Tuberculous abdominal lymphadenopathy causing reversible renovascular hypertension.

Renovascular hypertension is an important but not so common cause of hypertension. Rarely the extrinsic compression of renal arteries by retroperitoneal structures may be responsible for hypertension. Lymphadenopathy due to metastasis has been reported to cause renovascular hypertension. The present case reports hypertension which resulted from tubercular abdominal lymphadenopathy in a twenty one years male. The patient was treated with antitubercular medication with which his hypertension also got controlled. An unusual cause of hypertension and a rare complication of tuberculosis is reported.

Reappearing CT lesions: 4 cases.

An overwhelming majority of disappearing CT lesions in India have been aetiologically linked to cysticercosis. We report 4 patients with disappearing CT lesions in whom the lesion later reappeared at the same (3 patients) or different site (1 patient). One patient was a Taenia carrier. Serial MRI evaluation in one patient revealed a persisting lesion in the interval period. The contribution of these observations towards the understanding of the aetiology of disappearing CT lesions is discussed.

Incidence of dengue fever in relation to climatic factors in Ludhiana, Punjab.

An outbreak of dengue fever occurred in Ludhiana in 1996 and 1997. A total of 505 patients who attended the hospital attached to Dayanand Medical College, Ludhiana were clinically diagnosed to have dengue fever. Of these, 460 cases were noticed between October and December 1996 while during 1997 only 45 dengue fever cases were observed. Serological examination using dengue IgG and IgM blot was performed with single serum samples of 189 patients. Of these, 129 serum samples were detected positive for anti dengue antibodies. Twenty eight patients died in the dengue epidemic, 12 of whom suffered from dengue haemorrhagic fever (DHF) and six with dengue shock syndrome (DSS). Male patients outnumbered the female patients. Seasonal and cyclic pattern of the disease incidence was observed.

Incidence of HIV risk and prevention of infection in health care settings.

Tht HIV epidemic has created awareness about blood borne pathogens transmission in health care settings. Although, the risk of transmission of HIV and other blood borne pathogen may account for a very small proportion, yet the potential for such transmission always exists. Despite this, the use of proper and careful sterile procedures is sufficient to substantially reduce or even eliminate the risk of HIV infection.

Should beta-blockers be withdrawn in post-myocardial infarction patients before treadmill test?

In most patients of myocardial infarction, beta-blockers are used for secondary prophylaxis and a treadmill test is required for risk stratification. To study the effect of oral beta-blockers on interpretation of treadmill test, 54 consecutive patients were subjected to treadmill test four to six weeks after myocardial infarction. Fourteen patients with strongly positive treadmill test were referred for coronary angiography. Treadmill test was repeated in 37 patients 72 hours after withdrawal of beta-blockers. The peak exercise heart rate was significantly different while off and on beta-blockers (148 +/- 13 bpm vs 124 +/- 14 bpm, respectively; p < 0.01). The test was negative on both the occasions in 17 patients. On stopping beta-blockers, the negative test became mildly positive in five and strongly positive in six patients. The mildly positive test became strongly positive in four patients and remained almost unchanged in five. In 10 patients there was conversion of negative or mildly positive treadmill test into strongly positive result after withdrawal of beta-blockers. Thus the risk stratification changed significantly in 27 percent patients. It is suggested that beta-blockers can and should be withdrawn in post-MI patients before doing treadmill test.

Infectious diarrhoea--an update.

Infectious diarrhoea is one of the most common illness affecting mankind. Recent advancement have led to detailed understanding of causative agents and the pathogenesis of the infections. Fluid and electrolyte replacement remains the most important aspect of treatment. The role of antimicrobial agents is discussed.

Hepatitis A associated with myoglobinuria.

We report a patient with hepatitis A who had myoglobinuria. Creatine phosphokinase levels and electromyography and muscle biopsy findings were consistent with polymyositis.

Microbiological quality & incidence of organisms of public health importance in food & water in Ludhiana.

Bacteriological analysis of 713 samples of various types of foods and related articles and potable water samples from different places in Ludhiana, Punjab was carried out. The highest counts ranging from 2.5 x 10(6)-7.5 x 10(8) organisms/g were observed in raw vegetables and fruits, followed by 3 x 10(6)-9.8 x 10(7)/ml, 8.3 x 10(4)-8.9 x 10(7)/g and 1 x 10(3)-6.7 x 10(7)/g in fruit juice, milk and its products, and salty/non milk snacks respectively. Fresh chapati, dal, rice, cooked vegetables and karhi etc., showed no microbial contamination. However, samples of these articles from road side cafes gave counts up to 1 x 10(7) organism/g. The most probable number of coliforms and Escherichia coli/100 ml of water ranged from < 1 to > 1100. Although 1332 isolates of 16 types of organisms of public health significance were obtained those of proven enteropathogenicity were enterotoxigenic Esch. coli (55), Esch. coli O157 (3), enteropathogenic Esch. coli (1), enterotoxigenic Klebsiella (23), Streptococcus faecalis (152), Bacillus cereus (133), Staphylococcus aureus (125), Aeromonas spp (47), Salmonella spp (10), Shigella spp (4) and Yersinia enterocolitica (2). Poor quality of potable water and widespread occurrence of enteropathogens in food consumed by the common man in Ludhiana was evident.

Rapid identification of colonization factor antigens I & II of enterotoxigenic Escherichia coli by coagglutination test.

Specific antisera for colonization factor antigens (CFA/I and CFA/II) were adsorbed to Staphylococcus aureus Cowan I strain, ATCC 12598 to make coagglutination (CoA) reagents for detection of CFAs in enterotoxigenic Esch. coli (ETEC) isolates. Among 1782 strains of Esch. coli isolated from patients with acute diarrhoea, 238 (13.4%) strains exhibited CFA expression. Most prevalent CFA/I positive serogroups were 015, 0148, 0153, 020, 0128, 0114 and 078. CFA/II was detected among isolates of serogroup 080, 085, 06 and 08. Ten ETEC isolates each of serogroups 04, 07, 061, 068, 0117 and 0158 did not show presence of CFA/I or CFA/II. CoA technique proved an appropriate, rapid diagnostic tool which can be used for screening large number of Esch. coli isolates in epidemiological studies.

Epidemiology of coronary heart disease in a rural Punjab population--prevalence and correlation with various risk factors.

An epidemiological study to find out the prevalence of coronary heart disease (CHD) and the influence of risk factors on the prevalence of CHD in a total rural community of Punjab was conducted in Pohir, situated near Ludhiana. A total of 1100 individuals (623 males and 477 females) out of a possible 1617 individuals (> 30 yrs) living in 3 villages were studied. In each case a detailed history, physical examination and a 12 lead electrocardiogram (ECG) were recorded. Samples for blood sugar and serum cholesterol were taken. By Epstein's criteria of ECG (using the Minnesota coding), the prevalence of CHD was 30.8/1000, being higher in women (37.7/1000) than in men (25.6/1000). By a clinical judgement method considering history, ECG and treadmill testing (TMT) collectively, prevalence was 31.8/1000, being still higher in women (33.5/1000) than in men (30.5/1000). The prevalence of various risk factors like hypertension, smoking, hypercholesterolemia and diabetes was found to be 14.5%, 8.9%, 7.0% and 4.6% respectively. Of the various risk factors tested, hypertension, hypercholesterolemia and a positive family history showed an association with CHD. Only 38% of patients with CHD, 37% of the hypertensives and 52% of the diabetics were aware of its presence. The knowledge in the general population about risk factors causing CHD is poor.

Coagglutination test for detection of heat labile enterotoxin producing Escherichia coli strains.

A simple particle immunoassay based on the coagglutination (CoA) of Staphylococcus aureus strain Cowan 1 coated with heat labile enterotoxin (LT) specific antibodies was evaluated to detect LT in the cell lysates of blood agar grown Esch. coli. Among strains of Esch. coli isolated from 2661 patients with acute diarrhoea, isolates from 609 patients demonstrated LT production by CoA test. Most prevalent serogroups were 020, 078, 0128, 04, 0117, 068, 0158, 07, 0114, 0148 and 0145. A comparison of CoA with classical rabbit ileal loop and skin permeability factor assay for 100 strains showed 86, 69 and 83 LT positive strains respectively. CoA proved a more specific, simple, rapid and sensitive assay which may be useful for screening of large number of Esch. coli isolates in epidemiological investigations.

Loss of some virulence factors of enterotoxigenic Escherichia coli on repeated subcultures.

Thirty enterotoxigenic Esch. coli (ETEC) strains of predominant serogroups, isolated from patients with diarrhoea in Ludhiana, Punjab were investigated for expression of heat labile (LT) enterotoxin and colonization factor antigens (CFAs) on repeated subculture. These belonged to serogroup 078 (10), 080 (2), 0114 (6), 020 (3), 0128 (3), 0153 (2) and 08 (4) respectively. The isolates exhibited a differential response for expression of LT and CFAs on repeated subculturing. All the strains were positive for both LT and CFA up to six subcultures. Three strains of serogroup 0114 and one of 080 failed to express CFA while one strain each of serogroups 080, 0114, 020 and 08 failed to elaborate LT in the 8th subculture. Only 25 and 19 isolates were detected as stable producer of LT and CFAs up to 10th subculture.

Assessment of the modified internal gas generator system for isolation of Campylobacter.

The modified internal gas generator system (MIGGS) to create microaerophilic conditions for the isolation of Campylobacter was compared with two conventional methods viz., the Gaspak and the hydrogen and carbon dioxide gas mixture from gas cylinders. Ten reference strains of C. jejuni, C. coli and C. laridis were grown on Butzler's medium at optimum temperature under microaerophilic conditions. The MIGGS and Gaspak gave identical results which were better than with the compressed gas mixture. As the chemicals required for MIGGS are commonly available in the market, it works out to be less expensive than the commercial Gaspak. Further, investigations with MIGGS revealed Campylobacter in the faecal samples of 1.9 per cent (50 out of 2661) patients of diarrhoea visiting a Teaching Hospital in Ludhiana (Punjab). None of the 105 healthy volunteers excreted Campylobacter in their faeces. In the 50 positive patients, highest (22%) occurrence was observed in April followed by 16 per cent in May. High prevalence of Campylobacter diarrhoea was observed among infants and children up to 10 yr. Male patients were found to be more susceptible to infection than females (1.9:1). All strains were sensitive to the common antimicrobial agents tested.

ELISA for detection of heat stable enterotoxin producing Escherichia coli strains.

Among 557 strains of Esch. coli isolated from patients with acute diarrhoea, 392 (70.4%) isolates demonstrated ST production by ELISA. Predominant ST producing serogroups were 020 (45), 078 (40), 0128 (21), 061 (19), 0149 (9), 04, 055, 0106 and 0114 (8 each). The inhibition ELISA range was between 10.5 and 40.5 per cent. Visual difference between a negative and a positive ELISA test was distinct. A comparison of ELISA with classical suckling mouse assay for 100 strains showed 88 and 80 positive strains respectively for ST. ELISA proved a more specific, rapid and sensitive assay which may be useful for screening large number of isolates in epidemiological studies.

Seasonal fluctuations in the occurrence of enteroinvasive Escherichia coli diarrhoea.

Enteroinvasive Esch. coli (EIEC) was implicated in 2.1 per cent (57 out of 2661) diarrhoeal patients investigated at Ludhiana (Punjab). The predominant serogroups isolated were 028, 0147, 0124 and 0112. High prevalence of EIEC infection was noticed among infants (50.6%) followed by children up to 10 yr (19.3%). The peak incidence (24.5%) occurred during the hot and dry month of May as compared to 1.7 per cent in February. The disease incidence was positively correlated with mean minimum temperature and mean maximum temperature. All strains gave Sereny's test positive and were mostly susceptible to cephalothin, gentamicin, nalidixic acid, furazolidine and neomycin.