Effect of gestational diabetes on the vitamin D levels in the neonates: a case control study.

BACKGROUND AND OBJECTIVES: The present study was conducted to determine the effect of maternal gestational diabetes on the Vitamin D levels of the mother and their newborns and to compare it with healthy mother-infant pairs. METHODS: The study design was a Case Control study. It was conducted at the antenatal unit of Obstetrics and Neonatal unit of Pediatrics department of a tertiary care hospital in costal Karnataka. Consecutive sample of otherwise healthy pregnant women presenting with Gestational Diabetes Mellitus (GDM) and their healthy term neonates were taken as study group. The weight matched healthy mothers and their healthy term neonates were taken as controls. The blood samples of the mothers, at term and the cord blood samples of the neonates were collected for estimating the Vitamin D levels. Vitamin D levels in the cases and controls were the primary outcome measures. RESULTS: The mean value of Vitamin D levels in the GDM mothers was 10.74 ng/ml and in the mothers forming the control group was 23.53ng/ml (p value < 0.001). The mean value of Vitamin D levels in GDM babies was 8.47ng/ml and was 19.51ng/ml in the control (p value < 0.001). CONCLUSION: Comparison of Vitamin D levels of mothers and infants of both groups showed a positive correlation. GDM seems to exacerbate the Vitamin D deficiency in the mothers and their neonates.

Simple and economical method for identification and speciation of Staphylococcus epidermidis and other coagulase negative Staphylococci and its validation by molecular methods.

Coagulase-negative staphylococci (CoNS) have been increasingly recognized as a clinically important group of species that can cause several opportunistic nosocomial infections. There are at least 47 known species of Staphylococci and to differentiate all these species >40 biochemical tests need to be performed. The present study was able to refine the CoNS identification process by using only five tests to identify S. epidermidis from the rest and used six other tests to identify eleven other clinically significant CoNS species. A total of 242 CoNS isolates were collected from tertiary care hospitals and included in the study. The five-biochemical test scheme devised based on mathematical probability derived from a computer algorithm included fermentation of mannitol, maltose, mannose, trehalose and novobiocin susceptibility to differentiate S. epidermidis from other CoNS species. The remaining CoNS isolates other than S. epidermidis were further characterized with the help of six additional tests, which identified another eleven species. Species-specific PCR and 16SrDNA sequencing were used to confirm and validate the identification scheme. Species-specific PCR and 16SrDNA sequencing showed 100% agreement with non-divergent phenotypic test results, indicating that the five selected assays are highly specific for identifying S. epidermidis. In conclusion, this study used only 11 tests to identify most of the clinically significant CoNS that can reduce cost and time. This scheme is easy to perform in any laboratory with basic resources, the results of this study were validated using more accurate molecular methods such as PCR and 16S rDNA typing to confirm the utility of the proposed scheme.

Human hepatic met-enkephalin and delta opioid receptor-1 immunoreactivities in viral and autoimmune hepatitis.

Endogenous opioids participate in growth regulation. Liver regeneration relates to growth. Thus, we explored the expression of methionine enkephalin and of the delta opioid receptor 1 immunoreactivities with a polyclonal rabbit antibody in deparaffinized liver of patients with chronic liver disease. Fifteen of a total of fifty-eight samples expressed both opioid receptor and methionine enkephalin immunoreactivities, one sample expressed receptor but not methionine enkephalin immunoreactivity, and two samples expressed methionine enkephalin but not receptor immunoreactivity. Ten of the 45 (22%) samples from patients with chronic hepatitis C, four of the eight (50%) samples from patients with chronic hepatitis B, one of the five (20%) samples from patients with autoimmune hepatitis expressed both met-enkephalin and delta opioid receptor 1 immunoreactivities. The expression of methionine enkephalin and delta opioid receptor 1 immunoreactivities suggests that methionine enkephalin exerts an effect in situ, which may include regulation of liver regeneration. However, another possibility that concerns an effect of methionine enkephalin in the liver arises. As morphine, which acts via opioid receptors, has been reported to increase hepatitis C virus replication in vitro and to interfere with the antiviral effect of interferon, methionine enkephalin, analogous to morphine, may enhance the replication of the hepatitis C virus in the liver of patients with this type of viral hepatitis, and interfere with the therapeutic effect of interferon. These results may explain at least in part, why some patients with chronic hepatitis C infection do not respond to interferon therapy.

Liver derived endogenous opioids may interfere with the therapeutic effect of interferon in chronic hepatitis C.

A substantial number of patients with chronic hepatitis C does not respond to treatment with interferon and ribavirin, the approved drugs to treat this viral infection. In vitro studies have shown that morphine, which exerts its effects by binding to opioid receptors, enhances the expression of hepatitis C RNA in hepatitis C-replicon containing liver cells, and that it interferes with the antiviral effect of interferon on the hepatitis C virus. Met-enkephalin, one of the endogenous opioid peptides, can bind to the same receptors to which morphine binds, triggering similar receptor-mediated effects. The liver in cholestasis can express Met-enkephalin immunoreactivity (MEIR). MEIR can also be detected in the liver of some patients with chronic hepatitis C. This finding suggests that Met-enkephalin is produced by or that it accumulates in the liver of patients with this viral hepatitis. Analogous to the effect of morphine on the hepatitis C-replicon containing liver cells, we hypothesize that Met-enkephalin enhances the replication of the hepatitis C virus in liver cells, and that it interferes with the antiviral effect of interferon, contributing to the lack of efficacy of this medication in the treatment of this viral infection in some patients. If this hypothesis is correct, the study of opiate antagonists in combination with antiviral therapy in patients with hepatitis C expressing MEIR in their livers merits consideration.

Mycoplasma pneumoniae infection in children with acute respiratory infection.

A prospective study was performed on 93 children admitted to Kasturba Medical College Hospital, Manipal and TMA Pai Rotary Hospital of Udupi and Karkala. Blood samples from 93 children admitted to the ward with no respiratory illness were taken as age-matched controls for the inpatients, IgM antibody against Mycoplasma pneumoniae was detected using a commercial kit (Virion-Serion ELISA, Germany) following the manufacturer's instructions. 23.96% of the inpatients with respiratory tract symptoms had IgM antibodies against Mycoplasma pneumoniae. The highest infection rate was found to be in the 2-5 and 5-10 year age group. The most common mode of presentation was an upper respiratory focus of infection with cervical lymphadenopathy. Bronchial breathing signifying pneumonic consolidation was significantly less in the Mycoplasma positive group (p = 0.006). There was no statistically significant difference in the radiological findings in the Mycoplasma positive and Mycoplasma negative groups.

Chromoblastomycosis.

A 70-year-old male agriculturist from a rural area presented with a history of a painless verrucous lesion over the medial aspect of the left leg for 1 year following abrasion by a branch of a coconut tree. KOH preparation of the skin biopsy showed evidence of fungal elements. Cladophilalospora sp. was isolated in culture. The case was diagnosed as chromoblastomycosis. As there was no response to itraconazole, complete surgical resection of the lesion was done. At follow-up after 1 year there was clinical as well as mycological cure.

Study of genital lesions.

A total of one hundred patients (75 males and 25 females) age ranged from 17-65 years with genital lesions attending the STD clinic of Bowring and LC Hospitals Bangalore constituted the study group. Based on clinical features, the study groups were classified as syphilis (39), chancroid (30), herpes genitalis (13), condylomato lato (9), LGV (7t condylomata acuminata (5), genital scabies (3), granuloma inguinole (2) and genital candidiasis (1). In 68% microbiological findings confirmed the clinical diagnosis. Of the 100 cases 13% and 2% were positive for HIV antibodies and HbsAg respectively.

Case report. Disseminated cutaneous cryptococcosis in an immunocompetent host.

A 50-year-old Indian housewife presented with multiple cutaneous lesions over the upper back, thigh and both the extremities, which first appeared 5 months previously. The diagnosis of disseminated cutaneous cryptococcosis was made on the basis of the demonstration and isolation of Cryptococcus neoformans from the aspirated pus and skin biopsy. A serological test for HIV antibodies was negative. The patient responded to itraconazole treatment.

Keratomycosis due to Fusarium oxysporum--a case report.

A 30 year old muslim housewife presented with foreign body sensation to start with and later noticed white patch in the left eye with blurred vision since 3 days. KOH preparation of corneal scrapings revealed fungal elements. Culture isolate is identified as Fusarium oxysporum by standard methods. Fusarium oxysporum causing keratomycosis is reported for its rarity.

Prevalence of hepatopulmonary syndrome in cirrhosis and extrahepatic portal venous obstruction.

OBJECTIVE: Hepatopulmonary syndrome (HPS) is characterized by arterial hypoxemia in patients with chronic liver disease caused by abnormal intrapulmonary vasodilations. Data on its frequency vary from 5% to 29%. Most of these studies are from the West and in patients with cirrhosis. We, therefore, studied the prevalence of HPS in patients with liver cirrhosis and extrahepatic portal venous obstruction (EHPVO). METHODS: We studied 54 consecutive patients with liver cirrhosis (42 men and 12 women; mean age = 44.2 +/- 13 yr; Child grade A: 13, B: 22, and C: 19) and 50 patients with EHPVO (31 men and 19 women; mean age = 23.3 +/- 7.8 yr) Diagnosis of cirrhosis was made by history, liver function abnormalities, endoscopy, and sonography, whereas EHPVO was diagnosed by demonstration of a block in the splenoportovenous axis on sonography. Each of the patients underwent chest x-ray, arterial blood gas analysis, contrast-enhanced echocardiography (CEE), and pulmonary function tests. HPS was diagnosed in a patient with positive CEE, in the presence of hypoxia (PaO2 < 70 mm Hg) and/or elevated alveolar arterial oxygen gradient of > 20 mm Hg in the absence of any underlying cardiopulmonary disease. RESULTS: Ten of 54 patients (18.5%) with cirrhosis were positive on CEE compared with two of 50 patients (4%) with EHPVO. Six of the 10 patients positive with cirrhosis for CEE had associated hypoxia, whereas only one EHPVO patient with positive CEE had an elevated pulmonary alveolar arterial oxygen gradient of > 20 mm Hg. Thus, the incidence of HPS was 11.1% in patients with cirrhosis, compared with 2% in patients with EHPVO. One patient with HPS and cirrhosis had clinical cyanosis. CONCLUSION: HPS occurs more commonly in patients with cirrhosis but can also be seen in patients with EHPVO.

Prevalence of nonfermenters in clinical specimens.

One hundred and thirty three non fermenting gram negative bacilli isolated out of 625 different clinical specimens were identified and characterised. Samples were exudate from chronic suppractive otits media (341), diabetic foot (117) wound (116) and blood (51). Of these isolates Pseudomonas aeruginosa 105(78.94%) predominated followed by Acinetobacter sp 8 [6.1%], Pseudomonas putrifaciens 6(4.5%), Flavobacterium sp 6(4.5%), Xanthomonas maltophilia 5(3.75%), Alkaligenes sp 3 (2.25). 31 (23.30%) were resistant to commonly used antibiotics. Amikacin 85 (63.90%) was found to be more effective than fluoroquinolones (27.8-48.12%).

Onychomycosis caused by trichosporon beigelii.

Onychomycosis is caused primarily by dermatophytes, candida sp and nondermatophytic moulds. Trichosporon beigelii is an inhabitant of soil and occasionally is part of the normal flora of human skin. A 38- year- old male presented with brown discolouration of both big toes since one year. Repeated KOH preparation and culture of nail scrapings and clippings yielded Trichosporon beigelii, which was identified by standard techniques.

Spectrophotometric determination of some insecticides with 3-methyl-2-benzothiazolinone hydrazone hydrochloride.

A simple, rapid and sensitive spectrophotometric method is described for determining carbaryl, propoxur, fenitrothion and methyl parathion, based on reaction of their hydrolysis or reduction products (as appropriate) with 3-methyl-2-benzothiazolinone hydrazone hydrochloride in the presence of an oxidant (Ce(4+) or Fe(3+)) to give coloured species.