Prevalence and Antibiotic Susceptibility Pattern of Methicillin Resistant Staphylococcus aureus in Tertiary Care Hospitals.

Aims: Methicillin resistant Staphylococcus aureus (MRSA) is a major nosocomial pathogen in hospitals with hospital based outbreaks world-wide. The present study was carried out to estimate the prevalence of MRSA isolates in clinical specimens and to investigate the sensitivity pattern of resistant isolates against various antibiotics used for treating hospitalized patients. Study Design: The percentage of MRSA was defined as the number of S. aureus isolates resistant to methicillin divided by the total number of S. aureus isolates for which methicillin susceptibility test results were reported. Place and Duration of the Study: The study was conducted during January 2012 to December 2012 at Asian Hospital (tertiary care hospital), Faridabad, Delhi. Methodology: A total of 107 isolates of S. aureus were identified by standard laboratory procedures including catalase test, slide and tube coagulase tests, β- haemolysis on blood agar and growth on mannitol salt agar. Subsequently, antibiotic sensitivity pattern of S. aureus were determined by automated antibiotic susceptibility testing system Vitek 2 compact identification and susceptibility testing (ID/AST) system by using AST-GP-67 card. Result: 23 isolates (21.4%) were identified as MRSA and the remaining 84 (78.6%) were methicillin sensitive S. aureus (MSSA). All MRSA isolates were found to be resistant to penicillin, oxacillin, ciprofloxacin and levofloxacin. The antibiotic resistance pattern of these isolates were high against trimethoprim-sulfamethoxazole (91.3%), erythromycin (47.8%), gentamicin (43.5%), moxifloxacin (42.9%), and less resistance rate was observed against tetracycline (30.4%) rifampicin (13.6%) and clindamycin (4.8%). However, all isolates of Staphylococcus were sensitive to vancomycin, linezolid, nitrofurantoin, quinpristin/daflopristin. Conclusion: Findings presented in this study indicated a high level of resistance to widely used therapeutic agents. An appropriate knowledge on the current antibiotic susceptibility pattern of MRSA is essential for appropriate therapeutic scenario.

Study of the association of metabolic syndrome with schizophrenia in north eastern part of India.

Background: During last several years there has been growing interest in metabolic abnormalities in Schizophrenia. Studies in this context are lacking in this part of India. Aims & Objective: To study the association of metabolic syndrome with schizophrenia in North eastern part of India. Material and Methods: 50 Adult schizophrenic patients diagnosed as per DSM-IV TR Criteria and age and sex matched 50 subjects of control group were included in for prevalence of MetS as per the criteria of the International Diabetes Federation (IDF). Informed consent was obtained. The study was approved by local ethical committee. Results: Maximum numbers of subjects were in the age group 21-30 years and males were more than female in schizophrenia group. 14 (28%) patients in schizophrenia group and 6 (12%) subjects in control group had MetS. The mean Serum triglyceride of schizophrenia (153.41 ± 57.26) was significantly higher (p<0.05). Mean BMI of schizophrenia (22.55 ± 4.19) was higher as compared to control group (22.30 ± 3.35). 38 patients (76%) were taking antipsychotics for more than 6 months of duration, in which 14 patients (28%) were found to be having MetS while 24 patients (48%) had no MetS. 2nd generation antipsychotics were taken by 35 patients (70%) in which 14 patients (28%) were found to have MetS while 21 patient (42%) had no MetS. Conclusion: This study showed that prevalence of MetS, risk factors, was more in schizophrenia than control group and it was present more commonly in patients taking second generation antipsychotics.

The clinical spectrum of neurocysticercosis in the Uttaranchal region.

OBJECTIVES: To study the clinical and radiological spectrum of neurocysticercosis in the Uttaranchal region. METHODS: A total of 592 patients of neurocysticercosis attending various health camps, medical outdoor and indoor department were studied for their clinical and radiological presentation. RESULTS: Out of the total 15,000 patients screened, 592 patients (3.94%) were found to be suffering from neurocysticercosis. Majority of them were in the age group of 21-30 years. Most of them presented with generalized seizures (62.5%), others had headache (37.5%), focal seizures (20.8%), localizing neurological signs (16.6%), meningitis (4.1%), and dementia (1.3%). Radiologically, parenchymal lesions were most prevalent (81%). However, interventricular lesions were also not very uncommon (32%). Most of them had single lesions (53.5%), 26.7% had multiple lesions and 0.7% had midline shift. Significantly, large number of patients were vegetarians (39%); only 17.6% were pork eaters while the remaining 82.4% never had pork in their meals. CONCLUSION: We believe that such high percentage is at least a rough indicator of high incidence and prevalence of neurocysticercosis in the Uttaranchal region. They had wide range of clinical and radiological presentation. Small number of pork eaters and a significant number of vegetarians suggest other modes of transmission and needs further evaluation.

The effect of antidepressants on serum melatonin levels in endogenous depression.

OBJECTIVES: 1. To assess the serum melatonin levels in patients suffering from endogenous depression and the effect of pharmacological therapy. 2. To establish possible correlation between the height from the mean sea levels and the patients suffering from endogenous depression. METHODS: Forty patients, 18 males and 22 females, suffering from endogenous depression (according to DSM IV criteria), aged 48.3 +/- 12.32 years were evaluated and serum melatonin level was assayed between 9-10 am. They were not on any drugs/medication, which was likely to alter serum melatonin level for one month prior to study. The serum melatonin levels were assessed at 0, 3, 6 and 12 months while they were continued to be treated. It also included 30 controls of the matched age and sex and satisfying the inclusion criteria. The possible correlation was also studied between the serum levels and the height from the mean sea level at which the patients reside. RESULTS: The two groups were comparable at the beginning of the study. The serum melatonin levels started falling from three months onwards (from 9.99 +/- 3.59 pg/nl to 8.49 +/- 3.16 pg/nl; p < 0.05). However, the decline was maximum between 3-6 months (from 8.49 +/- 3.16 to 5.589 +/- 1.96; p<0.05). The serum levels became stationary beyond six months. Highest melatonin levels were observed in patients residing at an altitude of 6001-8000 metres (14.32 +/- 2.68 pg/ml; p < 0.05) followed by 4,001-6,000 meters (11.137 +/- 2.62 pg/ml; p < 0.05). However, the levels were almost stationary below 4,000 metres (p = 0.05). CONCLUSION: 1. Higher serum melafonin values were observed in patients suffering from endogenous depression. 2. Morning serum melatonin values decreased with pharmacological therapies. 3. Patients living at higher altitudes had higher serum values for the hormone.

Target gland functional status in patients with non-Cushing's pituitary macroadenomas undergoing transsphenoidal microsurgery.

OBJECTIVES: Hypopituitarism occurring in patients with pituitary macroadenoma may be reversible after pituitary microsurgery, and surgery itself can lead to hypopituitarism. This study was undertaken to evaluate target gland function prospectively in patients of non-Cushing's pituitary macroadenoma undergoing trans-sphenoidal microsurgery. MATERIAL AND METHODS: A prospective study of fifty patients of non-Cushing's pituitary adenoma was carried out to evaluate target gland (thyroid, adrenal and gonadal) undergoing trans-sphenoidal microsurgery. Thirty-two patients completed postoperative evaluation before radiotherapy. Target gland functions were assessed by measurement of T3, T4, TSH, basal and stimulated cortisol, LH, FSH, testosterone and estradiol. GH and PRL were also measured. Tumor size was assessed on CT/MRI scan. RESULTS: Hypothyroidism, hypoadrenalism and hypogonadism were present in 24%, 54% and 52% of patients. Preoperative hypopituitarism correlated with tumour size. Thyroid, adrenal and gonadal function improved in 87%, 50% and 31%; deteriorated in 4%, 29%, and 37%, respectively after trans-sphenoidal microsurgery. CONCLUSIONS: A subset of patients with non-Cushing's pituitary macroadenoma suffers from hypopituitarism, which reverses after surgery. Failure of recovery correlates with preoperative lower serum prolactin levels.

Role of emergency surgery to reduce mortality from rebleed in patients with aneurysmal SAH.

Potentially salvageable patients with aneurysmal subarachnoid hemorrhage may rebleed and die after admission to a hospital, awaiting an angiogram or surgery. In an attempt to reduce the number of patients thus lost, we are operating on such patients on an emergency basis. This report is a retrospective analysis of patients operated early after aneurysmal SAH, but during routine working hours, versus patients operated on an emergency basis. During an 18 month period 109 patients underwent surgery for intracranial aneurysm. Fifty two (Group 1) patients were subjected to emergency clipping of the aneurysm, and 57 (Group 2) patients underwent early clipping but during routine working hours. There was no selection bias between the two groups. Another 10 patients in Hunt and Hess Grade II and III rebled and died, after admission, awaiting an angiogram or surgery. The overall mortality for the two groups (Grade I to IV) was 11.9%. Mortality in Groups 1 and 2 was 9.6% and 14.0% respectively. At 1 month, good outcome was recorded in 86.6% patients in grade I, 69.2% patients in grade II and 42.8% patients in grade III in group I compared to 68.7% patients in grade I, 80% patients in grade II and 31.5% patients in grade III in group 2. However, the difference was not statistically significant. There was also no significant difference between the incidence of intraoperative brain swelling and delayed ischaemic neurological deficit between the two groups. Grade IV patients had a poor outcome in both the groups. Angiographic vasospasm was associated with poor out come, in either group, in grade IV patients. Patients in Grades I to III should undergo emergency surgery, if the surgeon is experienced and willing to operate at odd hours and necessary support facilities of neuroradiology and neuroanaesthesiology are available. This would avoid deaths in patients awaiting angiograms or surgery.

Trichobezoar with small bowel obstruction.

Trichobezoar is a rare clinical entity. Stomach is the common site of occurrence. Intestinal obstruction due to trichobezoar is extremely rare. We report a case of subacute bowel obstruction in a 7-year-old girl which required resection of the involved ileal segment and release of small bowel adhesions.

A clinico-pathological study of 29 cases of gliosarcoma with special reference to two unique variants.

In the present series, the clinical and pathological features of 29 patients of gliosarcoma diagnosed over a 12 yr period (1984-1995) are reviewed. Gliosarcomas constituted 0.48 per cent of all intracranial tumours and 4.9 per cent of all cases of glioblastoma multiforme. Most patients (68.6%) with these tumours were above 40 yr of age. However, an interesting observation in the present series was that 10.3 per cent of patients (3/29) were below 14 yr of age, the youngest being 9 months. A male preponderance was noted and the temporal lobe was involved in 55 per cent patients. Histologically, in 25 of the 29 tumours, the sarcomatous component had the appearance of fibrosarcoma. Tumours from 4 patients were unique in that one showed rhabdomyoblastic differentiation in the mesenchymal areas as confirmed by immunohistochemical stains and electron microscopy (gliomyosarcoma). In three others, the neoplastic spindle cell component was closely associated with discrete areas of osteogenic sarcoma. Follow up in 12 patients (including the 4 patients with unique variants) revealed poor outcome similar to glioblastomas. All of them died within 1 month to 1.5 yr following surgery and postoperative radiotherapy. This study possibly represents the most comprehensive and largest series of gliosarcomas being reported from India.

Blackgram mottle virus RNA and its in vitro translation.

In vitro translation of blackgram mottle virus RNA in rabbit reticulocyte lysate resulted in synthesis of five major virus specific polypeptides with mol wt 90,000(p90), 82,000(p82), 42,000(p42), 39,000(p39) and 32,000(p32), respectively. The polypeptide p39 was identified as coat protein based on its electrophoretic mobility and immunoprecipitation with BMoV-antiserum.

Congenital afibrinogenaemia.

A case of congenital afibrinogenaemia in a young female child is described. She had haemorrhagic tendency since birth in the form of markedly prolonged umbilical bleeding and easy bruising afterwards. Two of her brothers had bleeding tendencies, one died shortly after birth due to uncontrollable umbilical bleeding and other died at the age of 12 years from internal haemorrhage. The family study indicates the mode of inheritance to be probably autosomal recessive. The principal laboratory findings are complete non-coagulability of blood, grossly abnormal coagulation tests, zero ESR value, failure to detect fibrinogen by heat coagulation or chemical precipitation tests and biuret reaction and correction of thrombin time after fibrinogen infusion.

Diagnostic significance of pleural fluid eosinophilia during initial thoracocentesis.

A prospective study of pleural fluid eosinophilia (PFE) during initial thoracocentesis in 162 patients of pleural effusion was undertaken to determine its value in establishing an etiological diagnosis. Eighteen of the 162 cases showed pleural fluid eosinophilia (PFE), twelve could not be labelled with any definitive etiology even after extensive investigations, four belonged to the para-pneumonic group and resolved with treatment. Of the 32 patients with malignancy, PFE was seen in a single case of pleural mesothelioma. None of the patients with tuberculosis, empyema, systemic lupus erythematosus or amoebiasis had PFE. These findings suggest that PFE seen at initial thoracocentesis favours a benign diagnosis, with a rare chance of malignancy. Tuberculosis is unlikely in such patients.