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ORIGINAL ARTICLES
Epidemiology of urinary tract infection in neonatal intensive care unit: A single center study in Egypt
Doaa Mohammed Youssef, Hanaa Abd Elfateh, Randa Sedeek, Sherif Seleem
January-March 2012, 2(1):25-29
DOI:10.4103/2249-4855.104012  
Introduction: The aim of this study is to describe the epidemiology of urinary tract infection (UTI) in newborn infants admitted to neonatal intensive care unit (NICU) of Zagazig University. Patients and Methods: This study included 206 neonates admitted to the NICU in the period from 1/1/2010 to 1/6/2010. All neonates were subjected to detailed history taking, including prenatal history, natal history, and postnatal history, with stress on symptoms suggestive of UTI. We examined all neonates generally and locally, every case was subjected to urine analysis; suprapubic aspiration was done for all cases. "The diagnosis of UTI was established by the presence of at least 5 leukocytes per high power field." Urine culture, CBC (complete blood count), blood culture, and ultrasound scanning were also done for certain cases. Results: We found 75 newborns with clinical findings suggesting UTI. We classified our neonates according to the presence of at least 5 leukocytes in urine per high power field into two groups: Group I (−ve cases) without UTI included 44 neonates (31 males and 13 females) and Group II (+ve cases) with UTI included 31 neonates (24 males and 7 females). There was no significant difference between Group I and Group II with regard to gender, age, weight, and consanguinity. The incidence of UTI in NICU was 15.05% (33/206), prevalence among suspected cases of UTI in NICU was 41.3% (33/75), and of the 39 neonates with sepsis 33 had UTI (79.5%). Of the positive cases, 77.4% were full-term neonates and 22.6% were preterm neonates. Of the 31 cases with positive urinary culture there were 18 cases (58.1%) showing Escherichia coli, and 13 cases (41.9%) were positive for Klebsiella. Conclusion: This study has highlighted the need for routine urine analysis and culture, especially in high-risk newborns and to monitor the prevalence of UTI early in life. Also routine ultrasonographic screening should be done in all newborns with UTI to save the newborns and prevent the risk of complications, which may end in renal scarring and renal failure.
  4 6,453 543
Nephrotic syndrome in the first year of life
Manisha Sahay, Swarnalatha Gowrishankar, Girish Narayen, Anuradha
January-March 2012, 2(1):22-24
DOI:10.4103/2249-4855.104011  
Objective: To study the clinical profile, laboratory data, histopathology, and outcome of infantile nephrotic syndrome (INS). Materials and Methods: Over a 5 year period, 30 infants with nephrotic syndrome were seen at Osmania General Hospital. They were studied with regard to family history, antenatal details, birth history, clinical features including anthropometry and developmental milestones, laboratory investigations and histopathology of renal tissue (light microscopy and immunofluorescence), and treatment outcome. Results: There were 17 males and 13 females (1:0.8). The mean age at presentation was 8.6 months (2.5-12 months). History of consanguinity was obtained in 12 infants (40%) and birth asphyxia was present in 8 infants (26%). Eighteen (60%) were growth retarded and 10 (33.3%) had developmental delay. Hypertension was recorded in 8 (26%) and edema in 24 (80%). At presentation, renal failure was evident in 18 (60%) infants. Nephrotic range proteinuria and hypoalbuminemia were found in all and microscopic hematuria in 4 (13%) infants. Histology of renal tissue revealed congenital Finnish type (CNF) in 8 (26%), diffuse mesangial sclerosis (DMS) in 6 (20%), minimal change disease (MCD) in 6 (20%), mesangial proliferation with IgM deposits in 4 (13%), and focal segmental glomerulosclerosis (FSGS) in 4 (13%). Mesangial hypercellularity with cytomegalovirus infection was found in 2 (6.6%) infants. CNF and DMS on histopathology carried a very poor prognosis with none recovering, while the others showed variable response to treatment with steroids and cytotoxic therapy. Conclusion: INS is a rare disorder. The predominant histopathological lesions are CNF and DMS which carry a very poor prognosis.
  2 3,692 506
Peripheral arterial disease in patients with type 2 diabetes mellitus in South India: The urban vs rural divide
Bhavana Sosale, Y. J. V. Reddy, M. V. Nagbhushana, Aravind Sosale, Edward B. Jude
July-September 2012, 2(3):105-109
DOI:10.4103/2249-4855.132951  
Background and Aims: Peripheral arterial disease (PAD) is a marker for macrovascular disease and a risk factor for lower limb amputations, in patients with diabetes. The extent and impact of PAD in the rural population in India has not been well studied. The aim of this study was to screen for asymptomatic PAD using ankle brachial index (ABI) in order to characterize and compare risk factors associated with it and to look for the presence of ischemic heart disease (IHD) in rural and urban populations. Materials and Methods: This was an observational, cross-sectional study involving type 2 diabetic patients attending the diabetes clinic in an urban and rural hospital, in South India. Two hundred rural (R) and 400 urban (U) patients were screened for PAD over a period of1 year. An ABI ≤0.9 or >1.3 was considered abnormal. Patients with known PAD and or claudication were excluded as the aim was to look for PAD in asymptomatic patients. Anthropometric measurements and investigations were carried out. Risk factors were analyzed and P values and odds ratio (OR) were calculated. Results: 17.8% of patients had an ABI suggestive of PAD (R 20% vs U 16.8%). 63.6% were male. Known risk factors of PAD were identified and included dyslipidemia (85%; R 92.5% vs U 80.6%; OR 1.61), obesity (84.1%; R 85% vs U 83.6%; OR 0.75), hypertension (59.8%; R 47.5% vs U 67.2%; OR 1.26), and age >50 years (64.5%; R 55% vs U 70%; OR1.24). Except for smoking (22.4%; R 32.5% vs U 16.4%; OR 1.03), none of the other risk factors were different between groups. Mean duration of type 2 diabetes mellitus (T2DM) was 7.95±7.50 (R 4.66±5.22 vs U 9.61±7.93; P<0.001). Electrocardiogram (ECG) changes consistent with IHD were found in 25.3% of patients with PAD (R 20% vs U 28.3%; OR 3.06; confidence interval (CI) 1.81-5.18; P=0.001). Conclusion: Our study demonstrates that one in six asymptomatic South Indians with T2DM have PAD. One in four patients with PAD had ECG changes of IHD which was statistically significant. Based on the odds ratio, the rural patients with PAD had two and a half times higher risk of IHD, even though there was no statistically significant difference in cardiovascular risk factors, age, sex, and mean hemoglobin A1c (HbA1c) in both groups. Prevalence of PAD with a lower duration of DM and higher strength of association with IHD noted in the asymptomatic rural population in our study is a cause for concern.
  2 2,687 289
Seasonality of viral hepatitis
Auda Fares
July-September 2012, 2(3):110-114
DOI:10.4103/2249-4855.132952  
Viral hepatitis is an infection that has been reported to be present throughout the year, but some particular months are associated with higher incidences. The primary objective was to review and report on the current knowledge and evidence that exists on seasonality of different type of acute viral hepatitis world-wide in order to develop recommendations for future research, prevention and control. Materials and Methods: A systematic literature review was performed to identify all the primary reports and studies published during 1970-2012 on acute hepatitis A, B, C and E (AHA, AHB, AHC and AHE) in human subjects by searching PubMed, reference lists of major articles and correspondence with scientific experts. For each report or study included, the following information was extracted (as applicable to study): Location (country and setting), study population (number of cases, patients), seasonal or monthly rate and study duration. Results: There is no definite and consistent seasonal pattern has been observed on AHA; AHB; AHE and AHC, although evidence points towards spring and summer peak for hepatitis A, B, C and E. Multiple source of transmission such as; summer travel to an endemic area, swimming habits of the population in hot months, increase sexual contact, tattoo, poor hygiene and environmental sanitation and food habits (feco-oral transmission of viral hepatitis) probably exists and should be further investigated through analytical and epidemiological.
  2 2,349 216
CASE REPORTS
Cutaneous cysticercosis
Ravala Siddeswari, Siddula Manohar, B Sudarsi
October-December 2012, 2(4):132-134
DOI:10.4103/2249-4855.141134  
Cutaneous cysticercosis in human is an uncommon parasitic infection, mostly presents as asymptomatic subcutaneous nodules with prevalence of 12.9-38% in India. It may occur as an isolated feature or as part of the disseminated cysticercosis. Here with we report a 23 years female presenting with 6 months duration of seizures and subcutaneous nodules poorly responding to anti epileptics. Diagnosis of cutaneous cysticercosis was made by biopsy of subcutaneous nodules and patient responded to treatment.
  1 3,554 277
Gram-negative bacterial pyomyositis in a patient with diabetes mellitus and chronic renal failure
OP Kalra, Alpana Raizada
January-March 2012, 2(1):40-42
DOI:10.4103/2249-4855.104015  
Pyomyositis is a suppurative infection of the skeletal muscles. The predisposing conditions include immunosuppression accompanying malignancy, diabetes mellitus, renal failure, and acquired immunodeficiency syndrome, etc. We report a 49-year-old female with diabetes mellitus and chronic renal failure undergoing maintenance hemodialysis who presented with the suppurative stage of gram-negative bacterial pyomyositis due to Escherichia coli. She fully recovered following incision and drainage and appropriate antibiotic therapy. We highlight the importance of timely diagnosis of this uncommon and potentially life-threatening entity and the role of chronic renal failure and hemodialysis in causing this condition.
  1 3,815 300
Addiction to vitamin D: Unusual, unexpected substance abuse
Bharti Kalra, Yatan Pal Singh Balhara, Sanjay Kalra
January-March 2012, 2(1):43-45
DOI:10.4103/2249-4855.104016  
This case reviews the history and findings of a young patient with vitamin D deficiency, successfully treated with vitamin D, who became addicted to injectable calcitriol. To the best of our knowledge, this is the first report of such an occurrence in the world literature.
  1 5,584 360
LETTER TO EDITOR
Storage of insulin in rural areas
Sanjay Kalra, Bharti Kalra
April-June 2012, 2(2):88-89
DOI:10.4103/2249-4855.118669  
  1 4,949 560
ORIGINAL ARTICLES
Evaluation of HiCrome differential agar for speciation of candida
Shyamala K. Shettar, Asha B. Patil, Shobha D. Nadagir, T. A. Shepur, B. A. Mythri, Santosh Gadadavar
July-September 2012, 2(3):101-104
DOI:10.4103/2249-4855.132950  
Background: In recent years, non-albicans Candida (NAC) are being increasingly reported in many laboratories. There is a need to diagnose them early as some of the species are resistant to antifungals. We evaluated the utility of HiCrome agar for speciation of Candida in comparison to conventional methods. Materials and Methods: Ninety-six isolates of Candida were speciated by morphology on corn meal agar (CMA), sugar assimilation tests (SAT), and HiCrome agar. Sensitivity, specificity, and positive predictive and negative predictive values were obtained. Results: Sensitivity of HiCrome agar in identification of Candida albicans was 97.05%, C. tropicalis was 83.33%, C. glabrata 100%, and C. krusei 87.5%; and specificity was 98.07, 91.93, 92, and 92.30%, respectively. Conclusion: The present Candida differential agar is useful in identifying a few of the species. With further modifications this media may replace the need for conventional methods. The rapid availability of results and identification of species in mixed cultures is significant.
  1 12,698 719
Awareness of the revised national tuberculosis control programme and attitude to tuberculosis patients amongst medical undergraduates
Swati M Baveja, Pratibha J Dalal
April-June 2012, 2(2):68-72
DOI:10.4103/2249-4855.118663  
Purpose: This study was conducted to assess the knowledge of Revised National Tuberculosis Control Programme ( RNTCP) and attitude to tuberculosis (TB) among medical students and interns. Materials and Methods: This cross-sectional survey was carried out in a private medical college among 200 medical students. The students were asked to complete a written questionnaire. The answers were statistically analyzed using Statistical Package for the Social Sciences (SPSS) software program, IBM. In addition, item analysis was carried out for each question, wherever applicable. Results: Our analysis revealed that all students were aware of TB. They were also aware of RNTCP. In addition to the didactic lectures, students had gained information from different sources such as textbooks (168), case discussion (155), seminar (95), journals (75), and WHO publications (22). The average number of students with correct response was 122 (59.63%). Among the various categories of TB, the correct responses were highest for questions relating to diagnosis (146.25; 73.12%), followed by epidemiology (114; 62.16%), management (130.33; 61.75%), and risk perception (75.33; 28.5%). About 90% students feared the risk of transmission by inhalation from a TB patient with cough. Majority of the students were aware that all smear-positive patients should be isolated and treated. Item analysis of the multiple choice questions (MCQs) showed the areas that required more emphasis. Conclusions: Overall performance of III/I students was better than the rest of the study group. Students performed better in the epidemiology domain compared with the management and preventive aspects of TB. To ensure the successful control of TB and implementation of RNTCP, medical students need to be sensitized by conducting continuous medical education and orientation courses on RNTCP at regular intervals.
  1 3,888 370
Clinical profile and outcome of leptospirosis at tertiary care centre in western Maharashtra
Virendra C Patil, Harsha V Patil, Vaibhav Agrawal
January-March 2012, 2(1):30-37
DOI:10.4103/2249-4855.104013  
Background: Leptospirosis is an emerging spirochetal zoonosis world wide. Leptospirosis is common zoonosis that is under reported and under diagnosed in India. The aim of this study was to study the clinical profile outcome and prognostic factors in human leptospirosis at tertiary care centre. Settings and Design: This was a retrospective study of leptospira positive patients who were admitted in tertiary care centre. The study was conducted in 2010, over a period of 6 month from July to December. Materials and Methods: All patients who presented with clinical features and tested IgM positive for leptospirosis were taken into the study and analyzed based on modified Faine's criteria. Results: Out of total 23 patients there were 21 males and 2 females, with mean age was 32 years. Maximum incidence of cases was found in month of July and August. Out of total 23 patients, 18 (78.26%) were farmers and 5 (21.73%) were laborers. Predominant complaints were fever, jaundice, myalgia, and headache. All 23 had positive results for IgM against leptospira. Liver function tests were deranged in 16 (69.56%) and renal functions were deranged in 12 (52.17%). Total 7 (30.43%) patients had Weil's syndrome and 7 (30.43%) had acute respiratory distress syndrome (ARDS). Total 7 (30.43%) patients had neuroleptospirosis, out of which 5 (21.73%) had aseptic meningitis, one had paraparesis secondary to lumbar radiculopathy and one had meningoencephalitis. Hyperkalemia was present in 6 (26.08%) patients, 7 (30.43%) patients had hypokalemia. Total 11 (47.82%) patients had metabolic acidosis (pH<7.3) on arterial blood gas analysis. Two (8.69%) patients had disseminated intravascular coagulation and 3 (13.04%) patients had thrombocytopenia. There was one death due to meningoencephalitis with multiorgan failure with overall case fatality rate of 4.34%. Total nine patients with oliguric renal failure were treated with daily dialysis and seven patients with ARDS were on artificial ventilator. Applying modified Faine's criteria, all 23 were positive for leptospirosis. All patients responded ceftriaxone. Conclusions: Leptospirosis was unexpectedly found to be positive in many of our patients who were having pyrexia with multiorgan dysfunction during the monsoons. Hepatic dysfunction, acute renal failure, ARDS, and neuroleptospirosis in decreasing frequency were the commonest complication. Daily dialysis, ventilatory support and intensive care management has definitely reduced morbidity and mortality associated with leptospirosis with multi-organ failure.
  1 5,424 625
REVIEW ARTICLES
Kidney and pregnancy
Manisha Sahay
January-March 2012, 2(1):15-21
DOI:10.4103/2249-4855.104010  
Pregnancy is associated with many physiological changes in the renal system. Pregnancy can alter the course of some renal diseases as also pre-existing renal diseases may affect pregnancy outcomes. Pregnancy may be complicated by hypertension which warrants proper management. Acute kidney injury may complicate pregnancy. With chronic kidney diseases on the rise, it is important for the physician to be aware of management of pregnancy in these patients. Kidney transplant recipients have their unique set of problems and management of these patients poses a challenge for the physician. Hence, this review highlights the management of pregnant patients with renal diseases including issues related to dialysis and transplantation.
  1 7,122 762
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