Journal of clinical and diagnostic research https://www.jcdr.net/back_issues.asp JCDR Use of Disposable End Tidal Carbon Dioxide Detector Device for Checking Endotracheal Tube Placement. JAIN H, VARGESE C End tidal carbon dioxide (ETCO2) monitoring is the non-invasive measurement of exhaled CO2. It is of particular use for verification of endotracheal tube placement. It is easy to apply to breathing circuits. This technology has the potential to become a very useful tool in the pre-hospital setting. It is a commercially available, disposable, colorimetric ETCO2 detector in which colour changes using a numerical scale semi-quantitatively measures carbon dioxide percentage in exhaled gases, and it has been proved useful in adults and children. End tidal CO2 detectors provide an objective evidence of the tube position in the trachea. In addition to quickly revealing the misplaced oesophageal intubations it can prevent unnecessary re-intubations. Other uses in the Emergency Department include monitoring CPR efforts and monitoring the ventilatory and haemodynamic status of intubated and nonintubated patients. In addition, future uses may include using PetCO2 as an adjunct when monitoring the status of asthma treatment, when making the diagnosis of pulmonary embolism, and when measuring cardiac output noninvasively. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2007&month=June&volume=1&issue=3&page=104-109&id=65 https://doi.org/10.7860/JCDR/2007/.65 Study Of Clinical Profile Of Malaria At KMC Hospital, Attavar,India CHOWTA M N, CHOWTA K N <b>Introduction</b> India being a vast country with different geographical regions, the pattern of diseases may vary from place to place. The present study was undertaken to study the clinical features, complications, and response to treatment in a tertiary care hospital. <b>Methodology</b> A prospective analysis of adult patients suffering from malaria was carried out at KMC hospital, Attavar during the year 2002-2003. Diagnosis of the patients was based on clinical features and by peripheral smear. The mode of presentation, clinical course, laboratory investigations, antimalarials administered, and complications were recorded. The response to treatment was noted both clinically and by repeating peripheral blood smear examinations. <b>Results</b> Out of the 54 patients, 39 were males and 15 females. The age group of the patients ranged from 17 to 65 years. Fever was present in all the patients. 51.55 % of patients complained of headache and 31.55 % had vomiting. Jaundice was observed in 11 patients. Cough was also a complaint in four patients. Symptoms of gastritis were observed in two patients and two other patients had diarrhoea. Anaemia was present in 20 patients. Out of the 54 patients, 31.48% had infection with P.falciparum, 33.33% with P.vivax, and 29.62% had mixed infection. Chloroquine resistance was observed in nine patients. Complications were seen in 10 patients. <b>Conclusion</b> Injudicious use and inadequate dosage of the available drugs need to be curbed. To achieve the global aim of malaria control, we must carry out an epidemiological survey to monitor the progression of resistance while planning an effective antimalarial strategy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2007&month=June&volume=1&issue=3&page=110-115&id=66 https://doi.org/10.7860/JCDR/2007/.66 Assessment Of Polyalthia Longifolia Var. Pendula For Hypoglycemic And Antihyperglycemic Activity NAIR R, SHUKLA V, CHANDA S The hypoglycemic and antihyperglycemic activity of various solvent extracts of Polyalthia longifolia var. pendula leaf extracts was evaluated in alloxan induced experimental diabetes in rats. Diabetes was induced using 180 mg/kg i.p. of alloxan consecutively two times at an interval of 24 h. The test drugs were administered for 7 days. On 8th day various biochemical parameters like serum cholesterol, serum urea, serum creatinine, serum triglyceride, total serum protein, serum alkaline phosphatase, blood glucose and glycogen from liver were estimated. Polyalthia longifolia extracts and powder produced glucose lowering activity. However, the extracts did not modify any of the biochemical parameter significantly. Hence the extracts and crude powder are devoid of anti-diabetic properties, but has gross glucose lowering properties. The presence of anti-hyperglycemic effect against sucrose loading induced hyperglycemia is a significant finding. Now-a-days, it is considered that this effect is most important property in a drug used in diabetes treatment. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2007&month=June&volume=1&issue=3&page=116-121&id=67 https://doi.org/10.7860/JCDR/2007/.67 Aberrant Heterosis In Hemoglobinopathies With Special Reference To Beta-Thalassemia And Structurally Abnormal Hemoglobins E And S In Orissa, India BALGIR R S The population of India exhibits a wide range of genetic heterogeneity and, ecological and biological diversity including the reservoir for occurrence of a large number of abnormal hemoglobins and thalassemias in the world. Orissa state has nurtured ecological, cultural and genetic diversity of hemoglobinopathies, which has become a major genetic and public health problem in both tribal and nontribal inhabitants. Prospective studies are lacking in India. In Orissa, prospective studies of referral index cases of hemoglobinopathies provide most valuable data for analysis with respect to introspection and re-evaluation from research point of view. Intravenous blood samples were collected after obtaining informed consent from each index case of double heterozygosity for hemoglobinopathies. Background data of each individual were recorded like age, sex, caste, place of origin, reproductive history, consanguinity, etc. Twelve index cases of sickle cell-&#946;-thalassemia and 9 index cases of hemoglobin E-&#946;-thalassemia with anemia were subjected to detailed hematological and family genetic investigations. Routine standard hematological and biochemical investigations were carried out. This study highlights the rare occurrence of double heterozygosity of abnormal hemoglobins, i.e. Hb D, E and S with &#946;-thalassemia mutation for the first time from Orissa. Study showed that index cases with Hb E-&#946;-thalassemia and sickle cell-&#946;-thalassemia manifest variable clinical, hematological and prognostic profile. High levels of fetal hemoglobin in patients reduce the severity of clinical symptoms in some but not in others. &#946;-thalassemia or Hb E/S carrier mothers during their reproductive life either had spontaneous abortions or neonatal deaths. Aberrant heterosis for hemoglobinopathies such as occurrence of &#946;-thalassemia mutation with structurally abnormal hemoglobins (Hb S and Hb E) is a rare entity, but occurs with severe clinical manifestations only in those areas or communities where abnormal hemoglobins and &#946;-thalassemia are highly prevalent. This study provides for the first time a comprehensive database on the occurrence of double heterozygosity, testifying the genetic diversity and ethnic admixture in Orissa, India. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2007&month=June&volume=1&issue=3&page=122-130&id=68 https://doi.org/10.7860/JCDR/2007/.68 Serum Inhibin B: A Direct And Precise Marker Of Ovarian Function HALDER A, FAUZDAR A, GHOSH M, KUMAR A <b>Background</b> Inhibin B is a glycoprotein hormone produced mainly by granulosa cells of the ovary in early folliculogenesis. It selectively suppresses the secretion of pituitary FSH and has local paracrine actions in the gonads. Its measurement is useful for investigating female reproductive dysfunction. Objective The objective of this study was to examine serum levels of inhibin B in the assessment of ovarian function in patient with premature ovarian failure. <b>Material & Method</b> Serum from premature ovarian failure (n=34; group A), menopause (n=8; group B) and normally cycling fertile women (n=5; group C) was prospectively collected and stored at –80°C. Serum concentration of inhibin B was measured using specific solid phase sandwich ELISA. FSH level was measured using microparticle enzyme immuno assay (MEIA) for comparison. Independent sample t test was used to see the mean significance differences between groups. <b>Results</b> Inhibin B level was undetectable (i.e., <15pg/ml) in group A & B women. The mean value in group C women was 51.8pg/ml (range 26-75). Respective values of FSH were 78.8miu/ml (range 25-150), 100.7miu/ml (range 62-150) & 5.96miu/ml (range 4.2-7.9). Inhibin B level was significantly lower in group A & B than group C women (p<0.0001) whereas differences were insignificant between group A and B women. Similarly FSH level was significantly higher in group A & B than group C women (p<0.0001). We found wide variation in FSH level in group A women. In 5 women FSH level was below 40miu/ml and was related to exogenous estrogen intake more than 3 months of blood sampling. <b>Conclusion</b> This study demonstrated that inhibin B is a better predictor for ovarian failure than FSH and uninfluenced by exogenous estrogen intake (if taken >3 months before). https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2007&month=June&volume=1&issue=3&page=131-137&id=69 https://doi.org/10.7860/JCDR/2007/.69 CD5+ B Cells Ratio In Lepromatous Leprosy ILHAN F, CICEK D, GöDERKMERDAN A, TAHRAN G, BULUT V <b>Objective</b> Leprosy is a unique infectious disease, which is chronic and related to cellular immunity. It was known that who have a defect on cellular immunity, they are susceptible to M. leprae infection. CD19+CD5+ B cells are currently defined as B1 cells and they produce polyreactive antibodies. The aim of this study was to investigate the presence and the possible effect of natural antibody producing CD19+CD5+ B cells in leprosy disease patients. <b>Materials and Methods</b> We investigated B lymphocyte subset and total B and B1 cells by flow cytometry in 40 patients with lepramatous leprosy and 40 healthy controls. <b>Results</b>: Compared to the healthy controls, both CD19+CD5- conventional B cells and CD19+CD5+ B1 cells subsets were found to be higher in leprosy patients group. <b>Conclusion</b> The observed significant increases in CD19+CD5- and CD19+CD5+ B1 cells subsets in patients with lepramatous leprosy suggests that B1 lymphocytes known predisposed to autoimmunity may have a role on disorganized protective immune response in lepramatous leprosy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2007&month=June&volume=1&issue=3&page=138-141&id=70 https://doi.org/10.7860/JCDR/2007/.70 Full Mouth Rehabilitation GOPAL Y, MALLABADI R Full mouth rehabilitation cases are one of the most difficult cases to manage in dental practice. This is because such cases involve not only replacement of the lost tooth structure but also restoring the lost vertical dimensions. Full mouth reconstruction is basically a set of procedures that are aimed at correcting an improper bite position as well as restoring chipped or worn out teeth. Improper jaw position is implicated in various neuro-muscular disorders as well as in headache and neck ache. Correcting the jaw position not only restores proper function, but also helps in enhancing the cosmetic appearance of the patient. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2007&month=June&volume=1&issue=3&page=143-146&id=71 https://doi.org/10.7860/JCDR/2007/.71 Allergic Contact dermatitis with exfoliation secondary to calamine/diphenhydramine lotion in a 9 year old girl GUPTA S, SINGH M M, PRABHU S, PRABHU M, MISHRA P Calamine/diphenhydramine lotion is a bland, smoothening, antipruritic lotion commonly used in several dermatological conditions. Skin reactions due to this preparation are very rare. We report a case of contact dermatitis following the application of Calamine/diphenhydramine in a 9 year old child. The drug was stopped and the patient was managed symptomatically. The causality, severity and preventability assessments were carried out as per the standard criteria. We could not confirm the exact cause behind the adverse drug reaction (ADR) as the child’s parents was not willing for rechallenge. Since calamine is made up of zincoxide and ferric chloride, the exact compound that might have caused the ADR is not confirmed. Since Calamine/diphenhydramine is a commonly used preparation, one should be aware of this reaction. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2007&month=June&volume=1&issue=3&page=147-150&id=72 https://doi.org/10.7860/JCDR/2007/.72 Rhabdomyolysis And Hepatitis Associated With Pravastatin Therapy KHAN F Y, MATTAR I, ALSAMAWI M, LUTF A Q https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2007&month=June&volume=1&issue=3&page=151-154&id=73 https://doi.org/10.7860/JCDR/2007/.73 Propionibacterium Acnes Endophthalmitis NAYAK N, VERMA L, SATPATHY G, VENKATESH P <b>Background & objective</b> Endophthalmitis due to Propionibacterium acnes following cataract surgery has infrequently been reported.This is due to the difficulty in isolating this organism because of its sequestration in the posterior capsular bag. The objective was to isolate and identify this rare micro-aerophilic organism, P acnes from 2 cases of endophthalmitis following cataract surgery with intra-ocular implant. <b>Methods</b> Thorough clinical examination was conducted on the two cases of endophthalmitis occuring after 2 and 3 months of surgery respectively. Vitreous specimens were cultured under micro-aerophilic conditions. Bacterial identification and antibiotic sensitivity were performed by recommended procedures. <b>Results</b> P.acnes was isolated on both the occasions. Both the isolates were sensitive to ciprofloxacin and ceftazidime, but resistant to vancomycin and aminoglycosides. <b>Interpretation & Conclusion</b> P.acnes can cause post-operative endophthalmitis and should be suspected especially in late onset cases. Being sequestered in the capsular bag, it can create serious problems in management. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2007&month=June&volume=1&issue=3&page=155-158&id=74 https://doi.org/10.7860/JCDR/2007/.74 Pyrexia of Unknown Origin Caused by Retained Intra-Abdominal Foreign Body: Report of a case with review of literature VERMA A, MOHAN S, BAIJAL S S Pyrexia of unknown origin (PUO) is a common occurrence in developing countries and has a long list of known etiologies. Many isolated reports and case series suggest new causative factors for PUO. The present report tries to highlight a rare cause of this condition which has been scarcely documented in the literature. It also reinforces the basics of clinical management i.e., detailed clinical history and examination which dictate subsequent investigations. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2007&month=June&volume=1&issue=3&page=159-162&id=75 https://doi.org/10.7860/JCDR/2007/.75 Tuberculous Osteomyelitis Of Sternum: A Case Report JAIN V K, SINGH Y, SHUKLA A, MITTAL D Primary mycobacterial infection of the sternum is extremely uncommon. We present a case of tuberculous osteomyelitis of sternum successfully treated with four drug antituberculous therapy. Tuberculous sternal osteomyelitis is rare entity and one should suspect tuberculosis in a case of chronic draining sinus. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2007&month=June&volume=1&issue=3&page=163-167&id=76 https://doi.org/10.7860/JCDR/2007/.76 Ultrasound Biomicroscopy (Ubm) Characteristics Of Lisch Nodules In Neurofibromatosis Type 1 JETHANI J, THAKKAR H, RENUKA R Lisch nodules are the most common type of ocular involvement in NF-1. Lisch nodules are melanocytic hamartomas, usually clear yellow to brown in color, that appear as well-defined, dome-shaped elevations projecting from the surface of the iris. Lisch nodules are the most common clinical finding in adults older than 20 years with NF-1. We did Ultrasound biomicroscopy (UBM) of lisch nodules. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2007&month=June&volume=1&issue=3&page=168-170&id=77 https://doi.org/10.7860/JCDR/2007/.77 Iatrogenic Ureteric Rosary (Stone Street)! SINGH I, MITTAL G S We report a case of “iatrogenic ureteric rosary” or stone street! following an open pyelolithotomy for a giant staghorn stone which was operated elsewhere and was successfully managed by us with renal salvage and timely ureterolithotomy with stenting. The present case was reported to highlight an uncommon and rarely reported challenging problem of complex multiple (seventeen) secondary ureteric calculi obstructing the renal unit. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2007&month=June&volume=1&issue=3&page=171-172&id=78 https://doi.org/10.7860/JCDR/2007/.78 Low Grade Cystic Mesothelioma Of Rectus Sheath DEBNATH S, MISRA V, SINGH PA, SINGH M Low grade cystic mesothelioma or Benign multicystic mesothelioma is a rare neoplasm that arises from the peritoneal surface of abdominal or pelvic viscera as well as extraperitoneal space and omentum. Synonyms like multilocular peritoneal inclusion cysts(MPIC), benign multicystic mesothelioma are used interchangeably in the literature. Multicystic mesothelioma of the peritoneum was first described in 1979. To the best of our knowledge no case of cystic mesothelioma of rectus sheath has been described till date. A case of low grade cystic mesothelioma arising from the rectus sheath in a 35 yrs old female is documented here due to its rarity. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2007&month=June&volume=1&issue=3&page=173-176&id=79 https://doi.org/10.7860/JCDR/2007/.79 Intravascular Epithelioid Haemangioma Of Temporal Artery: A Diagnostic Difficulty PAI K, GUPTA A We report a case of Epithelioid haemangioma in a 23 year old female,arising in a branch of temporal artery presenting as a painless, pulsatile nodule in the temporal region,which was difficult to differentiate histologically from giant cell arteritis with thrombotic occlusion and neovascularisation.Laboratory investigations (Peripheral eosinophilia,and normal Erythrocyte Sedimentation rate and C-Reactive Protein) as well as clinical presentation helped in arriving at a diagnosis of Intravascular Epithelioid haemangioma. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2007&month=June&volume=1&issue=3&page=177-180&id=80 https://doi.org/10.7860/JCDR/2007/.80 Tigecycline - A Novel Expanded Spectrum Antibiotic for the Treatment of Serious Infections JOSE J, JIMMY B, SARAVU K Resistance to presently available antibiotics is increasing at an alarming rate, and the same proves to be a major hurdle in the treatment of infections, especially serious infections, where organisms with a wide range of antibacterial resistance are frequently present. The drug discovery sector is concentrating on developing antibiotics with a broader antibiotic coverage to overcome the existing resistance mechanisms displayed by organisms. Tigecycline is a member of a new class of antibiotics named glycylcyclines. This is an antibiotic class related to tetracyclines and has the above mentioned properties. This new drug has been shown to confer broad antibiotic coverage and prove effective against many species of multidrug-resistant organisms. The drug was approved by the US Food and Drug Administration for the treatment of complicated skin and skin structure infections and complicated intra-abdominal infections in June 2005. Tigecycline has been efficacious and well tolerated in clinical studies. The drug is not currently available in India. It will be a welcome addition to the current armamentarium for the treatment of serious infections. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2007&month=June&volume=1&issue=3&page=181-184&id=81 https://doi.org/10.7860/JCDR/2007/.81 Dysglycemia Associated With The Use Of Fluoroquinolones- Focus On Gatifloxacin JOSE J, JIMMY B, SARAVU K Fluoroquinolones are generally regarded as safe antimicrobial agents with relatively few adverse effects or drug interactions. Dysglycemia (hypo or hyperglycemia) has been reported rarely with many of the fluoroquinolones. The latest data suggests that gatifloxacin is one of the newer fluoroquinolones and is associated with a higher incidence of dysglycemic effects. The exact mechanism behind this effect is not known. The risk factors for the development of this effect are identified as diabetes mellitus, older age, renal insufficiency, and patients taking medications for diabetics (especially hypoglycemic agents). Potential for this increased risk of serious glucose abnormalities should be considered especially while using gatifoxacin in the identified risk groups. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2007&month=June&volume=1&issue=3&page=185-187&id=83 https://doi.org/10.7860/JCDR/2007/.83 Staphylococcus Aureus Enterotoxins: A Review BHATIA A, ZAHOOR S Food-borne diseases are of major concern worldwide. To date, 250 different food-borne diseases have been described and bacteria are the causative agents of two thirds of food-borne disease outbreaks. Food poisoning is a term used to express any type of disease, illness or malaffect after consuming food. The most serious type of food poisoning is bacterial food poisoning, which may be due to bacterial infection or food intoxication. Among the predominant bacteria involved in these diseases, Staphylococcus aureus is a leading cause of gastroenteritis resulting from the consumption of a food in which enterotoxigenic staphylococci have grown and produced toxins. As these toxins are excreted from the organism, they are referred to as exotoxins; however, they normally exert their effects on the gastrointestinal tract and therefore are called enterotoxins. While not considered a highly lethal agent due to the low mortality associated with the illness, staphylococcal enterotoxins are considered a potential biological threat because of their stability at high temperatures (100°C for 1 h) and ability to incapacitate individuals for several days to two weeks. Here, a brief review on Staphylococcal enterotoxins is given. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2007&month=June&volume=1&issue=3&page=188-197&id=85 https://doi.org/10.7860/JCDR/2007/.85 The significance of oestrogen and progesterone receptors in breast cancer VARGHESE C It was 40 years ago, that the importance of steroid hormone receptors in the biology of breast cancer was recognized. This important finding was the result of a study in which radiolabelled oestrogens concentrated preferentially in the oestrogen-influenced target organs of animals, and also in human breast cancers. Thus, the concept of an oestrogen receptor (ER) was established. Ever since, it has been observed that human breast cancers are dependent upon oestrogen and/or progesterone for growth, and that this effect is mediated through ERs and progesterone receptors (PRs). Thus ER and PR are both found to be overexpressed in malignant breast tissue. Oestrogen receptor (ER) and/or progesterone receptor (PR) expressing breast cancers are found to have different clinical, pathological, and molecular features. They have been found to play a significant role in the prognosis and treatment of breast cancers. Recent developments which provided new insights into hormone receptor biology and the increasing array of proteins that can modify their function, have helped modulate better therapies for breast cancer.(eg). ,Selective oestrogen receptor modulators (SERMS), which are drugs that interact with the oestrogen receptor, have been approved for the treatment and prevention of breast cancer. Also, less expensive, simpler, and possibly more accurate measurements of ER and PR have been made possible by methods for assaying receptor proteins. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2007&month=June&volume=1&issue=3&page=198-203&id=86 https://doi.org/10.7860/JCDR/2007/.86 Phenytoin-Induced Toxicity Due To Drug Interactions SATYANARAYAN R B, SINGHAL S, KAMAT V, YERAGANI V, KULKARNI C Phenytoin is effective against both partial and tonic-clonic seizures. It is said to act by limiting repetitive firing of action potentials evoked by sustained depolarization, mediated by slowing the rate of recovery of voltage activated sodium channels from inactivation. The optimal initial dose, suggested for phenytoin is 3 to 4 mg/kg, body weight /day, while the usual maintenance dose is 200 to 500 mg/day for an adult. Phenytion is completely absorbed from upper intestine and is metabolized by liver. It undergoes entero-hepatic recycling and is excreted in urine, either as free or conjugated form. It is widely distributed throughout the body and is extensively plasma protein bound (90%). The toxic effects of phenytoin depend upon the route of administration, duration of exposure and dosage. Its toxic manifestations present as a syndrome comprising of cerebellar, vestibular and ocular effects such as nystagmus, diplopia, slurred speech and ataxia. Mental confusion and exacerbation of seizure frequency have also been noted. Overdose leads to hypotension, coma and respiratory depression. The dosage adjustments of phenytoin are necessary, to achieve adequate control of seizures, along with monitoring of its plasma concentration. This is because it follows saturation kinetics such as the rate of elimination varies as a function of its concentration. The plasma half-life ranges from 6 to 24 hrs at plasma concentration below 10 mg/ml, but increases with higher concentration. As a result, even with small increments in it’s dosage to attain the levels towards therapeutic range, plasma drug concentration may increase disproportionately leading to toxicity. While, several reports are available indicating adverse drug reactions to phenytoin, the following case illustrates how phenytoin toxicity is affected by its interaction with other drugs especially in situations of polypharmacy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2007&month=June&volume=1&issue=3&page=205-208&id=82 https://doi.org/10.7860/JCDR/2007/.82