A one year prospective study to compare and evaluate diagnostic accuracy of modified Alvarado score and ultrasonography in acute appendicitis, in adults.

OBJECTIVES: To compare and evaluate diagnostic accuracy of modified Alvarado score and ultrasonography in co-relation to histopathology report for diagnosis of acute appendicitis. METHODOLOGY: A prospective study of the patients who underwent appendectomy for suspected acute appendicitis at K.L.E.S. Hospital and M.R.C. Belgaum. The clinical, radiological and ultrasonogrpahic data of 60 patients with suspected appendicits was collected. These patients were evaluated by modified Alvarado here and ultrasonographically, which was correlated with histopatholocial finding. RESULTS: Out of 60 patients, 38.33% had acute appendicitis. 40% had modified Alvarado score ≥ 7 and 38.33% patients were ultrasonographically positive. In the present study, modified Alvarado score has sensitivity of 78.26%, specificity 83.78%, positive predictive value 75.00%, negative predictive value 86.11%, diagnostic accuracy 81.00% false positive error rate 16.22% and false negative error rate 21.74%. Ultrasonography had sensitivity of 82.61%, specificity of 89.19%, positive predictive value of 82.61, negative predictive value of 89.19.Diagnostic accuracy of 86.67%, false positive error rate of 10.81%, false negative error rate of 17.39%. When modified Alvarado score and ultrasonography were positive, 17 true positive cases and no false positive cases. The false negative cases in modified Alvarado score were five. When it was combined with ultrasonography the false negative cases reduced to two that is 60% reduction in false negative cases. CONCLUSIONS: Modified Alvarado score is useful tool in clinical decision making. When compared with ultrasonography neither one is advantageous. However, additional information provided by ultrasonography improves diagnostic accuracy.

Disease prevalence in women attending the STD clinic in Mumbai (formerly Bombay), India.

Our objectives were to determine the prevalence of Neisseria gonorrhoeae and its association with other STD causing organisms. Three hundred and thirty-six consecutive women (female sex workers (FSWs) and married contacts), attending a sexually transmitted disease (STD) clinic in Mumbai, were screened for N. gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis. Per speculum examination was performed and clinical signs were recorded. Symptoms perceived by the women were also recorded. The mean age for married contacts, FSWs and gonorrhoea-positive women was 27.9, 29.7 and 27.5, respectively. 9.7% of the women were positive for N. gonorrhoeae, 23.2% were chlamydia-positive and 5.9% had trichomoniasis. N. gonorrhoeae was isolated more frequently from FSWs as compared to the married contacts. The prevalence of HIV was significantly higher among women with multiple sex partners (FSWs) (P<0.001). Gonococcal infection is significantly associated with the presence of HIV. A significant association between sexual habits and prevalence of gonorrhoea, trichomoniasis and HIV was observed. The prevalence of gonorrhoea over 1988 to 1996 remained approximately the same.

PIP: This clinical trial was conducted to determine the prevalence of Neisseria gonorrhea and its correlation with other sexually transmitted disease (STD) causing organisms. A total of 336 consecutive women (female sex workers (FSWs) and married contacts) attending an STD clinic in Mumbai, India, were screened for N. gonorrhea, Chlamydia trachomatis, and Trichomonas vaginalis. Speculum examinations were performed, the vulva and external genitalia were assessed for ulcers and warts, and clinical signs were recorded. The symptoms reported by the women were also documented. The mean age of married contacts was 27.9 years, while that of FSWs was 29.7 years. The mean age of gonorrhea-, chlamydia-, and trichomonas-positive women was 27.3, 28.0, and 28.8 years, respectively. This study showed that 9.7% of the women were gonorrhea-positive, 23.3% were chlamydia-positive, and 5.9% were trichomonas-positive. N. gonorrhea was more prevalent among FSWs than married contacts. Moreover, HIV was more prevalent among FSWs (P 0.001). Gonococcal infection is significantly associated with HIV. An important correlation between sex behavior and the prevalence of gonorrhea, trichomoniasis, and HIV was found. Between 1988 and 1996 the prevalence of gonorrhea remained approximately the same.

Association between auxotypes, serogroups, and antibiotic susceptibilities of Neisseria gonorrhoeae isolated from women in Mumbai (formerly Bombay), India.

OBJECTIVES: Gonococcal isolates were differentiated based on susceptibility pattern, penicillinase production (PPNG or non-PPNG), serogroup, auxotype, protein, and plasmid profile. The association between serogroup and auxotype and PPNG was determined. STUDY DESIGN: Women attending tertiary level health centers and the sexually transmitted disease (STD) clinic in Mumbai, India, were screened for Neisseria gonorrhoeae. Minimal inhibitory concentration testing was performed according to National Committee for Clinical Laboratory Standards (NCCLS) guidelines. Auxotypes, serogroups, protein profile, and plasmid content were also studied. RESULTS: Of the 33 isolates, 16 (48.5%) were resistant to penicillin, and 28 (84.8%) showed a chromosomally mediated resistance to tetracycline. Five (15.2%) isolates showed resistance to ciprofloxacin, whereas 12 (36.4%) showed a reduced susceptibility. Twenty-seven (81.8%) isolates belonged to the WI serogroup, and 15 (46.7%) were penicillinase producers (PPNG). Seventeen (51.5%) isolates were of the nonrequiring auxotype, whereas seven (21.2%) were proline requiring. Fifteen (55.6%) of the isolates belonged to the nonrequiring-WI auxotype/serogroup (A/S) class. Ten of the PPNG isolates possessed the 4.4 MDa plasmid, whereas four had the 3.2 MDa plasmid. Increases in the molecular weight of the major outer membrane protein were observed. CONCLUSION: A high prevalence of chromosomal resistance to penicillin and tetracycline was observed. The 4.4 MDa plasmid was the most prevalent among the PPNG isolates. We observed ciprofloxacin resistance, which has not been reported in previous studies in India. The nonrequiring auxotype was the most prevalent, followed by the proline requiring auxotype. WI serogroup was the most commonly observed among the isolates studied. The nonrequiring/WI A/S class was the most prevalent among the PPNG.

PIP: This study aims to determine the prevalence of penicillinase-producing Neisseria gonorrhea (PPNG), as well as to differentiate gonococcal isolates based on susceptibility pattern, penicillinase production, serogroup, auxotype, protein and plasmid profile among women attending tertiary level health centers and sexually transmitted disease (STD) clinics in Mumbai (formerly Bombay), India. An association between auxotypes, serogroups and antibiotic susceptibilities of Neisseria gonorrhea was determined. Subjects were screened for Neisseria gonorrhea; the minimal inhibitory concentration testing was performed according to National Committee for Clinical Laboratory Standards (NCCLS) guidelines. The antibiotics tested were penicillin, tetracycline, ciprofloxacin, and spectinomycin. The ability of various typing methods to distinguish different isolates was calculated using the discrimination index. Results showed that in the susceptibility testing group 16 (48.5%) were resistant to penicillin and 28 (84.8%) showed chromosomally mediated resistance to tetracycline. 5 isolates (15.2%) showed resistance to ciprofloxacin, while 12 (36.4%) showed reduced susceptibility. 27 (81.8%) isolates belonged to the WI serogroup, and 15 (46.7%) were penicillinase producers. In auxotyping, 17 (51.5%) isolates were of the nonrequiring auxotype, while 7 (21.2%) were proline requiring. 15 (55.6%) of the isolates belonged to the nonrequiring-WI auxotype/serogroup (A/S) class. In plasmid pattern, 10 of the PPNG isolates possessed the 4.4 MDa plasmid, while 4 had the 3.2 MDa plasmid. Increases in the molecular weight of the major outer membrane protein were observed. In conclusion, the combined use of auxotyping and serogrouping offers a good method for discriminating gonococcal isolates. A high prevalence of chromosomal resistance to penicillin and tetracycline was observed. The 4.4 MDa plasmid was the most prevalent among the PPNG isolates. The nonrequiring auxotype was the most prevalent, followed by the proline requiring auxotype. WI serogroup was commonly observed among the isolates, while the nonrequiring/WI A/S class was the most prevalent among PPNG isolates.

Corneal ulcer caused by Nocardia asteroides in a patient with leprosy.

Nocardia asteroides is a rare cause of keratitis usually associated with trauma. We report a case of corneal ulceration caused by N. asteroides in a patient with leprosy. This is the first case report of nocardial keratitis from Southeast Asia. The diminished corneal sensation in a patient with leprosy could be a predisposing factor for development or exacerbation of corneal ulceration.

Ureaplasma Urealyticum in Male Infertility.

Semen examination with special reference to semen analysis and culture for Ureaplasma urealyticum was carried out in 50 male infertile patients in the age group of 25 to 40 years, attending a private infertility clinic. Isolation of Ureaplasma urealyticum in 14 (28%) patients and the abnormalities in count and motility of spermatozoa suggest that ureaplasmas may play a role in human male infertility.