An outbreak of multidrug resistant typhoid fever in Bangalore

Six hundred and eighty five blood cultures from children clinically diagnosed as enteric fever yielded 176 salmonella strains showing isolation success rate of 25.7%,S. typhi were 164 (93.2%),S. paratyphi A 5 (2.8%),S. choleraesuis 4 (2.3%) andS. typhimurium 3 (1.7%). Antibiogram of 164 isolates ofS. typhi showed triple drug resistance (TDR) in 156 strains (95.1%) to chloramphenicol, ampicillin and cotrimoxazole, and sensitivity of 90.2% and 95.1% to norfloxacin and ciprofloxacin respectively. Minimum inhibitory concentrations (MIC) of chloramphenicol were between 360 mcg and 640 mcg per ml. Phage types of 38 strains of TDRS. typhi were predominantly E1 and 0 with prevalences of 47.4% and 36.8% respectively in this region. All children with S.typhi isolates sensitive to quinolones inVitro responded well to these drugs with almost no relapse and hence, the newer generation of quinolones could be considered as the first choice in the primary treatment of enteric fever.     

Thyroid hormone supplementation following open-heart surgery in children

In patients undergoing open-heart surgery, abnormalities in thyroid hormone levels have been observed even in the absence of primary thyroid disease. These abnormal changes in thyroid hormone level and function have been found to be sufficient to affect myocardial performance and postoperative recovery. In the intensive care unit, postoperatively, it has been found that features such as low cardiac output, left ventricular dysfunction and prolonged ventilator support were associated with hypothyroidism. We reviewed the available literature on the effect of thyroid hormone supplementation in paediatric patients undergoing open-heart surgery under cardiopulmonary bypass and concluded that children after complex congenital cardiac surgery are at risk of developing a clinically significant hypothyroid state in the early postoperative period. In the literature where the effects of supplementation of thyroxine were studied, beneficial effects were observed in terms of reduced mechanical ventilation time, reduced inotropic support and intensive care unit stay, rapid achievement of negative fluid balance and early recovery. Supplementation with thyroid hormones enables a smoother postoperative recovery and is beneficial. The total duration of this therapy is, however, unclear.     

EGFR Intron 1 polymorphism in Asian Populations and its correlation with EGFR gene expression and amplification in breast tumor tissues

AIM: The purpose of this study was to test the hypothesis if longer CA dinucleotide repeats are more common in the Asian population and also to gain insights into the interplay between the CA dinucleotide repeats and the frequencies of EGFR gene expression and amplifications as this might have therapeutic implications with regards to treatment with tyrosine kinase inhibitors. MATERIALS AND METHODS: The EGFR intron 1 polymorphism was analysed in three distinct healthy Asian subjects, namely, Chinese (N = 96), Malays (N = 98) and Indians (N = 100). Comparative genomic hybridisation was performed to investigate for changes in DNA copy number in relation to the polymorphic CA dinucleotide repeats in breast tumor tissues (N = 22). RESULTS: The frequency of short alleles with 14 and 15 CA repeats were most common in the Asian populations and significantly higher than those reported for Caucasians. The frequency of 20 CA repeats was 5%, almost 13-fold lower than previous reports. EGFR amplifications were detected in 23% and 11% of breast tumor tissues harboring short and long CA repeats, respectively. CONCLUSION: Our results show that the frequency of alleles encoding for short CA dinucleotide repeats is common in Asian populations. EGFR expression and amplification levels were also higher in Asian breast tumor tissues with short CA dinucleotide repeats. These findings suggest that the EGFR intron 1 polymorphism may influence response to treatment with tyrosine kinase inhibitors in breast cancer patients and further studies are warranted.     

Double aortic arch as a source of airway obstruction in a child

Double aortic arch (DAA) is a congenital vascular anomaly. The diagnosis was difficult till the child was symptomatic, and other causes were ruled out. We present the interesting images of a child of respiratory distress because of tracheal compression from DAA.     

Unruptured Sinus of Valsalva Aneurysm with Right Ventricular Outflow Tract Obstruction and Ventricular Septal Defect—A Rare Combination

Sinus of Valsalva aneurysms are rare cardiac anomalies that may be acquired or congenital. We describe the case of a patient who had an unruptured sinus of Valsalva aneurysm causing right ventricular outflow obstruction, with an associated subaortic ventricular septal defect. Sinus of Valsalva aneurysms rarely present until rupture occurs. However, the unruptured aneurysm of the right sinus of Valsalva caused significant right ventricular outflow tract obstruction, resulting in exertional dyspnea. Intraoperative multiplane transesophageal echocardiography and color Doppler helped in precise identification of structural anomalies, shunt location, and definitive surgical repair.     

Physical urticaria: Review on classification,triggers and management with special focus on prevalence including a meta-analysis

Background. Physical urticaria (PU) is a subset of chronic urticaria (CU) induced by physical stimuli. To date, there is no consensus in the literature on the prevalence of PU among patients with CU. Objectives. Our objective was to review the clinical presentation, diagnosis and management of PU and to estimate the prevalence of PU in CU patients. Methods. We performed a narrative review of PU and conducted a systemic review and meta-analysis to determine the pooled estimates of the prevalence of PU among patients with CU in the literature up to September 2014. We searched four databases (PubMed, Ovid MEDLINE and Web of Science) of published work for which full text was available in English or French. Studies were eligible if they measured the prevalence of PU in adults or children with CU worldwide and ineligible if CU cases were not differentiated from total urticaria cases. Meta-analysis was conducted using Stata, version 12.0 (StataCorp, College Station, TX). In addition, the quality and validity of the articles included in the meta-analysis was assessed. Results. Ten studies were included in our meta-analysis. Sample sizes ranged from 202 to 4157 patients. The pooled prevalence estimate of PU including and excluding cholinergic forms among all cases of CU were 13.1% (95% CI: 12.5, 13.6) and 14.9% (95% CI: 14.3, 15.7), respectively. Conclusion. Our results must be viewed with circumspection because of the small number of eligible articles and heterogeneity among studies. Even so, the results suggest that PU is an important subset of CU and that physicians should be aware of this important condition in order to manage patients appropriately.     

Spectrum of cardiac tumors excluding myxoma: Experience of a tertiary center with review of the literature

The aim of this study was to determine the histological spectrum of operated cardiac tumors, excluding myxoma, at a tertiary center in India. Between 1995 and 2010, we encountered 188 cases of operated cardiac tumors that had been subjected to histopathological examination.Morphological characterization was done by light microscopy along with histochemical stains. Immunohistochemistry using a panel of antibodies, i.e., vimentin, desmin, myogenin, smooth muscle actin (SMA), epithelial membrane antigen (EMA), cytokeratins, factor VIII-related antigen, S100-protein, synaptophysin, chromogranin, Bcl2, MIB-1, leukocyte common antigen (LCA), CD 3, CD20, CD34, and CD 99 (MIC-2) was performed wherever applicable.Out of the 188 cases, 184 were primary cardiac tumors, including 170 cases of benign cardiac tumors. Among the benign tumors, myxomas were the most frequent ones (168 cases), followed by fibroma (2 cases). Primary malignancy was diagnosed in 14 cases, including undifferentiated sarcomas [6], primitive neuroectodermal tumor [1], rhabdomyosarcoma [2] non-Hodgkin lymphoma [2], angiosarcoma [1], synovial sarcoma [1], and leiomyosarcoma [1]. Metastatic (secondary) tumors were seen in four cases, including one each of adenocarcinoma, choriocarcinoma, renal cell carcinoma, and alveolar soft part sarcoma. Hence, out of the total of 188 cases, 20 were non-myxoma cardiac tumors (NMCTs), including 2 benign tumors, 14 malignant tumors, and 4 metastatic tumors.In our series, the majority of cardiac tumors were primary in nature. The malignant primary tumors outnumbered benign ones, excluding myxomas, and the most common malignant histology was undifferentiated sarcoma, as opposed to the literature.