Abuse with impunity in sports: Some reflections

With the conviction of a US gymnastics coach on criminal sexual conduct and other charges, our attention is inevitably drawn to the sporting world in India. The case points to the imperative need for regulations, mandates and ethical codes to protect athletes, especially elite performers under pressure to win. As is now evident, authoritarian structures that do not allow athletes a voice are perfect locations for abuse. An examination of the state of ethical codes and regulations in sports in India is long due. This short essay looks at the issues that must find space in public discussion and in the deliberations of sporting bodies, with a particular emphasis on the role of the medical profession in sports.

Diagnostic Accuracy Of Xpertmtb/Rif Assay In Detection Of Pulmonary Tuberculosis And Rifampicin Resistance In Comparison With Conventional Methods.

Introduction: Tuberculosis is one of the oldest diseases with high morbidity and mortality. India accounts for one- fourth of the global TB burden (2.7million cases). Material and methods: A total 1056 patients were included in this study. All patients were requested to give two sputum samples, spot sputum sample (at the time of visit) and early morning sputum for mycobacterial testing. All spot samples tested with smear microscopy and Xpert MTB/Rif assay. Rifampicin resistant samples compared with conventional method. Results: Out of 1056 sputum samples GeneXpert MTB Rif assay detected positive 204 (19.3%), not detected 827 (78.31%). There is significant difference founded for positivity in spot samples and early morning sputum samples (P =0.0026). Rifampicins resistant were 8 (3.9%) andshown 100% sensitivity, specificity with Conventional method. Conclusion: For diagnosing tuberculosis and detecting Rifampicin resistance GeneXpert MTB/RIF has been especially recommended.

The Physiochemical, Biological Quality and Seasonal Variability of River Ganges in Varanasi, Uttar Pradesh, India

Background: The Ganga River is a life-line, a symbol of purity and virtue for countless people of India. Nearly all the sewage, industrial effluent, runoff from chemical fertilizers and pesticides used in agriculture within the basin, and large quantities of solid waste, including thousands of animals carcasses and hundreds of human corpses are dumped in the river everyday which posed a considerable public health threat to the religious bathers and a large number of people living along the river who uses Ganges water for drinking and other household purposes. Objective: To assess the physiochemical and biological quality of river Ganges water and to study the seasonality pattern of pollution of River Ganges. Materials and Methods: Two points namely Samne ghat and Rajghat (entry and exit point of Ganga into the city) were selected as the first and the last sampling stations, beside 8 other intermediate sampling stations to assess the physiochemical and biological quality of River Ganga water. The study was conducted from April 2013 to March 2014 and this period was crudely divided into three seasons viz Winter, Summer and Rainy season for the purpose of studying seasonality pattern of pollution. Results: As the river progress through city of Varanasi, Total dissolved solids (TDS), Chloride, Conductivity, Biochemical Oxygen Demand (BOD), Nitrate, Nitrite and Most Probable Number (MPN) increases, DO decreases progressively and Temperature and pH remain same. Conclusion: As far as quality of water with regard to recreational and industrial purposes are concerned, Ganges water may be considered useful but most of the parameters observed across different seasons indicates that it may not be used as potable water.

Fasciolopsiasis: Endemic focus of a neglected parasitic disease in Bihar.

Purpose: To describe a newly discovered, previously unreported endemic focus of fasciolopsiasis in the Phulwaria village, under tehsil Sugauli, East Champaran, Bihar. Materials and Methods: A study was conducted at village Phulwaria, following diagnosis of fasciolopsiasis in three children from the village. A total of 120 individuals, including all the children and adults who gave history of recent passage of red fleshy masses in their stool, were included in the study. The cases of fasciolopsiasis were treated with Praziquantel 25 mg/kg, three doses a day. Risk factors for the transmission of the parasite in the village were also studied. Results: Questionnaire revealed majority of the population suffering from abdominal discomfort and passage of red fleshy masses in stool. These fleshy masses were identified as Fasciolopsis buski. One hundred and eighteen individuals were presumably considered as cases of the parasitic infection. After treatment with Praziquantel, all of them passed the parasite in their stool for the next 2–3 days. On investigating, it was observed that all the conditions required for effective continuation of the life cycle of the parasite were present in this village. Conclusion: This study draws attention to a new endemic focus of fasciolopsiasis in Bihar, with a very high prevalence due to poverty, the lack of awareness about the parasite in villagers as well as ignorance among local medical practitioners. There is an urgent need for mass campaign around the region for its effective control.

Assessing the Gap in Policies of Human Resources, Quality and Communication for Indian Teaching Hospitals.

Introduction: Teaching hospital is one of the apex bodies of Indian hospital system, which is catering to much desired healthcare needs of both rural and poor urban society. Objectives: The study examines the status of Indian teaching hospitals both government and private in the changing global scenario by assessing the gaps in their management practices based on three core parameters, i.e. human resource management, quality improvement and patient safety, and communication and patient relation through their adherence to documentation and policy with respect to the expected norms nationally and internationally. The standards were chosen from Joint Commission of International Accreditation (JCIA) in concurrence with National Accreditation Board for Hospitals and Healthcare Providers (NABH) to ensure comprehensiveness and appropriateness to Indian environment. Design and settings: Eleven teaching hospitals were selected from the 6 divisions of Maharashtra (minimum 1 from smaller division and 2 or above from larger division). The medical superintendent was interviewed from each 11 hospital. The responses were given scores, such as 10, 5, 0 (full, partial, no compliance). Results: The overall scores for policy/documentation were 6.29 ± 1.96, 5.00 ± 3.06 and 2.95 ± 2.48 for HRM, quality and communication respectively, among teaching hospitals. Moreover, there were significant gaps among all 6 standards of human resource management (HRM) [F(5,60) = 24.217, p < 0.001], quality/ safety [F(5,60) = 21.524, p < 0.05] and communication [F(10,55) = 10.455; p < 0.05] on their own. Indeed, these hospitals were found to be significantly behind the global standards. Conclusion: Teaching hospitals comply with norms of staff, qualifications and department-wise infrastructure as part of Medical Council of India (MCI) regulations, which is prerequisite for global standards. So by designing hospital’s policies with inclusion of some cost-effective approaches, these hospitals can attain quality services.

Role of glipizide therapy on oxidative stress parameters in the patient with Type-II diabetes mellitus.

Background: Oxidative stress has an important role in the pathophysiology of diabetes mellitus (DM) Type-II. Oxidative stress has an important role in the progression of DM Type-II and its related complications such as retinopathy, neuropathy and many others. The present study was carried out to evaluate the effect of glipizide therapy on oxidative stress parameters in Type-II DM. Methods: Thirty newly diagnosed diabetes patients were given glipizide therapy on 1st day and continue for 3 months. 30 non-diabetic healthy volunteers served as a control. Plasma malondialdehyde (MDA), superoxide dismutase (SOD) and catalase levels were measured at the time of enrollment and at the end of 3 months of glipizide treatment. Result: The results are analyzed using paired t-test. Plasma MDA was significantly increased, whereas SOD and catalase were significantly reduced in newly diagnosed diabetic patients as compared to control. After 3 months of glipizide therapy, plasma MDA was significantly reduced, whereas SOD and catalase were significantly increased. Conclusion: Glipizide therapy significantly reduced oxidative free radicals and increased antioxidant mechanism, which reduced oxidative stress, progression DM-II and its related complication.

Effect of atenolol on hemoglobin level in mild to moderate hypertension.

Background: Hypertension is the most common cardiovascular disease and a major cardiovascular risk factor that causes significant morbidity and mortality worldwide. Most common type is primary (essential) hypertension and is genetically determined. It affects many systems of the body and can also alter various hematological parameters. The study was undertaken to check the effect of atenolol on hemoglobin (Hb) level in mild to moderate hypertension. Methods: The study was prospective and non-randomized. Thirty newly diagnosed hypertensives selected for atenolol therapy by medicine personnel were enrolled in the study based on inclusion and exclusion criteria. Patients were divided into pre-treatment (before starting atenolol therapy) and post-treatment group. Red blood cell (RBC) count, Hb, packed cell volume (PCV) and red cell indices were measured at the time of enrolment and then monthly after starting atenolol for next 3 months. Result: Results were analyzed by repeated measure analysis of variance. Atenolol treatment was found to increase Hb and PCV significantly, whereas no significant change in RBC count and red cell indices. Conclusions: Treatment with atenolol for mild to moderate hypertension has shown a significant increase in Hb and PCV level. This positive effect may be because of the decrease in sodium and water reabsorption by decrease in sympathetic overactivity and excretion of sodium and water by improvement in kidney functions. Atenolol has no any direct effect on Hb synthesis and erythropoiesis.

Healing Drug Can Harm Patients Badly :Severe Burn Injury in the Wound with Eusol Dressing – A Rare Entity.

EUSOL (Edinburgh University Solution of lime) is a commonly used solution in Surgical unit which will help the patient in faster wound healing. It is found most effective in Pseudomonads organism. But it will harm the patients too bad as burns if it is used in surgical application without proper dilution with normal saline or with distilled water.

Association of Malassezia species with dandruff.

Background & objectives: Malassezia species implicated with dandruff vary at different geographical locations. The present study was conducted to determine the spectrum and distribution of Malassezia species in dandruff patients and healthy individuals. Methods: Patients with dandruff from northern (Chandigarh) and southern (Manipal, Karnataka) parts of India (50 each) and healthy individuals (20) were included in the study. Dandruff severity was graded as mild, moderate and severe. Malassezia spp. isolated were quantified and identified by phenotypic characters and molecular methods including PCR-RFLP and DNA sequencing. Results: Number of Malassezia spp. retrieved was significantly higher (P<0.001) in dandruff cases (84%) as compared to healthy individuals (30%). Isolation of Malassezia spp. was significantly higher (P<0.01) in patients from southern India. In moderately severe cases M. restricta was single most predominant (37.8%) isolate from patients of northern part of India and M. furfur (46.4%) from patients of southern part of India. Malassezia density was significantly associated with the severity of dandruff (P<0.001). Interpretation & conclusions: Our results on a limited number of individuals show that Malassezia spp. associated with dandruff varies in different regions of the country and the density of yeasts increases with severity of disease.

Ewing's Sarcoma of the Sacroiliac Joint Presenting as Tubercular Sacroiliitis: A Diagnostic Dilemma

We report a case of Ewing's sarcoma of the sacroiliac joint in a 21-year-old male mimicking tubercular sacroiliitis, a rare entity not reported in literature. He presented with pain in the lower back radiating to the right lower limb along with constitutional symptoms of 3 months duration. On examination, the right sacroiliac joint was tender. The laboratory investigations showed anaemia, leukocytosis and raised erythrocyte sedimentation rate. On X-ray, features of right sacroiliitis were seen. This was further investigated with magnetic resonance imaging (MRI), which showed features consistent with tubercular sacroiliitis. Patient was then started on antitubercular treatment, but the improvement was not consistent. So, a contrast MRI was done, which indicated features of primary sarcoma. It was then further confirmed by a computed tomography-guided biopsy, which showed features consistent with Ewing's sarcoma of the sacroiliac joint.

Clinical Comparative Study: Efficacy and Tolerability of Tolperisone and Thiocolchicoside in Acute Low Back Pain and Spinal Muscle Spasticity

STUDY DESIGN: We performed a multicentric, randomized, comparative clinical trial. Eligible patients were randomly assigned to receive 150 mg of Tolperisone thrice daily or 8 mg of Thiocolchicoside twice daily for 7 days. PURPOSE: To assess the efficacy and tolerability of Tolperisone in comparison with Thiocolchicoside in the treatment of acute low back pain with spasm of spinal muscles. OVERVIEW OF LITERATURE: No head on clinical trial of Tolperisone with Thiocolchicoside is available and so this study is done. METHODS: The assessment of muscle spasm was made by measuring the finger-to-floor distance (FFD), articular excursion in degrees on performing Lasegue's maneuver and modified Schober's test. Assessment of pain on movement and spontaneous pain (pain at rest) of the lumbar spine was made with the help of visual analogue scale score. RESULTS: The improvement in articular excursion on Lasegue's maneuver was significantly greater on day 3 (p = 0.017) and day 7 (p = 0.0001) with Tolperisone as compared to Thiocolchicoside. The reduction in FFD score was greater on day 7 (p = 0.0001) with Tolperisone. However there was no significant difference in improvement in Schober's test score on day 3 (p = 0.664) and day 7 (p = 0.192). The improvement in pain score at rest and on movement was significantly greater with Tolperisone (p = 0.0001). CONCLUSIONS: Tolperisone is an effective and well tolerated option for treatment of patients with skeletal muscle spasm associated with pain.

Prevalence and Annual Risk of Tuberculosis Infection in Rural Mysore.

We carried out a tuberculin survey among 5-10 years old children in rural Mysore (n=1026) to estimate the annual risk of tuberculosis infection (ARTI). 90.8%of them had BCG scar.The prevalence of infection was estimated as 13.3% with 95% CI of 11.4-15.5 and ARTI as 1.38% .These figures are comparatively higher than what is reported from other places in India.

Colletotrichum graminicola keratitis: First case report from India.

Colletotrichum graminicola is a medically important fungus belonging to the order Melanconiales under the class Coelomycetes. The members of the genus Colletotrichum are primarily plant pathogens which cause anthracnoses (fungal infection in plants). In the past few decades, they are progressively being implicated as etiological agents of subcutaneous hyalohyphomycoses and keratomycoses. Of the five medically important members in the genus Colletotrichum, keratitis due to Colletotrichum graminicola is rare. We diagnosed Colletotrichum graminicola keratitis in a 44-year-old man who presented with a non-healing corneal ulcer since three weeks. Positive smears and cultures from the corneal scrapings established the causative organism as C. graminicola. The patient was treated with a combination of oral ketoconazole and topical fluconazole and natamycin. Infection resolved over 10 weeks and antimicrobials were stopped. We describe the clinical presentation and treatment outcome of Colletotrichum graminicola keratitis.

Observation on integron carriage among clinical isolates of Klebsiella pneumoniae producing extended-spectrum β-lactamases.

Purpose: Klebsiella pneumoniae is considered an important pathogen causing nosocomial and community-acquired infections and is often associated with the production of extended-spectrum β-lactamases (ESBL) belonging to SHV and CTX-M families, which are frequently described as a part of complex integrons, facilitate their horizontal transfer to other related as well as unrelated microbes. The present study was undertaken to investigate the occurrence and characterization of integrons among K pneumoniae isolates producing ESBL in a tertiary referral hospital. Materials and Methods: A total of 136 clinical isolates of K pneumoniae were investigated for the presence of ESBL. Their ESBL genes were characterized by multiplex polymerase chain reaction (PCR). Integrase gene PCR was performed to detect the presence of integron. The isolates were further typed by random amplification of polymorphic DNA (RAPD). Result: Out of 136 K pneumoniae isolates, 63 (46%) were confirmed to be ESBL producers. SHV (68%) and CTX-M (67%) ESBL genes were the most common in our study. Of the 63 ESBL-positive isolates, 58 (92%) strains carried integrons; 52 strains (82%) carried only class 1 integron, whereas 6 (9%) isolates harboured both class 2 integrons and the class 1 gene. However, in ESBL negatives, only 29 (40%) strains were positive for class 1 integron and none for class 2 integron. Conclusion: The presence of class 2 integron amongst ESBL-producing K pneumoniae is being described for the first time in this part of the world. The findings of this study strongly suggest that integrons have a role in the dissemination of ESBL-mediated resistance among the nosocomial isolates of K pneumonia.

Increased prevalence of extended spectrum beta lactamase producers in neonatal septicaemic cases at a tertiary referral hospital.

Emergence of extended spectrum beta lactamases (ESBLs) producing strains of gram negative bacteria, as one of the leading cause of septicaemia often complicates the clinical and therapeutic outcome. The present study was undertaken to investigate the prevalence of ESBLs in bacteria isolated from neonatal septicaemic cases along with their antimicrobial sensitivity pattern. Blood samples were collected from 243 suspected cases of neonatal septicaemia. Apart from susceptibility testing, all the gram negative isolates were subjected to phenotypic tests for ESBL production. Amongst the positive test samples (n = 115), 84 were gram negative rods. ESBL was detected in 26 (32%) isolates. Results indicate that routine ESBL detection should be made imperative and empirical use of third generation cephalosporins must be discouraged.

Observations on carbapenem resistance by minimum inhibitory concentration in nosocomial isolates of Acinetobacter species: an experience at a tertiary care hospital in North India.

Acinetobacter species are emerging as an important nosocomial pathogen. Multidrug-resistant Acinetobacter spp. has limited the option for effective treatment. Although carbapenems are effective for the treatment of such infections, resistance to this drug has recently been reported. This study was undertaken to assess resistance to carbapenem in clinical isolates of Acinetobacter spp. from hospitalized patients by both disc-diffusion and minimum inhibitory concentration (MIC) methods. All clinical samples from suspected cases of nosocomial infections were processed, and 265 isolates were identified as Acinetobacter species. These isolates were tested for antibiotic resistance by the disc-diffusion method with 14 antimicrobials, including meropenem and imipenem. Thereafter, all Acinetobacter species were subjected to MIC for meropenem. More than 80% resistance to second- and third-generation cephalosporins, aminoglycosides, and quinolones was recorded. Thirty percent of the strains were resistant to cefoperazone/sulbactam. Resistance to meropenem was observed in 6.4% of Acinetobacter spp. while 8.3% of the isolates showed intermediate resistance detected by MIC. All carbapenem-resistant/intermediate strains were also resistant to other (>10) antibiotics tested by the disc-diffusion method. The rising trend of resistance to carbapenem poses an alarming threat to the treatment for such infections. Regular monitoring, judicious prescription, and early detection of resistance to carbapenem are necessary to check further dissemination of drug resistance in Acinetobacter spp.

Slow Ca2+ channels neither contribute to upstroke of action potential nor to pacemaker potential in spontaneously active freshly isolated three day embryonic chick ventricle.

Contribution of slow Ca2+ channels to the upstroke of action potential (AP) and pacemaker potential was studied by observing the effects of Ca2+ channel activators- high [Ca2+]0, Bay-K-8644, isoproterenol, forskolin and dibutyryl-cAMP on spontaneous AP of freshly isolated 3 day embryonic chick ventricle (3 day ECV). The spontaneous APs showed maximal upstroke velocity (+Vmax), maximum diastolic potential (MDP), overshoot (Eov) and AP duration at -20 mv (APD20) of 42.60 +/- 2.40 V/sec, -59.05 +/- 0.95 my, 16.30 +/- 0.53 mv and 70.32 +/- 4.60 msec, respectively (an average value of 35 preparations). Bay-K-8644 (0.1-0.8 microM), isoproterenol (5-10 pM) and forskolin (0.1-2.0 microM) induced a concentration-dependent increase in APD20 and Eov without affecting +Vmax. Dibutyryl-cAMP (1 microM) also enhanced the APD20 and Eov and had no effect on +Vmax. Elevation of [Ca2+]0 from 0.6 mM to 9.6 mM caused a concentration-dependent increase in APD20 and Eov leaving +Vmax unaltered. Elevated [Ca2+] and the other Ca2+ channel activators had no significant effect on MDP in above concentration range. Increase in APD20 and Eov could be explained at least by activation of slow Ca2+ channels but the lack of any change in +Vmax clearly suggests that the slow Ca2+ channels do not contribute to the upstroke of AP. All these interventions reduced the rate of spontaneous firing without any noticeable effect on MDP. This finding shows that the slow Ca2+ channels also do not contribute directly to the generation of pacemaker potential in spontaneously active freshly isolated 3 day ECV.

A study of clinical profile of malaria in a tertiary referral centre in South Canara.

BACKGROUND & OBJECTIVES: The incidence of malaria is on the raise in South Canara district of Karnataka in the recent years and there is not much information on malaria from this region. This study was undertaken to analyse and introspect the presentation of this disease in a tertiary referral centre. METHODS: This retrospective case analysis was done on patients over the age group of 15 yr admitted with diagnosis of malaria to the Medical Department in this tertiary health institution situated in South Canara. The outpatient and inpatient records from September 2002 to August 2004 were retrieved and scrutinised using a prepared case sheet performa on the basis of patient's demographic profile, clinical findings, investigations, treatment and complications. RESULTS: A total of 314 patients were diagnosed and treated for malaria, of them 124 were treated as outpatients and 190 cases were managed as inpatients. Males (81%) outnumbered females (19%) and many were within the age group of 21-30 yr. The incidence of malaria increased from the month of June onwards coinciding the monsoon season. Plasmodium vivax was the major parasite type (52.54%), followed by P. falciparum (33.75%), mixed malarial infection (13.69%) and most of them received combination therapy. Hepatopathy was the most common complication and all the deaths were due to cerebral malaria. INTERPRETATION & CONCLUSION: Malaria is responsible for major health concern in this region, particularly in rainy season and is found to affect comparatively the younger adult population. P. vivax was the major parasite type causing malaria and most of the complications were due to P. falciparum.