Assessment of CT perfusion indices of the clinicoradiological response to anti-tubercular therapy in patients with intestinal tuberculosis.

AIM: To explore the possibility of using a novel technique, CT perfusion imaging, to monitor the response to anti-tubercular therapy (ATT) in patients with intestinal tuberculosis. MATERIALS AND METHODS: A prospective observational study was performed in adults with treatment naive-intestinal tuberculosis. Clinical, endoscopic, and conventional radiological findings of patients were compared at baseline and post-ATT. CT perfusion imaging was performed with recording of six perfusion parameters (blood flow, blood volume, mean transit time, time to peak, maximum peak intensity, and permeability/blood flow extraction). RESULTS: Twenty-two patients (13 women, 59%) with a median age of 25 years were recruited. The terminal ileum and ileocaecal junction were the most frequent sites of involvement (59%), with multiple segments of the intestine being involved in 16 patients (73%). Median duration of ATT was 6 months (range 6-10 months). Complete clinical response was observed in 22/22 (100%) patients, endoscopic response in 12/12 (100%) patients, and radiological response in 10/13 (76%) patients. There was a significant decrease in mean blood flow, blood volume, maximum peak intensity, and an increase in mean transit time and time to peak on follow-up CT perfusion imaging performed after 6 months of ATT. CONCLUSION: Significant alterations in CT perfusion parameters were demonstrated following treatment, consistent with a decline in inflammation and vascularity. CT perfusion imaging of the bowel is a novel means to assess the radiological response to ATT in intestinal tuberculosis, although at the cost of a higher dose of radiation exposure.

Ochrobactrum anthropi septicaemia.

Ochrobactrum anthropi is an emerging opportunist pathogen in immunocompromised patients. We report a case of septicaemia due to O. anthropi in an elderly male patient with coronary artery disease with severe left ventricular dysfunction admitted in the Intensive coronary care unit. Following intraaortic balloon pump (IABP) insertion, the patient developed a haematoma at the local site, which led to septicaemia. In spite of intensive treatment, the condition of the patient continued to deteriorate and he died on the seventh day. This infection with the microbiological characteristics useful for identification of the organism is described.

A simple, cost-effective quality assurance model for measurement of lipids in a large epidemiological study.

BACKGROUND: Laboratory measurements are an integral part of epidemiological studies in cardiovascular disease. Standardization and quality assurance is of utmost importance in the context of multicentre studies. METHODS: We evaluated a simple and cost-effective method of quality assurance for measurement of total cholesterol, high density lipoprotein (HDL) cholesterol and triglycerides in a study involving 10 centres. Three methods for quality assessment were used for the study that involved measurement of cholesterol, triglycerides and HDL cholesterol and included internal quality control, external quality control and 10% repeat analysis in addition to a uniform standardized protocol developed for the 10 centres. External quality control material was prepared and circulated by the coordinating laboratory. RESULTS: External quality control material was distributed 20 times during the study. The mean variance index suggested a substantial improvement in the performance of participating laboratories over a period of time for cholesterol and triglycerides. This was also evident in the improvement in per cent technical error as a measure of bias and a higher correlation between replicates of samples analysed in the coordinating laboratory and the participating centres for cholesterol, triglycerides and HDL cholesterol. CONCLUSION: A cost-effective quality assurance model for laboratory measurement using local capacities was developed and implemented in a multicentre epidemiology study. Such a programme would be useful for developing countries where cost-cutting is important.

HIV seropositivity among patients with sexually transmitted diseases.

2013 patients with various sexually transmitted diseases were screened for HIV antibodies in voluntary counseling and testing centre (VCTC) attached to Microbiology Lab of Govt. Medical College, Amritsar from Jan. 1998 to Dec. 2001. Sixty-one (3.03%) were found to be positive for HIV. 44 were males and 17 were females. There was a constant rise in the percentage positivity in females from 14.3% in 1998 to 38.09% in 2002. There was also rise in the prevalence of HIV among the STD attenders (1.65% in 1998 to 5.13% in 2001).

Comparative evaluation of conventional methods and ELISA based IgG antibodies detection for diagnosis of Helicobacter pylori infection in cases of dyspepsia.

Seventy five gastric biopsy specimens and 75 serum samples of same patients complaining of dyspepsia were collected. Biopsy specimens were processed for rapid urease test, gram staining and culture. Serum samples were used for detecting IgG antibodies against 128 kDa external protein (Cog A) of H. pylori using a commercially available ELISA kit. Rapid urease test was positive in 54 (72%), culture in 21 (28%) and gram staining in 15 (20%). Significant IgG levels were detected in 57 (76%) cases. It was therefore concluded that for diagnosis of H. pylori infection in cases of dyspepsia, determination of IgG levels can act as an important screening procedure.

Correlation of beta-lactamase production/methicillin resistance and phage pattern of Staphylococcus aureus.

Multiple drug resistance is exhibited by coagulase positive staphylococcus aureus isolated from hospitals. Prevalence of MRSA due to prolonged stay in the hospital, instrumentation/invasive procedure, surgical intervention and misuse of antibiotics have been reported. Antibiogram of 200 coagulase staphylococci showed 10% MRSA strains. Predominant phage type 81 belonged to unclassified group followed by phage type 84 belonged to group 3. As the management of MRSA is not easy, efforts should be made to eradicate the MRSA by taking strict aseptic conditions and the severe infections should be treated according to the sensitivity pattern of the strain.

Sex differences in morphology of coronary artery plaque assessed by intravascular ultrasound.

BACKGROUND: Results of autopsy studies have suggested that there are sex differences in morphology of coronary-artery plaques, but these differences have yet to be adequately evaluated in vivo. DESIGN AND METHODS: We performed preintervention intravascular ultrasound (IVUS) measurements on coronary plaques in a consecutive series of 76 men and 30 women with unstable angina pectoris. Both the target lesion and an adjacent reference site were evaluated. Arterial, plaque, and luminal areas were measured by planimetry. Plaques were classified as either calcified or uncalcified, and relative density of plaque was quantitatively assessed by videodensitometry, using a linear gray scale normalized with respect to density of adventitia. RESULTS: Although women were older than men (mean age 55.0 +/- 10.9 versus 60.4 +/- 12.2 years, P = 0.02), their target lesions were less dense (74.6 +/- 23.4 versus 86.2 +/- 22.2% of adventitial density, P = 0.02) and less often found to be calcified (20.0 versus 38.2%, P = 0.05). Similarly, reference sites in female subjects were less dense (77.6 +/- 15.3 versus 97.1 +/- 19.4% of adventitial density, P = 0.01). There was no sex difference in the severity of coronary stenosis. CONCLUSIONS: Both qualitative and quantitative sex differences in in-vivo morphology of coronary plaques morphology were detected by IVUS measurement. Plaques in women appear less videodense and are less often calcified than are those in men. Future studies employing sequential IVUS examinations are needed in order to determine whether these morphologic differences relate to a delay in initiation of plaques, slower progression of plaques, or other sex-specific modulators of plaque composition.

Cryptococcal meningitis in AIDS patients - a report of two cases.

A fifty-five year old gentleman with HIV infection was investigated for meningitis.Cryptococcus neoformans was isolated.Second case was a lady of 42 years, with HIV infection, was also investigated for meningitis. Cryptococcus neoformans was isolated. Antigen was detected in CSF as well as serum in both the cases.

Pathologic validation of a new method to quantify coronary calcific deposits in vivo using intravascular ultrasound.

Current methods of calcium quantification by intravascular ultrasound (IVUS) measure the arc of calcium using the cross-sectional image at the lesion and at the reference site while neglecting calcium elsewhere. Calcium at these sites may not adequately represent the extent of total epicardial coronary calcium. We devised a new method to quantify calcium as a percentage of the coronary luminal surface. This study examines whether this new method accurately reflects coronary calcium determined by histology. Seventeen postmortem coronary arteries were pressure-fixed and imaged by IVUS using a motorized pullback device. Total plaque-luminal circumferential length and calcified plaque-luminal circumferential length were measured from serial cross-sectional IVUS images every 1 mm. With use of Simpson's method, the total plaque and calcified plaque surface area was then calculated. Histologic sections were stained with hematoxylin-eosin and Movat pentachrome at 3-mm intervals. Calcium was independently quantified by planimetry under light microscopy. Histologic analysis (n = 253 sections) revealed a wide range of calcium (0 to 47 mm2; mean 12 +/- 16 mm3). The IVUS-derived calcified plaque surface area was 17 +/- 23 mm2), which represented 3.1 +/- 4.1% (range 0% to 13.9%) of the total plaque surface area. The histologic and IVUS quantification of calcium by this method was strongly related (r = 0.84, p <0.0001), which was an improvement over current 2-dimensional measures of calcium arc (r = 0.41, p = 0.18). Calculation of calcified plaque surface area from sequential IVUS images appears to accurately reflect the degree of total coronary calcification.

Sex differences in coronary artery size assessed by intravascular ultrasound.

BACKGROUND: Women have worse outcomes after myocardial infarction and coronary revascularization. The explanations are likely multifactorial but may include smaller coronary artery size. Smaller luminal diameter has been confirmed angiographically; however, because of possible confounding effects of coronary remodeling, angiographically silent atherosclerosis, and body size, it is unclear if there is a true sex influence on arterial size. METHODS: We performed intravascular ultrasound on left main (LM) and proximal left anterior descending (LAD) coronary artery segments that were free of significant atherosclerosis in 50 men and 25 women. Arterial and luminal areas were measured by planimetry and corrected for body surface area. We evaluated associations between sex and coronary dimensions with univariate and then multiple linear regression analyses. RESULTS: Mean uncorrected LM and LAD arterial areas were smaller in women than in men (21.53 vs 26.95 mm(2), P <.001, and 14. 68 vs 19.94 mm(2), P =.002, respectively), as were mean LM and LAD luminal areas (15.94 vs 18.79 mm(2), P =.020, and 10.13 vs 12.71 mm(2), P =.036, respectively). In multivariate models accounting for body surface area and controlling for other factors, sex independently predicted corrected LM and LAD arterial area. In analyses that additionally controlled for plaque area, sex independently predicted corrected LAD luminal area. CONCLUSIONS: LM and LAD arteries are smaller in women, independent of body size. This suggests an intrinsic sex effect on coronary dimensions. Future studies should investigate underlying mechanisms because they may lead to novel therapeutic strategies and improved outcomes for women with coronary artery disease.

Bacteriology of bronchial secretions in non-tubercular lower respiratory tract infections.

Fifty samples of bronchial secretions collected from patients of non-tubercular lower respiratory tract infections through fiberoptic bronchoscopy (FOB) were cultured both for aerobic and anaerobic organisms. Thirty-three (66%) samples yielded bacteria. Out of these, thirty were isolated in pure culture and from three, a mixed growth of aerobic and anaerobic micro-organisms was obtained. Aerobic bacteria were the predominant isolates. Stephylococcus aureus (10), pseudomonas (9) and streptococcus pneumoniae (8) were the major aerobic isolates. Ciprofloxacin was found to be the most effective drug against aerobes and metronidazole against anaerobes in vitro susceptibility tests.

Influence of combined therapeutic potential of meso 2,3-dimercaptosuccinic acid and calcium disodium edetate on lead-induced testicular alterations in rats.

The therapeutic efficacy of a combination of meso 2,3-dimercaptosuccinic acid (DMSA) and calcium disodium EDTA in protecting testicular disorders in chronic lead intoxication was investigated. The results indicate that two five-days courses of the combined therapy produced a more effective recovery in the lead induced biochemical and histopathological disorders compared to conventional single 5 days therapy. No adverse effect of the chelators, when administered individually or in combination, was noticed in the testes of control (without lead exposure) animals.

Predominant phage types of coagulase positive staphylococci in hospital infections.

360 strains of Staphylococcus aureus isolated from various clinical specimens were subjected to bacteriophage typing. 247(68.6%) strains were typable. Among the typable strains 75(20.83%) belonged to phage group I, 45(12.5%) belonged to phage group III, 6(1.67%) belonged to phage group II and 14(3.89%) strains belonged to miscellaneous group. By far, the largest was the mixed group having 107(29.72%) strains. 113 strains (31.4%) were untypable. All the strains were tested for antibiotic sensitivity test. 287 (79.7%) were multiple drug resistant strains.

Microbial profile of pelvic inflammatory disease.

A total of 100 cases were studied. Fallopian tubes removed at operation constituted a very good material to study the infections of upper genital tract. Along with fallopian tubes, HVS from same patients were cultured both for aerobic and anaerobic organisms. Bacteriological analysis of 100 cases of fallopian tubes and same number of HVS showed bacterial growth in 30 cases (30%) whereas in HVS samples growth was obtained in 50 cases (50%). In 66.67% of cases same bacteria were isolated both from HVS and fallopian tubes which strongly favours the theory of ascending infection. Out of all antibiotics ciprofloxacin showed the widest spectrum of activity (94.20%). All anaerobes were sensitive to metronidazole.

Structural changes induced by sulphur mustard in rabbit skin.

Sulphur mustard (SM) is a bifunctional alkylating agent which can react with a wide variety of molecules of biological interest. The interaction of SM with animal skin elicits a varied histopathological response in cellular components on a temporal scale. The extracellular matrix (ECM) undergoes tremendous structural changes as a result of SM exposure. Sulphur mustard induces oedema, infiltration of polymorphonuclear cells and destruction of cells. Injury appeared to be most severe on the third day after exposure, when the thickness of the skin registered the maximum change from the control. The initiation of recovery could be noticed on the 6th day, when the intercellular gap in the ECM began to reduce significantly, indicating reformation of damaged skin. Simultaneous reformation was also noticed in the epidermis and other cellular components. However, recovery was far from complete and continued beyond the 6th day.

Therapeutic potential of meso 2,3-dimercaptosuccinic acid or 2,3-dimercaptopropane 1-sulfonate in chronic arsenic intoxication in rats.

The therapeutic efficacy of two thiol chelators, meso 2,3-dimercaptosuccinic acid (DMSA) or 2,3-dimercaptopropane sulfonate (DMPS) in treating chronic arsenic intoxication was investigated in male rats. Both the chelators were effective in promoting urinary arsenic excretion and restoring arsenic induced inhibition of blood delta-aminolevulinic acid dehydratase activity and hepatic glutathione level. Elevation of urinary delta-aminolevulinic acid excretion and arsenic concentration in blood, liver and kidneys were reduced significantly by both the chelators. Histopathological lesions induced by arsenic were also effectively reduced by the above chelators. DMSA being more effective than DMPS. The results suggest DMSA and DMPS to be effective antidotes for treating chronic arsenic toxicity in experimental animals.