Comparative evaluation of paired blood culture (aerobic/aerobic) and single blood culture, along with clinical importance in catheter versus peripheral line at a tertiary care hospital.

Purpose: Paired blood culture (PBC) is uncommon practice in hospitals in India, leading to delayed and inadequate diagnosis. Also contamination remains a critical determinant in hampering the definitive diagnosis. Objectives: To establish the need of PBC over single blood culture (SBC) along with the degree of contamination, this comparative retrospective study was initiated. Materials and Methods : We processed 2553 PBC and 4350 SBC in BacT/ALERT 3D (bioMerieux) between October 2010 and June 2011. The positive cultures were identified in VITEK 2 Compact (bioMerieux). True positivity and contaminants were also analyzed in 486 samples received from catheter and peripheral line. Results : Out of 2553 PBC samples, positivity was seen in 350 (13.70%). In 4350 SBC samples, positivity was seen in 200 samples (4.59%). In PBC true pathogens were 267 (10.45%) and contaminants were 83 (3.25%), whereas in SBC 153 (3.51%) were true positives and contaminants were 47 (1.08%). Most of the blood cultures (99.27 %) grew within 72 h and 95.8% were isolated within 48 h. In 486 PBCs received from catheter/periphery (one each), catheter positivity was found in 85 (true positives were 48, false positives 37). In peripheral samples true positives were 50 and false positives were 8. Conclusion: Significantly higher positive rates were seen in PBCs compared with SBCs. Automated blood culture and identification methods significantly reduced the time required for processing of samples and also facilitated yield of diverse/rare organisms. Blood culture from catheter line had higher false positives than peripheral blood culture. Thus every positive result from a catheter must be correlated with clinical findings and requires further confirmation.

Ethnomedicine: use in dental caries

Ubiquitousness and increasing prevalence of dental caries makes it one of the most important problems in public health. Due to high cost and lack of resources at primary levels prevention is better in dental caries. Since the origin is related to bacteria, antibacterial is mainstay of treatment. Lack of high efficacy with antibacterial agents, unwanted effects and resistance to these agents are drawing attention of scientists to search for new and better drugs. Plants products are currently gaining attention for treatment of various ailments. Although, these has been exploited for various oral ailments this article describes use of plants products for prevention and cure of dental caries.

Pseudoexstrophy in a female child.

A six-year-old female patient presenting with a swelling in the infraumbilical part of the abdomen, bulging out on straining, was diagnosed to have pseudoexstrophy bladder. The urinary tract was normal. The patient had bifid clitoris. There was no other associated malformation. Surgical repair of abdominal wall defect was done successfully. A new classification of exstrophy variants is proposed.

Choledochal cyst: a 10-year experience.

A retrospective study of 11 cases of choledochal cyst over a period of 10 years is presented. There were 8 females and 3 males in a ratio of 2.67:1. The classical triad of jaundice, mass and abdominal pain was seen in none of our patients. Ultrasonography was diagnostic in 9 out of 11 (80%) patients. Surgical procedures performed were, complete excision of the cyst with Roux en Y hepaticojejunostomy (nine cases), internal drainage of the cyst (one case) and excision of the extrahepatic cyst with Roux en Y hepaticojejunostomy in one case of Type IV choledochal cyst. One patient died in the immediate postoperative period. Others have remained well upto 10 years follow-up. We recommend total cyst excision with hepaticojejunostomy as the treatment of choice.

Cystic lymphangioma with special reference to rare sites.

A 10 year retrospective study of 45 cases of cystic lymphangioma (CL) in children is presented. There were 25 females and 20 males. Age ranged from 6 months to 8 years. Common sites were involved in 38 and rare sites in 7 patients. Rare sites were--gluteal region (1), pelvis (1), retroperitoneum (1), mesentery (2), inguinal region (1) and inguinoscrotal region (1). The clinical presentation included sudden increase in size (25), lump abdomen (3), gluteal abscess (1), abdominal distension (1) and inguinal swelling (2). Diagnosis was established preoperatively in 38 cases, and after surgery and histopathology in 7 cases. Near total or subtotal excision was carried out in all cases. Facial nerve palsy (1) and recurrence (2) were the complications of surgery. The study is presented to highlight the occurrence of the cystic lymphangioma at rare sites to avoid diagnostic errors and unnecessary mutilating surgery.

Post traumatic bile ascites.

A 4 year old girl with progressive distension of abdomen and previous history of blunt abdominal trauma was found to have bile ascites due to left hepatic duct (LDH) injury. The management with a brief review of literature is discussed below.

Esophageal atresia with blocked distal tracheo-esophageal fistula.

A new born male child diagnosed for pure esophageal atresia was subsequently found to have blocked tracheo-esophageal fistula. The case is reported in view of its rarity and difficulty in management.

Abdomino-scrotal lymphangioma.

Retroperitoneum, pelvis and scrotum are unusual sites of lymphangiomas. Retroperitoneal lymphangiomas presenting as inguino-scrotal masses are extremely rare. An unusual case of retroperitoneal lymphangioma extending into scrotum, presenting as acute scrotum is reported due to its unusual location. Complete surgical excision with careful attention to avoid damaging contiguous structures is the treatment of choice.

Morgagni hernia in a neonate with ventricular septal defect.

A neonate with Morgagni hernia and ventricular septal defect is reported. Presentation of Morgagni hernia in neonates is rare, but when it does, it is associated with other congenital anomalies.

Etiology of sporadic acute and fulminant non-A, non-B viral hepatitis in north India.

BACKGROUND: Viral hepatitis is a major public health problem in India. AIM: To investigate the association of various hepatitis viruses in patients with acute liver diseases in north India. METHODS: One hundred and thirteen patients with acute viral hepatitis (AVH; n = 70) or fulminant hepatic failure (FHF; N = 43) were evaluated for the presence of hepatitis A, B, C and E virus infection. Hepatitis C virus (HCV) testing was done using second-generation anti-HCV ELISA test and reverse transcriptase polymerase chain reaction (PCR) for the detection of HCV RNA in the serum of patients with non-A, non-B (NANB) hepatitis. Detection of IgM anti-HEV antibody was done in patients found negative for the above viruses (n = 53). RESULTS: Hepatitis A and B viruses accounted for 3.5% and 42.5% of the 113 cases, respectively. HCV infection accounted for 12% of the NANB cases with AVH and 15.5% with FHF. PCR was more useful than serological tests for the detection of HCV infection. HEV infection accounted for 49% of the NANB, non-C cases with AVH and 25% with FHF; pregnant women with HEV infection had a fulminant course. No etiological agent could be established in 28.3% of cases. CONCLUSION: HEV is the most important cause of NANB hepatitis; hepatitis B virus is still a major concern, while HCV is not an important cause of acute viral liver disease in India.

Huge omental cyst mimicking ascites.

An unusual case of omental cyst is described. A 4-year-old child presenting as abdominal distension of short duration, clinically diagnosed as ascites, was subsequently proved to be giant omental cyst. The case is reported because of its unique presentation.

Congenital segmental dilatation of intestine.

We are reporting two cases of segmental dilatation of small intestine presenting as neonatal intestinal obstruction. Clinco-pathological features, etiology and management are discussed in brief.

Pyloric membrane and congenital hydronephrosis--a rare association.

A rare association of pyloric membrane, Meckel's diverticulum and pelvi-ureteric junction obstruction in a 3-year-old boy is reported.