Occurrence of II and V staphylococcal cassette chromosome mec types among coagulase-negative staphylococci from Northeastern part of India

Introduction: Coagulase Negative Staphylococci, the most commonly isolated pathogen are becoming emerging threats to the community as well as to the nosocomial environment. The present study underscores the distribution of Staphylococcal cassette chromosome mec (SCCmec) types among Methicillin resistant Coagulase Negative Staphylococci from the environmental origin. Methods and Materials: Environmental and food sample (n = 460) from different location of northeastern region of India were collected for a period of one year and were phenotypically and genotypically screened using cefoxitin disc and PCR techniques for mecA and mecC gene detection. All the MR-CoNS isolates possessing mecA gene were subjected to 16srDNA sequencing for species identification. SCCmec typing was determined by evaluating using primer sets from type I to type V. Antibiotic susceptibility testing was performed for all the isolates. Statistical analysis with chi-square test using SPSS-21 statistical software. Results: Methicillin resistance shown by one hundred forty three isolates were carried out for molecular analysis, among them 53.84% serves as mecA carrier. Distribution of Staphylococcus haemolyticus was more frequent and was found that SCCmec types II and V were predominant among the study isolates. Linezolid was the drug of choice for the CoNS isolates. Statistical analysis showed an insignificant result for the tested antibiotics and SCCmec types. Conclusion: This study therefore interprets the relative importance of SCCmec types among MR-CoNS isolates.

a comparative study between early enteral feeding (within 24 hours) versus conventional enteral feeding after enteric anastomosis.

Background: Traditionally, enteric feeds are withheld for a period of 48-72 hrs, sometimes even more following enteric anastomosis depending upon return of full peristaltic sounds. This results in a period of nonstimulation of gut –‘Gut Rest’, which was supposed to result in better anastomotic healing. But this same also deprives the intestinal mucosa of surface nutrients as well as prolongs parenteral fluid therapy, thereby depriving the patients of adequate nutrition. Along with it, prolonged parenteral therapy also keeps the patients bound to bed with its resultant complications like, prolonged hospital stay and increased cost of therapy. Objectives: To compare the benefits of early enteral feeding over conventional enteric feeding following enteric anastomosis with special regards to patients recovery and complications. Methods and materials: The selection of patients into group A (60) and group B (60) was done after having fulfilled inclusion and exclusion criteria. Informed consent was obtained. The patients of group A were fed via enteral route within 24 hrs of enteric anastomosis. The patients of group B were fed via enteral route after 48-72 hrs or appearance of full peristaltic sounds following enteric anastomosis. These patients were followed in post operative period for their drain output, any nausea, vomiting or significant abdominal distension, prolonged ileus, post operative duration of shospital stay, post operative infective complications (e.g. wound infection, UTI, RTI), and different haematological and biochemical examinations. Results: This study shows that post operative nausea-vomiting, anastomotic leakage rate, re-exploration , wound infection and RTI rates are higher in group A than those of group B. In this study, the incidence of UTI in post operative period is higher in group B. But the differences in above mentioned variables are not statistically significant. Whereas appearance of intestinal peristaltic sound is earlier in group A (42.8 ± 10.68 hours) compare to that of group B (52.6 ± 13.46 hours). Here, the difference is statistically significant (p value = 0.000022) The duration of post operative hospital stay is shorter in group A (8.45 ± 5.143 days) than that of group B (10.533 ± 4.952 days). The difference of duration post operative hospital stay is statistically significant (p value = 0.0257). Removal of nasogastric tube, resumption of oral feeding, and passage of first flatus and/or defecation were earlier in the group A than that of the group B; the differences were statistically significant. The post operative day-5 albumin level is better in group A (3.147 ± 0.4409 gm/dl) than that of group B (2.935 ± 0.3124 gm/dl). This difference is also statistically significant (p value = 0.0029). There are three mortalities in group Awhereas one mortality in group B. This difference in mortality in two groups is not statistically significant.

An approach for identification of individuals in a mass disaster in Indian set up.

In the changing scenario of mass disaster, which has become almost one of the stories of daily news paper, Disaster Victim Identification has become important for its medico-legal as well as nations socio-economical aspects. This expertise gives the Forensic Experts a resource advice in dealing with human identification in a simpler way in Indian context. The idea of this work was born after the Ganeswari express accident that occurred in West Bengal, in May 2010, after which the situation demeaned a discussion between the Forensic Experts, Forensic Scientists and police personnel to frame a simpler guideline for Disaster Victim Identification. The recommendations made in this paper, as well as in many cited references, are intended to provide the forensic experts the minimum guidance for victim identification by photography and storing samples suitable for DNA analysis. It also gives a guideline for matching the DNA samples with the relative of the victims that will provide better chances of victim identification.

A new way to resist rape.

In a case of sexual assault, rape was prevented by biting of portion of the tongue of the accused by the victim. This case is reported to highlight an almost unheard-of measure the victims girl adopted to prevent rape.

Scleredema of Buschke: a rare post-streptococcal complication.

A 19-year male presented with acute onset, gradually progressive symmetric indurations involving the skin over the face, neck, shoulders and upper part of chest following an upper respiratory tract infection. Detailed history and examination did not reveal evidence of Raynauds' phenomenon, nail changes, digital ulcers, pigmentation or any systemic involvement. Autoantibodies for systemic sclerosis were absent. Histopathology of skin biopsy documented scleredema. Antistreptolysin O (ASO) titer was elevated. We diagnosed a case of Scleredema adultorum of Buschke following a streptococcal throat infection. We report this case to highlight the importance of clinically differentiating this relatively benign, self-limiting disorder from systemic sclerosis.

Observations of hepatic encephalopathy profile in a tertiary care centre.

A study was conducted among 67 patients presenting with hepatic encephalopathy to establish the aetiological diagnosis and record the incidence of acute and chronic liver diseases. They all had undergone thorough clinical and laboratory evaluation. The factor precipitating encephalopathy was also identified. Among 67 patients 19 (28.4%) had acute liver disease and 48 (71.6%) had chronic liver disease. Majority of patients had grade 2 encephalopathy at presentation. Among the acute cases most common aetiology was acute viral hepatitis due to hepatitis B and E viruses whereas alcoholic liver disease was the most frequent cause of chronic liver disease. The most common precipitating factor was gastro-intestinal haemorrhage.

Glycaemic consequences of HIV and highly active antiretroviral therapy: a pilot study and review of literature.

The metabolic consequences of HIV and AIDS are accentuated in the setting of highly active antiretroviral therapy. Peripheral lipodystrophy, central adiposity, hyperlipidaemia, insulin resistance and diabetes mellitus are frequent associations of protease inhibitor containing highly active antiretroviral therapy regimens. Ninety patients aged 25-50 years (males 52, females 38), seropositive for HIV 1 and 2 or both were selected to see the glycaemic profiles in asymptomatic early HIV disease with CD4 counts > 100/microl and to compare this with the glycaemic profile of (a) advanced HIV disease (CD4 counts < 200/microl), not on highly active antiretroviral therapy and (b) advanced HIV disease (CD4 counts < 200/microl), on uninterrupted non-protease inhibitor highly active antiretroviral therapy > 6 months. All the patients were grouped into 3: (1) Group A: CD4 counts > 500/microl (n=37), highly active antiretroviral therapy naive, (2) group B: CD4 counts < 200/microl (n=21), not on highly active antiretroviral therapy, and (3) group C: CD4 counts < 200/microl, receiving uninterrupted non-protease inhibitor based highly active antiretroviral therapy for > 6 months (n=32). The fasting blood glucose, glycosylated Hb (HbA1c) levels, were measured in all the patients in 3 groups and significance of difference between means was calculated among various groups. Body weight and waist-hip ratio were also measured. The results were analysed and compared with other studies.

Cronkhite-Canada syndrome with adenomatous and carcinomatous transformation of colonic polyp.

We describe a 70-year-old woman who presented with watery diarrhea and was found to have gastric and colonic polyposis, cutaneous hyperpigmentation, alopecia and onychodystrophy (Cronkhite-Canada syndrome). Histology of a polyp from the stomach showed features of juvenile or retention type (hamartomatous) polyp. One colonic polyp revealed features of tubular adenoma, with moderate dysplasia. Another large pedunculated colonic polyp showed a tubulovillous adenoma with a focus of well-differentiated adenocarcinoma confined to the submucosa of the stalk. Adenomatous and carcinomatous epithelial changes can occur in Cronkhite-Canada syndrome.

Evaluation of in vitro and in vivo antibacterial activity of dobutamine hydrochloride.

PURPOSE: To determine the in vitro and in vivo antibacterial activity of a cardiovascular drug dobutamine hydrochloride. METHODS: The minimum inhibitory concentration (MIC) of dobutamine was determined both by agar and broth dilution methods against 331 strains of bacteria from three gram positive and 13 gram negative genera. The antibacterial action of dobutamine was further tested in animal models. RESULTS: Dobutamine was seen to possess powerful inhibitory action (5-200mg/mL) against most test bacteria in in vitro studies. It was bacteriostatic in nature. In vivo studies showed that the drug offered significant protection (p< 0.001) to mice challenged with a virulent bacterium. CONCLUSION: Dobutamine showed remarkable antibacterial property against several pathogenic bacteria. Its potential as an antibacterial agent may be confirmed after further pharmacological studies.

Massive hepatomegaly: a presenting manifestation of multiple myeloma.

We report a 50-year-old woman presenting with isolated massive hepatomegaly. Liver histology showed dilated sinusoids within which some atypical cells, probably of hematopoeitic origin, were identified. Bone marrow was densely packed with similar atypical cells with high nucleo-cytoplasmic ratio, which tested positive for plasma cell markers. Plasma protein electrophoresis showed a distinct M spike in the gamma globulin fraction and skeletal survey revealed multiple lytic lesions in the skull and pelvic bones. Thus, a final diagnosis of multiple myeloma was made. The patient has received six cycles of chemotherapy and is doing well.

Binding of globular proteins to DNA from surface tension measurement.

Extent of binding (gammap) of globular proteins to calf-thymus DNA have been measured in mole per mole of nucleotide as function of equilibrium protein concentration. We have exploited measurement of the surface tension of the protein solution in the presence and absence of DNA to calculate the binding ration (gammap). Interaction of bovine serum albumin with DNA has been studied at different pH. Interaction of bovine serum albumin with DNA has been studied at different pH, ionic strength and in presence of Ca2+. Interaction of BSA with denatured DNA has also been investigated. Binding isotherms for other globular proteins like beta-lactoglobulin, alpha-lactalbumin and lysozyme have been compared under identical physicochemical condition. It has been noted with considerable interest that globular form of protein is important to some extent in protein-DNA interaction. An attempt has been made to explain the significance of difference in binding ratios of these two biopolymers in aqueous medium for different systems in the light of electrostatic and hydrophobic effects. Values of maximum binding ration (gammap(m)) at saturated level for different systems have been also presented. The Gibb's free energy decrease (-deltaG0) of the binding of proteins to DNA has been compared more precisely for the saturation of binding sites in the DNA with the change of activity of protein in solution from zero to unity in the rational mole fraction scale.

Role of destructive operations in modern day obstetrics.

One hundred and forty-one cases of obstructed labour was referred to RG Kar Medical College and Hospital in the last one year. Out of 12,034 total hospital deliveries, incidence of obstructed labour was 1.17% whereas 36 cases (0.29%) accounted for intra-uterine foetal death (IUD). Of the IUD with obstructed labour, 69.4% were delivered by destructive operation and 30.6% by lower segment caesarean section (LSCS). Craniotomy was performed in 44.4% cases and evisceration in 25% of cases. About 68% of the patients were in the young age group belonging to 20-30 years and 36% of cases were primigravida. It ws found that cephalopelvic disproportion was the commonest cause of obstruction for which craniotomy was performed. Traumatic rupture uterus was encountered in one case. There was no maternal death following destructive operation.