Clinicoepidemiological profile of necrotizing fasciitis in a tertiary care center of western Odisha

Background: Necrotizing fasciitis (NF) is a state of infection promptly intensifying the destruction of skin with underlying tissue leading to permanent infirmity and high mortality irrespective of good parenteral drug coverage and contentious surgical handling. NF normally begins as a confined infective focus that initially presents as cellulitis later rapidly progresses to large areas of infection which disproportionate to pain. Aims and Objectives: The primary aim of this study is to determine the incidence and management methods of NF in tertiary health-care center of western Odisha. Materials and Methods: A retrospective review of medical records of patients diagnosed with NF presenting to department of general surgery, Veer Surendra Sai Institute of Medical Sciences and Research Burla, from March, 2020 to February, 2022 was performed. Various information such as patient’s demographics, type of presentation at the time of admission, age group affected, body parts affected, mode of injury, and microbiological status were collected in a predesigned format for analysis. Data were presented in number and percentage. Results: A cumulative of 96 cases with clinical features of NF was reviewed. The median age group range was 31–40 years. Nearly 94.7% cases had significant underlying comorbidities. Extremities were most commonly affected part. About 82.2% cases had undergone surgical debridement, 13.5% cases fasciotomy, and 4.2% cases skin grafting. Most common mode of injury is trivial injury. Group A Streptococcus is most common cause of organism. Almost 78.3% cases were healed. Conclusions: NF can induce upscaled morbidity and mortality if left undetected and untreated in primordial stages. The medics, paramedics, and specialists including surgeons need to have a high degree of intuition to diagnose NF at its beginning stages and thus precisely put resuscitative efforts, plan for debridement, and need for any urgent referral.

Comparison of clinical utility of Cancer Ratio, CEA, Malignant Cytology in diagnosis of suspected malignant pleural effusion

Introduction: Pleural effusion is one of the manifestation of a malignant disease which may be malignant pleural effusion with demonstrable malignant cells in the fluid or para-malignant pleural effusion which is reactive response or due obstruction of lymphatic drainage rather than invasion of pleural cavity. Various modalities are there to investigate this condition including routine microscopy, cytology, biopsy etc. Objective: To understand and compare the utility of cancer ratio, tumor markers, malignant cytology in cases of suspected malignant pleural effusion. Material and Methods: This Case Control Cross sectional study was conducted among patients attending respiratory OPD at Sir Sunder Lal Hospital, BHU, Varanasi, diagnosed with malignant pleural effusion and non-malignant pleural effusion. Results: Significant association was found between Cancer Ratio-Carcinoembryonic Antigen, CEA (p = 0.0069), CEA-Cytology (p = <0.01801)

Women's Empowerment: Bringing Women’s Rights and Health into Focus- A Comparative Analysis of State Fact Sheets of National Family Health Survey (NFHS)-4 & 5

Introduction: Women’s empowerment is a crucial factor for economic and social growth. India being committed to making women contribute equally to the growth of the country by 2030 (SDG-5), this study highlighted the major shortcomings in the domain of Women’s health, social and economic growth parameters. Methods: For this study, data related to health and non-health parameters were used from National Family Health Survey factsheets. In reference to “the Global Gender Gap measure by the World Economic Forum”, the indicators have been classified into 4 broad themes, for each of which, indicators were se-lected from NFHS factsheet for analysis, interpretation, and reporting. Results: A2.9% increase in the child sex ratio from 991 to 1022 females per 1000 males over the last two NFHS rounds, indicates a significant societal shift in the country. Out of 21 selected indicators, 4 pa-rameters namely Screening test for cervical and breast cancer, Marriage of women before 18 years of age and Anaemia amongst women have shown a negative change over the past 5 years. Conclusion: The study found that, India has made significant progress around the health, education, economic and social empowerment parameters. But to get an adequate assessment of developments, we need to expand the basket of indicators to holistically analyze change.

Low incidence of metabolic syndrome in patients taking atypical antipsychotic in Eastern India

Background: Atypical antipsychotics, widely used in many psychiatric diseases, are known to cause metabolic syndrome (MetS). But, there is sparse of prospective study to see the effect of atypical antipsychotics causing MetS in drug na飗e or drug free patients among the Indian population. This study aimed to determine the incidence of MetS and change in individual risk factor for MetS in schizophrenia and mood disorder patients after three months of receiving atypical antipsychotics. Method: Sixty patients of schizophrenia (n=40) and mood disorders (n=20) were screened at the baseline and all of them were prospectively followed up for the occurrence of MetS after three months. Results: By applying the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (NCEP/ATP III) modified criteria for Asian, the incidence of MetS was found to be 11.66%. When analysing the individual risk factor for MetS, the mean value from baseline to follow-up was weight (in kg) 58.55�.03 to 59.80�.24 (p<0.001), waist circumference (cm) 80.52�33 to 81.43�42 (p<0.001), systolic blood pressure (mm/Hg) 113.93�28 to 117.53�.89 (p<0.001), diastolic blood pressure (mm/Hg) 74.80�31 to 78.32�79 (p<0.001), fasting blood glucose (mg/dl) 86.23�.02 to 91.35�.04 (p<0.001), triglyceride (mg/dl) 97.32�.41 to 101.25�.38 (p<0.001), high-density lipoproteins (HDL) (mg/dl) 48.07�98 to 48.05�57 (p=0.951). Conclusion: Our study suggests that incidence of MetS in Indian population was 11.66% after three months of using atypical antipsychotic drugs in patients with schizophrenia or mood disorder. The change in mean value in the individual risk factor for MetS was statistically significant. Long-term follow-up studies are required to identify the real burden of MetS after using atypical antipsychotic drugs.

Pharmacognostical And Phytochemical Standardization Of Physalis Minima L. Leaf

Objective: To evaluate the pharmacognostical and phytochemical parameters of Physalis minima leaf. Methods: The leaf of Physalis minima was examined for macroscopical, microscopical, physicochemical parameters and fluorescence analysis. Extracts obtained from the leaf was analyzed for phytochemical screening and estimation of total tannin, phenolic and flavonoid content following the standard procedure available in the literature. Results: Morphologically, the leaf was found to be ovate in shape, 5 to 8 cm long and up to 3 cm width with dentate margin, asymmetrical base, hairy surface, reticulate veins on each side of midrib, green in colour, characteristic odour and slight bitter in taste. Microscopic study has shown the important diagnostic characters of Solanaceae family which is characterized by presence of dorsiventral leaf with anomocytic stomata, grandular or uniseriate trichomes and cluster crystal of calcium oxalate. Physicochemical parameters like foreign organic matter (0.78%), loss on drying (8.23%), total ash (11.4%), acid insoluble ash (2.2%), water-soluble ash (6.1%), sulphated ash (2.4%) alcohol soluble extractive (10.4%), water-soluble extractive (9.5%), ether soluble extractive (1.8%) foaming index (below 100), swelling index (1), volatile oil and heavy metal content were quantified. Phytochemical analysis of different extracts of Physalis minima leaf has shown the presence of phytoconstituents viz. alkaloids, steroids, tannin, flavonoids, protein. Quantification of phytoconstituents was also reported like phenols (10.59±0.65 mg/gm equivalent to tannic acid), tannin (8.24±0.27 mg/gm equivalent to tannic acid) and flavonoids (87.17±0.87 mg/gm equivalent to rutin) respectively. Conclusion: This present study was provided the qualitative and quantitative standard of Physalis minima will help to prevent the possible steps of adulteration with other species of the same genus.

Fungemia due to Trichosporon mucoides in a diabetes mellitus patient: A rare case report.

Trichosporon species are widely distributed in nature and can occasionally belong to the human microbiota. For many years, Trichosporon beigelii, the only species of this genus, was found as the aetiological agent of superfi cial skin infection called white piedra. However, many cases of invasive trichosporonosis caused by different newly delineated species of Trichosporon have been published in increasing numbers in recent past years, especially in immunocompromised persons. We report a rare case of fungemia due to Trichosporon mucoides in a diabetes mellitus patient, which will add to the emerging list of trichosporonosis infections.

Ocular sparganosis.

A 50-year-old male attended outpatients department with complaints of irritation, foreign body sensation and mild redness in his right eye. On examination a conjunctival nodule was found with localised inflammation. All investigations were normal. Surgical excision of the nodule was contemplated. During local dressing a live tapeworm about 20 cm in length and 3 mm in breadth emerged. Pathological examination confirmed it to be a tapeworm spirometra. The case was diagnosed to be ocular sparganosis.

Severe haematoma of the vulva--a report of two cases and a clinical review.

Haematoma of the vulva may occur following blunt trauma due to its highly vascular structure. We present two cases of haematoma of the vulva caused by domestic violence, following a kick on the perineum and falling astride on the perineum. Evacuation of the haematoma and repair of lacerated tissues were successfully performed.

Pedunculated angiomyxoma of the vulva - a rare clinical entity.

BACKGROUND: Aggressive angiomyxoma is an uncommon mesenchymal tumor that preferentially involves the pelvic and perineal regions of females. Since its initial description in 1983, approximately 65 cases have been reported in the English literature. CASE: A 33-year-old parous woman with a slow growing pedunculated soft tissue tumour of the vulva which later underwent surface ulceration. Pathological findings in the case were suggestive of an aggressive angiomyxoma, a distinctive soft tissue non-malignant tumour, which could, at times be locally aggressive.

Frequency and role of hepatitis-C virus and type II cryoglobulinemia in membranoproliferative glomerulonephritis.

BACKGROUND: Many studies have claimed a major role of chronic hepatitis-C virus (HCV) infection in immune-mediated diseases such as membranoproliferative glomerulonephritis (MPGN). Chronic HCV infection is also known to produce essential mixed cryoglobulinemia (EMC), which in turn may manifest as vasculitis and cryoglobulinemic MPGN. OBJECTIVE: The aim of the study therefore, was to determine frequency of association and pathogenetic role of HCV infection as well as that of EMC in MPGN patients. METHODS: Fifty-three adult patients of MPGN were studied for HCV, HBsAg, EMC, C3, anti-nuclear antibody (ANA), rheumatoid factor serologically. Histopathology, immunofluorescence (IF) were conducted in all patients and electron microscopy (EM) in those who were found HCV positive. Simultaneously 37 follow-up patients of HCV associated chronic hepatitis were investigated for EMC, renal functions and urinalysis done for evidence of glomerulonephritis (GN). RESULTS: Thirteen percent MPGN patients were HCV positive, however, no viral particle could be seen in electron microscopy in glomeruli of these patients. There was no serologic evidence of HCV induced immune complex GN. None of the MPGN patients showed cryoglobulinaemia. Similarly none from HCV associated chronic hepatitis group had EMC nor showed evidences of glumerulonephritis. CONCLUSION: Thirteen percent of adult MPGN patients in north India were seropositive for HCV, indicating significant association. However, clear evidence in favour of its pathogenetic role was lacking in our study. Secondly, this study reveals that MPGN is non-cryoglobulinemic and HCV is not a major cause in our population compared to what is reported from other countries. These observations need confirmation by a larger study.

Pulmonary mucormycosis in a diabetic renal transplant patient.

A 50-year-old male, diabetic, post transplant patient had recurrent pneumonia. The first episode responded well to antibiotics, while on the second occasion he had a necrotising pneumonia, which developed into a thick-walled cavity. Despite antibiotics, his condition rapidly deteriorated precluding bronchoscopy or percutaneous biopsy. Post-mortem lung biopsy revealed typical hyphae of mucormycosis.

Pneumocystis carinii pneumonia: role of high resolution computed tomography.

Pneumocystis carinii (PC) is a common opportunistic infection in renal transplant recipients and requires an early diagnosis for its successful treatment. For its definitive diagnosis PC needs to be demonstrated in bronchoalveolar lavage (BAL) fluid. At times BAL may not be possible or get delayed. In such conditions typical appearances seen on high resolution CT of the chest help in early diagnosis of PC pneumonia (PCP). This easily performed procedure helped in early diagnosis of PCP in two patients.

Results of renal transplantation on conventional immunosuppression in second decade in India: a single centre experience.

BACKGROUND: In-spite of many renal transplant (RT) centres in the country, there is paucity of data on the survival results in India. Furthermore, there is hardly any data of results in second decade. In this study we present the results of RT in second decade at our centre. METHODS: RT at our hospital is being done since 1972. First eight years saw occasional RT and complete data is not available in these patients. So, we have excluded these patients from the study. We have included rest all 144 patients who had RT between Jan. 1981 to Dec. 1989, so as to have at least 10 years of follow-up or more. All these patients were on conventional immunosuppression. RESULTS: Of the 144 patients, 126 (87.5%) were males and the mean age was 29.5 +/- 8.5 years (range 14-54). Basic disease was presumed chronic glomenulonephritis (CGN) in 79.9%, vesicouretenic reflux (VUR) in 8% and diabetic nephropathy in 1.4% patients. Mean number of haemodialysis (HD) and blood transfusion before RT were 44 +/- 24.7 and 8.9 +/- 4.7 (range 0-25), respectively. Mean donor age was 40.9 +/- 10.1 year (range 18-62). HLA matching was haploidentical in 74.5% cases, HLA identical in 3% cases and 11.5% were less than two-antigen match. Of the 63% patients, who had at least one acute rejection (AR) during their follow-up, 78.8% cases had this AR within first three months after the renal transplant. During 10 years of follow up, 65 patients died (23 with normal graft function and 42 with chronic rejection) and 17 lost to follow-up. Eight patients lost their graft but were surviving at 10 years and 54 had functioning graft till the time of analysis. With mean follow-up of 83.9 +/- 61.2 (range 1-216) months, 10-year actuarial patients and graft survival was 53% and 47%, respectively. Graft half-life in these patients is 92 months. In multivariate analysis of the donor age, number of blood transfusion (BT), degree of HLA matching and AR, only AR was found to be statistically correlated with the graft outcome (p=0.004). CONCLUSION: Our study concludes that in our set-up during eighties, on conventional immunosuppression, actuarial patient and graft survival at 10 year is 53% and 47%, respectively with graft half-life being 92 months. Only acute rejection has been found to affect the graft outcome in these patients.

Influence of HLA compatibility on renal graft survival using live unrelated & cadaver donors in India.

BACKGROUND & OBJECTIVES: Living unrelated donor (LURD) renal transplantation has shown a rising trend over the last 5 yr at our center following the passing of The Transplantation of Human Organs Act by the Government of India in 1994. In this paper, the results of LURD and cadaver (CAD) donor renal transplantation are compared. We have also looked into factors that have a bearing on graft survival such as the extent of HLA mismatch (MM), infections, acute rejections (AR), donor age and sex. METHODS: A total of 42 LURD and 25 CAD renal transplants performed between March 1994 and February 1999 has been included in the study. HLA typing, panel reactive antibody (PRA) screening and T and B cell cross match assay were performed by the complement dependent cytotoxicity (CDC) method for all patients. RESULTS: The graft survival rates were generally higher in the LURD category as compared to the CAD group and were significant at 6 month period (90 vs 56%, P = 0.002). A follow up of the patients up to 60 months revealed a matching effect since the 3, 4 allele MM group had better survival rates as compared to the 5, 6 MM group. Twenty six of the 67 recipients (39%) experienced episodes of acute rejection (AR). Patients with 3, 4 MM had fewer such episodes than those with 5, 6 allele MM (P < 0.05). Of the 32 deaths, 20 were those with a functional kidney, of which 15 were caused by severe infections. INTERPRETATION & CONCLUSION: Better HLA matching ensures fewer episodes of rejection and better long term graft survival in comparison to the poorly matched grafts. The graft survival for LURD recipients was appreciably higher than that of CAD recipients.

A study of behaviour patterns of normal children in a dental situation and its relationship with socioeconomic status, family type and sibling position.

Different psychosocial variables, such as socioeconomic status, family type and sibling position may be considered to be of great significance as it may influence child behaviour pattern in a dental treatment situation. 143 children in the age group of 3-14 years were selected randomly from the out patient department of Pediatric Dentistry, Dental Wing, S. C. B. Medical College, Cuttack with an aim of assessing relationship, if any, between the magnitude of behaviour and the above mentioned psychosocial variables. Behaviour rating was done using Frankl behaviour rating scale. The results of the study reveals no significant relationship between socio economic status, family type and sibling position with child behaviour pattern, but a trend has been observed that children of high socio economic back ground behave more positively, children of a nuclear family exhibit more negative attitude and middle siblings show less negative behaviour than youngest and eldest.