Frequency of Hyponatremia in Adults with Acute Bacterial Meningitis

Bacterial meningitis is a life-threatening disease. Bacterial meningitis patients are prone to develop acute hyponatremia. In the central nervous system infection hyponatremia could be due to the Syndrome of Inappropriate Anti Diuretic Hormone secretion. The frequency of hyponatremia in adults with acute bacterial meningitis patients was seen in this study. This cross-sectional study was conducted in the Internal Medicine Department of Mymensingh Medical College Hospital, Mymensingh, Bangladesh from February 2016 to July 2016. A total of 50 patients were enrolled in this study by purposive sampling. Among 50 acute bacterial meningitis patients, 33 (66%) were diagnosed as hyponatremic state. The mean serum sodium level of 33 hyponatremic bacterial meningitis cases was 130.66±2.95 mmol/L. Most of the cases (78.79%) were mild hyponatremic state (130 mmol/L-135 mmol/L) whereas 18.18% were revealed as moderate hyponatremia (125 mmol/L-129 mmol/L). Only 3.03% of cases were presented as severe cases (≤124 mmol/L). The result revealed that a large number of patients with acute bacterial meningitis were suffering from hyponatremia and in the majority of cases were mildly hyponatremic.

Atypical Presentations of Childhood Simple Partial Seizures: a Case Series

Childhood epilepsy can masquerade as a variety of psychiatric disorders or behavioural abnormalities. Differentiating between simple partial seizure and psychiatric disorders remains a challenge. We report on three children with simple partial seizure, each presented atypically with migraine, tingling sensations, and/or crying spells. When dealing with atypical symptomatology, clinicians should utilise a multidirectional, rather than unidirectional, diagnostic approach when making their diagnosis.

Neuroprotective effect of Vitamin K2 against gut dysbiosis associated cognitive decline

Vitamin K2/ Menaquinones produced predominantly by the gut microbiome improve bone health and prevent coronary calcification. The central nervous system has been linked with gut microbiota via the gut-brain axis and is strongly associated with psychiatric conditions. In the present study, we show the role of Vitamin K2 (MK-7) in gut dysbiosis-associated cognitive decline. Gut dysbiosis was induced in mice by administering Ampicillin (250 mg/kg twice a day orally) for 14 days and Vitamin K2 (0.05 mg/kg) for 21 days with or without antibiotic treatment and altered gene expression profile of intestinal microbes determined. This was followed by behavioural studies to determine cognitive changes. The behavioural observations are then correlated with proinflammatory, oxidative, and brain and intestinal histopathological changes in antibiotic-treated animals with or without vitamin K2 administration. With the use of antibiotics, Lactobacillus, Bifidobacterium, Firmicutes, and Clostridium's relative abundance reduced. When vitamin K2 was added to the medication, their levels were restored. Cognitive impairment was observed in behavioural trials in the antibiotic group, but this drop was restored in mice given both an antibiotic and vitamin K. Myeloperoxidase levels in the colon and brain increased due to gut dysbiosis, which vitamin K2 prevented. The acetylcholine esterase and oxidative stress markers brought on by antibiotics were also decreased by vitamin K2. Additionally, vitamin K2 guarded against alterations in intestine ultrastructure brought on by antibiotic use and preserved hippocampus neurons. So, it can be concluded that vitamin K2 improved cognitive skills, avoided hippocampus neuronal damage from antibiotics, and lowered intestine and brain inflammation and oxidative stress.

The outbreak of the monkeypox virus in the shadow of the pandemic

The human monkeypox virus (MPXV) was first identified in 1959. Since then, the incidence of the disease has been sporadic. The endemic regions were identified in Africa's central and western areas. However, the infection started to spread in 2017 to non-endemic regions such as North and South America, Europe, and Asia. Since May 2022, the non-endemic areas reported 62,635 till 20th September 2022. Although the monkeypox virus has a mortality of ≥ 10%, it showed only 82 mortalities worldwide in 2022. The common symptoms include chills, fever, fatigue, and skin lesions, and the complications include secondary respiratory tract infections, encephalitis, blindness, and severe diarrhea. The factors responsible for spreading the virus include improper handling and consumption of infected bushmeat, unprotected sexual intercourse, contact with an infected person, no smallpox vaccination, improper hygiene, lower diagnostic capacity, and strong travel history from the endemic regions. The therapeutic strategy is symptom-based treatment and supportive care. Antivirals and vaccines such as Tecovirimat, Brincidofovir, Cidofovir, Imvamune, and ACAM2000 have shown promising results. The primary purpose of the review is to perform an epidemiological study and investigate the pathobiology, diagnosis, prevention, treatment, and some associated complications of the monkeypox virus in 2022.

Non-structural protein 1 (NS1) variants from dengue virus clinical samples revealed mutations that influence NS1 production and secretion

Dengue diagnosis primarily relies on NS1 ELISA and serological (IgG/IgM) tests. There are reports of low and variable sensitivity of the widely used NS1 ELISA tests. Poor sensitivity has been attributed to patient's infection status, prevalent serotypes, and the geographical origin of the samples. We investigated whether NS1 mutations directly have any impact on NS1 ELISA-based dengue virus (DENV) detection in clinical samples. Fifty-eight serum samples were collected from dengue-endemic area during 2015-2017 and tested with three commonly used NS1 ELISA kits. The samples were subjected to diagnostic RT-PCR and sequencing of structural gene(s). Sequencing of NS1 gene revealed amino acid changes which were transferred to respective wild type NS1 backbone to determine their effects on NS1 production and secretion in Huh-7, Vero, and A549 cells. Eighty-seven percent samples were virus RNA-positive but 65% of these were NS1 ELISA-positive. NS1-gene mutations like Val236➔Ala (DENV2) or Trp68➔stop codon in DENV3 were associated with decreased NS1 production and secretion. These mutations were originally identified in NS1 ELISA-negative clinical isolates. All DENV1 and > 80% DENV2 were NS1 ELISA-positive. The three NS1 ELISA could not detect recently circulating DENV3 single infections despite being RNA-positive. Among serotypes 1-3, wild-type NS1 production was highest for DENV1 and lowest for DENV3 in all cell lines tested. Mutations in circulating DENV directly correlated with NS1 production and secretion and, hence, ELISA-based NS1 detection. Further studies to define more NS1 mutations in clinical samples are needed to optimize ELISA kits for more sensitive dengue diagnosis.

Molecular determinants, clinical manifestations and effects of immunization on cardiovascular health during COVID-19 pandemic era - A review

The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has enveloped the world into an unprecedented pandemic since 2019. Significant damage to multiple organs, such as the lungs and heart, has been extensively reported. Cardiovascular injury by ACE2 downregulation, hypoxia-induced myocardial injury, and systemic inflammatory responses complicate the disease. This virus causes multisystem inflammatory syndrome in children with similar symptoms to adult SARS-CoV-2-induced myocarditis. While several treatment strategies and immunization programs have been implemented to control the menace of this disease, the risk of long-term cardiovascular damage associated with the disease has not been adequately assessed. In this review, we surveyed and summarized all the available information on the effects of COVID-19 on cardiovascular health as well as comorbidities. We also examined several case reports on post-immunization cardiovascular complications.

Water quality assessment of the Ganges River during COVID-19 lockdown

Ganges River water quality was assessed to record the changes due to the nation-wide pandemic lockdown. Satellite-based (Sentinel-2) water quality analysis before and during lockdown was performed for seven selected locations spread across the entire stretch of the Ganges (Rishikesh-Dimond Harbour). Results revealed that due to the lockdown, the water quality of the Ganges improved with reference to specific water quality parameters, but the improvements were region specific. Along the entire stretch of Ganges, only the Haridwar site showed improvement to an extent of being potable as per the threshold set by the Central Pollution Control Board, New Delhi, India. A 55% decline in turbidity at that site during the lockdown was attributed to the abrupt halt in pilgrimage activities. Absorption by chromophoric dissolved organic matter which is an indicator of organic pollution declined all along the Ganges stretch with a maximum decline at the downstream location of Diamond Harbour. Restricted discharge of industrial effluent, urban pollution, sewage from hotels, lodges, and spiritual dwellings along the Ganges are some of the reasons behind such declines. No significant change in the geographic trend of chlorophyll-a was observed. The findings of this study highlight the importance of regular monitoring of the changes in the Ganges water quality using Sentinel-2 data to further isolate the anthropogenic impact, as India continues the phase-wise opening amidst the pandemic.

The interplay between spatial and heliconical orientational order in twist-bend nematic materials

The helical pitch formed by organic molecules, such as the α-helix of proteins, usually requires hydrogen bonding between chiral units and long-range positional order. It was recently found that certain liquid crystal oligomers can have a twist-bend nematic (NTB) phase with nanoscale heliconical structure without hydrogen bonding, molecular chirality or positional order. To understand the nature of this unique structure, here we present hard and resonant tender X-ray scattering studies of two novel sulfur containing dimer materials. We simultaneously measure the temperature dependences of the helical pitch and the correlation length of both the helical and positional order. In addition to an unexpected strong variation of the pitch with the length of the spacer connecting the monomer units, we find that at the transition to the NTB phase the positional correlation length drops. The helical structure was found not only in the NTB phase but observed even in the upper range of a smectic phase that forms just below the NTB state. The coexistence of smectic layering and the heliconical order indicates a layered (SmATB) phase wherein the rigid units of the dimers are tilted with respect to the smectic layer normal in order to accommodate the bent conformation of the dimers and the tilt direction rotates along the heliconical axis.

The Pattern of Lipid Profile in Patients with Chronic Kidney Disease

Dyslipidemia is a common problem in chronic kidney disease patients. Dyslipidemia in chronic kidney disease patients has been known to be a major risk factor of their cardiovascular disease and may contribute to progressive renal dysfunction. The result of the study might be of interest in improving preventive strategies and in management of dyslipidemia in chronic kidney disease patients. This cross sectional study was conducted to evaluate changes in lipid profile in patients with chronic kidney disease stage-3 to stage-5 patients and to correlate the biochemical abnormalities with progression of the disease in Mymensingh Medical College Hospital, Bangladesh from October, 2016 to April, 2017. In this study 200 patients were including and subjected to do complete blood count, erythrocyte sedimentation rate, random blood sugar, routine examination of urine, serum creatinine and fasting lipid profile. Two hundred (200) patients (134 males, 66 females) with the mean age were 50.5±12.43 years. 44.5% patients were in CKD stage-5, 37.5% patients were in CKD stage-4, 18% patients were in CKD stage-3. Mean value of Triglyceride (TG) was 194±47.20. Eighty nine percent (89%) patient had hyper-triglyceridemia and 11% had normal triglyceride level. It was statistically significant increased in triglyceride level (p<0.05). Mean value of High density lipoprotein cholesterol (HDL-C) was 34±6.10. Low HDL-C had in 87.5% patients, normal in 12.5% patients and was statistically significant reduction in HDL-C level (p<0.05). Low Density Lipoprotein cholesterol (LDL-C) mean was 113±35.6. High level of LDL-C had optimal/or near optimal in 47% patients, 39% patients had borderline high and 14% patients had that was not statistically significant (p>0.10). Total cholesterol (TC) mean was 212±45.3. In 38% patients had within desirable level, 62% patients had high level of Total cholesterol (TC). It was not statistically significant change (p>0.01).

Practical consensus recommendations on duration of adjuvant hormonal therapy in breast cancer

Optimization of adjuvant systemic therapy in women with early-stage hormone receptor-positive breast cancer includes the consideration of chemotherapy and duration of hormone therapy. Adjuvant hormonal therapy significantly improves long-term survival of breast cancer patients with hormone receptor-positive disease. Despite the proven clinical efficacy of tamoxifen and aromatase inhibitors, many breast cancer survivors either fail to take the correct dosage at the prescribed frequency (adherence) or discontinue therapy (persistence). Expert oncologist discussed on the duration of adjuvant hormonal therapy for improvement of OS and quality of life of breast cancer patients by providing reduction in recurrence and mortality. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at this practical consensus recommendations for the benefit of community oncologists.

The Current Indian Epidemic of Dermatophytosis: A Study on Causative Agents and Sensitivity Patterns

Background

In the recent years, the frequency, severity, clinical characteristics, treatment response, and relapse rate of dermatophytosis have dramatically changed in India. Given the surge in dermatophytosis, we had undertaken a study to isolate and identify the common species causing dermatophyte infection and to know the in vitro efficacy of the common antifungals against them.

Materials and Methods

A total of 103 new cases that were not on any treatment for the past 3 months were included. Skin scrapings were collected for direct microscopic examination and for fungal culture in Sabouraud 4% dextrose agar (SDA) with chloramphenicol and cycloheximide slant tubes, and dermatophyte test media. Fungi were identified on the basis of their macroscopic and microscopic features with the help of lactophenol cotton blue staining and urease test. Also, the drug sensitivity of the dermatophytes was tested with the common antifungals.

Results

Of the 55 cases (53.4%) that were positive for dermatophytes in the culture, 29 showed possible contamination. Trichophyton was the predominant organism (49 cases) with T. verrucosum being the commonest species (26 cases), followed by T. rubrum (15 patients), and T. mentagrophytes (8 cases). All species of Trichophyton were found to be most sensitive to itraconazole amongst systemic antifungals and luliconazole amongst topical antifungals.

Conclusion

This study concluded that the causative agent for the dermatophytosis was changing in India and in our subset, T. verrucosum caused the maximum number of infections. Itraconazole and luliconazole had the highest sensitivity amongst systemic and topical antifungals, respectively. It also showed that terbinafine had comparatively less sensitivity to most organisms.

Impact of conventional retting of jute (Corchorus spp.) on the environmental quality of water: a case study

Production of quality jute fibre primarily depends on the retting process of jute. However, the quality of retting water is of great concern because of the scarcity of available water bodies for retting. A study conducted on physico-chemical and microbiological changes in retting water (pre- and post-retting) from four intensively jute-growing districts namely Nadia, North 24 Parganas, Hooghly and South Dinajpur of West Bengal, India, during jute retting. The post-retting water samples recorded lower pH (6.22 to 7.08) and higher EC (electrical conductivity) (0.509 to 0.850 ds/m) compared with pre-retting water samples (pH 6.63 to 7.44; EC 0.197 to 0.330 ds/m) collected from all the four districts under study. The biological oxygen demand (BOD) and chemical oxygen demand (COD) increased several folds in the post-retting water samples indicating very high microbial growth and activities and depleted oxygen level compared with pre-retting water. The Ca + Mg (calcium + magnesium) content in pre-retting water was high (24.15 to 36.60 ppm) which raised further (61.30 to 103.67 ppm) in post-retting water, while the bicarbonate content also increased and ranged between 2.72 and 6.81 me/l in post-retting water compared with its status in pre-retting water (1.30 to 3.15 me/l). The post-retting water was found to be a rich source of nutrients like nitrogen (N), phosphorus (P), iron (Fe), manganese (Mn), zinc (Zn) and copper (Cu) which increased substantially because of jute retting as compared with their status in pre-retting water. The population of pectinolytic, xylanolytic, cellulolytic and ligninolytic bacterial cfu (colony forming unit) increased by 1.5 times in post-retting water as compared with pre-retting water, because these specific bacterial population were involved in the degradation of pectin, xylan, cellulose and lignin during retting of jute. Thus, post-retting water can be judiciously used as a potent source of primary, secondary and micronutrients for succeeding crops besides having higher BOD and COD as a result of higher microbial growth related to jute retting.

Coenzyme Q10 ameliorates cadmium induced reproductive toxicity in male rats

This study aimed at investigating the protective role of CoQ10 against cadmium (Cd)-induced reproductive toxicity in male rats. Adult male Wistar rats were exposed to an acute dose of Cd (25 mg/kg bwt; Cd group), Cd+CoQ10 (25 mg/kg bwt Cd+10 mg CoQ10; Cd-Q10 group) and distilled water (control) in vivo for 15 consecutive days and semen quality was assessed. A significant reduction was noted in sperm concentration, progressive motility, morphology and DNA integrity in both Cd- and Cd-Q10 groups in comparison to control indicating Cd-induced testicular lipid per oxidation (LPO) and decline in indigenous antioxidant defense system as measured by total antioxidant capacity (TAC) (p<0.05). However, simultaneous co-administration of CoQ10 along with Cd (Cd-Q10 group) was able to improve sperm concentration, motility, progressive motility, morphology, DNA integrity, and testicular TAC as well as lower LPO compared to Cd group (p<0.05). Results indicate that used dose of CoQ10 is capable of moderately ameliorating reproductive toxicity of Cd by improving semen quality and reducing testicular oxidative stress.

Selective picomolar level fluorometric sensing of the Cr(vi)-oxoanion in a water medium by a novel metal–organic complex

Selective picomolar level fluorometric sensing of the Cr(vi)-oxoanion in a water medium has been achieved by a novel metal–organic complex.

Burden Assessment, Psychiatric Morbidity, and Their Correlates in Caregivers of Patients with Intellectual Disability

OBJECTIVE

Intellectual disability in a child places great stress on a family and caregiver and this leads to significant socio-occupational dysfunction and impaired quality of life for caregivers. This study aimed to assess socio-demographic characteristics, burden, and psychiatric morbidity of the caregivers of persons with intellectual disability, as well as to determine the variables that correlated with burden and psychiatric morbidity.

METHODS

An observational study was carried out in an outpatient psychiatric unit of a tertiary care teaching hospital in India from October 2014 to April 2015. A total of 100 caregivers of intellectually impaired individuals were assessed for burden and psychiatric morbidity.

RESULTS

In all, 39% of the caregivers had a high burden score, 46% perceived mild-to-moderate burden severity, and 15% perceived no to mild burden. Mild-to-moderate depressive symptoms were present in 23% and 16% had severe-to-extremely severe depressive symptoms. Mild-to-moderate anxiety symptoms were evident in 19% of caregivers and a further 19% had severe-to-extremely severe anxiety symptoms.

CONCLUSION

Routine assessment of burden and psychiatric morbidity in the caregiver will help to reduce their burden and thus help them care for their children more appropriately and efficiently.

Risk Factor Analysis for Oral Precancer among Slum Dwellers in Delhi, India

Background:

An outfall of urbanization in developing countries has been the mushrooming of slums where dwellers live in pitiable environmental conditions representing the lowest rung of social strata. This group is more vulnerable to practicing deleterious social habits, including tobacco and alcohol abuse.

Aim:

The present study was undertaken to understand the strength of association between risk factors suspected of causing oral precancer among slum dwellers in Delhi.

Subjects and Methods:

A house-to-house survey was conducted in an urban slum cluster situated in the heart of Delhi city by a single trained investigator who recorded oral mucosal lesions according to WHO criteria. Demographic details and history of suspected risk factors was recorded by personal interview of each subject. The obtained data was coded, cleaned, and analyzed manually. Chi-square test was applied and Odds’ ratios were calculated to analyze the association of risk factors with oral precancer. A statistically significant difference was set at 95% confidence interval.

Results:

A total of 479 subjects of both sexes were examined and 31 cases clinically diagnosed as having oral precancer, of which majority were leukoplakia. All cases except one reported practicing habits that are known risk factors for oral precancer, i.e., smoking/smokeless tobacco, chewing betel leaf/nut, and combination of these habits with alcohol. Association of oral precancer with smokeless tobacco was higher than that with smoking or chewing betel leaf/nut alone.

Conclusion:

Practicing combination of habits with alcohol was found to be the most strongly associated risk factor for oral precancer.

Obstetric Emergencies: Feto-maternal Outcome at a Teaching Hospital

Aims: This study was done to know the pattern of obstetric emergencies and its influence on maternal and fetal outcome. Methods: A descriptive study was carried out in the department of obstetrics and gynecology at Kathmandu Medical College Teaching Hospital from 1st June 2013 to 31st May 2014. Cases were categorized as early pregnancy emergencies (ruptured ectopic pregnancy, complications of abortion), ante-partum emergencies and intra-partum emergencies (antepartum haemorrhage, preeclampsia, eclampsia, preterm prelabor rupture of membranes, rupture uterus), post-partum emergencies (postpartum haemorrhage, retained placenta, placenta accreta, uterine inversion), puerperal emergencies (postpartum sepsis), fetal emergencies (cord prolapse, shoulder dystocia). Outcome noted were type of emergency, obstetric intervention done, maternal and perinatal morbidity and mortality. Results: A total of 80 (4.45%) obstetric emergencies occurred among 1796 deliveries .The most common obstetric emergencies were obstetric hemorrhage (62.5%), severe preeclampsia (23.5%) and preterm prelabor rupture of membranes (10%). The obstetric interventions done were cesarean section (43.75%), exploratory laparotomy (33.75%) and blood transfusion (40%). Obstetric emergencies were responsible for 66.6% of total maternal death and 24.56% of total perinatal death. Conclusions: In spite of best efforts, some obstetric emergencies do occur. Obstetric hemorrhage and severe preeclampsia are the frequent obstetric emergencies. Cesarean section, exploratory laparotomy and blood transfusion were the commonly performed interventions. A better outcome can be achieved by national policy of promoting utilization of antenatal care, institutional deliveries, skilled birth attendance at delivery, liberal blood transfusion and regular training of doctors and nurses. DOI: http://dx.doi.org/10.3126/njog.v9i1.11186 NJOG 2014 Jan-Jun; 2(1):37-40

Non-descent Vaginal Hysterectomy: Safety and Feasibility

Aims: To assess safety and feasibility of non-descent vaginal hysterectomy. Methods: A hospital based prospective study was conducted at the department of obstetrics and gynecology of Kathmandu Medical College Teaching Hospital from 1st January 2010 to 31st December 2011. All the patients undergoing non -descent vaginal hysterectomy for benign indication, without suspected adnexal pathology were included in the study. Vaginal hysterectomy was done in usual manner. In bigger size uterus morcellation techniques like bisection, debulking, myomectomy, slicing, or combination of these were used to remove the uterus. Data regarding age, parity, uterine size ,estimated blood loss, length of operation, complication and hospital stay were recorded. Results: A total of 50 cases were selected for non-descent vaginal hysterectomy. Among them 43 cases successfully underwent non-descent vaginal hysterectomy. Commonest age group was (41-45 years) i.e. 40%. All patients were parous. Uterus size was <10 weeks in 27 cases and >10 weeks in 23 cases. Commonest indication was leiomyoma of uterus (63%). Mean duration of surgery was two hours. Mean blood loss was 205.26ml. Reasons for failure to perform NDVH was difficulty in opening pouch of Douglas in three cases. In rest of four cases there was difficulty in reaching the myoma and transverse diameter was too large so as to prevent descent of the uterus. The most common complication was post –operative pain in 23% of cases. Febrile morbidity was present in 4.6% of cases. Blood transfusion was required in seven cases. Average duration of hospital stay was three days. Conclusions: Vaginal hysterectomy for benign gynecological causes other than prolapse is safe and feasible. For successful outcome size of uterus, size in all dimensions and location of fibroid should be taken into consideration.Today in the era of minimally invasive surgery, non descent vaginal hysterectomy needs to be considered and seems to be a safe option. DOI: http://www.dx.doi.org/10.3126/njog.v7i2.11134   Nepal Journal of Obstetrics and Gynaecology / Vol 7 / No. 2 / Issue 14 / July-Dec, 2012 / 14-16

Expression of phosphatase and tensin homolog, epidermal growth factor receptor, and Ki-67 in astrocytoma: A prospective study in a tertiary care hospital

BACKGROUND

Though the tumor grade is a key factor influencing the choice of therapies, particularly determining the use of adjuvant radiation and specific chemotherapy protocols, role of abnormality in phosphatase and tensin homolog (PTEN) expression and variation in epidermal growth factor receptor (EGFR) labeling index (LI) and Ki-67 LI in survival and clinical outcome have been studied by many researchers in the recent past.

AIMS

The aim was to evaluate the expression of PTEN, EGFR and Ki-67 in different grades of astrocytic tumors by means of immunohistochemistry and to judge their role in overall survival (OS).

MATERIALS AND METHODS

This study was conducted on 57 cases of different grades of astrocytomas. Expression of PTEN, EGFR and Ki-67 was assessed by immunohistochemistry on formalin fixed and paraffin-embedded sections and the OS was evaluated by Kaplan-Meier survival curves and log-rank test for 2.5 years from the date of primary resection.

RESULTS

Most of the tumors (59.6%; 34 cases out of 57) displayed WHO Grade IV features. Distribution of age, EGFR LI and Ki-67 LI expressed strong positive (≥0.5) correlation with the grade of tumors. However, the PTEN positivity was inversely related with the grade of the tumors. Lower WHO grades, lower values of Ki-67 LI, EGFR LI and PTEN positivity were associated with better survival.

CONCLUSION

Expression of PTEN, EGFR LI and Ki-67 LI should be combined with the basic histopathological features including WHO grade to predict the prognosis and therapeutic outcome.

Subcutaneous mycoses caused by Rhytidhysteron species in an immunocompetent patient

Subcutaneous mycoses are chronic fungal infections of the skin and subcutaneous tissues caused by variety of fungal agents and usually occur following trauma with vegetative matter. We report a case of subcutaneous mycoses caused by rare fungus belonging to the genus Rhytidhysteron, in an immunocompetent male who presented with a subcutaneous nodule on left foot. This unusual species was identified and confirmed by molecular methods.

GA-optimized feedforward-PID tracking control for a rugged electrohydraulic system design

Rugged electrohydraulic systems are preferred for remote and harsh applications. Despite the low bandwidth, large deadband and flow nonlinearities in proportional valves valve and highly nonlinear friction in industry-grade cylinders that comprise rugged systems, their maintenance are much easier than very sophisticated and delicate servocontrol and servocylinder systems. With the target of making the easily maintainable system to perform comparably to a servosystem, a feedforward control has been designed here for compensating the nonlinearities. A PID feedback of the piston displacement has been employed in tandem for absorbing the unmodeled effects. All the controller parameters have been optimized by a real-coded genetic algorithm. The agreement between the achieved real-time responses for step and sinusoidal demands with those achieved by modern servosystems clearly establishes the acceptability of the controller design.

Effect of Some Non Functional Surfactants and Electrolytes on the Hexavalent Chromium Reduction by Glycerol: A Mechanistic Study

Hexavalent chromium is a widespread environmental contaminant and a known human carcinogen. Kinetics of reduction of hexavalent chromium by bio-molecule glycerol in micellar media have been studied spectrophotometrically. The cytoplasmic reduction of hexavalent chromium to trivalent chromium occurs in micro-heterogeneous systems. In vitro, the micelles are considered to mimic the cellular membranes. The electron transfer processes occurring in the micellar systems is considered as model to obtain insight into the electron transport process prevailing in biological systems. Micellar media is also a probe to establish the mechanistic paths of reduction of hexavalent chromium to trivalent chromium. Effects of electrolytes common to biological system are studied to establish the proposed reaction mechanism strongly.

Stability-indicating Reversed-phase Liquid Chromatographic Method for Simultaneous Determination of Losartan Potassium and Ramipril in Tablets

A stability-indicating reversed-phase liquid chromatographic method has been developed and validated for simultaneous determination of losartan potassium and ramipril. Separations were achieved using a C(18) column with mobile phase consisting of acetonitrile and (0.2% v/v, pH 2.5) aqueous trifluoroacetic acid (45:55, v/v) in isocratic mode at 1 ml/min flow rate. Column effluent was monitored at 210 nm using a UV detector. The method was validated for selectivity, linearity, accuracy, precision, sensitivity and robustness. Novel microwave-assisted forced degradation technique was employed for evaluation of selectivity. The method demonstrated excellent linearity for losartan potassium and ramipril with regression coefficients of 0.9999 and 0.9998, respectively. The linearity range was found to be 62.5-5000 ng/ml and 125-10,000 ng/ml with the mean percentage recoveries of 100.36% (±2.27) and 100.16% (±3.33) for losartan potassium and ramipril, respectively. In a robustness study, a full factorial design revealed that the analytical response remains unaffected by small variations in the critical chromatographic factors. The method was found to be sensitive with quantification limits of 44.30 and 79.93 ng/ml for losartan potassium and ramipril. The method was successfully employed for the determination of losartan potassium and ramipril in commercially available and in-house prepared tablets.

Hip fracture patients in India have vitamin D deficiency and secondary hyperparathyroidism

SUMMARY

This study evaluated the parameters of bone mineral homeostasis including 25(OH)D and PTH in 90 Indian patients with hip fracture and 90 controls. Hypovitaminosis D, secondary hyperparathyroidism, and biochemical osteomalacia was present in 77, 69, and 50 % patients, respectively, significantly higher compared to controls. Vitamin D deficiency is an important risk factor for hip fracture.

INTRODUCTION

The prevalence of vitamin D deficiency is not well known in hip fracture patients from India. Therefore, the present study was conducted to evaluate the parameters of bone mineral homeostasis including 25(OH)D and intact PTH in hip fracture from North India.

METHODS

Ninety consecutive patients with hip fracture and similar number of age- and sex-matched controls were enrolled in the study. The fasting venous samples were analyzed for 25-hydroxyvitamin D (25-OHD), intact parathyroid hormone (PTH), alkaline phosphatase (ALP), calcium, and phosphorus. Vitamin D deficiency was defined as serum 25-OHD of <20 ng/dl.

RESULTS

The mean age of hip fracture subjects was 65.9 ± 12.6 which was comparable in men and women. Majority of study subjects were women (70 women and 20 men). The serum 25(OH)D and calcium levels were significantly lower, whereas the intact PTH and ALP levels were significantly higher in patients compared to controls. There was significant negative correlation between serum 25(OH)D and PTH. In the hip fracture group, 76.7 % of the subjects had vitamin D deficiency, and 68.9 % had secondary hyperparathyroidism. In the control group, vitamin D deficiency and elevated PTH levels were seen in 32.3 and 42.2 %, respectively.

CONCLUSION

About three fourths of hip fracture patients have vitamin D deficiency, and two thirds have secondary hyperparathyroidism. Therefore, the serum 25-OHD level may be a useful index for the assessment of risk of hip fracture in India.

Multidrug-resistant acinetobacter infection and their susceptibility patterns in a tertiary care hospital

Background:

Antibiotic-resistant Acinetobacter nosocomial infection is a leading problem. It acts as an opportunistic pathogen to cause a wide spectrum of infection including nosocomial pneumonia, meningitis, endocarditis, skin and soft tissue infections, urinary tract infection, conjunctivitis, burn wound infection and bacteremia. Multidrug-resistant Acinetobacter infection creates a great problem in hospital setting.

Materials and Methods:

The clinical specimens obtained from ICU and different surgical and medical wards were investigated using standard microbiological techniques to know the distribution of and their resistant profile. Antimicrobial resistance was studied using the modified Kirby Bauer disk diffusion technique following the CLSI protocol.

Results:

Major infections found in different medical wards, surgical wards and ICU were due to Acinetobacter baumannii (74.02%), A. lowfii (14.2%), A. haemolyticus (7.79%), A. junii (3.8%) among Acinetobacter spices. Acinetobacter showed increased resistant against majority of commercially available drugs imipenem (5.2%), meropenem (9.75%), piperacillin-tazobactum (18.2%), netilmicin (16.24%), amikacin (14.29%), ceftazidime (74.1%), gentamicin (70.13%), ofloxacin (42.21%).

Conclusion:

A. baumannii was found to be associated with UTI, RTI, septicemia, bacteremia, and meningitis and wound infection. A. baumannii displayed higher resistance to more number of antibiotics than other nosocomial pathogens from ICU.

Experiences of gynecological laparoscopic surgeries in a teaching hospital

BACKGROUND

Laparoscopic surgery has revolutionised the field of gynaecological surgery. Presently, almost all gynaecological procedures can find an alternative laparoscopic or hysterescopic approach. The aim of the study was to share the early experience of gynecological laparoscopic surgeries performed at Kathmandu Medical College Teaching Hospital.

METHODS

A study was carried out at Kathmandu Medical College Teaching Hospital from 1st January 2009 to 16th August 2012. All the patients undergoing gynecological laparoscopic surgeries were analyzed for the indication, type of procedure and its complications.

RESULTS

Overall 300 patients successfully underwent laparoscopy during the study period of which diagnostic laparoscopy was in 115. Operative laparoscopy was in 185. Sixty five cases underwent laparoscopic cystectomy. Sixty cases underwent laparoscopic assisted vaginal hysterectomy (LAVH). Salpingectomy for ectopic pregnancy was done in sixteen cases. Twelve cases contemplated for laparoscopic cystectomy underwent laparotomy. LAVH was converted to abdominal hysterectomy in four cases and laparotomy was done in two cases because of bladder injury and primary hemorrhage (from vault). Of minor complications the most common was port site infection and post-operative nausea and vomiting.

CONCLUSIONS

Laparoscopic gynecological surgery has tremendous potential in Nepal. Most of the surgeries can be carried out safely and favorable outcome has been noted in all the cases undertaken.