Rare yeasts causing fungemia in immunocompromised and haematology patients: Case series from Delhi.

Systemic fungal infection related to fluconazole‑resistant yeasts are emerging in immunocompromised patients. In this case‑series, we report eight cases of fungemia caused by Trichosporon spp. (2), Stephanoascus ceferrii (1), Kodamaea ohmeri (1), Pichia kutrawersi (2), Candida rugosa (1) and Candida lusitianae (1) in immunocompromised patients. All the yeasts except (Trichosporon asahii) were sequenced. As these rare species are inherently resistant to antifungal agents and they may lead to the development of nosocomial outbreaks, therefore, accurate identification followed by antifungal susceptibility testing is crucial for proper treatment and management.

Drowning in concentrated syrup.

Drowning is one of the two leading causes of accidental death in children. Most of the cases can be attributed to fresh or salt water drowning. We report an unusual case of acute respiratory distress syndrome in a one year old child following drowning in concentrated sugar syrup, in whom timely intervention and early supportive therapy resulted in a favorable outcome.

Barium poisoning mimicking Guillain-Barre syndrome.

Barium poisoning is an important cause of areflexic quadriplegia associated with hypokalemia. Presenting features may mimic Guillain-Barre syndrome. A high index of suspicion of barium poisoning in two patients who presented with features resembling Guillain-Barre syndrome, led to timely management and early recovery in both the cases.

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.

LDH isozymes with anomalous bands in semen of leprosy patients.

Activity of LDH isozymes was evaluated electrophoretically on 7% acrylamide gel in semen of 37 leprosy patients (15 with borderline, 12 with borderline tuberculoid and ten with lepromatous leprosy) and ten fertile men of 30-45 years of age. Significantly lower activities were recorded of LDH1 in all categories of leprosy patients. Similarly, lowering of LDH2 activity was noticed in borderline and lepromatous cases only, lowering of LDH4 activity in lepromatous cases only and LDH5 activity was lowered in borderline leprosy patients. Lowest activity of LDH3 and absence of LDHx were found in lepromatous leprosy. However, in borderline tuberculoid patients, LDH3 and LDHx were significantly higher. This exceptional increase in activity was found to be due to presence of additional (anomalous) isozymes bands of LDH3, LDHx and LDH4 in 25% of borderline tuberculoid patients. Additional bands of LDH3 have also been located in 40% of the borderline leprosy patients.

Transcatheter closure of secundum atrial septal defect with atrial septal defect occlusion system (ASDOS): initial experience and short-term follow-up.

Transcatheter closure of secundum atrial septal defect is a well known alternative to surgery. It was attempted in seven patients (age range 7-34 years, mean 20.1 +/- 6.5 years) with the double umbrella nitinol device (ASDOS, Dr. Ing Osypka, Germany). The interatrial septal anatomy and blood flow were examined by transthoracic and multiplane transoesophageal echocardiography. The size of atrial septal defect varied from 1.25-2.4 cm (mean 1.75 +/- 0.3 cm), minimal septal rim 0.5-1.0 cm (mean 0.75 +/- 0.20 cm), and Qp/Qs 1.6-3.2:1 (mean 2.4 +/- 0.6). One patient had an atrial septal defect following surgery for left atrial myxoma. The procedure which involved the use of monorail system for deployment of device under transoesophageal echocardiography guidance, was successful in six (86%) of the seven patients. The size of the implanted device ranged from 30-45 mm. In two patients, the right atrial umbrella had to be oversized in comparison to the left atrial umbrella for stability and adequate occlusion of the defect. The patient in whom the procedure failed had a defect size of 1.7 cm, with minimal septal rim (anterosuperior) of 5 mm; however, the device could be easily retrieved. Immediately after and at follow-up of one year, transoesophageal echocardiography-guided colour flow mapping revealed complete abolition of left-to-right shunt in five (83%) of the six patients. One patient had a small residual flow at the posterior rim of the defect; none had atrioventricular valve regurgitation. Although the procedure is complex, it is safe with the advantage of excellent control on the monorail system for proper positioning, repositioning and, if required, retrieval of the device.

Semen biochemistry of leprosy patients.

Studies have been made on the semen of three categories (borderline, borderline tuberculoid and lepromatous) of leprosy patients to evaluate the seminal biochemical constituents viz. fructose, glycerylphosphorylcholine and acid phosphatase besides the physical properties viz. volume, pH, liquefaction time, sperm density and sperm motility. In all categories of leprosy patients, seminal pH, liquefaction time and sperm density underwent significant decline. The decline in the seminal volume and sperm motility was significant only in borderline leprosy. It was observed that seminal glycerylphosphorylcholine (GPC) concentration and acid phosphatase activity declined in all categories of leprosy patients but GPC showed a significant decline only in borderline tuberculoid and acid phosphatase declined significantly only in borderline and lepromatous leprosy.

Transcatheter coil occlusion of persistent ductus arteriosus using detachable steel coils: short-term results.

Twenty patients underwent transcatheter occlusion of persistent ductus arteriosus (PDA), 1.5-5.5 mm in diameter, with detachable steel coils. A coil having a diameter at least twice that of the narrowest ductal diameter was used. Procedural success was achieved in all, using a single coil in 14 and multiple coils in the remaining 6. At follow-up after 2-12 (6.7 +/- 2.8) months, continuous murmur persisted in only one patient, while 4 (20%) patients had residual shunt on Doppler colour-flow imaging. There was no instance of coil embolisation, thromboembolism, intravascular haemolysis, local vascular complication or sepsis. Transcatheter occlusion of PDA with detachable coils is a safe, technically easy and cost-effective method with the added advantage of feasibility in small children.

LDH-x in azoospermia: a new diagnostic alternative to vasography and testicular biopsy.

Activities of different isozymes of lactate dehydrogenase were studied in semen samples from fertile, and different groups of infertile men. No isozyme except the sperm specific LDH-x or C4 showed any difference in activity with changes in sperm density. Activity of LDH-x exhibited a trend positive to changes in sperm density and became absent in obstructive and vasectomized azoospermia. Among other types of azoospermia, the activity became very high in maturation arrest but very low in patients with testicular biopsy showing germ cell aplasia, such as in SCOS and ghostlike tubules. Diagnostic usefulness of the estimation of LDH-x activity in semen is discussed.

Modifications in the seminal protein pattern and concentration among infertile men.

Lower concentrations of protein observed in semen of infertile men were mostly due to absence of vesicular proteins with higher isoelectric pH above pH 8.3. Two to four proteins with lower isoelectric pH showing electrophoretic mobility and originating both from seminal vesicle and prostate were absent in infertile semen samples. Concentrations of such proteins among oligozoospermic and azoospermic samples with complete maturation arrest and Sertoli cell only syndrome decreased mainly towards cathode, whereas, in vasectomized azoospermia the number of protein bands decreased both towards cathode and anode, though the concentration decreased mainly in the anodic proteins.

Massive lymphadenopathy in chronic myelocytic leukemia.

A 50 year old male presented with massive lymphadenopathy and was found to be in extramedullary blast crisis is reported. Lymphadenopathy regressed on busulphan therapy and the overt blast crisis took 15 months to occur after initial presentation.