Clinical etiology of myiasis in ENT: a reterograde period - interval study / Etiologia clínica da miíase em otorrinolaringologia: um estudo retrospectivo

Myiasis in ENT, once a deadly disease still presents as a significant outdoor problem, though advances in management including supportive therapy has led to early healing with significant reduction in bed occupancy rate. AIMS: To assess the clinico etiology, relationship of myiasis to habit and habitat of patients and to assess the changes in age, seasonal, socioeconomic incidence, nasal bacterial flora and usefulness of certain commonly done tests with reference to a gap of 25 years. MATERIALS & METHODS: The presenting study was conducted on 80 patients selected over a period of two time intervals ; first 40 cases were chosen from 1979 to 1980 and next 40 over 2003 to 2004. Cases were studied in a retrograde manner and data tabulated. RESULTS & CONCLUSIONS: Atrophic turbinates was the commonest pathological finding in nose in 30 percent of cases . Significant change seen was in the age group 51 and above with a rise of 30 percent. Mode during 2003-04 was 60 years. Incidence of palatal perforation dropped from 17.88 to 2.5 percent . Klebsiella emerged as a significant contributor to the nasal microbial flora. VDRL and split skin smear showed poor etiological association for the diseases.

Miíase em ORL não é mais uma doença fatal, mas ainda está presente como um significativo problema em ambientes externos. Entretanto, progressos alcançados no tratamento, incluindo terapêutica de suporte, têm levado à cura precoce com significativa redução na taxa de internação hospitalar por causa dessa enfermidade. OBJETIVOS: Avaliar a etiologia clínica e as associações entre miíase e os hábitos e habitats dos pacientes; e avaliar diferenças no tocante à idade, estação do ano, incidência socioeconômica, flora bacteriana nasal e a utilidade de certos exames comumente feitos - um estudo retrospectivo de 25 anos. MATERIAIS E MÉTODOS: O presente estudo envolveu 80 pacientes selecionados em dois períodos; os primeiros 40 casos foram selecionados de 1979 a 1980, e os 40 seguintes foram coletados entre 2003 e 2004. Os casos foram estudados de forma retrospectiva e os dados foram analisados em tabelas. RESULTADOS E CONCLUSÕES: Cornetos atróficos representaram o achado nasal patológico mais comum - em 30 por cento dos casos. Alterações significativas foram encontradas na faixa etária dos 51 anos e acima, com um aumento de 30 por cento nestes. A média etária entre 2003-04 foi de 60 anos. A incidência de perfuração palatina caiu de 17,88 por cento para 2,5 por cento. Klebsiella foi o germe mais significativamente presente na flora microbiana nasal. Os exames de VDRL e teste cutâneo mostraram pobre associação etiológica entre as doenças.

A cardiac evoked response algorithm providing automatic threshold tracking for continuous capture verification: a single-center prospective study.

BACKGROUND: The AutoCapture algorithm as implemented in Regency and Microny pacemakers (Pacesetter Inc., Sylmar, CA, USA) provides beat-by-beat monitoring of capture based on proper detection of the evoked response, provides high output back-up pulse when loss of capture occurs, performs periodic threshold evaluations and acquires the capture threshold data in a time-based event counter for later retrieval. The safety and efficacy of this algorithm was prospectively evaluated at a tertiary care hospital of north India. METHODS AND RESULTS: Fifty-four patients (38 males, mean age 66+/-13 years) received a ventricular pacemaker model Regency SC+ with low polarization bipolar lead for high-grade atrioventricular block (n=42) and sick sinus syndrome (n=12). Evoked response and polarization signal were assessed initially at 24 hours postimplant, and follow-up measurements were systematically conducted at week 1 and months 1, 3 and 6. Further evaluation of eligible patients was performed at 6-monthly intervals. Lead implantation parameters were optimum in all patients. At 6 months, the algorithm was functional in 51 patients. The pacing threshold increased to 0.89+/-0.36 V (p<0.001) in the first month and stabilized thereafter. Significant saving of energy was accomplished by a constant output safety margin of 0.3 V instead of the traditional 100%. While the evoked response signal remained stable throughout the study period, the potential signal increased significantly from 0.6+/-0.7 mV to 1.0+/-0.6 mV (p<0.001) in the first month and remained steady subsequently. Back-up pacing in the event of exit block was confirmed in all 25 patients who underwent a 24-hour Holter test. Based on the suggested sense margins, ventricular undersensing was observed in 7 (28%) patients, the majority of whom had competitive cardiac rhythms. An elderly patient with pneumonic illness succumbed to pulmonary embolism at 6 months. CONCLUSIONS: This large single-center experience on AutoCapture demonstrates the success of this algorithm in low-energy ventricular pacing without compromising the patient's safety.

Polymicrobial etiology of dental caries.

The present study was carried out to establish the normal bacterial oral flora and the aerobic and anaerobic bacterial flora from deep seated dental caries, and to determine the antimicrobial sensitivity of the clinical isolates so obtained Streptococcus mutans (48%) and Streptococcus sanguis (20%) were the main aerobic isolates whereas Lactobacillus spp. (52%), Veillonella spp. (24%) and Actinomyces spp. (12%) were the major anaerobic isolates. Hundred percent of the samples from dental caries yielded polymicrobial isolates while in two samples from healthy individuals S. mutans was the sole isolate. As the flora changed from healthy tooth to dental caries it changed from one predominated by anaerobic gram-positive cocci to anaerobic gram-positive bacilli. All the anaerobes isolated were sensitive to metronidazole and cefotaxime, whereas all the isolated streptococci were sensitive to penicillin, erythromycin and clindamycin. Incorporation of the antibiotics in baseline restoration, if technically feasible, has been advocated.

Cerebrospinal fluid free N-acetyl neuraminic acid levels--a diagnostic and prognostic test in meningitis.

Cerebrospinal fluid (CSF) free N-acetyl neuraminic acid (NANA) levels were estimated in 20 cases each of pyogenic and tubercular meningitis (TBM) and 10 controls. The levels of free NANA were significantly high (P less than 0.001) in pyogenic and partially treated pyogenic meningitis when compared to TBM. The CSF free NANA levels had direct correlation with severity of the disease, CSF sugar and protein levels in pyogenic meningitis. The CSF free NANA can even be a prognostic criterion in management of pyogenic meningitis. Higher the levels, poorer the prognosis.