INITIAL EXPERIENCE WITH SHOCK WAVE LITHOTRIPSY AT ARMY HOSPITAL (R & R) DELHI CANTT

Army Hospital (R & R) has acquired an Electrohydraulic Lithotripter (DIREX NOVA), the first of its kind in the Armed Forces for the treatment of stone diseases. The first 200 patients who underwent Extracorporeal Shock Wave Lithotripsy (ESWL) have been analysed in this study. This being a pilot study would serve as a beginning of an ongoing experience with this non-invasive procedure and its benefits for the stone population in the Armed Forces.KEY WORDS: ESWL, Lithotripsy     

TRANSFUSION REACTIONS: AFMC EXPERIENCE

Transfusions of blood and its components are useful and lifesaving. Adverse effects occur during or after transfusion, called hazards or complications of blood transfusion. Complications/hazards of various types which occurred in the patients following transfusion of blood/blood components in Armed Forces Hospitals of Pune-Kirkee complex were analysed with relevant investigations. Out of a total number of 13,039 transfusions of blood and blood components from 01 June 1995 to 31 July 1997, there were 104 (0.8%) adverse reactions. Non haemolytic febrile transfusion reaction was the commonest seen in 73 (70.2%) transfusions, followed by allergic reactions in 19 (18.3%) cases. Nonspecific reactions were seen in 11 (10.6%). One haemolytic transfusion reaction occurred due to wrong labelling of blood sample received from the ward for compatibility testing. There were no fatalities.KEY WORDS: Blood transfusion, Complication, Febrile reaction     

EARLY DIAGNOSIS IN POST RENAL TRANSPLANT OPPORTUNISTIC INFECTIONS: A FRESH LOOK

A total of 86 renal transplant patients who were transplanted with live related donor (LRD) and live unrelated donor (LURD) kidneys were studied for opportunistic infections. Immune diagnosis of Toxoplasma, Cytomegalovirus (CMV), Herpes-simplex virus type II (HSV-2), Aspergillosis and Tuberculosis was carried out in these patients along with sputum examination, CSF studies and biopsy of lymphnode and other tissues in few cases. A high degree of Toxoplasma, CMV & HSV-2 positivity was seen in transplanted patients. However sensitivity of serological diagnosis of tuberculos was found to be low with standard criteria, which increased significantly when modified criteria were used. It is concluded that regular immunological monitoring should be carried out in transplanted patients so as to reach an early diagnosis and management of opportunistic infections.KEY WORDS: Immune diagnosis, Opportunistic infections, Transplantation     

Nosocomial outbreak of septicaemia in neonatal intensive care unit due to extended spectrum β-lactamase producing Klebsiella pneumoniae showing multiple mechanisms of drug resistance

A total of 14 phenotypically similar clinical isolates of Klebsiella pneumoniae, resistant to multiple drugs including cefotaxime and ceftazidime, were isolated from blood of neonates admitted to neonatal intensive care unit (NICU) within a short span of 10 days. Alarmed at the possibility of occurrence of outbreak, a thorough investigation was done. Microbiological sampling of the NICU and labour room (LR) environment yielded 12 K. pneumoniae isolates. The presence of extended spectrum β-lactamase (ESBL) in the clinical and environmental strains was detected by double-disk synergy test (DDST), CLSI phenotypic confirmatory disk diffusion test (PCDDT) and E-test ESBL strips. Amp-C screen (disk) test was done to determine Amp-C β-lactamase production. 100% clinical strains, 57% NICU strains and 80% LR strains were ESBL positive. 57% clinical, 43% NICU and 20% LR strains were Amp-C screen positive. Polymerase chain reaction (PCR) of representative ESBL positive (10 clinical and 5 environmental) strains showed CTX gene and TEM and/or SHV gene in all. K. pneumoniae showing multiple mechanisms of drug resistance was responsible for the outbreak.     

O16 Organoleptic assessment of pure odour compounds representative of the metabolic end‐products of oral microbes

We have measured various production rates of volatile compounds in tongue scrape cell suspensions, oral biofilm models and the oral cavity in situ and wish to relate these to equivalent levels of oral malodour as assessed by the human nose. Objectives To assess the relationship between measured concentrations of pure odourants and resultant organoleptic scores (using a defined 0–5 score). Methods Seven odour judges, all with experience of organoleptic assessment, were used in this study for all experiments carried out at a single site (UWE, Bristol). A wide range of pure odourants were prepared at a range of concentrations (from a stock of 0.1 M) and were dispensed as 12 ml volumes into ‘universal’ bottles (24 ml capacity) leaving a headspace of 12 ml. The bottles were secured with rubber‐lined metal caps, labelled with a randomized code and were presented to the odour judges for assessment using the Rosenberg 0–5 scale. The volatile sulphur compounds (H₂S and CH₃SH) were presented as gases with dilutions being prepared through a dynamic gas flow rig (using oxygen free nitrogen as the diluent) and presented to the odour judges at a flow rate of 200 ml min^?1. Group means of determinations for each odourant were plotted against log10 of the concentration. Linear regression analysis was used to measure the gradient, 95% CI, and the scatter of the points around the gradient (R² value). Results Organoleptic scores were proportional to the log10 concentration of odourant. Detection thresholds (expressed as mol dm^‐3) were skatole (7.2 × 10^?13) < methyl mercaptan (1.0 × 10^?11) < trimethylamine (1.8 × 10^?11) < butyrate (2.3 × 10^?10) < hydrogen sulphide (6.4 × 10^?10) < putrescine (9.1 × 10^?10) < dimethyldisulphide (5.9 × 10^?8). Hydrogen sulphide showed highest olfactory power whilst putrescine was the lowest. Conclusions The olfactory response is exponential in nature. For any single compound, its contribution to malodour depends on: odour (olfactory) power, threshold (of detection) and volatility in addition to the concentration. It is now possible to relate production rates of VC's in models to typical levels of oral malodour perceived by the human nose.     

The inability of Streptococcus mutans and Lactobacillus acidophilus to form a biofilm in vitro on dentine pretreated with ozone

Background: The use of ozone therapy in the treatment of dental caries is equivocal. The aim of this study was to use an in vitro model to determine the effects of prior ozone application to dentine on biofilm formation and to measure any associated reduction in bacteria viability. Methods: Twenty dentine discs were bonded to the bases of 5 mL polycarbonate screw top vials. Ten dentine discs were infused with ozone for 40 seconds, 10 samples remained untreated as a control. The vials were filled with nutrient medium, sterilized and placed into the outflow from a continuous chemostat culture of Streptococcus mutans and Lactobacillus acidophilus for four weeks. At the conclusion of the experiment bacterial growth was monitored by taking optical density readings of the growth medium in each vial and the outer surface of the dentine specimens were examined by scanning electron microscopy as shown by SEM analysis. Results: Ozone infusion prevented biofilm formation on all the treated samples while there was substantial biofilm present on the control specimens. While the average optical density of the control specimens was almost twice that of the ozone infused dentine (0.710 for the control with a SD of 0.288 and 0.446 for the ozonated samples with a SD of 0.371), the results were not significant (p > 0.05). Conclusions: This preliminary study has shown that the infusion of ozone into non‐carious dentine prevented biofilm formation in vitro from S. mutans and L. acidophilus over a four‐week period. The possibility exists that ozone treatment may alter the surface wettability of dentine through reaction with organic constituents.     

Use of influenza vaccines in children with an egg allergy

Children are at increased risk of morbidity from influenza. Influenza vaccines are grown in eggs, leading to a minute amount of egg protein in their composition. Recent research and new practice parameters spurred by the 2009 global influenza pandemic have challenged the need to withhold influenza vaccine from patients with an egg allergy. The available data suggest that anaphylaxis from influenza vaccines is exceptionally rare, even in patients with an egg allergy. Reported allergic reactions to trivalent inactivated influenza vaccine and pH1N1 influenza vaccines have been rare; when reactions occurred, they have not caused anaphylaxis. This position statement reviews the available evidence on influenza vaccine/egg allergy-related anaphylaxis, and recommends protocols to safely administer the trivalent inactivated influenza vaccine in lower- and higher-risk children with an egg allergy.