International Journal of Medical and Pharma Research (IJMPR)

Index Copernicus Journal id: 7526

ISSN 2277-2413

Volume 2 (2) June 2013

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Research Papers

1. Water Soluble Contrast Study Predicts the Need for Early Surgery in Adhesive Small Bowel Obstruction
Dr. Mahim Koshariya¹, Dr. Samir Shukla², Dr. Sudesh Sharda³, Dr. Akhilesh Ratnakar³, Dr. Vishal Rampuria³, Dr. Avinash Pratap Singh⁴, Dr. Varun Pendro⁴, Dr. Puspendra Baghel⁴, Dr. Samit Chaturvedi⁴, Dr. M.C. Songara⁵
Associate Professor¹, Assistant Professor², Senior Resident³, Resident⁴, Professor and Head⁵
Department of Surgery, Gandhi Medical College & Associated Hamidia Hospital, Bhopal-462012, Madhya Pradesh, India.
Vol. 2(2) : pp 51-56 (2013)
Abstract: The study was carried out with the aim to investigate whether the water soluble contrast study followed for 24 hours can be a reliable indicator of the need for earlier surgical intervention in adhesive small bowel obstruction or not? To avoid much dreaded complications like bowel strangulation due to delayed surgical intervention, and to determine the management approach for patients in whom avoiding surgery is highly desirable such as those with multiple previous abdominal operations or small bowel obstruction in the early post-operative period.
40 patients admitted in emergency with clinical and radiologic evidence of adhesive small bowel obstruction were included in this study. All patients were treated conservatively for initial 48 hours. The Gastrograffin study was performed in 28 patients after 48 hours as12 patients showed spontaneous relief in symptoms of obstruction within 48 hours and were managed conservatively.
25 cases showed contrast agent beyond Ileocecal junction on plain radiograph in erect posture before 24 hours of ingestion of oral contrast and conservative treatment was continued. The remaining 3 cases had complete obstruction as shown by the contrast study and underwent surgery.
The use of water soluble contrast agent Gastrograffin in adhesive small bowel obstruction after failed conservative treatment can be of great help in diagnosis and management of adhesive small bowel obstruction.
Keywords: Gastrograffin, Small bowel obstruction, Water soluble contrast study, Adhesive small bowel obstruction, Bowel obstruction, Small bowel.

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2. Study of Bacterial Pathogens in Sputum Samples and Their Antibiotic Sensitivity Pattern
Gurjeet Singh¹, A.D. Urhekar², Asha T. Kore³
Student¹, Professor and Head², Lecturer³
Department of Microbiology, MGM Medical College, Kamothe, Sector-18, Navi Mumbai-410209, Maharashtra, India.
Vol. 2(2) : pp 57-62 (2013)
Abstract: Lower respiratory tract infections are among the most common infectious diseases of humans worldwide and account for high mortality and morbidity. In human beings, these include infections below vocal cords and it includes infections of trachea, bronchi and alveoli. Sputum was collected in a sterile wide mouth universal container. Sputum samples were examined microscopically, inoculated on - Blood agar, MacConkey’s agar and Chocolate agar. Organisms were identified by using standard microbiological methods. Antibiotic sensitivity was carried out by Kirby Bauer method. An overall prevalence of 364/555 (65.59%) of LRTIs was observed in this study. Age and sex wise distribution – males 330/555 (59.46%) females 225/555 (40.54%). Males were predominant than females in all age groups.
The predominant organisms isolated from LRTIs were Streptococcus pneumonia, Pseudomonas aeruginosa, Klebsiella pneumoniae. Ampicillin+sulbactam, linezolid and ciprofloxacin demonstrate high level of sensitivity on respiratory tract pathogens. This study supports use of ampicillin+sulbactam as appropriate in the patients with LRTIs.
Keywords: Streptococcus pneumoniae, Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter, Lower Respiratory Tract Infections, Antibiotic sensitivity test.

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3. Prevention of Relapse in Alcohol Dependence Syndrome
Dr. Amitabh Saha
Department of Psychiatry, 92 Base Hospital, Srinagar, J&K, India.
Vol. 2(2) : pp 63-67 (2013)
Abstract: Few studies on relapse preventive strategies on soldiers with alcohol dependence syndromes have been carried out in the armed forces. There have been various factors for causes of relapse even after undergoing detoxification and other therapeutic measures. The use of anticraving medications and psychotherapy has been the common modalities used in the management of people dependent on alcohol. Several causes of relapse have been studied but fewer done on serving soldiers of Indian armed forces.
100 soldiers diagnosed with alcohol dependence syndrome were placed into two separate groups of fifty each. One group was placed on anticraving medication- Tab Acamprosate, and the other group was maintained on psychotherapy sessions. They were followed up at 0, 6 and 12 month period. Scales were used to screen alcohol dependence (ADS, Brief MAST) and a scale specifically designed for the Indian soldier were used to assess stressful life events (AFMC Life Events Scale).
Relapse rates were ascertained at the given time of follow up. Analysis revealed that a total of 09 soldiers relapsed in this one year period. The relapse rates were higher in the first six months after therapy than in the later follow up period. 06 cases that relapsed were from psychotherapy group and the remaining 03 cases were from the group receiving anticraving medications. But the difference between the two groups was not statistically significant. Various stressful events were highlighted using Marlatt’s taxonomy for causes of relapse.
Relapse rate was commoner in the initial months after undergoing detoxification therapy. Anticraving medication was in no way superior to a structured psychotherapy sessions in relapse prevention.
Keywords: Alcohol dependence syndrome, Anticraving medication, Psychotherapy, Stress, Acamprosate, Relapse.

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4. Study of Baseline Salmonella Agglutinin Titer in Apparently Healthy Individual
Asha T. Kore¹, Brijnandan Singh², A.D. Urhekar³
Lecturer¹, Student², Professor and HOD³,
Department of Microbiology, MGM Medical College, Kamothe, Navi Mumbai-410209, India.
Vol. 2(2) : pp 68-73 (2013)
Abstract: Introduction: Salmonella typhi and paratyphi A, B & C cause typhoid and paratyphoid fever. This is an acute, life threatening febrile illness. Typhoid fever is a global infection with a fatality rate of 10%. The disease is a cause for concern and a major public health problem in developing countries.
Materials and Methods: Study was done in MGM Hospital, Kamothe, Navi Mumbai in 2011 to 2012. Apparently healthy 100 individuals (Blood donors) were randomly selected from blood bank of MGM Hospital. Commercially available antigens containing Salmonella enteric serovar, Typhi O, H, AH & BH antigens were used for screening (slide agglutination) & quantitative (tube agglutination) estimation of antibodies. Screening of total 100 samples was done by slide agglutination method. And positive samples were further tested by tube agglutination method. Dilutions used were 1:20, 1:40, 1:80, 1:160, 1:320, 1:640 and 1:1280.
Results: From total 100 samples 87 were males & 13 were females. 75 samples were positive & 25 were negative for salmonella antibodies. From total samples Typhi “O” antibodies were positive in 71 individuals, Typhi “H” in 67, Paratyphi “AH” 6 & Paratyphi “BH” in 1. The maximum titres in healthy individuals were as follows. “TO”-1:40, “TH”-1:40, “AH”-1:40 & “BH”-1:20.
Conclusion: Among 100 samples of healthy individuals tested, 75 were positive for agglutinins of Salmonella serotypes. The maximum healthy individuals showed titre of 1:40 for Salmonella typhi “TO”, “TH” & Paratyphi “AH” antibodies. Hence, the titre of 1:80 or more should be considered as suggestive for typhoid fever. For “BH” 1:40 & above is significant. Salmonella antibody titre in normal individuals varies in different geographical areas. Hence normal antibody levels should be determined for particular local area.
Keywords: Typhoid, Widal test, Baseline titre, Baseline Salmonella, Salmonella, Agglutinin Titer.

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5. Bacteriological Profile of Stool Samples in Hospitalised Patients with Special Reference to Diarrhoeagenic E. Coli
Dr. Anahita V. Hodiwala¹, Y. Nisha²
Professor¹, Student²
Department of Microbiology, M.G.M. Medical College and Hospital, Kamothe, Navi Mumbai, India.
Vol. 2(2) : pp 74-78 (2013)
Abstract: E. coli are bacteria that normally live in the intestine of humans and animals. In this study we examined the bacteriological profile in stool samples from patients suffering from diarrhea and studied the prevalence, serotypes and antibiotic susceptibility pattern of Diarrhoeagenic E. coli (DEC) in cases of diarrhea.
We examined 227 stool samples, out of which 100, i.e. 45.3% were reported as Diarrhoeagenic E. coli (DEC) as all these samples indicated bacterial infection on microscopy and no other diarrhoeagenic pathogen was isolated from them. Slide agglutination was done for all these strains using O157 antisera and they were sent for serotyping to CRI, Kasauli.
We found that approximately 52% of these patients presented with diarrhea, 31% with gastroenteritis and 17% with ulcerative colitis. The other major diarrhoeagenic pathogen isolated from stool samples after E. coli was Vibrio cholerae (5.2%). DEC isolates showed highest susceptibility to Amikacin (98%) and least to Augmentin (12.6%). Majority of DEC strains were found to be Enterotoxigenic E. coli (ETEC) i.e. 41%, followed by Enterohaemorrhagic E. coli (EHEC), i.e 26% and only 4% were Enteropathogenic E. coli (EPEC).Our study emphasizes that strains of E.coli have been shown to cause diarrhea by several different pathogenic mechanisms and DEC remains an important cause of diarrhea, particularly in developing countries.
Keywords: Diarrhoeagenic E. coli (DEC), Enterotoxigenic E. coli (ETEC), Enterohaemorrhagic E. coli (EHEC), Enteropathogenic E. coli (EPEC), E. coli, Bacteriological profile.

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6. Utility of Chrom Agar for Differentiation of Candida Species and Detection of Antifungal Susceptibility by Macrobroth Dilution Method
Dr. Sharadadevi Mannur Y¹, Dr. Sandhya Bhat K², Dr. Neelesh Naik³, Dr. Nagaraj ER⁴
Associate Professor¹, Assistant Professor³, Professor⁴
Sri Siddhartha Medical College, Agalakote, Tumkur-572107, Karnataka, India.
Assistant Professor², Meenakshi Medical College, Hospital and Research Institute, Enathur, karrapettai post, Kanchipuram-631552, Tamil Nadu, India.
Vol. 2(2) : pp 79-81 (2013)
Abstract: Various clinical samples were inoculated on Sabouraud's dextrose agar (SDA), Blood agar (BA) and Mac Conkey’s agar (MA) and were also inoculated on HiCrome Candida Differential Agar (CHROM agar) to improvise species identification. Isolates were further characterized by performing conventional tests. Antifungal susceptibility test was done for fluconazole and itraconazole in this study. The MIC breakpoints of fluconazole and itraconazole were prepared using CLSI Guidelines for antifungal susceptibility testing. We used a modification of solid agar antifungal susceptibility (SAAS) method used in different laboratories.
Candida albicans was the commonest species isolated, followed by C. dubliniensis, C. tropicalis, C. parapsilosis and C. krusei. All the isolates were susceptible to fluconazole and itraconazole with an MIC range of 16-64 μg/ml and 0.5-1 μg/ml, respectively.
CHROM agar is a very useful medium for the speciation of Candida isolates. Even though our hospital is a tertiary care centre, none of the Candida isolates showed the resistance pattern to fluconazole and itraconazole. Hence clinicians can use azole antifungals to treat the patients with candidiasis in our hospital setting.
Keywords: Candida sp., CHROM agar, Fluconazole, Itraconazole, Antifungal susceptibility, Macrobroth dilution method.

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Case Reports

1. Xanthogranulomatous Pyelonephritis and Segmental Dilatation of Ureter : A Rare Association
Dr. Hemonta K. Dutta¹, Dr. P. Duarah²
Associate Professor¹, Department of Pediatric Surgery,
Professor², Department of Pediatrics,
Assam Medical College & Hospital, Dibrugarh - 786002, Assam, India.
Vol. 2(2) : pp 82-84 (2013)
Abstract: Xanthogranulomatous pyelonephritis (XGP) is an atypical form of chronic pyelonephritis characterized by diffuse, focal or segmental suppurative destruction of renal parenchyma. Segmental dilatation of ureter is characterized by a giant, focal segmental dilatation of mid ureter. We report a child who had duplication of the kidney with segmental dilatation of both upper and lower moiety ureters. The lower moiety was non-functioning and showed structure of xanthogranulomatous pyelonephritis on histology. These associations were not reported earlier.
Keywords: Pyelonephritis, Xanthogranulomatous pyelonephritis, Segmental dilatation of ureter, Segmental giant ureter, Segmental cystic dilatation, Ureter.

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2. T-Condylar Fracture of Distal Humerus in a 3 Year Old Male Child : An Unusual Case Presentation of Mild to Moderate Degree of Trauma
Dr. Surendar Kumar¹, Dr. Hemendra Kumar Agrawal², Dr. Mohit Garg², Dr. Ramandeep³
Senior Resident¹, Post Graduate II², Post Graduate I³,
Central Institute of Orthopaedics, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi-110029, India.
Vol. 2(2) : pp 85-87 (2013)
Abstract: Fractures of intercondylar humerus and shaft humerus both are very rare in children. Supracondylar with intercondylar fractures of humerus in children below 3 years age are rarely encountered. Treatment for this age group of patient has not been clearly mentioned in literature & text books. A three-year-old boy suffered with T-condylar fracture of the distal humerus. Open reduction and pinning were performed. The purpose of this report is to discuss diagnosis and treatment of this unusual injury and to increase focus on management options for these rare fractures. Through this case report we would like to bring attention to this rare fracture and demand for further research in its diagnosis and treatment options, so that functional results in such children could be improved.
Keywords: Supracondylar, Olecranon osteotomy, Arthography, Percutaneous fixation, T-condylar fracture, Distalhumerus.

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Review Paper
 

1. Laboratory Diagnosis of Malaria: A Brief Review
Dr. Sandhya Bhat K¹, Dr. Apurba Sastry¹
Assistant Professor¹, Department of Microbiology, Meenakshi Medical College & Research Institute, Kanchipuram, Near Chennai, India.
Vol. 2(2) : pp 88-94 (2013)
Abstract: Malaria remains today a heavy burden on tropical endemic countries and a threat to non-endemic countries. Recently rapid, cost effective diagnostic tests are available for malaria diagnosis, however, malaria cases are still increasing due to several factors. Traditional methods like blood smear examination even though considered standard method for speciation of malarial parasite, but it has its own limitations. Quantitative blood smear (QBC) examination is rapid, highly sensitive, but its sensitivity falls down when the parasitaemia drops down to 0.002%.
Rapid immunochromatographic (ICT) tests detecting Histidine Rich Protein-II antigen and plasmodium Lactate Dehydrogenase are very useful in emergency conditions and non-availability of trained personnel. Molecular techniques like PCR are useful for detection of anti-malarial drug resistant strains of malarial parasites. Serological techniques for antibody detection are useful to identify the infected donors in cases of transfusion induced malaria. Newer diagnostic techniques are introduced to overcome the limitations of traditional diagnostic techniques.
Keywords: Malaria, Plasmodium, Laboratory diagnosis, Malaria diagnosis, Malaria literature, Malaria laboratory diagnosis.

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International Journal of Medical and Pharma Research (IJMPR)
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