Endophthalmitis caused by Acinetobacter baumanni: a case series

PURPOSE

To profile the etiology, clinical outcomes and drug sensitivity patterns in endophthalmitis caused by Acinetobacter baumanni.

METHODS

Retrospective analysis of all the cases of Acinetobacter baumanni endophthalmitis presenting to tertiary referral care ophthalmic hospital in Eastern India from January 2009 to December 2011 were done.

RESULTS

A total of four cases were included in the study. Out of the four cases one was post traumatic and the rest were post cataract surgery. All the cases underwent vitreoretinal surgical intervention followed by intravitreal antibiotics. A. Baumanni was isolated from vitreous in all the cases. Among all the drugs tested bacteria were found sensitive to ciprofloxacin (100 %) whereas all tested resistant to ceftazidime. Out of the four cases one had to be eviscerated, another developed retinal detachment post vitrectomy, one was phthisical at final followup, and only one patient achieved a vision of 20/200 with clear media and attached retina at final visit.

CONCLUSION

A. Baumanni is a very rare cause of endophthalmitis with poor visual and anatomical outcomes. Ciprofloxacin should be considered as first the line intravitreal antibiotic.

Cytokine imbalance in systemic lupus erythematosus: a study on northern Indian subjects

OBJECTIVE

The phenotype of systemic lupus erythematosus (SLE) in Asian Indians is more severe as compared with that in Caucasians. The reason is not clear. In this context, we studied serum levels of interferon-gamma (IFN-γ), tumor necrosis factor-alpha (TNF-α), interleukin-4 (IL-4) and interlekin-10 (IL-10). Their interrelations and correlation with SLEDAI scores were evaluated.

MATERIALS AND METHODS

Forty patients with active SLE and 40 controls were studied. The mean SLEDAI score and anti-ds DNA level of the patients were 21.45 ± 8.61 and 176.68 ± 81.31 (IU/ml), respectively. Cytokines were estimated by enzyme-linked immunosorbent assay.

RESULTS

In controls, the levels of IFN-γ were highest, followed by TNF-α, IL-10 & IL-4. In patients, however, the levels of TNF-α were highest, followed by IFN-γ, IL-10 & IL-4. IL-10 and IL-4 correlated negatively, and IFN-γ and TNF-α correlated positively with the SLEDAI scores. As compared with controls, in patients, the mean values of TNF-α, IL-10 and TNF-α/IL-10 ratio were higher by 6.9, 2.9 and 2.3 times, respectively (p < 0.001). Significant positive correlation was found between these two cytokines in patients (r = 0.327, p < 0.05) but not in controls. The levels and ratio of IL-4 and IFN-γ were comparable between patients and controls. These two cytokines correlated negatively both in controls (r = -0.358, p < 0.05) and patients (r = -0.990, p < 0.001). The ratio of TNF-α/IL-4 was 4.2 times higher, and those of IFN-γ/IL-4 and IFN-γ/IL-10 were 1.89 and 3.40 times lower in patients as compared with controls. A positive correlation between IL-10 and IL-4 (r = 0.345, p < 0.05) and a negative correlation between IL-10 and IFN-γ (r = -0.382, p < 0.05) were observed only in patients.

CONCLUSION

This study showed a distinct profile of cytokine imbalance in patients with SLE from the northern plains of India. The levels, ratios and correlations of cytokines in patients suggested significant deviation from normal. Correlations of cytokines with SLEDAI scores indicated that TNF-α contributes significantly to the pathological manifestations of SLE in patients from the region. A detailed study is warranted.

Bloodstream Bacterial Pathogens and their Antibiotic Resistance Pattern in Dhahira Region, Oman

OBJECTIVES

To describe the epidemiological, clinical, microbiological characteristics and antimicrobial resistance pattern of Bloodstream infections in Dhahira region, Oman.

METHODS

Clinical data was collected from all patients with positive blood cultures for two years period. Standard laboratory methods were used for blood culture. Antibiotic sensitivity was tested using Kirby-Bauer disc diffusion method.

RESULTS

Of the 360 bacterial pathogens isolated from 348 patients, 57.8% were gram-positive and 42.2% were gram-negative. The common isolates were: Streptococcus species 76 (21.1%), coagulase-negative Staphylococci 75 (20.8%), Escherichia coli 43 (11.9%), Staphylococcus aureus 41 (11.4%). Overall, mortality was 21.3% (74/348). Staphylococcus species (Staphylococcus aureus and CoNS) were more commonly resistant to Trimethoprim/ Sulphamethoxazole (35.3%) and Penicillin (25.9%). Streptococcus species were resistant to Trimethoprim/Sulphamethoxazole (39.1%) and Erythromycin (19.6%).

CONCLUSION

Bloodstream infections are important causes of morbidity and mortality in our patients, especially among chronically ill elderly adult males. Prescription of proven resistant antibiotics to suspected bacteremic patients needs attention in Dhahira region.

Curcumin ameliorates reserpine-induced pain-depression dyad: behavioural, biochemical, neurochemical and molecular evidences

An apparent clinical relationship between pain and depression has long been recognized. Depression and pain are often diagnosed in the same patients. The emerging concept for pain-depression pathogenesis is the dysfunction of biogenic amine-mediated pain-depression control and the possible involvement of nitrodative stress-induced neurogenic inflammation. The present study was designed to investigate the effect of curcumin on reserpine-induced pain-depression dyad in rats. Administration of reserpine (1mg/kg subcutaneous daily for three consecutive days) led to a significant decrease in nociceptive threshold as evident from reduced paw withdrawal threshold in Randall Sellitto and von-Frey hair test as well as significant increase in immobility time in forced swim test. This behavioural deficit was integrated with decrease in the biogenic amine (dopamine, norepinephrine and serotonin) levels along with increased substance P concentration, nitrodative stress, inflammatory cytokines, NF-κβ and caspase-3 levels in different brain regions (cortex and hippocampus) of the reserpinised rats. Curcumin (100, 200, 300mg/kg; ip) dose dependently ameliorated the behavioural deficits associated with pain and depression by restoring behavioural, biochemical, neurochemical and molecular alterations against reserpine-induced pain-depression dyad in rats.

High Horn's index score predicts poor outcomes in patients with Clostridium difficile infection

Several variables have been proposed to predict the prognosis of patients with Clostridium difficile infection (CDI), but a clinically useful tool to stratify resource utilization has not been determined. Horn's index, a severity score based on underlying clinical illness, reliably predicts patients at high risk of CDI. The purpose of this study was to assess the use of Horn's index to stratify patients with CDI at high risk of poor clinical and economic outcomes. Hospitalized patients diagnosed with CDI were followed prospectively for three months. Horn's index scores were calculated for each patient on the day of the positive toxin test for C. difficile, and used to stratify differences in outcome variables (length of hospital stay, mortality and hospital costs). Eighty-five CDI patients (50% male, 64% Caucasian) were recruited. Discharge mortality was 0% for patients with Horn's index scores of 1 or 2, 5% for those with a score of 3, and 50% for those with a score of 4 (P < 0.001). Three-month mortality was 0%, 5%, 17% and 60% for patients with Horn's index scores of 1, 2, 3 and 4, respectively (P = 0.0004). Median three-month hospital costs were $8,585, $12,670, $29,077 and $68,708 for patients with Horn's index scores of 1, 2, 3 and 4, respectively (P < 0.001). Patients with Horn's index scores of 3 or 4 had a significantly longer hospital stay [mean 33.4 (standard deviation, SD 33.3) days] than patients with scores of 1 or 2 [mean 15.1 (SD 16.2) days, P = 0.001]. This study found Horn's index to be a simple and useful method for identifying CDI patients at high risk of poor clinical and economic outcomes.

Relationship of leukocyte CR1 transcript and protein with the pathophysiology and prognosis of systemic lupus erythematosus: a follow-up study

Complement Receptor 1 (CR1) is a key complement regulatory protein (CRP) involved in the clearance of immune complexes. Earlier, we reported a marked decline of leukocyte CR1 (L-CR1) transcript and protein in patients with active systemic lupus erythematosus (SLE) and suggested L-CR1 transcript as a putative non-invasive disease marker for SLE. This follow-up study involving 18 patients with active SLE was conducted for further confirmation of the relationship between L-CR1 and SLE. Blood samples from the patients were collected on day 1 of the diagnosis (0 month) and at different time intervals (3 and 6 months) for analysis of L-CR1 transcript and L-CR1 protein by semi-quantitative reverse-transcriptase-polymerase chain reaction (RT-PCR) and western blotting respectively. Within 6 months, 15 patients entered remission. On day 1, the mean values of L-CR1 transcript (8.42 ± 3.53) and L-CR1 protein (4683 ± 1094) in the SLE patients were 6 times and 12 times lower than the normal controls (n = 103). At the end of month 6, these values increased by 4.5 and 6.5 times respectively for CR1 transcript (37.86 ± 8.52) and protein (30,265 ± 8614). Simultaneously, the SLE Disease Activity Index (SLEDAI) scores decreased by 4.8 times (4.47 ± 3.32) as compared with the scores obtained on day 1 (21.45 ± 5.67). Moreover, CR1 values correlated negatively with the SLEDAI scores. Levels of L-CR1 protein and transcript remained low in the three patients who did not enter remission. All of the above results suggested that an increase in the levels of L-CR1 related to good prognosis. Since the levels of L-CR1 protein is influenced by variables like proteolytic cleavage and secretion from leukocytes, the values of L-CR1 transcript on day 1 and subsequent follow-up points may bring a better insight into the state of the disease activity. An extended follow-up study is needed to confirm the significance of L-CR1 as a prognostic marker for SLE.

A Note on the Effect of Hamycin on Electrolytes in the Frog Heart

Treatment of frog heart with hamycin, an antifungal antibiotic, effected an increase in the potassium content of perfusion fluid. Changes in sodium content were not observed.

Acclimatory response to hydrogen peroxide and glutathione under salt-boron stress through their impact on mineral nutrition and antioxidant defense system in pigeonpea (Cajanus cajan L.)

Investigations were carried out on a salt tolerant (Manak, H77-216) and a comparatively salt sensitive (ICPL 88039) genotypes of pigeonpea (Cajanus cajan L. Millsp.) under NaCl, B and NaCl + B stress to examine the acclimatory response to H2O2, glutathione and H2O2 + glutathione through their effect on mineral nutrition, morpho-physiological parameters and antioxidant defense system. Both B and NaCl alone and their combinations had deleterious effect on dry biomass of plumule, enhanced relative stress injury (RSI), lipid peroxidation with concomitant increase in Na, Cl and B contents. However it did not bear any correlation with osmotic potential of plumule and K contents. Antioxidative enzymes like superoxide dismutase (SOD), catalase (CAT), ascorbate peroxidase (APX), peroxidase (POX) and glutathione reductase (GR) also decreased with salt, B and salt + B treatments. However contents of H2O2 enhanced and that of ascorbate declined under aforementioned treatments. These injurious effects are partially alleviated by exogenous application of H2O2; glutathione (GSH) and H2O2 + GSH treatments. The role of H2O2 and GSH in the present study is suggestive of triggering multifunctional signal transduction in plant defense mechanisms to prevent cellular oxidation, membrane injury, lipid peroxidation and protein enzyme inactivation.

Determination of Working Length of Root Canal

BACKGROUND

This study was undertaken to determine the working length of root canal by microprocessor controlled impedance quotient apex locator and conventional radiographic method.

METHODS

Patients whose teeth were to be extracted were selected for this study. A total of 100 teeth in the same or different patients were identified. Biomechanical preparation of the canal was done for smooth negotiation of the entire canal. The electrode of the Root ZX™ was attached to the selected file and the length adjusted till the beep of the Root ZX™ indicated the apical foramen. The electrode was removed but the file was stabilized with the help of soft gutta percha. An intraoral periapical (IOPA) radiograph was taken using basic guidelines. The tooth was then extracted under local anaesthesia along with the file in the tooth. A window was cut on one surface of the root apex approximately 4mm from the apex to expose the root canal. The file tip was identified. The distance of the file tip from the apex was measured under 3X magnification and the reading recorded. Similarly the distance from the file tip to the radiographic apex was measured on the radiograph under magnification and the reading recorded. All the readings were tabulated. The actual distances measured between the extracted tooth, the electronic apex locator and on the radiograph were compared using a paired 't' test to determine the accuracy of each method in relation to the minor diameter.

RESULT

It was observed that the radiographic method had a significant variation from the electronic method when compared to the actual measurement on the extracted tooth.

CONCLUSION

The electronic method is a more accurate method as compared to radiographic method for determination of working length of the root canal.