Emergence and dissemination of antibiotic resistance: a global problem

Antibiotic resistance is a major problem in clinical health settings. Interestingly the origin of many of antibiotic resistance mechanisms can be traced back to non-pathogenic environmental organisms. Important factors leading to the emergence and spread of antibiotic resistance include absence of regulation in the use of antibiotics, improper waste disposal and associated transmission of antibiotic resistance genes in the community through commensals. In this review, we discussed the impact of globalisation on the transmission of antibiotic resistance genes in bacteria through immigration and export/import of foodstuff. The significance of surveillance to define appropriate use of antibiotics in the clinic has been included as an important preventive measure.

Two step meso-acidophilic bioleaching of chalcopyrite containing ball mill spillage and removal of the surface passivation layer

Meso-acidophilic bacterial leaching of ball mill spillage (containing chalcopyrite >80%) was carried out in an innovative two-step bioleaching method. The major drawback of meso-acidophilic bioleaching limiting industrial application is the passivation phenomenon over the ore surfaces in iron-sulfur rich environments. In the present study, we present a novel wash solution that efficiently removed the passivation layer. FTIR characterization of the bioleached sample indicated that the residues could be further leached to recover extra copper after wash solution application. XRD study indicated accumulation of sulfates (SO(4)(-)) of Na, K, Fe and oxy hydroxides of iron [FeO(OH)] in the form of jarosite outlining the passivation layer. SEM, FESEM-EDS studies indicated severe corrosion effects of the wash solution on the passivation layer. Two step bioleaching of the ore sample yielded 32.6% copper in 68days in the first interlude and post wash solution application yielded 10.8% additional copper.

Extra-adrenal Paraganglioma: An Uncommon Cause of Secondary Hypertension in a Young Subject

An 8 year boy was admitted with features of tuberculous meningitis. He was detected to have hypertension. Further investigations revealed an extra-adrenal paraganglioma. Tuberculous meningitis and paraganglioma could be chance associations. Paraganglioma is a rare and potentially lethal cause of secondary hypertension, very uncommon at this age. If left untreated it leads to complications arising from unrelenting hypertension. We report a case report on this very rare disease of paraganglioma presenting in an unexpected way. Key words: Paraganglioma; Tuberculous meningitis; Secondary hypertension DOI: http://dx.doi.org/10.3126/jnps.v31i3.4965 J Nep Paedtr Soc 2011;31(3): 238-240

Seronegative necrolytic acral erythema: a distinct clinical subset?

A patient was referred to us with asymptomatic, erythematous, nonitchy, scaly lesions present bilaterally on the dorsa of his feet and toes since the last 2 months. Both the legs had pitting edema as well. There were hyperkeratosis, focal parakeratosis, acanthosis and scattered spongiosis in the epidermis, and proliferation of capillaries with perivascular infiltration of lymphomononuclear cells in the dermis. There was no serological evidence of hepatitis C virus. Laboratory investigations revealed hypoalbuminemia and low-normal serum zinc. On clinicopathological correlation, we made a diagnosis of necrolytic acral erythema (NAE). The lesions responded dramatically to oral zinc sulfate and topical clobetasol propionate within 3 weeks with disappearance of edema and scaling and only a minimal residual erythema. This is the first reported case of NAE from Eastern India. NAE with negative serology for hepatitis C may be viewed as a distinct subset of the condition that had been originally described.

Localized convexity subarachnoid haemorrhage--a sign of early cerebral venous sinus thrombosis

BACKGROUND

The diagnosis of cerebral venous sinus thrombosis (CVST) requires a high index of suspicion owing to the wide spectrum of clinical manifestations. Amongst the different presentations, radiological evidence of subarachnoid haemorrhage (SAH) often leads to diagnostic errors.

METHODS

Between March 2005 and December 2007, 233 patients with CVST were reviewed at our centre, and this report summarizes 10 cases that presented with SAH. The early clinico-radiological pointers towards a diagnosis of CVST are highlighted and previously published reports are reviewed.

RESULTS

The mean age at presentation was 33 years (range 25-50), and the median duration from onset of symptoms to admission was 5 days (range 2-15). In all cases, there was radiological evidence of SAH with or without associated parenchymal bleeding or other signs of CVST. SAH was usually localized, involving the sulci of the cerebral convexity and sparing the basal cisterns. Aetiologically, there were two cases with both hyperhomocysteinaemia and polycythaemia and one case each of antiphospholipid antibody (APLA) syndrome, post-partum state, oral contraceptive use and dehydration because of diarrhoea. Eight patients improved with anticoagulant therapy despite the presence of SAH.

CONCLUSIONS

Localized SAH (whether focal, unilateral or bilateral), especially when confined to the parasagittal or dorsolateral convexity of the brain and without involvement of the basal cisterns, may provide an early pointer towards an underlying CVST. The presence of predisposing factors for CVST accords a further diagnostic hint.

Squamous Cell Carcinoma Developing in a Diabetic Foot Ulcer

Documented cases of malignant transformation of foot ulcer in a diabetic patient in medical literature are very few. This study presents 2 interesting cases of long-standing diabetic foot ulcer, which were subsequently diagnosed to have squamous cell carcinoma on histopathological examination.