (1-4) years for HBsAg clearance. RESULTS: HBeAg clearance occurred in 9 patients (64%) in the interferon group, and in one control patient (p < 0.01). HBsAg clearance occurred in only one patient in the treatment group during follow up of mean 2.4 years. No patient in the control group cleared HBsAg. Patients having high ALT level at the beginning of treatment had significantly higher HBeAg clearance rate (7 of 7) than patients with low ALT levels (2 of 7; p < 0.05). CONCLUSION: Low-dose interferon therapy is effective in attaining HBeAg, but not HBsAg, clearance in chronic HBV infection.

Spectroscopic characterization of gelonin--assignments secondary structure and thermal denaturation.

Gelonin, a type 1 ribosome inactivating protein (RIP), having only one polypeptide chain, and which could be used against deadly diseases like cancer and AIDS is investigated spectroscopically through infrared (IR), diffused reflectance infrared fourier transform (DRIFT) and Raman techniques and observed vibrational modes are assigned. It is found that gelonin is having mainly alpha-helix and beta-sheet structure with some turn and disordered structure, the estimated percentage structure using Raman data being approximately 32% alpha-helix, approximately 20% beta-sheet, approximately 26% turn and approximately 22% disorder type. The temperature dependent infrared study of gelonin reveals its thermal stability, the denaturation temperature being around 60 degrees C and disordered contribution increasing with heating.

Serodiagnosis and immune profile in rheumatoid arthritis.

One hundred and seventy-five cases of clinically diagnosed rheumatoid arthritis, 82 non-rheumatoid cases suffering from various other diseases and 40 healthy normal controls were investigated for detection of rheumatoid factor, quantitation of serum immunoglobulin, demonstration of antinuclear antibody (ANA) and LE cell phenomenon. Microlatex agglutination test of serum for rheumatoid factor (RF) showed 64% positivity in rheumatoid group and 1.2% positivity in non-rheumatoid group. All three immunoglobulins (IgG, IgM, IgA) were found to be raised in serum of patients with rheumatoid arthritis, whereas only IgA level was elevated in serum of patients with non-rheumatoid diseases. ANA and LE cell phenomenon were observed in 3.4% and 2.8% cases respectively in cases of clinically diagnosed rheumatoid arthritis who had been suffering from severe active rheumatoid arthritis. In non-rheumatoid group RF was positive in significant titre in only one case of leprosy. Synovial fluid and synovium were found to be heavily infiltrated by plasma cells and lymphocytes. RF appears first in synovial fluid and then in serum. Hence RF titre in blood may not attain significant level for the first several months.

Visual acuity testing in cataract--an insight (cataract classification density based).

The senile cataracts have been graded on the basis of density objectively. The letter visual acuity, laser interferometric visual acuity and pin hole visual acuity were compared in various grades of cataracts and controls (phakic and aphakic) in 140 eyes. It was found that good correlation exists in all eyes except when cataract density is grade III or IV. The laser interferometry has good prognostic value when the predictability is assessed in early stages of cataract (Grade I & II).