Conservative management of a traumatic non-destructive grade II extraperitoneal rectal injury following motor vehicle collision.

Rectal injuries are rare sequelae of blunt force abdominal trauma and are notorious for delayed recognition with resulting high morbidity and mortality. The management of traumatic colorectal injury is mired in old dogma and until recently mandated faecal diversion. Here we present a case of extraperitoneal rectal perforation successfully managed conservatively following blunt trauma.

Understanding the viridians group streptococci: Are we there yet?

The viridans group streptococci are a heterogeneous group of organisms which exist as commensals in the oropharynx and the gut. They cause serious infections when they gain entry into sterile sites particularly in patients with predisposing conditions. Classification and species differentiation of these organisms has always been a challenge because of phenotypic differences between strains of the same species. Facklam's typing scheme based on six metabolic properties has been the most widely used and many commercial identification systems are based on it. Due to the ambiguity in species differentiation based on phenotypic tests, nucleic acid-based methods have been developed to improve the identification of these organisms. Results using genotypic methods such as 16S rRNA and sodA gene sequencing have been promising. Multilocus sequence analysis of seven house-keeping genes map, pfl, pyk, ppaC, rpoB, soda and tuf amplified by polymerase chain reaction was found to be an accurate alternative to other methods and could be useful in the characterisation of larger collections of isolates.

Appendiceal tie syndrome.

Intestinal knot syndromes such as ileosigmoid knots, ileal-ileal knots have been described in the literature. We describe a case of a long inflamed appendix wrapping around a loop of ileum causing an appendico-ileal knot, a rare form of closed loop obstruction with only five cases reported previously. The use of CT scanning prior to surgery is discussed and literature reviewed.

Chlamydosporulation of Candida albicans and Candida dubliniensis on mustard agar.

Chlamydospores are distinctive morphological forms characteristic of Candida albicans, a phenomenon shared only with the closely related species Candida dubliniensis. The production of chlamydospores has remained an important diagnostic criterion for the differentiation of C. albicans and C. dubliniensis from other yeast. We herein describe a new medium, mustard agar, for chlamydosporulation in Candida. All the strains of C. dubliniensis and C. albicans tested produced chlamydospores on mustard agar, whereas none of the other five species produced chlamydospores.

Comparison of double disc and three dimensional methods to screen for ESBL producers in a tertiary care hospital.

Extended spectrum beta lactamases (ESBLs) continue to be a major problem in clinical setups world over, conferring resistance to the expanded spectrum cephalosporins. An attempt was made to study ESBL production among Enterobacteriaceae members from a tertiary care center in Chennai. A total of seventy randomly collected isolates of the family Enterobacteriaceae from a tertiary care center was studied for their susceptibility patterns to various antibiotics and detection of ESBL producers by double disc synergy (DDS) test and three dimensional test (TDT). Eighty percent of the isolates were multidrug resistant (MDR) and 20% were ESBL producers. TDT detected 85.7% whereas only 14.2% were detected by DDS. In the present study, a large number of isolates were found to be MDR and ESBL producers. TDTs were found to be better than DDS in the detection of ESBLs. Continued monitoring of drug resistance is necessary in clinical settings for proper disease management.

Cutaneous zygomycosis due to Rhizopus oryzae in a patient with acute lymphoblastic leukemia.

We report herein a case of primary cutaneous zygomycosis caused by Rhizopus oryzae in a 7-year-old girl with acute lymphoblastic leukemia (ALL) receiving intensive chemotherapy. The diagnosis was based on observation of hyphal elements in cutaneous biopsy and isolation of the fungus in culture. The patient responded to surgical intervention and treatment with amphotericin B.

Effect of Azadirachta indica (neem) on the growth pattern of dermatophytes.

PURPOSE: To determine the minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC) for the extracts of the leaves and seeds of the plant Azadirachta indica against various dermatophytes. METHODS: Clinical isolates of dermatophytes(Trichophyton rubrum, Trichophyton mentagrophytes and Microsporum nanum) were treated with extracts of leaves and seeds of the plant Azadirachta indica (neem) for antifungal activity by in vitro tube dilution technique. RESULTS: The MIC of neem seed extracts was 31 microg/mL for all the dermatophytes tested. The neem seed extract at 15 microg/mL concentration (below MIC) was observed to be sufficient for distorting the growth pattern of the organisms tested. CONCLUSIONS: The changes in growth curve of the treated dermatophytes were found to be statistically significant with reference to the untreated fungi.

Efficacy of fluconazole and itraconazole in the treatment of oral candidiasis in HIV patients.

A total of 46 strains of Candida were collected from HIV infected patients, of which 25 strains were isolated from patients with oral candidiasis, and 21 strains were from mouthwash samples of asymptomatic carriers. The most common species isolated was Candida albicans (73.9%), followed by Candida tropicalis (21.7%). In vitro susceptibility of the strains to fluconazole and itraconazole was tested using minimum inhibitory concentration (MIC) studies by agar dilution technique. Out of the 18 strains of C. albicans isolated from mouthwash samples, four were resistant to fluconazole whereas only two were resistant to itraconazole. Out of 16 strains of C. albicans isolated from oral lesions, one was resistant to fluconazole where as all were sensitive to itraconazole. Among the other species of Candida tested, C. tropicalis gave higher MIC values to both drugs than other species such as Candida guillermondii and Candida krusei. In vitro MIC values correlated well with in vivo responses in patients. Hence, itraconazole may be used as an alternative in the treatment of candidiasis, which does not respond to fluconazole therapy.

Modified ultrafiltration reduces morbidity after adult cardiac operations: a prospective, randomized clinical trial.

BACKGROUND: Extracorporeal circulation contributes to morbidity after open-heart surgery by causing a systemic inflammatory reaction. Modified ultrafiltration is a technique able to remove the fluid overload and inflammatory mediators associated with use of cardiopulmonary bypass. It has been shown to reduce morbidity after cardiac operations in children, but the impact on adult cardiac procedures is unknown. METHODS AND RESULTS: Five hundred seventy-three consecutive adult patients were prospectively randomized to either ultrafiltration after cardiopulmonary bypass (treatment) or to no ultrafiltration (control). Parsonnet score was used to assess the severity of the patients' clinical conditions. Analysis was done with Student's t test or Mann-Whitney U test for continuous variables and Fisher's exact test or Pearson's chi(2) for discrete variables. Hospital mortality was 2.5% (7 of 284) in the treatment group versus 3.8% (11 of 289) in the control group (P=0.357). Hospital morbidity was lower in treated patients (66 of 284 [23.2%] versus 117 of 289 [40.5%], P=0.0001). Cardiac morbidity was similar (26 of 284 [9.1%] versus 35 of 289 [12.1%], P=0.251), whereas significantly lower rates of respiratory (20 of 284 [7.0%] versus 36 of 289 [12.5%], P=0.029), neurological (5 of 284 [1.8%] versus 14 of 289 [4.8%], P=0.039), and gastrointestinal (0 of 284 versus 4 of 289 [1.4%], P=0.044) complications were found in treated patients. Transfusion requirements were also lower in treated patients (1.66+/-2.6 versus 2.25+/-3.8 U/patient, P=0.039). Duration of intensive care (39.9+/-49.2 versus 46.3+/-72.8 hours, P=0.218) and hospital stay (7.6+/-3.5 versus 7.9+/-4.4 days, P=0.372) were comparable. CONCLUSIONS: Modified ultrafiltration after cardiopulmonary bypass is associated with a lower prevalence of early morbidity and lower blood transfusion requirements. The impact on length of hospital stay needs further analysis. Routine application of modified ultrafiltration after adult cardiac operations is warranted.

EMM types of Streptococcus pyogenes in Chennai.

The M protein of group A Streptococcus (GAS) is the major virulence factor and is coded by the emm gene. The current serologic M typing methods are now being replaced by alternate means of M type deduction such as emm gene sequencing. This is the first report of emm types of GAS which are prevalent in south India. We found no marked preponderance of any single emm sequence among our clinical isolates with 11 emm sequences being present in 34 isolates.

Disc diffusion test in the identification of Candida species.

A total of 448 clinical isolates and seven reference strains of Candida species were tested for their susceptibility to a group of dyes and chemicals. All strains were also identified by conventional methods. The chemicals/dyes used in the disc diffusion tests were brilliant green, janus green, cycloheximide, fast green, rhodamine 6 G, ethidium bromide and 2, 3, 5 triphenyl tetrazolium chloride. Sensitivity to the chemicals was coded by a seven-figure code. Resistogram patterns obtained were found to be specific for each species. The disc diffusion test was found to be inexpensive, quick and gave reliable results within 18 h.

Motivated cultural cognition: the impact of implicit cultural theories on dispositional attribution varies as a function of need for closure.

The authors propose that need for closure (NFC) leads attributors to respond to an ambiguous social event by increasing reliance on implicit theories received from acculturation. Hence, the influence of NFC should be shaped by chronically accessible knowledge structures in a culture, and, likewise, the influence of culture should be moderated by epistemic motives such as NFC. The specific hypotheses drew on past findings that North American and Chinese attributors possess differing implicit social theories, North Americans conceiving of individuals as autonomous agents and Chinese conceiving of groups as autonomous. The present studies found the predicted pattern that among North American participants, NFC increased attributions to personal but not group dispositions. Among Chinese participants, NFC increased attributions to group but not personal dispositions. The findings are discussed in light of an emerging dynamic account of culture and cognition.