Pulmonary Tuberculosis Presenting as Surgical Emphysema without Pneumothorax and/or Pneumomediastinum

Surgical emphysema as a presenting manifestation of pulmonary tuberculosis in the absence of pneumothorax and/or pneumomediastinum is not yet known. We report one such case in which surgical emphysema was probably the result of rupture of a pulmonary cavity into subcutaneous tissue resulting from caverno-pleuro-cutaneous fistula.

A case of human thelaziasis from Himachal Pradesh.

Small, chalky-white, threadlike, motile worms were isolated from the conjunctival sac of a 32 year-old woman residing in the Himalaya mountains. They were identified as both male and female worms of Thelazia callipaeda. To the best of our knowledge, this is the second case report of human thelaziasis from India.

Amoebic renal cyst: a case report

Entamoeba histolytica can infect any organ of the body, but only one case of renal involvement has been reported till now in the literature. We report a rare case of amoebic renal cyst in a 78-yearshowing favorable outcome with metronidazole treatment and therapeutic drainage.

Pulmonary leiomyosarcoma.

A case of pulmonary leiomyosarcoma presenting as a mass lesion on skiagram chest with low attenuation value on computerized scan is presented.

Primary tuberculosis of soft palate.

Primary tuberculosis of upper respiratory tract including oral cavity is a rare disease. One such unusual case is reported.

Non-fermenters in urinary tract infection.

Sixty four (4.4%) strains of non-fermenting gram negative bacteria (NFGNB) were isolated out of 1,380 bacterial isolates from 7,784 urine samples, of which 43 were isolated from male patients and 21 from female patients. P. aeruginosa was found to be the commonest (67.2%) followed by A. lwoffi (7.8%), A. anitratus and P. acidovorans testosterani (6.2% each), P. maltophilia and P. denitrificans (4.8% each), P. putida and P. vesiculare (1.5% each). Forty two(65.6%) of these isolates were isolated as pure cultures and 22(34.4%) as predominant organisms. Most of these isolates i.e. 50-88.8% were sensitive to Norfloxacin and Ofloxacin and 22.2% to 66.6% of these isolates were sensitive to Gentamycin and Cephalexin whereas 11.1% of these isolates were sensitive to Co-trimoxazole and Ampicillin. All of these isolates were resistant to Penicillin and Tetracycline.

Sporotrichosis of abdominal wall.

A rare case of sporotrichosis of abdominal wall has been described from high mountainous region of Himachal Pradesh. Its clinical importance has been discussed in the light of available literature.

A new medium for rapid slide culture of tubercle bacilli.

Human blood medium (HBM) and egg enriched sheep blood medium (SBM) were evaluated to see their efficacy for primary culture of tubercle bacilli. SBM is found to be equally effective compared to HBM. Both types of media were associated with a low rate of contamination (2.75%). Availability of culture results after 7 days compared to 6 weeks on Lowenstein-Jensen media is a distinct advantage of slide culture method with a possible use in primary isolation and in evaluation of drug sensitivity pattern of Mycobacterium tuberculosis.

Epidemiology of rheumatic and congenital heart diseases in school children.

A stratified random sample of 10,263 school-going children in the age group of 6-16 years from government and private schools were screened for the prevalence of rheumatic fever, rheumatic heart diseases and congenital heart diseases. Fourteen children were found to have rheumatic heart disease with valvular lesions either single or in combination eg, pure mitral stenosis (6 cases), mitral regurgitation (4 cases), combined mitral stenosis and mitral regurgitation (3 cases) and aortic and mitral regurgitation (one case). Eight children had congenital heart diseases in the form of ventricular septal defect (3 cases), atrial septal defect (2 cases), patent ductus arteriosus (2 cases) and congenital bicuspid aortic valve (one case) while none had active rheumatic fever.

Influence of prior information of drug toxicity on patient compliance.

Sixty patients with pulmonary tuberculosis, who had not received any chemotherapy in the past, were divided into two groups. All the patients were put on isoniazid, rifampicin and pyrazinamide for 8 weeks followed by isoniazid and rifampicin for another 18 weeks. Group A patients were informed of the likely occurrence of anorexia and/or vomiting but Group B patients were not. Routine and default retrieval home visits were given to ensure maximal drug compliance. Drug toxicity related early defaults were significantly less common in Group A patients (1 of 30) as compared to Group B (6 of 30).

Seroprevalence of HIV antibodies, Australia antigen and VDRL reactivity in Himachal Pradesh.

3000 subjects from four high risk groups--patients attending STD clinics, hospital personnel, blood donors and foreign nationals were screened for the presence of HIV antibodies HBsAg and VDRL reactivity. No evidence of HIV infection was found in Himachiali population. However, there of the 150 foreign nationals screened were found positive for HIV antibodies. Overall HBsAg positivity and VDRL reactivity was found to be 5.53 per cent and 9.07 per cent respectively. The importance of circumspected and unswerving machinery for the surveillance of HIV antibodies in the high risk population of the state is emphasised.

Intestinal parasitism in Himachal Pradesh.

A total of 1629 cases were included in the study for the presence of intestinal parasites during 12 mobile camps in different areas of Himachal Pradesh. 47.08% were positive for parasites. The prevalence rate of helminthic parasites was 32.41% and that of protozoal parasites was 20.81%. The parasitic prevalence has been discussed in the light of peculiar geographical situation of the area.

Nocardia associated with pulmonary tuberculosis.

A total of 209 cases of pulmonary tuberculosis were screened for the presence of Nocardia in their sputa. In 2.9 per cent of the cases Nocardia asteroides was isolated. The increasing importance of this microorganism has been discussed in the light of other reports from India.

Seroprevalence of HIV infection in Himachal Pradesh.

Serum samples from 2645 individuals representing all the twelve districts of Himachal Pradesh were screened for antibodies to Human immunodeficiency virus (HIV), employing ELISA test. These were categorised into four major high risk groups, viz, patients attending STD clinics (1305), voluntary blood donors (1012), hospital staff dealing with blood and blood products (200) and foreign nationals (128). No evidence of HIV infection was found in Himachali population. Two foreign nationals were repeatedly found positive for HIV antibodies by ELISA test and these were confirmed by Western Blot technique.

Incidence of australia antigen (HBs Ag) in Himachal Pradesh.

2405 high risk subjects (1193 patients attending STD clinics, 1012 blood donors and 200 hospital personnel) and 500 apparently healthy individuals representing all the twelve districts of the State of Himachal Pradesh were screened for HBs Ag employing reverse passive haemagglutination (RPHA) technique. HBs Ag positivity was found to be 6.77 per cent in test groups and 3.6 per cent in the control group. Maximum positivity was found in STD patients (9.55 per cent) followed by hospital personnel (8 per cent) and blood donors (3.26 per cent). The highest incidence was noticed in district Kullu and no positive case was found in Lahaul and Spiti district of Himachal Pradesh. Remedial measures for prevention of Hepatitis-B virus infection have been emphasized.

Acridine orange stain--a rapid method for diagnosis of neonatal septicemia.

The present study included 150 newborns; 100 clinically septic and 50 clinically aseptic who served as control. Out of 100 clinically septic newborns, blood culture was positive in 33 (33%), serum CRP was positive in 64 (64%) and acridine orange stained buffy coat smear was positive in 76 (76%). Serum CRP was found to be the most specific (specificity 96%) and acridine orange stained buffy coat smear examination the most sensitive (sensitivity 94.3%) test for diagnosis of neonatal septicemia.