Collagenofibrotic glomerulopathy – A rare disease diagnosed with the aid of transmission electron microscopy

Collagenofibrotic glomerulopathy (CFG) is a rare idiopathic kidney disease characterized by abnormal deposition of atypical Type III collagen fibers in the glomerulus causing subendothelial and mesangial expansion, manifesting as progressive renal dysfunction accompanied by proteinuria. The majority of CFG cases reported in literature are from Japan where this disease entity was initially recognized. There is an increased awareness and diagnosis of this rare renal disease in India with the recent increase in utilization of electron microscopy (EM) in clinical diagnostic settings. We describe a 28-year-old Bangladeshi woman who presented with hypertension and nephrotic range proteinuria not amenable to treatment with steroids and cyclophosphamide, whose renal biopsy demonstrated diagnostic ultrastructural features of CFG. This illustrative case is presented to highlight the role of EM analysis for diagnostic accuracy in renal biopsy evaluation in addition to demonstrating the unusual renal biopsy findings of this rare entity.

Assessment of Knowledge and Practice to Control Nosocomial Infection, Among the Staff Nurses, Hi-Tech Medical College & Hospital, Bhubaneswar

Background: A nosocomial infection is that which is acquired in a hospital or other health care agency upto 48 hours after hospital admission, upto 3 days after discharge, upto 30 days after an operation or was admitted to hospital for other reasons other than the infection. Nurses have the major role to prevent the hospital acquired infection. Appropriate knowledge and practice in preventing nosocomial infection is important in their in their day to day patient care. Objective: To assess the knowledge and practice to control nosocomial infection & also to find out the association between knowledge and practice to control nosocomial infection with the selected demographic variables. Material & Methods: The study was conducted in different wards of Hi-Tech Medical College & Hospital, BBSR. The sample size was 122 and the universal sampling technique was used. After obtaining written informed consent from the study participants, data was collected using two standardized tool. Knowledge was assessed by a scoring key and practice was assessed by likert scale. The association of knowledge and practice with demographic variables was analysed using chi square test. Results: 89.4% of staff nurses were females, 39.3% were in the age group of 31-40 years. and majority (51.6%) were GNM. There was no significant association (p<0.05) found, neither with knowledge nor with practice, with different demographic variables.

Tuberculous Synovitis of Knee Joint.

Tuberculosis of the appendicular skeleton is an uncommon infection by tubercle bacilli. Thirty percent of the skeletal tuberculosis involves joints, the knee being the third most common joint affected. We report a case of tuberculous synovitis of the knee joint in a 69 years old male. The diagnosis was done by Ziehl – Neelsen stain and culture on Lowenstein – Jensen medium of the synovial fluid along with X-ray finding of the knee joint. Though the sputum sample was negative for AFB, X-ray of the chest showed finding suggestive of old pulmonary tuberculosis. The patient was treated with the anti tubercular regimen and responded well .

Role of azithromycin against clinical isolates of family enterobacteriaceae: A comparison of its minimum inhibitory concentration by three different methods.

PURPOSE: To determine the effect of azithromycin, a new azalide antibiotic, on clinical isolates of the family Enterobacteriaceae and to determine and compare its minimum inhibitory concentration (MIC) by disk diffusion, agar dilution and E-test methods. MATERIALS AND METHODS: One hundred fifty-nine bacterial strains belonging to the family Enterobacteriaceae, isolated from different clinical samples, were tested for their susceptibility to azithromycin by disk diffusion, agar dilution and E-test methods. The MIC values were analysed and the percentages of agreement between the different methods were mentioned. RESULTS: Of the 159 isolates of the family Enterobacteriaceae, 60.37% were E. coli followed by Klebsiella species 28.3%, Salmonella and Shigella species 3.77% and Enterobacter and Citrobacter species 1.88% each. Maximum isolates were obtained from urine 117/159 (73.58%). Azithromycin was found to be more active against Salmonella and Shigella species, showing 100% sensitivity the by E-test and 83.33% by the disk diffusion methods. In the agar dilution method, 83.33% of Salmonella and 66.66% of Shigella species were sensitive to azithromycin. The overall agreement between disk diffusion and agar dilution method was 96.8%, between agar dilution and E-test was 88% and between disk diffusion and E-test was 91.2%. CONCLUSION: Azithromycin may become an important addition to our antimicrobial strategies, especially for the treatment of bacterial diarrhoea and infections caused by Salmonella typhi.

Cryptococcal meningitis in acquired immunodeficiency syndrome.

OBJECTIVE: To study the clinical course and outcome of cryptococcal meningitis (CM) in patients with acquired immunodeficiency syndrome (AIDS). METHOD: Patients infected with human immunodeficiency virus (HIV) and symptoms suggestive of meningitis were evaluated with detailed history, clinical examination and investigations. Diagnosis of CM was based on positive India ink preparation or positive fungal culture of CSF. All patients were treated with amphotericin those showing response were put on oral fluconazole. RESULT: A total of 431 patients with HIV infection were admitted to this centre during the study period, of these 15 were diagnosed to have CM. Majority of the patients had a subacute presentation with signs of meningeal irritation seen in only seven patients. India ink preparation and positive fungal culture on cerebrospinal fluid (CSF) established diagnosis in all cases. All patients were treated with amphotericin B and fluconazole. Complete response was noticed in seven patients, two patients were lost to follow-up and six patients died during the course of therapy. Raised intracranial tension (ICT) and disseminated disease were associated with poor prognosis. CONCLUSION: CM is a common opportunistic fungal infection in patients with AIDS. A high index of clinical suspicion and routine mycological surveillance is required to diagnose this infection. Majority of patients respond to therapy except those who have disseminated infection, altered sensorium and features of raised ICT at presentation.