Spontaneous rupture of a choledochal cyst and the role of hepatobiliary scintigraphy.
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Aniline Compounds↗
Biomedical subjects
B K Das
Publications and source records attributed to B K Das.
Bacteriological profile of post-neurosurgical meningitis in Indian children.
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Child↗
Bacteriological and antimicrobial susceptibility profile of soft tissue infections from Northern India.
BACKGROUND: Soft tissue infections require a judicious combination of antimicrobial therapy in addition to surgical debridement to limit tissue loss and preserve life. AIMS: To study the bacterial etiology of soft tissue infections and their antimicrobial susceptibility pattern. SETTINGS AND DESIGN: A single institutional retrospective study of one year duration from January to December 2002. MATERIALS AND METHODS: A total of 5039 consecutive pus samples received in the Bacteriology Laboratory was analyzed from the records. RESULTS: There were a total of 2783 bacterial isolates comprising of 1504 gram negative bacilli and 1279 gram positive cocci. Staphylococcus aureus was the commonest isolate followed by Escherichia coli and Pseudomonas species. Methicillin resistance in S. aureus was found to be 38.56%, high level aminoglycoside resistance was observed in 53.3% enterococci and 66.75% of the gram negative bacilli were extended spectrum beta-lactamase producers. Rifampicin and vancomycin showed best activity for S. aureus; for gram-negative bacilli, piperacillin-tazobactam combination showed best activity. CONCLUSIONS: Continuous monitoring of antimicrobial susceptibility pattern in individual settings together with their judicious use is emphasized to minimize emergence of drug resistant bacteria.
Anti-Bacterial Agents↗
Chiari I malformation related syringomyelia: radionuclide cisternography as a predictor of outcome.
BACKGROUND: This prospective study, conducted in patients with Chiari I malformation (C I) related syringomyelia who underwent posterior decompression and duroplasty, utilizes radionuclide cisternography in order to study the cerebrospinal fluid (CSF) dynamics at the foramen magnum and to predict the clinical outcome following surgery. METHODS: 17 consecutive patients of C I with syringomyelia (but without hydrocephalus or fixed atlanto-axial dislocation), underwent a detailed neurological examination and were assigned a clinical disability score based on the modified Klekamp and Samii score. A radionuclide cisternography (using Tc99m-DTPA) was performed via the lumbar route and the ascent of the tracer was followed utilizing a gamma camera immediately after injection and then sequentially after 1, 2, 4, 6 and 24 hours. After posterior decompression and duroplasty, the modified Klekamp and Samii score was repeated at follow-up visits (range: 3 months to one year) along with radionuclide cisternography at 3 months, and MR imaging at 6 months. FINDINGS: Three patterns of tracer flow were observed: a). rapid flow (n=7); b). supratentorial subarachnoid delay (n=7); and, c). foramen magnum block (n=3). The patients having foramen magnum block had the poorest clinical scores on admission. At follow up, there was an improvement in the clinical scores so that the mean scores in all three categories reached nearly the same level. Following posterior decompression, the radionuclide cisternography performed in 10 patients showed a rapid flow of the tracer without any obstruction. The syrinx resolved in 4 of the 11 patients in whom an MRI was done. INTERPRETATION: The patients with C I with syringomyelia may often have a free flow of tracer across the FM. Posterior decompression and duroplasty provides maximum clinical relief in patients with a demonstrable foramen magnum block on radionuclide cisternography while those with a normal flow have less relief. The symptomatology related to brain-stem compression immediately responds to the surgical procedure but the syrinx-induced signs and symptoms of spinal cord dysfunction persist.
Adolescent↗
Hemichorea: a rare presentation of tuberculoma.
Hemichorea due to tuberculoma has not been reported. We managed a 16-year-old girl who developed transient left hemichorea due to right sided striatal tuberculoma. Chorea regressed following 1 week of antitubercular treatment with corticosteroid therapy and disappeared at 3 months. In a patient presenting with chorea, striatal tuberculoma should also be considered especially in the area where tuberculosis is prevalent.
Adolescent↗
Bacterial antigen detection test in meningitis.
OBJECTIVE: To evaluate the role of bacterial antigen detection test in cerebrospinal fluid (CSF) for a rapid etiological diagnosis of bacterial meningitis. METHODS: The study included 36 cases of bacterial meningitis and 14 controls. Latex particle agglutination test (LPA test) for detection of bacterial antigen was done in the CSF using slidex meningitis kit (Biomeriux, France). RESULTS: Using LPA test, an etiological diagnosis could be made in 83% cases of bacterial meningitis. In contrast, CSF Gram stain and culture showed 36% and 6% positivity, respectively. The sensitivity and specificity of LPA test were 83% and 100%, respectively. The common etiological organisms were S. pneumoniae, H. influenzae type b and N. meningitidis A. S. pneumoniae was encountered in all age groups while H. influenzae type b was found only below one year of age. CONCLUSIONS: LPA test is a rapid and superior diagnostic tool as compared to CSF Gram stain and culture. The study recommends LPA test as an adjunct laboratory test for rapid etiological diagnosis of bacterial meningitis for prompt institution of proper antibiotics.
Adolescent↗
Serum immunoglobulin E in early childhood wheezing.
OBJECTIVE: To study the serum Ig E levels in patients presenting with wheezing under the age of 24 months. METHODS: The study was conducted on 38 cases and 35 controls. The children presenting with first attack of wheezing were clinically considered as bronchiolitis and those with recurrent attacks with positive history of atopy in the patient or in their first degree relatives were considered as bronchial asthma. The Ig E estimation was done by immune assay method. RESULTS: The mean serum Ig E was significantly higher in asthma patients (p < 0.001). It was also higher in bronchiolitis patients but the difference was not statistically significant. However, 26 per cent of these patients had values above 1 SD of the control mean. These patients were considered as potential cases of asthma. CONCLUSION: The determination of serum Ig E may be of value in identifying those children presenting with first wheezing attack, who may develop asthma in future. Only a long-term follow-up of these patients can give an answer to the postulation that raised Ig E level at the time of first viral lower respiratory tract infection is a potential marker for the development of recurrent wheezing in later life.
Asthma↗
Plasma glucose and tumour necrosis factor-alpha in adult patients with severe falciparum malaria.
Plasma glucose was assessed in 81 patients with severe falciparum malaria at the time of presentation along with tumour necrosis factor-alpha (TNF-alpha). The lowest plasma glucose value was 3.38 mmol/l and none of the patients had hypoglycaemia at admission. Plasma glucose values were not significantly lower in those with multiple organ dysfunction (MOD) than in patients with single organ dysfunction (cerebral malaria only) and in those who died compared with patients who survived. Conversely, TNF-alpha showed a good correlation with depth of coma and was significantly higher in patients who had MOD and those who died. There was no correlation between plasma glucose and TNF-alpha values.
Adolescent↗
Pentoxifylline adjunct improves prognosis of human cerebral malaria in adults.
Fifty-two adult patients with cerebral malaria were randomly categorized into two groups to receive either quinine dihydrochloride (Qn) alone or a combination of Qn and pentoxifylline (Px). Thirty-two of them received intravenous (i.v.) Qn (group I), and 20 patients (group II) received i.v. Qn along with parenteral Px support (10 mg/kg/day) for the initial 3 days. There was significant improvement in coma resolution time in group II (21.6 +/- 13.9 h) in comparison with group I (63.5 +/- 19.7 h) (P < 0.001), and mortality was 25% of patients in group I against 10% patients receiving Px adjunct (P > 0.05). Three days post-therapy, serum tumour necrosis factor-alpha (TNF-alpha) levels decreased significantly in patients on Px support (day 0 TNF = 415.62 +/- 477.80 pg/ml; day 3 TNF = 47.92 +/- 27.9 pg/ml; P = 0.0029). There was no significant change in TNF levels in those on quinine alone (day 0 TNF = 477.08 +/- 933.90 pg/ml; day 3 TNF = 589 +/- 602.3 pg/ml; P > 0.05). There were no serious side-effects necessitating withdrawal of patients receiving Px therapy.
Adult↗
Hashimoto's encephalopathy: clinical, SPECT and neurophysiological data.
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Adult↗
Cerebrospinal fluid lysozyme level for the diagnosis of tuberculous meningitis in children.
Lysozyme activity was assayed in the cerebrospinal fluid (CSF) of 32 tuberculous meningitis (TBM), 17 bacterial meningitis, 10 partially treated bacterial meningitis, 18 encephalitis and 18 control subjects. The mean CSF lysozyme activity was significantly raised (p < 0.001) in TBM patients compared with other study groups. A cut-off CSF lysozyme level of > or = 26 U/l had a sensitivity and specificity of 93.7 and 84.1 per cent, respectively for the diagnosis of TBM. Overall, it was found to be a better test than any other single test and thus can be used for rapid and early diagnosis of TBM in children.
Case-Control Studies↗
Helicobacter pylori infection and recurrent abdominal pain in children.
The association of Helicobacter pylori infection with recurrent abdominal pain (RAP) was studied in 65 children aged between 3 and 12 years. Cases with a specific cause for abdominal pain were excluded from the study. All the patients were subjected to upper gastrointestinal endoscopy and antral biopsy. The biopsy specimens were subjected to rapid urease test, histopathological examination, and culture to document the presence of H. pylori in the gastric mucosa. All the patients were put on H. pylori eradication drugs for 10 days. About 69 per cent of the children had histopathological evidence of antral inflammation. Helicobacter pylori detection rate was 77 per cent. About 83 per cent of patients had complete symptomatic relief when followed over a period of 6 months. The study concludes a possible association of H. pylori with recurrent abdominal pain in children and all these patients should be considered for H. pylori eradication.
Abdominal Pain↗
Antimicrobial resistance profile of nosocomial uropathogens in a tertiary care hospital.
A retrospective analysis was done of the resistance pattern of urinary tract pathogens isolated over a 4 months period in a tertiary care hospital. There were a total of 871 clinical isolates comprising of 793 gram negative bacilli and 78 gram positive cocci obtained from 5477 consecutive urine samples. Extended spectrum beta lactamase production was observed in 71.5% of the gram negative bacilli; of these 6.18% were also inhibitor resistant. High level aminoglycoside resistance was observed in 70.17% of Enterococcus isolates while methicillin resistance was documented in 23.8% of the Staphylococcus isolates. A high level of resistance was also noted for ciprofloxacin. Multidrug resistance is a common problem in hospitals which emphasizes the need for judicious use of antimicrobial agents and their continuous in vitro monitoring.
Cross Infection↗
Venous thrombosis associated with Salmonella: report of a case and review of literature.
We describe here the first case of Salmonella paratyphi A bacteremia associated with deep vein thrombosis in a 10-year-old patient. In spite of aggressive antibiotic therapy and supportive care, the patient died of progressive respiratory distress and septic shock. Awareness of unusual clinical presentation of Salmonella infection in important. A review of the previously reported cases of Salmonella associated venous thrombosis worldwide is also presented.
Child↗
Sporadic variety of pallido-pyramidal syndrome.
A rare case of a 40-year-old lady with a sporadic variety of the pallido-pyramidal syndrome (PPS) is reported. She had marked parkinsonian features on the left side. Her single photon emission computed tomography showed left frontoparietal and basal ganglia hypoperfusion. CT scan and central motor conduction time were normal. She responded partially to a combination of trihexyphenydil and L dopa/C dopa therapy. In view of the diversity in the genetic, clinical and laboratory features, it is possible that PPS may be a heterogeneous condition.
Adult↗
Serum cortisol and thyroid hormone levels in neonates with sepsis.
OBJECTIVE: To evaluate the thyroid hormone and cortisol levels in neonates with sepsis in relation to the final outcome. It was hypothesized that the hormonal level could act as some prognostic guideline. METHODS: Forty nine neonates, aged 8- 28 days, diagnosed as neonatal sepsis were selected for the study. Neonates below 8 days of age, 35 weeks of gestation and 2000 g of birth weight were excluded from the study. Twenty FT-AGA neonates beyond day 7 of life served as control for the study. The hormones were estimated by radioimmunoassay. RESULTS: The neonates with sepsis had significantly higher mean serum cortisol and lower mean serum total T4 at admission as compared to healthy neonates. The mean serum total T3 level was also lower, but the difference was not statistically significant. The mean serum TSH levels were comparable in both groups. The levels normalised following recovery. Sixteen neonates succumbed to the disease process. The non-survivors had significantly lower mean total T3 and total T4 levels as compared to the survivors. CONCLUSION: The endocrinal abnormalities are of transient nature as a response to sepsis. Low total T3 and total T4 are the predictors of adverse outcome in neonates with sepsis.
Humans↗
Nasopharyngeal carriage of Haemophilus influenzae.
OBJECTIVE: Nasopharyngeal colonization of Haemophilus influenzae (H. influenzae) in young children may be important in developing countries. METHOD: In this study, we screened school going children for carriage of H. influenzae. A total of 44 H. influenzae isolates out of a collection of 162 were characterized for biotypes, capsular serotypes and antibiotic resistance. RESULTS: A significant proportion of H. influenzae (25/44) isolates were serotype b. High antibiotic resistance was observed against commonly administered antibiotics like ampicillin (79%), chloramphenicol (20%), trimethoprim sulfamethoxazole (84%) and erythromycin (95%). Comparison of antibiotic resistance profile of nasopharyngeal isolates was observed to be correlated with those of H. influenzae from disease. CONCLUSION: Multidrug resistant nasopharyngeal H. influenzae in young healthy children may act as reservoir. Monitoring of antibiotic resistance among nasopharyngeal H. influenzae as a surrogate for invasive H. influenzae seems an attractive option.
Age Distribution↗
Molecular characterization of serotype G2 and G3 human rotavirus strains that have an apparently identical electropherotype of the short RNA pattern.
The literature is conflicting whether or not rotavirus strains with different G serotype have an identical electropherotype. This is a contentious but an important issue because large parts of molecular epidemiological studies of rotaviruses have been based on the conception that a single strain of rotavirus can be defined by a single electropherotype. Here, we examined in detail by reverse-transcription PCR genotyping, electropherotyping, sequencing, and genogrouping using RNA--RNA hybridization three human rotavirus strains isolated in India that had apparently identical electropherotypes although one strain was typed as P[4], G3 while the other two typed as P[4], G2. These three strains showed an identical electropherotype on 7.5% and 12.5% polyacrylamide gels, but co-electrophoresis on a 10% gel demonstrated that segment 8 of the P[4], G3 strain migrated more slowly than the cognate segment of the P[4], G2 strains. Genogrouping assay and nucleotide sequencing provided evidence for the hypothesis that the P[4], G3 stain was an intergenogroup reassortant in which a P[4], G2 strain of the DS-1 genogroup had acquired the VP7 gene from an yet-unidentified concurrently circulating G3 strain. While electropherotyping remains a valuable asset for molecular epidemiology of rotaviruses, this study underscores the importance of co-electrophoresis under different electrophoretic conditions when pinpointing subtle differences.
Antigens, Viral↗