Prevotella oris: A lesser known etiological agent of pleural effusion.

Prevotella are gram negative, obligate anaerobes and includes pigmented and non-pigmented species. They are typically regarded as commensals, especially of the gastrointestinal tract and oral cavity, although opportunistic endogenous infections are known to be caused by a small number of strains. We report a case of a 51-year-old man with right-sided chest pain. Chest X-ray showed mild haziness in the right lung and he was diagnosed with right sided pleural effusion. Prevotella oris was isolated after pleural pus culture.

Electrocardiographic Changes in Ostium Secundum Atrial Septal Defect- Before and After Shunt Closure- A Retrospective Cohort Analysis.

INTRODUCTION: Atrial Septal Defect by virtue of its left to right shunt induces geometric and electrical remodeling of the right sided chambers of the heart which produces prototypical changes in the Electrocardiogram. Various patterns produced by ASD in the ECG can give a clue in diagnosing the defect. Reversal of remodeling after the shunt closure and its accompanying changes in ECG are also helpful in follow up of these patients Methodology: This is a retrospective cohort analysis, wherein, ECG of the patients who have undergone ASD closure by percutaneous device closure or surgical closure during the study period,were obtained from hospital records and they were followed up. After screening, 60 patients met the inclusion criteria and were included in the study. ECG of the patients before closure of ASD and on immediate post procedure day, 2 weeks, 1month, 3 months, 6 months and 1year were obtained and analyzed. RESULTS: Mean age of the study population was 28.4 ± 09 years. In analysis of ECG after closure of ASD, the mean QRS axis reduced from 108 ± 10 to 70 ±12 degrees (P = 0.016), mean QRS duration reduced from 123 ± 30 ms to 80 ± 27 ms (P= 0.28). Mean PR interval reduced from 188 ± 30 ms to 123 ± 24 ms (P value= 0.09). The Crochetage Sign disappeared in the 2 patients who had it before closure of the defect. The amplitude of R' wave in rSR' in right precordial leads reduced over 2 years. rR' and qR pattern in right precordial leads reverted to rSr' pattern in 10 out of 12 patients. The other 2 patients who did not show reversal had residual shunt. No clinically significant complete heart block was observed in any patient. CONCLUSION: ECG forms as an easily available tool for diagnosis of ASD as well as in assessing the success of closure in the follow up after the closure of ASD by surgical or percutaneous device therapy. Failure of reversal of electrocardiographic signs of ASD after the closure should prompt search for residual shunt or pulmonary complications.

Reversible Cardiovocal (Ortner's) Syndrome in Dilated Cardiomyopathy - A Rare Presentation of a Common Disease.

Ortners syndrome is a rare cause of recurrent laryngeal nerve palsy due to cardiac causes. After the description of this syndrome by Ortner in patients with mitral stenosis, it was described by many authors in multiple other cardiac conditions. Here we present a case of Ortner's syndrome in Dilated cardiomyopathy,which reverted completely after medical management of DCMP.

Level of Health Literacy Among Type 2 Diabetic Persons and its Relation to Glycemic Control.

INTRODUCTION: Health literacy is the degree to which an individual can obtain, process, understand and communicate about health related information to make informed health decisions. Our aim was to study the influence of Diabetic health literacy in affecting the glycemic control in Diabetic patients. METHODOLOGY: This is a Cross sectional Analytical study in 200 diabetic patients. Diabetic Knowledge Test developed by Michigan Diabetic Research and Training Center was modified after appropriate permission and was used to measure health literacy. HbA1C was used as a measure of glycemic control. RESULTS: In the study population, Median HbA1C was 9 gm% with Interquartile Range (IQR) of 6.10-11.80 in low health literacy group, 7.80 with an IQR of 5.95-9.32 in marginal health literacy group and 6.20 with an IQR of 5.38-7.90 in adequate health literacy group (P Value <0.001). After adjusting for socio demographic characteristics, Linear regression analysis showed that HbA1C decreased by 0.385 for every one point increase in Questionnaire score [Std.error 0.60, 95% C.I. "-0.502 to -0.267, P Value <0.001]. The Odds of achieving adequate glycemic control was 0.309 in marginal health literacy group and 0.205 in low health literacy group. (95% C.I=0.092-0.455). On applying Pearson's correlation between answer score and HbA1C,we got correlation coefficient "r"=-0.417 indicating a strong negative correlation. We also found that patients with low health literacy had higher chances of developing hospitalizations (P=0.027), Neuropathy (P =0.001) and retinopathy (P=0.049). CONCLUSION: This study shows that inadequate health literacy is an independent predictor of glycemic control and complications. Development of strategies to communicate more effectively with patients who have poor health literacy are needed at the patient clinician level and the patient system level and should be based on a deeper understanding of the needs and competencies of patients with poor health literacy.