Evaluation of Changes in the Pharyngeal Airway Space as a Sequele to Mandibular Advancement Surgery: A Cephalometric Study.

PURPOSE: To evaluate effect of mandibular advancement on pharyngeal airway space using lateral cephalogram. MATERIALS AND METHODS: Twenty patients who were diagnosed with class II skeletal malocclusion and underwent surgical intervention for the correction of their dentofacial deformity following orthodontic treatment were included. The soft tissue changes in the pharyngeal space were brought about by the surgical intervention, and the changes that had occurred in increasing the airway were evaluated by using cephalogram. RESULTS: The results of this study showed that following mandibular advancement surgery, the pharyngeal airway space increased along with an increase in the length and thickness of the uvula with a reduction in the angulation. All the changes remained stable in the late postoperative phase. CONCLUSION: Patients who underwent mandibular advancement showed a significant increase in the pharyngeal airway space and that remained stable during the evaluation period. As a consequence, mandibular advancement seems to be the most stable surgical movement in relation to airway dimensional gains.

Increasing burden of hospital acquired infections: resistance to cephalosporin antibiotics among klebsiella and Escherichia coli.

The drug susceptibility pattern of klebsiella species and Escherichia coli to cephalosporins was examined in the year 2004 and 2005. A total of 180 klebsiella and 220 E coli in 2004 and 95 klebsiella and 210. E coli in the year 2005, isolated from various clinical specimens were studied. Resistance rates among the klebsiella species, ranged from 50.00%-86.36% and 42.10%-84.21% in 2004 and 2005 respectively. Resistance rates among E coli ranged from 46.66%-90.8% and 50.0%-86.66% in 2004 and 2005 respectively. In the year 2005 resistance to cefixime and cefpodoxime significantly increased. Resistance marginally increased to cephalexin, cefuroxime and ceftazidime. Resistance to cefotaxime was considerably low (42.10%) in 2005 compared to 62.96% in 2004. The study highlights the importance of exercising caution in the choice of empirical therapy. It also points towards the need for regular monitoring of resistance pattern in the hospital and temporary withholding of the antibiotic with high resistance so as to prevent the spread of multidrug resistant strains in the hospital and the community.

Comparison of disc diffusion methods for the detection of extended-spectrum Beta lactamase-producing enterobacteriaceae.

BACKGROUND: Resistance to broad-spectrum ß lactams, mediated by extended-spectrum ß lactamases (ESBLs), is an increasing problem world wide. This resistance poses problems for in vitro testing and reporting. Increased prevalence of ESBLs among Enterobacteriaceae creates a great need for laboratory testing methods that will accurately identify their presence. MATERIALS AND METHODS: During the study, the Enterobacteriaceae isolated were tested for the presence of ESBL by the National Committee for Clinical Laboratory Standards (NCCLS) screening test, Jarlier double disc synergy (approximation) test (DDST) and NCCLS phenotypic confirmatory test (PCT), and compared their efficiency in detection. RESULTS: A total of 313 Enterobacteriaceae were isolated and tested for the presence of ESBL. NCCLS PCT identified 200 (63.89%) as ESBL producers and DDST identified 176 (56.23%), with a P-value of <0.001. Among the screening agents, ceftazidime had a better sensitivity (89.49%) and specificity (95.74%). CONCLUSIONS: Close monitoring of the susceptibility pattern of isolates and careful spacing with specific discs can identify many ESBL producers. Ceftazidime has a better sensitivity and specificity as a screening agent. A combination of different tests can be useful for accurate identification.

Use of octenidine dihydrochloride in meticillin-resistant Staphylococcus aureus decolonisation regimens: a literature review.

Decolonisation of patients colonised with meticillin-resistant Staphylococcus aureus (MRSA) is one of the recommended methods for controlling MRSA in hospitals but there is a limited choice of agents that can be used. Octenidine dihydrochloride is a relatively new antiseptic that has been used for MRSA decolonisation in some countries. On reviewing available literature on its use for MRSA decolonisation, only four observational studies were found. All of these were small studies, which differed in study design. MRSA decolonisation rates of 6-75% have been reported. Patients with wound colonisation were included in these studies but it was not clear if the hair was treated in two of these. Octenidine appears to be as effective as chlorhexidine for MRSA decolonisation with fewer adverse effects, but large randomised trials incorporating octenidine as a skin disinfectant for MRSA decolonisation need to be undertaken to confirm its usefulness in clinical settings.

Application of laser engineered net shaping (LENS) to manufacture porous and functionally graded structures for load bearing implants.

Fabrication of net shape load bearing implants with complex anatomical shapes to meet desired mechanical and biological performance is still a challenge. In this article, an overview of our research activities is discussed focusing on application of Laser Engineered Net Shaping (LENS) toward load bearing implants to increase in vivo life time. We have demonstrated that LENS can fabricate net shape, complex metallic implants with designed porosities up to 70 vol.% to reduce stress-shielding. The effective modulus of Ti, NiTi, and other alloys was tailored to suit the modulus of human cortical bone by introducing 12-42 vol.% porosity. In addition, laser processed porous NiTi alloy samples show a 2-4% recoverable strain, a potentially significant result for load bearing implants. To minimize the wear induced osteolysis, unitized structures with functionally graded Co-Cr-Mo coating on porous Ti6Al4V were also made using LENS, which showed high hardness with excellent bone cell-materials interactions. Finally, LENS is also being used to fabricate porous, net shape implants with a functional gradation in porosity characteristics.

Changing characteristics of Vibrio cholerae: emergence of multidrug resistance and non-O1, non-O139 serogroups.

The serogroups and antimicrobial susceptibility patterns of V. cholerae isolated in Hubli, India during the years 2000 to 2004 were monitored. A total of 256 V. cholerae isolates were obtained during the study period, of which 129 (50.4%) belonged to serogroup O1 while the O139 and non-O1, non-O139 serogroups constituted 61 (23.8%) and 66 (25.8%) isolates, respectively. V. cholerae O1 Ogawa was the predominant isolate during the first 2 years of the study. However, this was replaced by V. cholerae non-O1, non-O139 serogroups in the following years. The V. cholerae, which was susceptible to most enteric antimicrobials in 2000, was found to be multidrug resistant in subsequent years, with the development of fluroquinolone resistance since 2002. Surveillance of the epidemiological and microbiological characteristics of V. cholerae provides useful information for managing cholera cases. The V. cholerae non-O1, non-O139 serogroups coupled with multiple antimicrobial resistance may form a group of emerging diarrheal pathogens in the tropics.

Evaluation of chromogenic MRSA medium, MRSA select and Oxacillin Resistance Screening Agar for the detection of methicillin-resistant Staphylococcus aureus.

AIMS: An evaluation of Chromogenic MRSA medium (CMRSA), MRSASelect (MRSAS) and Oxacillin Resistance Screening Agar (ORSA) was performed to determine the optimum medium providing a rapid and sensitive method for methicillin-resistant Staphylococcus aureus (MRSA) detection. METHODS: A total of 632 clinical specimens were cultured on the three media in first phase of the study, while 720 clinical specimens were cultured on CMRSA and ORSA in the second phase. RESULTS: The sensitivity and specificity, respectively, of the media in the first phase were: CMRSA 88.9% and 98.45%; MRSAS 92.1% and 99.1%; ORSA (24 h incubation) 68.3% and 98.8%; and ORSA (48 h incubation) 85.7% and 96.3%. In the second phase the sensitivity and specificity, respectively, were CMRSA 91.2% and 98.6%; ORSA (24 h incubation) 58.9% and 98.2%; and ORSA (48 h incubation) 85.6% and 95.6%. The positive predictive values of the two chromogenic media were higher than that for ORSA. There were fewer false-positive results with the chromogenic media (1.4% for CMRSA and 0.8% for MRSAS) compared with ORSA (3.3%). CONCLUSIONS: Performing latex agglutination tests on growth from chromogenic media provides results for 93.8% of MRSA isolates within 24 h. There is a small increase in cost of chromogenic media compared with ORSA ( pound28 for MRSAS, and pound36 for CMRSA, per 1000 specimens) and direct agglutination tests ( pound80 per 1000 specimens). However early availability of MRSA screening results can reduce the burden of MRSA in hospitals because of early implementation of infection control measures.

Extended spectrum beta lactamase producing Klebsiella pneumoniae in neonatal intensive care unit.

OBJECTIVE: As infections due to Extended Spectrun beta Lactamase (ESbetaL) producing Klebsiella pneumoniae were increasing in the NICU at Karnataka Institute of Medical Sciences Hospital, Hubli, India, the present study was carried out to identify any environmental sources and the mode of transmission. METHODS: Environmental samples from various sites were collected monthly for a period of six months. RESULTS: ESbetaL producing K. pneumoniae were isolated from all the sites except room air at least on one occasion. ESbetaL producing K. pneumoniae was always isolated from one of the incubators, medicine trolley and sink; while at least one of the health care workers carried it in the hands four out of six times tested. ESbeta L producing K. pneumoniae with similar antibiogram were also isolated from the clinical samples obtained from the neonates. CONCLUSION: Widespread use of third generation cephalosporins as a pre-emptive antibiotic for suspected cases of septicaemia may have contributed to emergence of ESbetaL producing K. pneumoniae in addition to other risk factors. ESbetaL producing K. pneumoniae have extensively colonised the environment of the NICU. Transmission of these pathogens to the neonates has probably occurred through the healthcare workers. Efforts to improve hand hygiene among the healthcare workers and mothers are urgently needed.

Methicillin resistant Staphylococcus aureus infections-implications in hospital infection control.

BACKGROUND: A significant part of nosocomial infections are caused by methicillin resistant Staphylococcus aureus (MRSA). Nosocomial MRSA are known to be multidrug resistant and thus difficult to treat. METHODS: A 2 year study was conducted between January 2001 and December 2002 at Karnataka Institute of Medical Sciences Hospital, Hubli to assess the prevalence of MRSA and its antibiotic susceptibility pattern in various wards. RESULTS: S. aureus was isolated from 714 patients, 283 (37.53%) of which exhibited methicillin resistance. Although these MRSA were multidrug resistant in all the wards, the problem was more severe in NICU and orthopedic wards. CONCLUSION: The results highlight the need for effective implementation of infection control measures in the hospital. There is a need for the judicious use of antimicrobial agents in the hospital and outside as their indiscriminate use can exert pressure in selecting out MRSA and other multidrug resistant organisms.

Fluoroquinolone-resistant Vibrio cholerae isolated during a cholera outbreak in India.

During the cholera epidemic of 2002 in and around Hubli, south India, Vibrio cholerae strains resistant to fluoroquinolones were isolated. Among the isolates of V. cholerae non-O1, non-O139 serogroups, 55.9% and 47.1% were resistant to norfloxacin and ciprofloxacin, respectively. However, only 12.5% of the O1 serogroup strains were resistant to both norfloxacin and ciprofloxacin. Though the O139 serogroup strains were susceptible to these antibiotics, they exhibited multidrug resistance. Emergence of fluoroquinolone-resistant V. cholerae that also exhibited multidrug resistance is of great significance in the epidemiology and control of cholera.

Neonatal sepsis caused by Salmonella enterica serovar Weltevreden.

Salmonella enterica serovar Weltevreden is an uncommon cause of gastroenteritis occurring worldwide. For the first time, we report 2 cases of neonatal sepsis caused by S. Weltevreden from Hubli, India. In the first case, the neonate had features of septicemia and S. Weltevreden was isolated from a blood culture. The other neonate had omplalitis and clinical features of septicemia. S. enterica serovar Weltevreden was isolated from the umbilical swab culture of this neonate. Even though extensive investigations were conducted, the source of infection could not be identified. Both neonates recovered completely after appropriate antibiotic and supportive therapy.

Community-acquired methicillin-resistant Staphylococcus aureus infections in a south Indian city.

There are increasing numbers of reports of community-acquired Staphylococcus aureus being resistant to methicillin. The present study was undertaken as no such reports are available for the developing nations. In a prospective study, between June to December 2001, at the Karnataka Institute of Medical Sciences, Hubli, Karnataka, India, methicillin-resistant S. aureus (MRSA) isolates were tested for clindamycin-susceptibility, a surrogate marker for community-acquired strains. Patients with clindamycin-susceptible isolates were interviewed to determine if they had acquired them in the community and also to identify any risk factors. Of the 116 patients with S. aureus infection, 18.1% had infection with methicillin-resistant strains. Clindamycin-susceptible MRSA accounted for 61.9% of cases. Among these, 46.1% patients were confirmed to have acquired the MRSA from the community, based on inclusion criteria. The community-acquired MRSA were susceptible to multiple antibiotics, as compared to nosocomial isolates. Except for one patient with diabetes mellitus, no other patient had any known risk factor for acquiring MRSA. As significant numbers of MRSA infections are being acquired from the community, treatment options for S. aureus infections may need to be reviewed. Effective infection control programs for the community should be considered to prevent the spread of these infections.

Comparison between conventional and QBC methods for diagnosis of malaria.

Stained blood film examination is a widely used technique for the diagnosis of malaria. Comparison of this technique was made with the QBC method, which is based on fluorescent staining of the blood cells and parasites. Of the 1435 blood samples studied, 57 (3.97%) samples were positive for malarial parasites by QBC method, while only 44 (3.07%) samples were positive by the blood film examination. Plasmodium vivax was detected in 27 (47.37%), P. falciparum in 26 (45.61%) and mixed infection of P. vivax and P. falciparum in 4 (7.02%) cases. Samples with low levels of parasitaemia (QBC grades 1+ and 2+) were often found to be negative by blood film examination. QBC method was easy to perform, had a higher sensitivity and could be interpreted rapidly, as compared to the Leishman stained blood film examination.

Incidence of Vibrio cholerae serogroup O139 infection with low virulence in Hubli, Karnataka (India).

384 stool samples from patients with acute gastroenteritis were processed by standard culture techniques and antibiogram of V. cholerae was performed. Stool samples from 93 (24.22%) patients yielded V. cholerae, 58 (62.37%) of which were V. cholerae, El Tor O1 Ogawa, 31 (33.33%) V. cholerae O139 and 4 (4.30%) V. cholerae non O1 non O139. Of the culture proven cholera cases watery diarrhoea was observed in 79 (84.95%), vomiting in 57(61.29%), muscle cramps in 21 (22.58%) and sweating in 18 (19.35%). Majority of these patients presented with moderate dehydration 57 (61.29%). Mild dehydration was found in 19 (20.43%) and severe dehydration in 17 (18.28%). While majority of patients with O139 infection had mild to moderate dehydration 25 (80.65%), severe dehydration was more common with O1 infection 11 (64.71%). This study reflects the importance of monitoring the V. cholerae by serogrouping, antibiogram typing, which keep on varying constantly.

Subconjunctival dirofilariasis in India.

Human dirofilariasis caused by Dirofilaria repens, have been reported to occur widely throughout Asia, Europe and Africa. Reports of this infection from India are however limited. Herein we report a case of subconjunctival dirofilariasis from Karnataka state of India. A 42 year old man presented with a history of pain and swelling in the left eye. A live parasite measuring 3.5cm in length was surgically removed from the nodular swelling in the conjunctiva. The parasite was identified as Dirofilaria repens, adult male.

Clinico-bacteriological study of neonatal septicemia in Hubli.

Septicemia is a leading cause of neonatal morbidity and mortality in India. In a study of 242 infants with septicemia conducted between March 1996 & June 1997 at Hubli, Karnataka, 43.39% infants had 'very early onset' sepsis (VOS), 40.08%, had 'early onset' sepsis (EOS), and 16.53% 'late onset' sepsis (LOS). 54.55% neonates had birth weight below 2000 g and 39.67% were born before 37 weeks of gestation. The cardiorespiratory signs and jaundice were the most frequent clinical features. The blood culture positivity rate was 64.87%. Klebsiella species was the commonest causative pathogen found and multidrug resistance was frequent. The overall mortality rate was 47.52% and the case fatality rate in LOS was higher than in VOS and EOS (p < 0.001). The mortality was significantly higher in neonates with lower birth weight and lower gestational age (p < 0.001). The study underlines the importance of monitoring the various features of neonatal septicemia, as well as the drug resistance of the pathogens from the nurseries.

Immunoglobulin-M estimation and C-reactive protein detection in neonatal septicemia.

Immunoglobulin-M estimation, and C-Reactive Protein test and blood culture were performed on 57 neonates, clinically suspected to have septicemia. IgM level of > or = 20 mg/dl was found in 58.62% cases and CRP test was positive in 68.98% of culture proven sepsis. Blood culture was positive in 29 cases, with the predominant organism being Klebsiella. Of the 2 tests, CRP had a higher sensitivity (68.97%) while IgM estimation had a higher specificity (82.14%). When the 2 tests were considered together the sensitivity and specificity further increased. Death rate among neonates with IgM levels < 20 mg/dl was 5 times higher than those with elevated IgM levels.

Nail relocation by nail flap in digital injuries.

In circumstances where the nail complex is intact and undamaged it may be wiser to relocate the nail as a flap based on its vascular supply rather than resort to pulp replacement procedures such as a cross-finger flap or similar techniques which leave a hyposensitive pulp and a "parrot-beak" deformity of the nail. In "acute" finger injuries this procedure is decidedly preferable to amputation through the head of the middle phalanx.