Parry Romberg syndrome: a case report.

Parry Romberg syndrome is a rare neurocutaneous disorder of unknown etiology characterized by facial hemiatrophy of fat, skin, connective tissue and MRI changes in the brain. Here we report a 30 years old woman who presented with facial hemiatrophy, headache and facial pain, hemi-masticatory spasm, atrophy of tongue, temporal hemianopia and hyperintense lesions on MRI.

Isolation, speciation, and antibiogram of clinically relevant non-diphtherial Corynebacteria (Diphtheroids).

Purpose: Coryneform or the non-diphtherial Corynebacterium species largely remains a neglected group with the traditional consideration of these organisms as contaminants. This concept, however, is slowly changing in the light of recent observations. This study has been done to find out the species distribution and antibiogram of various members of the clinically relevant Coryneform group, isolated from various clinical materials. Materials and Methods: One hundred and fourteen non-duplicate isolates of diphtheroids from various clinical isolates were selected for the study. The isolates were identified to the species level by using a battery of tests; and antimicrobial susceptibility was tested by using a combination of Clinical and Laboratory Standards Institute (CLSI) and the British Society for Antimicrobial Chemotherapy (BSAC) guidelines, in the absence of definitive CLSI guidelines. Results: Corynebacterium amycolatum was the predominant species (35.9%) in our series followed by the CDC Group G organisms (15.7%). Each of the remaining 19 species comprised of less than 10% of the isolates. More than half the total isolates were resistant to the penicillins, erythromycin, and clindamycin; while excellent activity (all the strains being susceptible) was shown by vancomycin, linezolid, and tigecycline. Chloramphenicol and tetracycline also had good activity in inhibiting more than 80% of the isolates. Multiply drug resistance was exhibited by all the species. Conclusion: This study was an attempt to establish the clinical significance of coryneform organisms. The high level of resistance shown by this group to some of the common antibacterial agents highlights the importance of processing these isolates in select conditions to guide the clinicians towards an appropriate therapy.

Simultaneous detection of Neisseria gonorrhoeae and Chlamydia trachomatis by PCR in genitourinary specimens from men and women attending an STD clinic.

Neisseria gonorrhoeae and Chlamydia trachomatis are the two most common bacterial sexually transmitted infections that manifest primarily as urethritis in males and endocervicitis in females, though the infection may be asymptomatic especially in women. Since complications may occur in untreated symptomatic and asymptomatic infected individuals, early diagnosis and treatment of infected individuals is required to prevent severe sequelae and spread of these diseases. Recently molecular amplification assays like Polymerase Chain Reaction (PCR) and Ligase Chain Reaction (LCR) have been found to be highly sensitive and specific methods for detection of N. gonorrhoeae and C. trachonmatis not only in urethral and cervical specimens but also in urine. The objective of this study was to screen male and female Sexually Transmitted Disease (STD) clinic attenders, with and without symptoms suggestive of urethritis and cervicitis for presence of N. gonorrhoeae and C. trachomatis using a multiplex PCR based assay, to compare its performance with culture for N. gonorrhoeae and Direct Fluorescent Antibody (DFA) staining for C. trachomatis and also to compare the efficacy of PCR test performed on urine and genital swab specimens collected from this high risk group. Genital specimens and urine was collected from STD clinic attenders. N. gonorrhoeae and C. trachomatis was detected in genital specimens by culture and DFA respectively. Multiplex PCR was used to detect N. gonorrhoeae and C. trachomatis infection in both genital and urine specimens. Among men with urethritis, N. gonorrhoeae was detected in 70% by culture and 77% by PCR, while C. trachomatis as detected in 7.5% by DFA and 17.5% by PCR. Among females with endocervicitis, N. gonorrhoeae was detected in 7.7% by culture and 30.7% by PCR, while C. trachomatis was detected in 7.7% by DFA and in 15.4% by PCR. None of the asymptomatic males were positive for N. gonorrhoeae and C. trachomatis by conventional methods, while 43.9% were positive for N. gonorrhoeae and 7.5% for C. trachomatis by PCR. Fifty per cent of asymptomatic women were positive for C. trachomatis by PCR alone. We encountered PCR positive but culture/DFA negative results and also PCR negative but culture/DFA positive results. In view of this a single PCR test cannot be used for diagnosis and treatment of N. gonorrhoeae and C. trachomatis infection unless confirmed by a second test.

Sturge Weber syndrome.

A variant of hemangioma and an uncommon congenital condition, the Sturge Weber syndrome (SWS), also called encephalo trigeminal angiomatosis, is a neurocutaneous disorder with angiomas involving the skin of the face (cutaneous angioma) and pia arachnoid (leptomeningeal angioma). It occurs typically in the ophthalmic and maxillary distributions of the trigeminal nerve (1,2). Here we present a case of a 14 year old girl.

Portal hypertension in sarcoid liver disease with hypomelanotic skin involvement.

Portal hypertension due to sarcoid liver disease is a rare entity. We report the case of a 50-year-old female with sarcoid liver disease leading to portal hypertension. The literature on portal hypertension due to hepatic sarcoidosis has been reviewed and the role of steroid therapy discussed.

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.

Utility of Direct Fluorescent Antibody Test for detection of Chlamydia trachomatis and its detection in male patients with non gonococcal urethritis in New Delhi.

The purpose of this study was assessment of prevalence of Chlamydia trachomatis and utility of Direct Fluorescent Antibody (DFA) test for its detection in male patients with non gonococcal urethritis in New Delhi, India. Thirty male patients with symptoms of dysuria showing polymorphs in their gram stained urethral smears with no evidence of Neisseria gonorrhoeae, and negative for Trichomonas vaginalis and Candida albicans by wet mount were subjected to DFA test for detection of C. trachomatis in urethral samples. Microscopic examination of gram stained urethral smears revealed 5-7 polymorphs/HPF in 90% of the patients. Evidence of C. trachomatis with DFA (MicroTrak) was detected in 11 cases (36.67%) when a cut off of 10 elementary bodies was considered essential. It is concluded that C. trachomatis is an important cause of non gonococcal urethritis in male patients in New Delhi and DFA test is a useful diagnostic tool in its detection. Where facilities are not available for its detection antichlamydial therapy should be recommended emperically.

Parakeratosis pustulosa--a distinct but less familiar disease.

Parakeratosis pustulosa (PP) is a distinct but less commonly known skin disease, which is frequently seen, in young girls. We describe the clinical and histological features of PP in a 7 month old female baby. Further, it is stressed that unless carefully looked for, this entity may be easily misdiagnosed as chronic paronychia, acrodermatitis of Hallopeau, pustular psoriasis, atopic dermatitis, tinea pedis or dry fissured eczematoid dermatitis and mistreated subsequently.

Rising quinolone resistance in Neisseria gonorrhoeae isolates from New Delhi.

BACKGROUND & OBJECTIVES: Treatment for gonorrhoea with fluoroquinolones is recommended. However, reduced susceptibility and treatment failure with fluoroquinolones has recently been reported. We undertook to study the antibiotic susceptibility pattern and the incidence of quinolone resistance in 36 consecutive isolates of Neisseria gonorrhoeae from April to November 2000. METHOD: Antibiotic susceptibility testing was performed by the Kirby Bauer disc diffusion technique and minimum inhibitory concentration (MIC) of ciprofloxacin was determined by the agar dilution method. Penicillinase producing N. gonorrhoeae (PPNG) were identified by using the nitrocefin disc method. RESULTS: Thirty six strains of N. gonorrhoeae obtained from 44 consecutive male patients (81.9%) were studied. By the disc diffusion method, only 3 (8.3%) of these isolates were found to be sensitive to ciprofloxacin. All isolates were sensitive to ceftriaxone while 23 (63.9%) were sensitive to tetracycline and 12 (33.3%) to penicillin. Four (11.1%) of the N. gonorrhoeae isolates were PPNG. Twenty seven (75%) isolates were found to be resistant to ciprofloxacin by MIC determination. INTERPRETATION & CONCLUSION: Incidence of ciprofloxacin resistance amongst N. gonorrhoeae isolates is on the rise in New Delhi. Periodic monitoring of antimicrobial susceptibility pattern of N. gonorrhoeae to antimicrobials other than quinolones is essential to prevent treatment failure in patients with gonorrhoea.

Treatment seeking behaviour in sexually transmitted diseases.

The present study has been conducted to assess social and behavioural factors predisposing individuals suffering from sexually transmitted diseases to seek treatment and the role of the health provider in them. Out results showed that the demographic, socio-economic and behavioural characteristics of patients seeking treatment at alternative places and those attending the referral hospital in the first instance were comparable. Inhibition, time and distance were important considerations for selecting a health facility. Private clinics were the most preferred (72.4%) source of treatment. In 60.3% of cases written prescriptions were not given and advice regarding treatment of sexual partner was not there in any of the cases. 98.3% of the patients lacked awareness about their disease and 91.4% patients about the treatment they were receiving.

Utility of gelatin particle agglutination test (MLPA) for rapid serodiagnosis of leprosy in a hyperendemic area.

The anti-PGL M. leprae specific antibodies were estimated by MLPA test in 79 patients of leprosy, 8 contacts of lepromatous cases and 10 healthy controls in a hyperendemic area. The results indicated an over all seropositivity of 50.6% in leprosy patients. Three of the eight contacts and five of the controls also gave positive results. Higher seropositivity rates were noted in multibacillary patients (73% in lepromatous, 53.6% in borderline, 40% each in tuberculoid and indeterminate and 10% in pure neuritic types). The practical application of MLPA test in its present form as a serodiagnostic procedure for screening subclinical or clinical infections in leprosy patients appear to be of limited value in hyperendemic areas. Further studies involving large series of subjects are necessary for reaching definite conclusions.

Hepatitis B surface antigen, hepatocellular carcinoma and cirrhosis in south India--an autopsy study.

This study is aimed at finding the association of hepatocellular carcinoma and cirrhosis with hepatitis B surface antigen in a particular geographical area, Andhra Pradesh State in South India. In total, 206 cases of autopsy livers were studied for the presence of hepatitis B surface antigen by orcein staining. Of the 114 cases of cirrhosis 67.54% were positive for the antigen. There were 13 cases of macronodular, 55 cases of mixed and 46 cases of micronodular cirrhosis. The antigen positivity was 100%, 98.7% and 21.74% respectively. The difference in positivity between micronodular and the other two types of cirrhosis was statistically significant (P less than 0.01). Of the 58 cases of hepatocellular carcinoma, 50 were associated with cirrhosis. In 80% of these cases, hepatitis B surface antigen was demonstrated, whereas 75% of cases of hepatocellular carcinoma not associated with cirrhosis, were positive for hepatitis B surface antigen. The geographical importance of these findings was discussed.

Biologically active polymer supports based on cellulosic derivatives: synthesis and kinetic study.

Bioactive cellulose derivatives have been synthesised by coupling enzymes/antibiotics on carboxymethyl cellulose acid chloride and cellulose carbonate. The effect of pH and temperature on the enzymatic activity of amyloglucosidase immobilised on cellulose carbonate was studied. Michaelis-Menten kinetics have been obeyed to the first degree of approximation despite the restricted mobility of the attached enzyme on the polymer support. Lineweaver-Burk plots for the amyloglucosidase immobilized on carboxymethyl cellulose acid chloride at ambient pH with cellulose carbonate at pH 8 have also been plotted. The Michaelis-Menten constant for the immobilized amyloglucosidase on cellulose carbonate at pH 8 was 9.1 mM, and the activation energy for starch hydrolysis was 21.8 kcals/mole.

Impact of scorpion Heterometrus fulvipes venom on cholinesterase rhythmicity in the tropical mouse Mus booduga.

Rhythmicities of acetylcholine (ACh) and acetylcholinesterase (AChE) were studied in the mouse, Mus booduga (Gray), following intramuscular injection of scorpion, Heterometrus fulvipes (C. Koch) venom. Envenomation inhibited the activity levels of ACh and AChE in all the tissues selected for experimentation. Control animals exhibited diel rhythmicity in ACh and AChE while envenomated animals showed fluctuation in the Phase (delta phi), amplitude (A), Acrophase (phi) and the extreme activity hours (X and X1).