Burkholderia cepacia causing liver and splenic abscess: Two case reports

Burkholderia cepacia infections are common among immunocompromised patients but multiple reports have shown that it can affect immunocompetent patients also. We are reporting two patients with multiple liver and splenic abscesses caused by Burkholderia cepacia. First case is a 54-year-old diabetic male presenting with fever, abdominal pain, bilateral lower limb weakness, and incontinence of urine. Second case is a 41-year-old male presenting with fever and confusion. Both had liver and splenic abscesses. Pus aspirated from the abscesses grew Burkholderia cepacia. Both responded to cotrimoxazole. Our case report emphasizes growing incidence of Burkholderia cepacia in immunocompetent patients.

External dacryocystorhinostomy conventional surgery versus Pawar implant: A comparative study

Purpose: External dacryocystorhinostomy (DCR) surgeries are cost-effective with excellent success rates. The present study was designed to compare the safety and efficacy of conventional external DCR versus external DCR using Pawar silicone implant in chronic dacryocystitis. Methods: This is a prospective, comparative, interventional case series over a period of 18 months with patients managed by external DCR surgery with and without Pawar implant. Institutional review board approval was obtained before the study. The success of the surgery was objectively measured by sac patency on syringing at the last follow up. Results: A total of 65 patients with chronic dacryocystitis were included in the study. The mean age of patients in the series was 41.43 years (median, 41 years; range, 12 years-60 years). All patients presented with epiphora (100%) and underwent external DCR and were chosen for conventional surgery (n = 33, 51%, group 1) or Pawar silicone implant surgery (n = 32, 49%, group 2) on a random basis. The mean duration of the surgery from the time of skin incision to skin closure for group 1 was 27.7 minutes (median, 26 minutes; range, 21-30 minutes) while in group 2, it was 75.5 minutes (median, 75 minutes; range, 60-88 minutes), which was statistically significant (P < 0.01). The success rate of the procedure done in group 1 was 90% which increased to 97% after the management of failed cases as compared to the success rate in group 2 of 91% and 94%, before and after the management of failed cases, respectively. Conclusion: External DCR using Pawar implant is a safe surgery which is faster than conventional external DCR with almost equal success rates between both the procedures.

Correlation of Maternal Age with Prevalence of Chromosomal Anomalies in Patients of Anorectal Malformation

Introduction: Aims: To identify the Anorectal malformations patients in North Indian region and then study the karyotype of these patients to evaluate cytogenetic aberrations and then correlate it with the maternal age. Subjects and Methods: Forty eight patients of anorectal malformation were selected from Department of Paediatric Surgery, KGMU, UP, Lucknow. Blood samples were collected and their cytogenetic study was done in the Department of Anatomy, KGMU-U.P, Lucknow. Karyotypes obtained were further analysed. Results: Out of 48 children enrolled in the study, karyogram could be obtained for 45 cases (93.75%). Maternal age at the time of birth of the child was <30 years in 91.1% cases. There were only 8.9% women who were >30 years of age at the time of birth of the child. However, proportion of those with anomalies was significantly higher in >30 years age group (75%) as compared to that in <30 years age group (2.4%). Conclusion: Although low maternal age was found most commonly, but number of cases with chromosomal anomalies was reported more in >30 years of age, which could be due to increased risk of congenital anomalies and malformations with advanced age.

Comparison of optical coherence tomography angiography and fundus fluorescein angiography features of retinal capillary hemangioblastoma

The aim of this study is to compare the optical coherence tomography angiography (OCTA) and fundus fluorescein angiography (FFA) features of retinal capillary hemangioblastoma (RCH). This is an observational case series of three patients with von Hippel朙indau (VHL) disease and one patient with juxtapapillary RCH. All patients underwent FFA with a mydriatic fundus camera and OCTA with swept-source angio OCT. The FFA and OCTA characteristics of tumors were compared. In our series, FFA could identify tumors as small as the width of a third-order retinal artery, which was missed on clinical examination. OCTA identified these tiny tumors, but only those closer to the posterior pole. Both FFA and OCTA could identify the intrinsic vasculature and feeder vessel in juxtapapillary RCH. On OCTA, the tumors were better defined than in FFA. The depth of the lesion can be identified on OCTA. Feeder and the draining vessels could be identified precisely in OCTA than FFA, particularly in small tumors. OCTA can identify tumors in VHL missed on clinical examination. It can identify the feeder vessel and intrinsic vasculature of sessile juxtapapillary RCH and aids in its diagnosis. Tumors are better defined in OCTA than FFA due to the absence of leakage. However, FFA can identify nearly all the early tumors, but OCTA fails to image the peripheral tumors due to its smaller field and prolonged acquisition time. Technological advances and the development of wide-field OCTA in the future can be helpful in identifying all the unsuspected tumors in VHL disease.

Histo-cytological responses of the prolactin cells of the catfish Heteropneustes fossilis to cadmium exposure / Respuesta histológica y citológica frente a la exposición a cadmio de las células prolactínicas del pez gato Heteropneustes fossilis

Cadmium is an important metal for modern industrial processes and, being biologically non-essential, poses health hazards to the organisms. In this study we aimed to evaluate the effect of cadmium exposure on the histo-cytology of prolactin cells in the freshwater catfish, Heteropneustes (H.) fossilis. Fish were subjected to 288 mg/L (0.8 of 96 h LC50) and 72 mg/L (0.2 of 96 h LC50) of cadmium chloride for short-term and long-term, respectively. After sacrificing the fish, the blood was collected on 24, 48, 72 and 96 h in short-term and after 7, 14, 21, and 28 days in long-term experiment and analyzed for plasma calcium levels. Also, pituitary glands were fixed on these intervals. The plasma calcium levels of short-term cadmium exposed fish remain unchanged after 24 h. The levels exhibit a progressive decrease from 48 h onwards. The fish exposed to cadmium for 7 days exhibit a decrease in the plasma calcium level. Thereafter, the levels progressively decrease till the end of the experiment (28 days). The prolactin cells of the control fish exhibit structural resemblance to the description given for the prolactin cells of normal H. fossilis. No change in the histological structure and nuclear volume of prolactin cells of cadmium non-exposed fish has been noticed throughout the experiment. In cadmium treated fish, the prolactin cells remain unchanged till 14 days. On day 21, the nuclear volume of these cells exhibits an increase and the cells degranulate. These changes increased profoundly on day 28. In addition, vacuolization and cytolysis were also encountered on day 28 following cadmium treatment. It is concluded that cadmium affects the prolactin cells of the fish H. fossilis thus disturbing the ionic balance.

El cadmio es un metal importante para los procesos industriales modernos, siendo no esencial biológicamente, representa riesgos para la salud de organismos. En este estudio tratamos de evaluar el efecto de la exposición al cadmio por el aspecto histológico y citológico de células secretoras de prolactinas del pez gato de agua dulce Heteropneustes (H.) fossilis. Los peces fueron sometidos a una exposición de 288 mg/L (0,8 de 96 h CL50) and 72 mg/L (0,2 de 96 h CL50) de cloruro de cadmio por a corto y largo término respectivamente. Después del sacrificio de los peces, la sangre fue colectada, tomando muestras de 24, 48, 72 y 96 hs en el corto término y de 7, 14, 21 y 28 días en las sometidas a largo término, la cuales se analizaron para medir niveles de calcio. Además, las glándulas pituitarias fueron fijadas en esos intervalos El nivel plasmático de calcio en los experimentos de exposición a corto tiempo se mantuvo sin cambio tras 24 h. Los niveles exhibieron una caída progresiva a partir de las 48 hs. Los peces expuestos a cadmio por 7 días presentaron una disminución en el nivel plasmático de calcio. Después de esto, los niveles decayeron progresivamente hasta el fin del experimento (28 días). Las células prolactínicas de los peces controles mostraron semejanza estructural a la descripción dada para estas células normales en H. fossilis. No se observaron cambios en la estructura histológica y el volumen nuclear de las células prolactínicas de los peces no expuestos a cadmio a través de todo el experimento. En los peces tratados con cadmio las células prolactínicas se mantuvieron sin cambios hasta los 14 días. En el día 21, el volumen nuclear de esas células se incrementó y estas células presentaron desgranulación. Estos cambios aumentaron profundamente en las muestras del día 28. Adicionalmente en el día 28 posterior al tratamiento con cadmio se encontró vacuolización y citólisis. Se concluyó en que el Cadmo afecta las cñelupas prolactínicas de H fossilis, produciendo disturbios en el balance iónico.

Identification of compatible bacterial and fungal isolate and their effectiveness against plant disease.

Forty-three isolates of Trichoderma spp. and forty isolates of bacterial (fluorescent pseudomonads) biocontrol agents were isolated and evaluated for their relative biocontrol potential and thereafter development of mixed formulation of efficient compatible fungal and bacterial bio-agents. Different isolates of either Trichoderma or Pseudomonas exhibited differential antagonistic activity with different species of tested pathogens. Pseudomonas in general, suppressed the growth of Trichoderma under in-vitro conditions however, a few combinations were found compatible. Fungal isolate PBAT-43 (T. harzianum) and bacterial isolate PBAP-27 (P. fluorescens) emerged as most compatible and efficient and therefore were used for development of mixed formulation. Individual and mixed formulations were evaluated for their relative bio-efficacy under glass-house and field conditions. Mixed formulation exhibited increase in seed germination ranges from 25.5 - 72.11 % and disease control 47.68- 76.00 % in different crops as compared to control. Application of compatible mixture of fungal and bacterial bio-control agents possessing various mechanism of pathogen suppression is suggested as a reliable and potential means of disease suppression.

Effect of sublethal exposure of Cartap on hypothalamo-neurosecretory system of the freshwater spotted murrel, Channa punctatus (Bloch).

In order to record the effect of carbamate pesticide on hypothalamus of Channa punctatus, fish were exposed to sublethal concentration (0.18 mg l(-1), 30% LC50 for 96 hr) of Cartap for 24, 48, 72 and 96 hr under static bioassay condition. Hypothalamo-neurosecretory complex of the murrel consisted mainly of nucleus preopticus (NPO), nucleus lateralis tuberis (NLT) and their axonal tracts. NPO is a paired structure situtated on either side of the third ventricle anterodorsal to the optic chiasma and looked inverted L-shape in the sagittal section. NPO is morphologically divisible into a dorsal pars magnocellularis (PMC) consisting of large neurons and ventral pars parvocellularis (PPC) formed of smaller neurosecretory cells. NLT cells are distributed in the infundibular floor adjacent to the pituitary stalk. Sublethal Cartap treatment induced an initial hypertrophy of the neurosecretory cells of NPO and NLT followed by loss of staining affinity as well as varying degrees of cytoplasmic vacuolization and necrosis. Herring bodies (HB) were also encountered in the neurohypophysis of the treated fishes.

Awareness about taeniasis and neurocysticercosis among municipal schoolteachers in Delhi.

Taenia solium is the commonest parasitic infection of CNS and an important cause of new-onset seizures and epilepsy in children and adults. Human activities impact on almost every one of the stages of the lifecycle of the worm as man is responsible for dispersion of the parasite's egg through outdoor defecation and indiscriminate disposal of feces. Health education to cause behavioral changes in these practices can therefore be an effective intervention strategy. We conducted a study to assess KAP regarding taeniasis and neurocysticercosis among municipal school teachers in Delhi. The findings are presented in this communication. The study revealed that, general information related to personal food hygiene was known to majority of the teachers but core information in the context of taeniasis/cysticercosis and seizure prevention was lacking.

Interaction between warfarin and tamoxifen: a case report.

Warfarin is a commonly used anticoagulant with documented reports of drug interactions. Tamoxifen is used in the adjuvant hormonal treatment of women with oestrogen-receptor- positive breast cancer. Warfarin and tamoxifen are known to interact with each other with a resultant increase in the bleeding tendency. These reports are mainly from the white population. We report a case of drug interaction between warfarin and tamoxifen with an acute onset. This report suggests that when these drugs are co administered, careful monitoring of the coagulation profile is needed.

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.

Epidermolytic hyperkeratosis with rickets.

A 6-year-old child presented with generalized hyperkeratosis, most marked over the flexures; windswept deformity of the legs; and limping since 3 years. On the basis of the clinical, histopathologic and biochemical findings, he was diagnosed as a case of epidermolytic hyperkeratosis with rickets. He was treated with parenteral vitamin D3 and calcium supplements orally. Nutritional rickets has been reported in children with various types of ichthyosis like lamellar and X-linked types. We report this case of epidermolytic hyperkeratosis with rickets for its rarity.

Hereditary coagulation factor X deficiency.

Stuart Prower factor (Factor X) deficiency is a rare hereditary autosomal recessive coagulation disorder. We have come across three cases in the course of last 20 years at our institute. These patients presented with prolonged bleeding after minor trauma, epistaxis, subcutaneous bluish black nodules and two of them presented with history of consanguinity in parents. Hematological findings in correlation with clinical manifestations revealed severe factor X deficiency.

Antithrombin III assay using thrombin in disseminated intravascular coagulation (DIC), other thromboembolic disorders and hepatic diseases.

Fifty cases comprising 11 cases of disseminated intravascular coagulation (DIC), 16 cases of venous thromboses and 23 cases of hepatic diseases were studied for AT III levels using clotting assay. Twelve samples were subjected to ATIII estimation by the commercially available synthetic chromogenic assay. Twenty age and sex matched controls were also analysed to find out the reference value for the techniques. Low AT III levels, if present, were correlated with other markers of DIC, viz FDP and D-dimer assays. There was a decrease in the AT III levels in all the three disease categories with a significant difference between the AT III levels of the three disease categories. In DIC, lowest levels were observed which correlated well with FDP and D-dimer levels. There was no significant difference between the average AT III levels measured by both the clotting and synthetic chromogenic assay with the former procedure being relatively inexpensive.

Role of chest CT scan in determining etiology of primary spontaneous pneumothorax.

BACKGROUND: Spontaneous pneumothorax occurs subsequent to a disruption in the continuity of visceral pleura and escape of air into pleural space. It is usually difficult, sometimes impossible to detect evidence of pulmonary pathology by clinical or conventional radiographic methods. Computed tomography provides additional informations not obtainable with conventional diagnostic modalities. METHODS: To determine the role of CT scan in the aetiological diagnosis and subsequent management of patients with primary spontaneous pneumothorax, a perspective study was undertaken. RESULTS: A total of 40 patients with spontaneous pneumothorax with normal skiagram chest after management of pneumothorax, were included in the study. In 75% of these cases, CT revealed underlying lung pathology as a cause for primary spontaneous pneumothorax. CONCLUSION: Our study shows that CT scan is a useful imaging modality in determining the aetiology of primary spontaneous pneumothorax.

Immuno-pathotyping of Karnal bunt (Tilletia indica) isolates of wheat using anti-mycelial antibodies.

Two types of polyclonal antibodies raised against whole lyophilized (LMA) and fractionated mycelial antigen (FMA) of most virulent, Pantnagar isolate of T. indica were used for the development of immunoassay systems, viz. dot immuno-binding assay (DIBA) and indirect enzyme linked immuno-sorbent assay (ELISA) procedures. The immuno-assays were developed by performing antigen concentration kinetics and antibody dilution curves analyses. These assays were employed for immuno-analysis of diversity amongst KB pathogen based on antibodies reactivity pattern and subsequently categorization into distinct sero-groups. The reactivity of two polyclonal antibodies was tested with 15 (P1-P15) isolates of T. indica. When anti-LMA antibodies were tested, four serologically distinct groups were formed based on percent reactivity (>75%, highly reactive; 60-75%; moderately reactive, <50-25%; low reactive and <25%, non-reactive). However, when anti-FMA antibodies were used, two distinct sero-groups were formed based on reactivity patterns (group I, highly reactive P1, P3, P4, P11 and P13, group II, less reactive P2, P4, P5, P6, P7, P8, P9, P10, P12, P14 and P15).

Pulmonary chondroid hamartoma with unusual presentation.

Large-sized pulmonary chondroid hamartomas are very uncommon. We report a case of a 40-year-old male patient with a large sized chondroid hamartoma occupying almost the whole of one hemithorax, presenting with superior vena caval obstruction, left vocal cord palsy and adrenal involvement.