Can daily bathing with 4% chlorhexidine + daily chlorhexidine wipe for 1 week be effective in decolonizing Candida auris colonization?

BACKGROUND

Herein, it is aimed to present the decolonizing rates of Candida auris colonized cases after daily bathing with 4% chlorhexidine plus daily cleaning with 4% chlorhexidine wipe for 1 week (will be mentioned as DCHX).

METHODS

The study period was from October, 2021, to November, 2022. Inclusion criteria were (i) age > 18, (ii) receiving DCHX, (iii) proven C. auris carrier on auricular, or axillar or inguinal swab surveillance cultures up to 5-day period before DCHX. Cases with three consecutive negative surveillance cultures 3 days apart were considered to be decolonized.

RESULTS

A total of 38 cases [14 female, aged 61.8 ± 15.5 years] fulfilled the inclusion criteria. Six (15.8%), 23 (60.1%), and 22 cases (57.8%) were postauricular, inguinal, and axillary culture positive, respectively. Only three cases (7.9%) were triple culture positive. Nine cases (23.7%) had three consequent negative surveillance cultures after DCHX and were considered to be decolonized. There was no significant difference in decolonization rates of concomitant only antibiotic receiving cohort vs. concomitant antifungal + antibiotic receiving cohort (5/16 vs. 2/8, p = 1) were decolonized similarly. Of the nine C. auris decolonized cases, two developed C. auris infection in 30 days follow-up after decolonization. However, 10 (34.5%) of 29 non-decolonized cases developed C. auris infection (p: 0.450) within 30 days after surveillance culture positivity. Over all cohorts, day 30 mortality was 23.7% (9/38).

CONCLUSION

In conclusion, based on our observational and relatively small uncontrolled series, it appears that DCHX is not very effective in decolonizing C. auris carriers (especially in cases who are C. auris colonized in > 1 areas), although it is not completely ineffective.

Endovascular and percutaneous transabdominal embolisation of pseudoaneurysms in pancreatitis: an experience from a tertiary-care referral centre

AIM

To analyse the technical challenges, clinical success, and associated complications of endovascular and percutaneous embolisation of pancreatitis-related pseudoaneurysms.

MATERIALS AND METHODS

A retrospective study of patients referred for embolisation of pancreatitis-related pseudoaneurysms between January 2014 and March 2019 was conducted. Computed tomography angiography (CTA) was performed to assess the morphology of the aneurysms prior to any intervention. Percutaneous or endovascular embolisation was performed. Details of CTA and methods of embolisation were recorded. Technical success, clinical success, and complications were reported.

RESULTS

A total of 80 patients (mean age, 40.69 ± 13.41 years, 73 male) underwent embolisation during the study period. Pseudoaneurysms were related to chronic pancreatitis (CP) in 44 (55%) patients and acute pancreatitis (AP) in 36 (45%) patients. Pseudoaneurysms were detected in 65 (81.2%) patients on CTA. The most common site of pseudoaneurysms was gastroduodenal artery (GDA) followed by splenic artery. Seven patients were treated with percutaneous thrombin injection and five were treated with percutaneous glue injection under ultrasound/fluoroscopy guidance. The remaining patients (n=68) underwent catheter angiography with endovascular embolisation. Technical success was achieved in 4/7 (57%) percutaneous thrombin cases and in all the cases (5/5, 100%) with percutaneous glue or endovascular (68/68,100%) embolisation.

CONCLUSION

Endovascular or percutaneous embolisation of pseudoaneurysms has high technical success with an excellent safety profile.

Influence of tongue volume, oral cavity volume and their ratio on upper airway: A cone beam computed tomography study

Background

Our study aimed to measure the tongue volume (TV), oral cavity volume (OCV), and their ratio (TV/OCV) and correlate with upper airway using cone-beam computed tomography (CBCT).

Method

The volume of oral cavity, tongue and upper airway were obtained by the manual process of segmentation of CBCT data of 15 subjects. The mean age of the sample was 21.86 years (range 15-33 years). Segmentation of the upper airway, tongue and oral cavity was performed manually using Mimics 11.0 (Materialise, Leuven, Belgium) software at different thresholds for air and the tongue. The Hounsfield units (HU) for airway volume of the different facial region ranged from -1024 to -500. For tongue volume, Hounsfield units (HU), ranging from -200 to 200 was calculated.

Results

A significant negative correlation between TV/OCV and oropharynx (r = - 0.51; P = 0.04), TV/OCV and oral cavity airway volume (r = - 0.74; P = 0.002) was found. There was a significant and a positive correlation with TV/OCV and tongue volume (r = 0.65; P = 0.009).

Conclusion

A significant negative correlation established between TV/OCV, oropharynx and oral cavity airway volume. This finding indicates an influence tongue volume, oral cavity volume and their ratio on patency of the oropharynx.

D test: a simple test with big implication for Staphylococcus aureus macrolide-lincosamide-streptograminB resistance pattern

D test is a simple disc diffusion test giving high throughput results. It is used to study the macrolide lincosamide streptogramin resistance (MLSB), both constitutive and inducible as well as macrolide streptogramin resistance (MSB) in Staphylococcus aureus. In this test, erythromycin (macrolide) and clindamycin (lincosamide derivative) discs are placed adjacent to each other over the Mueller Hinton agar medium inoculated with the test organism. The growth of the organism up to the edges of the disc, flattening of the clindamycin zone (D test positive) near the erythromycin disc (resistant) and susceptible to both antibiotics implicate that the organism is having constitutive MLSB (CMLSB), inducible MLSB (IMLSB) and no resistance respectively. Further, the organism susceptible to clindamycin without any flattening of the zone (D test negative) near clindamycin disc (resistant) implicates that the organism is having macrolide streptogramin resistance (MSB). The test is performed in the same MHA plate in which the antibiotic sensitivity test is being done, taking into consideration that the discs are placed adjacent to each other maintaining the distance. Since clindamycin and streptogramin are among the few drugs of choice in the treatment of methicillin resistant S. aureus (MRSA) infections, knowing the resistance to these antibiotics is imperative.

Critical pulmonary stenosis: challenges following surgical correction

A 20-day-old girl was diagnosed with critical pulmonary valvular stenosis with patent ductus arteriosus (PDA). She underwent surgical pulmonary valvotomy and infundibular resection. A trial snaring of the PDA resulted in significant systemic desaturation, and the PDA was left undivided. A continuous infusion of prostaglandin was used to keep the PDA open for the next 8 days. The PDA acted as a "natural systemic-to-pulmonary shunt" to provide pulmonary blood flow until right ventricular compliance and function improved. The various causes of persistent desaturation following pulmonary valvotomy are discussed.

Endoscopic ultrasound-guided fine needle aspiration of peritoneal nodules in patients with ascites of unknown cause

Ascites can pose a difficult diagnostic problem and in some patients, despite extensive work-up, diagnostic laparoscopy or laparotomy is required. We evaluated the usefulness of endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) of peritoneal nodules in 12  patients with undiagnosed ascites (9  men, 3 women; mean [SD] age 47.5 [11.8] years). On EUS, peritoneal deposits, noted as hyperechoic rounded lesions compared with surrounding anechoic ascitic fluid, were observed in 10/12  patients (83.3%). Cytological examination of EUS-FNA samples from these deposits revealed metastatic adenocarcinoma in four patients, poorly differentiated carcinoma in one patient and pseudomyxoma peritonei in one patient. It also revealed inflammatory cells without granulomas in four patients, and polymerase chain reaction (PCR) for Mycobacterium tuberculosis was positive in 2/4 patients (50%). Deposits were larger and clearly defined in malignant ascites in comparison with tubercular ascites. No complications of EUS-FNA were observed.

Glucose-6-phosphate dehydrogenase deficiency and cardiac surgery

Cardiac surgery involving cardiopulmonary bypass (CPB) in its conventional form involves many processes leading to free radical production, such as perioperative ischemia, reperfusion, circulation of whole body blood through the CPB circuit, hypothermia and acidosis. The red blood cells of a glucose-6-phosphate dehydrogenase (G6PD)-deficient person are unable to scavenge these free radicals, resulting in haemolysis. Here, we describe the successful anaesthetic management of two G6PD-deficient children who underwent cardiac surgery, on and off CPB, without any obvious haemolytic reaction, followed by a discussion of the disorder, with specific consideration of perioperative management of such cases.

Ectopic Cushing's syndrome: experience from a tertiary care centre

BACKGROUND & OBJECTIVE

Ectopic secretion of adrenocorticotropic hormone (ACTH) is rare, contributing to 10 per cent cases of endogenous Cushing's syndrome. We describe our experience of about two decades of patients with ectopic Cushing's syndrome (ECS) seen at a tertiary care centre from north India.

METHODS

Records of patients with ECS from 1985 to 2006 were retrospectively reviewed that included the presenting manifestations, clinical symptoms and signs, biochemical investigations including plasma cortisol, ACTH and high dose dexamethasone suppression test (HDDST), imaging modalities to localize the non pituitary source of ACTH production, management and follow up of these patients.

RESULTS

The study group included 12 patients (7 men) with mean (+/-SD) age at presentation 27.6 +/- 9.5 yr (range 13 to 48 yr) and the mean lag period between onset of symptoms and the diagnosis was 18.3 +/- 12.9 months with a range of 3 to 48 months. The weight loss (41.7%) followed by hyperpigmentation (25%) and infections (16.7%) were the common presenting manifestations. Cuticular atrophy (100%), hypertension (100%), bruise (92%) and proximal myopathy (83%) were the commonest signs. Plasma cortisol at 0800 h was 1267.3 +/- 483.3 nmol/l and at 2200 h was 1214.9 +/- 442.6 nmol/l indicating loss of circadian rhythm. The mean plasma ACTH was 221.1 +/- 55.9 (range 21.7 to 950 pg/ml). All but 2 patients had non-suppressibility of 0800 h plasma cortisol with HDDST. Five patients had thymic carcinoid, 3 had bronchial and one each had islet, hepatic and gut carcinoid and one had medullary thyroid carcinoma as a cause of ectopic ACTH secretion. The mean duration of follow up of these patients was 42.6 months and only two could sustain cure while remaining had either residual or recurrence.

INTERPRETATION & CONCLUSION

Ectopic Cushing's syndrome is a rare disease with varied manifestations and associated with increased morbidity and mortality. It presents with clinical features quite similar to classical Cushing's. Surgery with removal of primary tumour was found to be treatment of choice.

Unusual malignant tracheal tumour presenting with acute airway obstruction

A 25-year-old male presented with features of acute airways obstruction. He was diagnosed to have a lower tracheal mass with near total tracheal obstruction and complete obstruction of the left main bronchus. The tumour was resected successfully using a two-step method of ventilation. Histopathology of the mass revealed it to be a spindle cell sarcoma. Subsequently, local irradiation and systemic chemotherapy was given.

Sonoenteroclysis: a new technique for the diagnosis of small bowel diseases

BACKGROUND

Radiologic evaluation of small bowel is usually done by barium examination, which involves considerable radiation exposure. A new sonographic method, sonoenteroclysis, is a promising technique for diagnosing small intestinal disorders. In this study the applicability, performance, and diagnostic yield of sonoenteroclysis were assessed and the results of this novel method were compared with those of barium enteroclysis.

METHODS

Forty-five consecutive patients with suspected small bowel disorder were studied. All patients underwent abdominal ultrasound before and after infusion of an isotonic nonabsorbable electrolyte solution containing polyethylene glycol through a nasojejunal tube (modified Billbao Dotter tube), and images at various levels were obtained. Small bowel wall thickness, luminal narrowing, intestinal dilatation, peristalsis, and extraintestinal complications were noted. It was followed by barium enteroclysis and findings were recorded. Findings of sonoenteroclysis were compared with those of barium enteroclysis.

RESULTS

Satisfactory distention of the intestinal lumen was obtained with sequential visualization of jejunoileal loops in 34.4 +/- 18.4 min. Of 45 patients, 10 showed normal small bowel on sonoenteroclysis and barium enteroclysis. These 10 patients served as controls. Sonoenteroclysis displayed normal diameters smaller than 3.0 and 2.0 cm for the jejunum and ileum, respectively. Bowel wall thickness was 1.7 to 3.0 mm and all five layers of bowel wall could be well appreciated. Valvulae conniventes were clearly visualized with a fold thickness between 1.4 and 2.0 mm. The remaining 35 patients showed abnormalities in the form of strictures, matted bowel loops, dilated loops, thickened folds, deformed ileocecal junction, mass lesions, etc., on sonoenteroclysis and barium enteroclysis. In addition, sonoenteroclysis showed thickened bowel wall with loss of stratification. Extraintestinal findings such as enlarged lymph nodes and ascites were also disclosed at the time of sonography. These were diagnosed subsequently as cases of tuberculosis (n = 23), celiac disease (n = 6), adenocarcinoma (n = 2), leiomyoma (n = 2), Immunoproliferative small intestinal disease (n = 1), and segmental enteritis (n = 1).

CONCLUSIONS

The diagnostic accuracy of sonoenteroclysis for detecting small bowel lesions is comparable to that of barium enteroclysis. This new, widely available, inexpensive, and undemanding technique can be used as an initial investigation in the evaluation of patients with small bowel disorders.

Retained intracardiac spring: an unusual foreign body

A rare case of a penetrating intracardiac injury due to a ball-point pen in an adult male is reported. The patient presented with a retained metal spring embedded in the interventricular septum without any cardiac defects. A small metal tip of the pen was also present in the left lung. The patient was asymptomatic and without any cardiovascular compromise. The cardiac injury was managed conservatively. At two years after the injury the patient is still asymptomatic.

Immunogenicity of low-dose and conventional-dose recombinant hepatitis B vaccines in healthy adolescents in India

INTRODUCTION

The recombinant hepatitis B vaccine, at a conventional dose of 20 microgrammes, is highly effective in a majority of the population. Recent studies have reported that a 10-microgramme dose is as effective as the conventional dose, especially in young adolescents. This study compares the effect of two different doses of recombinant hepatitis B vaccine (Enivac HB) in healthy adolescents.

METHODS

Ninety-two adolescents were randomised into two equal groups to receive either 10 microgrammes (group 1) or 20 microgrammes (group 2) of vaccine using the vaccination schedule of 0, one and six months. Blood samples were collected at 30, 60, 90, 180 and 210 days to detect anti-HBs antibodies. At each interval, geometric mean titres were calculated for seroconverted subjects.

RESULTS

After the initial doses of the vaccine, greater proportion of subjects receiving the higher dose seroconverted. However, at six months, all subjects who received the low dose seroconverted, as did those who received the conventional dose. Furthermore, there were significant differences in the anti-HBs geometric mean titres for seroconverters at 180 days (218.27 versus 111.43) and 210 days (345.14 versus 133.35). The difference in the overall reactogenicity for the two dose levels was not remarkable, although the higher dose produced more local symptoms.

CONCLUSION

10-microgramme recombinant vaccine can be used in routine immunisation in healthy adolescents. If quick immunisation is needed, as in high-risk groups, the conventional dose should be administered, as it results in earlier seroconversion with higher anti-HBs geometric mean titres.

Severe acute bleeding from portal colopathy controlled by somatostatin: a case report

Portal hypertensive colopathy (PHC) is a recently described entity in patients with portal hypertension which can cause even life-threatening lower gastrointestinal bleeding. In contrast to variceal bleed, there is no standardized treatment for the control of bleeding from these lesions. We report a case of alcoholic cirrhosis with portal hypertension, in whom bleeding from colonic angiodysplasia-like lesions was effectively controlled by somatostatin infusion.

Hemobilia as presenting manifestation of polyarteritis nodosa

Polyarteritis nodosa (PAN) is a multisystem necrotizing inflammatory vasculitis of medium-sized muscular arteries. Hepatobiliary complications secondary to thrombosis or aneurysm formation in PAN are rare and are associated with poor outcome. We describe an 18-year-old man with PAN who presented with hemobilia secondary to rupture of a hepatic artery aneurysm, which was successfully managed with coil embolization followed by immunosuppressive therapy.

The prevalence of hepatitis C virus antibodies among the voluntary blood donors of New Delhi, India

Infection with hepatitis C virus (HCV) is a major cause of transfusion-associated hepatitis, cirrhosis and hepatocellular carcinoma. The present study was conducted with an objective to evaluate the prevalence of anti-HCV antibody in New Delhi, India using a large number of healthy voluntary blood donors. A total of 15,898 healthy voluntary blood donors were subjected to anti-HCV testing (using a commercially available third generation anti-HCV ELISA kit) and 249 were found to be reactive for anti-HCV antibody, yielding an overall prevalence of 1.57%. No significant difference was found between the HCV positivity rate of male (1.57%; 238/15,152) vs. female (1.47%; 11/746) donors, family (1.58%; 213/13,521) vs. altruistic (1.51%; 36/2377) donors and first-time (1.55%; 180/11,605) vs. repeat (1.61%; 69/4293) donors. The age distribution of anti-HCV reactivity showed a maximum prevalence rate of 1.8% in the age group of 20-29 years. In addition, there was a clear trend of decreasing positivity for anti-HCV with increasing age and this trend was statistically significant. The results of the present study show that the prevalence of anti-HCV antibodies in the healthy voluntary blood donors of New Delhi, India is considerably higher than the reported seroprevalence of HCV in majority of the industrialized nations and this represents a large reservoir of infection capable of inflicting significant disease burden on the society. In addition, donors of New Delhi, India showed a trend of decreasing seroprevalence with increasing age, possibly implying a higher exposure rate to HCV in younger subjects.

Sclerotinia Root Rot: A New Threat to Buckwheat Seedlings in India

In the temperate regions of India, buckwheat (Fagopyrum esculentum Moench and F. tataricum Gaertn.) is produced extensively. During the first week of June in 2001 and 2002, a severe incidence of root rot (35% seedling mortality) was observed in the Sangla Valley of Himachal Pradesh when the crop was at the seedling stage. The disease was more severe on F. tataricum, resulting in a poor crop stand. The disease appeared as water-soaked areas on the upper portion of the root, which turned brown. The brown patches gradually proceeded downward covering the whole root system. The above ground foliage wilted and died. The disease spread rapidly with cloudy, humid weather and day temperatures ranging from 15 to 20°C. Mycelium of the causal fungus was inter- and intracellular type with hyaline, branched, and septate hyphae. Sclerotia were pink but later turned black, measuring 3.0 to 3.5 mm in diameter. The pathogenicity of the causal fungus was proved following Koch's postulates. The pathogen was identified as Sclerotinia sclerotiorum (Lib.) de Bary (2). In Japan, the association of S. libertiana on buckwheat has been reported (1). To our knowledge, this is the first report of Sclerotinia root rot on buckwheat from India. References: (1) H. Singh and T. A. Thomas. Indian Counc. Agric. Res. New Delhi, India, 1978. (2) H. J. Willets and J. A. L. Wong, Bot. Rev. 46:101,1980.

Serological study of hepatitis A virus infection amongst the students of a medical college in Delhi & evaluation of the need of vaccination

BACKGROUND & OBJECTIVES

Recent seroepidemiological studies have demonstrated a decrease in the seroprevalence of hepatitis A virus (HAV) infection, thereby increasing the pool of susceptible adult population. Health care workers, especially those working in paediatric wards and nurseries, are at an increased risk of developing HAV infection. The present study was undertaken to determine the prevalence of antibody against HAV (IgG anti-HAV) among a batch of medical students of the Maulana Azad Medical College, New Delhi, so as to identify the proportion of students who would be susceptible to HAV infection and hence would benefit from a vaccination programme against HAV.

METHODS

A total of 91 medical students were enrolled and divided into groups on the basis of sex. The serum samples were evaluated for the presence of immunoglobulin (IgG) against HAV (IgG anti-HAV) using a commercially available enzyme linked immunosorbent assay (ELISA) kit.

RESULTS

The mean age of all the subjects was 19.9 +/- 1.5 yr and the male: female ratio was 1.2: 1. Fifty seven (62.6 +/- 5.1%) students were positive for IgG anti-HAV while 34 (37.4%) were seronegative and hence susceptible to HAV infection. No statistically significant difference was observed in the seroprevalence of HAV between males and females [64 +/- 6.7% (32/50) versus 60.9 +/- 7.6% (25/41)].

INTERPRETATION & CONCLUSION

our results indicate that more than one-third of the medical students were seronegative for IgG anti-HAV and hence at an increased risk of developing HAV infection as a result of occupational exposure. Therefore, we suggest that students in a health care set up should undergo vaccination against HAV after pre-vaccination immunity screening.

Hepatopulmonary syndrome: a case report

The Hepatopulmonary Syndrome (HPS) is one of many extrahepatic manifestations of liver failure. It consists of a triad of liver dysfunction, intrapulmonary vascular dilatation and hypoxemia. We present a case of post necrotic cirrhosis (HBV related) who developed exertional dyspnoea subsequent to the development of hepatopulmonary syndrome.