Ocular manifestations of Rickettsia conorii in South India

Purpose: Among the major groups of rickettsiosis, the commonly reported diseases in India are: (a) Typhus group induced—scrub typhus, murine flea-borne typhus; (b) Spotted fever group induced—Indian tick typhus; and (c) Q fever. Though many scrub typhus outbreaks have been reported from India, only one outbreak of spotted fever—serologically proven Indian tick typhus (Rickettsia conorii)—has been reported. We report for the first time ocular manifestations of serologically proven R. conorii infection in a cluster of patients. Methods: In this retrospective study, case records patients with serologically proven Indian tick typhus (Rickettsia conorii) were reviewed for clinical manifestations and treatment outcomes. Results: In the months of February to April 2016, a cluster of 12 patients (23 eyes) visited us with defective vision. Examination showed multifocal retinitis; mostly bilateral; patients had a history of fever approximately 4 weeks prior to onset of symptoms. After excluding other causes of multifocal retinitis, a diagnosis of rickettsial retinitis was made after Weil–Felix test (WFT) was significantly positive, and enzyme-linked immunosorbent assay was positive for R. conorii. Course of the disease, visual outcome, and investigations are discussed. Doxycycline along with oral corticosteroids was effective in treating the condition. Conclusion: Systematic fundus examination should be part of the routine evaluation of any patient who presents with fever and/or skin rash living in or returning from a specific endemic area. Clinical clues to diagnosing ocular rickettsiosis could be multifocal retinitis predominantly involving the posterior pole and macular involvement in the form of serous macular detachment or macular hard exudates. A positive WFT still serves as a useful and cheap diagnostic tool for laboratory diagnosis of rickettsial disease. Doxycycline along with oral corticosteroids was effective in treating the condition.

A prospective randomized study comparing the efficacy of the LMA ClassicTM, the AMBU Aura40 Laryngeal MaskTM and the I-GelTM using fibroptic bronchoscope in spontaneously breathing anesthetized patients.

Background: Supraglottic airway devices (SAD’s) have revolutionized airway management both inside and outside the operating room ever since the invention of the LMA Classic. Objectives: Objective of this study was to compare efficacy of LMA classic, Ambu Aura laryngeal mask and I-gel in terms of ease of insertion, fiberoptic bronchoscopic assessment of the glottic view, oropharyngeal leak pressure, intra and post-operative complications. Material and methods: Ninety patients of ASA Grade 1 or 2, aged 18–70 years, scheduled for elective short surgical procedures requiring general anesthesia were randomly divided in to three groups as LMA Classic, Ambu Aura40 laryngeal mask and I-gel group whose airway were secured with these devices. Anesthetic technique was standardized and maintained on spontaneous breathing. The number of attempts for the correct positioning (at least 6 square Etco2 traces on the capnograph and 4 ml/kg tidal volume) of the device were counted. Glottic view was noted by fiberoptic bronchoscope passed into the supralottic device and graded as 1 = Vocal Cords entirely visible, 2 = Vocal Cords or Arytenoids Cartilages partially visible, 3 = Epiglottis only visible, 4 = No laryngeal structures visible. Oropharyngeal leak pressure (OPLP) was measured. Intra and post-operative complications were looked for and recorded. Results: Ambu Aura40 could be positioned successfully in a single attempt in 90% of the patients (27 out of the 30), whereas it’s only 80% in both the LMA Classic and the I-gel groups without a statistical significance (P = 0.518). Successful positioning during the next or second attempt was more with I-gel compared to LMA classic (20.0% and 16.7% respectively). 63.3% of Ambu laryngeal mask group had a glottic view grade of 1 while only 46.7% and 13.3% of patients in the LMA classic and the I-gel group had a similar glottic view respectively which was statistically significant (P = 0.000). Significantly higher mean OPLP with I-gel 36.23 ± 3.00 and least with LMA classic 30.90 ± 2.15 (p=0.000). 3 patients (10%) in the LMA Classic group complained of sore throat in the postoperative period which was statistically significant (P = 0.045). Conclusion: Over all Ambu Aura40 laryngeal mask airway device is superior in comparison to the other devices with respect to parameters studied. I-gel due to high oropharyngeal pressure leak could be useful in positive pressure ventilation. The LMA Classic is associated with a minimal incidence of sore throat in our study.

Evaluation of surgical methods and outcome of the treatment for varicose veins.

Background: Varicose veins of lower extremities are the most common peripheral vascular disease and it calls for treatment due to the morbidity and loss of working hours it causes. In advocating surgery the need to establish the need for surgery in the patient cannot be over emphasized. In the present study, the various surgical methods available and the outcome of the treatment for varicose veins in patients were evaluated. Methods: The study was conducted in teaching & general hospital and government general hospital, attached to medical college. The various available surgical procedures were used in the present study after the informed consent from all the patients. Results: Trendelenburg’s operation was done in 4.76% of cases, it was coupled with stripping of long saphenous and subfascial ligation of perforators 33.33% cases. In 9.52% cases with competent saphenofemoral junction, only subfascial ligation was carried out by small transverse incisions. Postoperative wound infection was seen in 20.59% of cases. Conclusion: Our study revealed that the Trendelenburg’s operation is carried out in all the patients with saphenofemoral incompetence. Stripping of the long saphenous vein from above downwards is safer for the saphenous nerve than stripping from below upwards. Stripping of long saphenous vein till the below knee level is an adequate procedure. This can be combined with the multiple ligation or excision of varicose tributaries.

Pattern and modes of presentation of varicose veins of lower limbs.

Background: Varicose veins of the lower extremities are one of the most common peripheral vascular diseases and calls for treatment. Therefore the present study was undertaken to study the pattern and various modes of presentation of the patient with varicosities of the lower limbs. Methods: The study was conducted in teaching & general hospital and government general hospital, attached to medical college. A detail clinical history was taken and a thorough clinical examination was done. The signs and symptoms of patients were reported. Results: 42 cases were afflicted with varicose veins of the lower extremities comprising only 10.99% of the total admissions with vascular complaints. Maximum incidence was in the age group 21-40 years (61.9%). 57.14% of cases were involved in occupation requiring prolonged periods of standing and/ or violent muscular contraction. The most common presenting complaint was pain which varied from dragging pain to night cramps associated with heaviness of the limbs. Edema was present in 11 cases, predominantly localized to below knee with pitting nature. Conclusion: Our study revealed that the disease is most prevalent in the 2nd and 3rd decades of life. We concluded that occupation involving prolonged standing and/or violent muscular contractions contribute to or precipitate varicose veins if not actually cause them.

The age and mode of presentation of benign prostatic hyperplasia at Hubli in Karnataka.

Background: The peculiarities of the prostate are that in old age when most of organ regresses in size it enlarges and causes trouble. By virtue of its position, it guards outlet of urinary bladder. It must be admitted that even today the extent nature of etiology, pathogenesis and diagnosis are all-debatable. Therefore, the present study was aimed at elucidating the age and mode of Benign Prostatic Hyperplasia among the patients in and around Hubli, Karnataka. Methods: The study was conducted after the institutional ethical committee approval and written informed consent from all the patients. 21 cases of BPH were included in the present study. The signs and symptoms of mode of presentation were recorded. The urine was examined for the presence of albumin, pus cells, epithelial cells and RBCs. Results: The maximum incidence of the disease was in the age group of 60-69 years. Majority of the patients had difficulty in micturition followed by increased frequency of micturition both during day and night Patient with retention usually had distension of bladder. These patients complained of dull aching pain in the suprapubic area and in the groin region. Burning micturition (14.28%), dribbling of urine (4.76%), urgency (4.76%), and haematuria (4.76%) were present. Routine urine examination showed albumin (28.56%), pus cells (23.80%), epithelial cells (19.04%) and haematuria (4.76%). Conclusion: Incidence of BPH at Hubli region of Karnataka is 0.3001% of total hospital admission. The maximum age incidence of BPH is in the age group of 60-69 years. Majority of the patients had difficulty in micturition increased frequency of micturition both during day and night a large number of cases show association with presence of urinary tract infection.

Evidentiary value and effects of contaminants on blood group factors in medico-legal grounds.

Background: Blood is considered to be the most common trace evidence obtained from the scene of crime. Blood grouping reveals vital information regarding identification, in relation to crime investigation. With this respect contamination with dust, rust, bacteria and detergent will have any effect on blood grouping was studied. Material and methods: Randomly A, B, AB, Rh positive samples were taken in duplicates and were added with rusted pins, dust particles, detergent, staphylocopcci bacteria and without any addition one tube was kept in room temperature. Controls were kept in refrigerator at 4-8 ˚C to compare the results. Results: There were lots of changes in blood groups after 10 days of incubation in all tubes with contamination. Blood samples in dust after 10 days incubation had changed from A, B, AB to O blood group with Rh negativity. Blood samples in rust had retained with original ABO group but Rh positives were converted to Rh negative. Detergent tubes had also changed Rh positive to negetive retaining original ABO. There was no change in either ABO or Rh blood groups in tubes with Staphylococci bacteria. Conclusion: Stains contaminated with common agents like dust, rust, bacteria and detergent give inconclusive results by mixed agglutination method with passage of time. The results may be accepted with caution, as the opinion might be medico legally significant.

Safe Blood transfusions: Still a risk in India.

Introduction: Nucleic acid testing (NAT) is the latest approved method for detection of transfusion transmitted infections. With higher prevalence of infections in window period and occult infections, blood safety can be compromised when testing is done using only serological techniques. With this background this study had been taken up to compare the results of serological test with NAT. Material and methods: Voluntary blood donations were screened for hepatitis B, hepatitis C and human immunodeficiency virus using ELISA. All samples were sent for ID-NAT and results of both methods were compared, analyzed individually. Results: A total of 11,393 blood units were collected during the study period. ELISA test results. showed 176 (1.54%) positivity for these transfusion transmitted infections (TTIs) in total. Among them, 133 (75.56%) was HBV, 22 (12.5%) was HCV and 21 (11.93%) was HIV as shown by ELISA. ID- NAT test results showed 174 (1.52%) positive in total. As analyzed by individual test results, 37 (0.32%) of total blood samples showed positivity in NAT which showed negative results in ELISA. Also 38 (0.33%) of total blood samples (HBV = 27, HCV = 08, HIV = 03) which showed positivity in ELISA were negative in NAT. Conclusion: ID-NAT is definitely a useful screening method for HBV, HCV, HIV. It clarifies infections in window period, occult infections and false seroreactive cases.

Cemento Ossifying Fibroma of the Maxilla - A Case Report.

Cemento ossifying fibroma is a uncommon benign fibro osseous lesion commonly occurs in the young adults in the age group of 20 to 40 yrs, most commonly in the females with an female to male ratio of 5:1.It usually occurs in the craniofacial bones and rarely in long bones, of the craniofacial bones, posterior mandible in the region of premolar molar area is commonly seen. The occurrence COF in the maxillary, ethmoid, frontal, and sphenoid sinuses are rarely reported in the literature. A rare case of COF affecting the maxilla in a young male patient is discussed.

Morphological patterns of endometrium in infertile woman-a prospective study.

Background and Objective: Infertility is a global health problem because 8-12% of all couples worldwide, around 80 million are infertile. Endometrium is the most sensitive indicator of ovarian function. Endometrial biopsy with routine hematoxylin and eosin staining is an important investigation in the Indian Scenario. Therefore the present study has undertaken to investigate the morphological patterns of endometrium in infertile women. Materials and Methods: This study was carried out in the Department of Pathology, Bangalore Medical College after the ethical clearance from the institutional ethics committee. The study included 90 cases with complaints of infertility (primary / secondary). The premenstrual D & C was done to obtain endometrial biopsy. The endometrial tissue was fixed; processed, sectioned and performed Hematoxylin & Eosin stain for morphology of endometrium, dating of endometrium and Ziehl-Neelsen (ZN) stain for acid fast bacilli was also performed. In this descriptive analysis, values are mentioned as percentages. Result: In the present study, we also observed 2 cases of Tuberculosis (TB), 5 cases exhibited cystic hyperplasia and only a single case of endometrial polyp was seen. But, the percentage of cases of secretory phase was more. Simple cystic hyperplasia was seen in 3 cases of primary and 2 cases of secondary infertility. Conclusion: In the present study we concluded that the anovulatory endometrium, simple cystic hyperplasia and luteal phase defect formed the major etiological basis of many cases of infertility and the tuberculosis endometritis and endometrial polyp formed the minor group of etiology.

Comparative study of cardiovascular response in trained and untrained volleyball and basketball players.

Background: Exercise training increases cardiovascular functional capacity and decreases myocardial oxygen demand at any level of physical activity. The aim of present study was to observe and compare the changes induced by isometric hand grip exercise on cardiovascular responses in young healthy male and female trained Volleyball and Basketball players with age and sex matched untrained controls. Methods: This study was carried out at Department of Physiology, J.S.S. Medical College and Hospital. Two hundred and forty (240) participants were included and were divided into trained Volleyball & Basketball players and healthy adult controls of both sex with 40 members in each category. Estimation of SBP, DBP, MAP and HR were carried out before, after and during various duration of exercise by adopting standard procedures Results: The mean SBP, DBP, MAP and HR at various durations for male subjects playing basketball, Volleyball and Control groups shows a significant increase (p<0.0001) in all the parameters at rest, during isometric HG exercise and at post exercise in untrained Control subjects. Conclusions: Exercise training increases cardiovascular functional capacity.

Evaluation of cardiovascular responses to isometric exercise in trained female basket ball and volley ball players.

Background: Physical inactivity is recognized as a risk factor for coronary artery diseases. The aim of present study was to observe changes induced by isometric hand grip exercise on cardiovascular responses in young healthy trained female Volleyball and Basketball players. Methods: This study was carried out at Department of Physiology, J.S.S. Medical College and Hospital. Hundred and eighty (180) female participants were included and were divided into trained Volleyball & Basketball players and healthy adult controls of 60 each. Estimation of SBP, DBP, MAP and HR were carried out before, after and during various duration of exercise by adopting standard procedures Results: The mean SBP, DBP, MAP and HR at various durations for female subjects playing basketball, Volleyball and Control groups shows a significant increase (p<0.0001) in all the parameters at rest, during isometric HG exercise and at post exercise in untrained Controls compared with trained subjects. No significant difference was observed in the above said parameters at rest, during isometric HG exercise and at post exercise between Subjects and between volleyball and basketball players. Conclusions: Exercise leads to significant decrease in cardiovascular stress in trained individuals.

Fatal septicaemia due to Chromobacterium violaceum

Human infection caused by Chromobacterium violaceum is rare but when it occurs, it is associated with a high mortality rate. This is a report of a young adult male who presented as a surgical emergency and succumbed soon after. The most common feature of this infection is sepsis, followed by cutaneous involvement and liver abscesses. Chromobacterium infection as a differential in a case of sepsis is important for clinicians to suspect, especially in tropical countries.

Cutaneous rhinosporidiosis.

Rhinosporidiosis is a chronic granulomatous disease of the mucocutaneous tissue, which clinically presents as polypoidal growths. Cutaneous lesions are infrequent and are generally associated with mucosal lesions. We present a case of cutaneous rhinosporidiosis in association with recurrent nasopharyngeal rhinosporidiosis in a 65-year-old male patient. He presented with dysphagia for solid foods and skin growth on the left side of jaw of 2 years duration. Histopathology of cutaneous and nasopharyngeal lesions revealed numerous thick walled sporangia in a vascular connective tissue along with a granulomatous inflammation confirming the diagnosis of cutaneous and nasopharyngeal rhinosporidiosis. Endoscopic removal of nasopharyngeal polyp was done and he was started on dapsone therapy.

Kaposi's varicelliform eruption.

Kaposi's varicelliform eruption (eczema herpeticum) is the name given to a distinct cutaneous eruption caused by herpes simplex and certain other viruses that infect persons with preexisting dermatosis. Most commonly it is associated with atopic dermatitis. We report a case of a three-year-old atopic child who presented with extensive vesicular eruption suggestive of Kaposi's varicelliform eruption. There was history of fever, malaise and extensive vesicular eruptions. Diagnosis was made based on clinical features and Tzanck smear examination. Patient responded adequately to oral acyclovir therapy.

Tuberculous skin ulcer following needle-prick injury in a health care professional.

A case of cutaneous inoculation tuberculosis in a 25-year old health care professional is reported. The diagnosis was confirmed by histopathology and isolation of Mycobacterium tuberculosis by BACTEC 460TB radiometric method. Rapid healing of the ulcer was noted in response to surgical debridement and specific anti-tuberculous therapy.