Reduced susceptibility of carbapenem-resistant Klebsiella pneumoniae to biocides: An emerging threat.

Dealing with carbapenem-resistant Klebsiella pneumoniae (CR-Kp) strains, which are generally pan-drug resistant, is an uphill task for health care professionals. Owing to limited therapeutic options and the possibility of development of resistance to commonly used biocides in hospital settings, CR-Kp infections pose a serious threat of emergence of a dreaded pandemic. The aim of the study was to highlight the possibility of emergence of biocide resistance among CR-Kp strains. A case study was conducted in a Super-specialty Hospital in September 2015. A 65-year-old female patient post-laparotomy was admitted to the General Intensive Care Unit of a Super-specialty Hospital. CR-Kp was isolated from the blood and mucus trap samples of this patient. Susceptibility testing of three commonly used biocides in our hospital, namely sodium hypochlorite (4% available chlorine), 5% w/v povidone iodine (0.5% w/v of available iodine) and absolute ethanol (99.9%), respectively, was carried out using K. pneumoniae ATCC 700603 as control. The test isolate showed reduced susceptibility to sodium hypochlorite in comparison to K. pneumoniae ATCC 700603. The possibility of emergence of biocide resistance among CR-Kp strains poses a threat of disrupting our ongoing efforts for implementation of effective infection control measures.

Development of OMP based indirect ELISA to gauge the antibody titers in bovines against Pasteurella multocida.

Pasteurella multocida (P. multocida) is an important pathogen of various domestic animals. The outer membrane proteins (OMPs) play a major role in pathogenesis and immunogenicity of P. multocida. The aim of the study was to develop indirect enzyme linked immuno sorbant assay (ELISA) based on OMPs to ascertain the antibody titers in animals post-infection or to gauge the potency of vaccine. The OMPs were extracted and purified from P. multocida P:52 (vaccine strain) and P. multocida B:2 isolated from natural outbreak of Haemorrhagic septicaemia (HS) and analyzed on SDS PAGE and through western blot. The OMPs profile of the vaccine strain and the isolate from the natural outbreak of HS were found to be similar. Optimization of various components viz. coating antigens, anti-species conjugate, etc. were carried out against both anti-P. multocida hyper immune and pre immune serum. Validation of OMP based indirect ELISA assay to measure immune response against P. multocida in bovine revealed 91% diagnostic sensitivity (DSN) and about 100% diagnostic specificity (DSP) at 25% cut off. OMP based indirect ELISA was found to be more specific, but less sensitive as compared to WCL based assay.

Cryptococcus laurentii fungemia.

In the last few years there has been an increasing incidence of infection due to non-neoformans Cryptococcus spp. especially in immunocompromised host. Cryptococcus laurentii is a non-neoformans Cryptococcus which has rarely been known to cause bacteremia and pulmonary infection in humans. Here we report a case of fungemia due to Cryptococcus laurentii.

Utility of venous compression in deep venous thrombosis evaluation revisited.

OBJECTIVE: Ultrasound venous compression (UVC) is considered the gold standard for confirmation of deep venous thrombosis (DVT) of the lower extremities. The objective of this study was to assess the contribution and significance of venous compression in comparison to color flow duplex (CFD) ultrasonography alone in the diagnosis of DVT. METHODS: Retrospective analysis was performed of all DVT studies during two years period. DVT examinations were performed with a 5.8-7.6 MHz linear broadband transducer following the American Institute of Ultrasound in Medicine guidelines for the performance of DVT examination. The images were categorized as normal, partial thrombus, or complete thrombus. RESULTS: A total of 428 patients comprised the study group. In total, 467 DVT examinations were performed (39 patients had bilateral examinations). Of the lower extremity examinations, 347/467were normal and 120/467 were abnormal. Complete thrombus was evident in 49/120 patients, while 71/120 patients had partial thrombus. We observed the thrombus on gray scale imaging in all 120 positive patients. No patient had venous compression negative for thrombus and CFD positive for thrombus. There was one patient with visualization of thrombus on gray scale imaging and complete venous compression (negative for thrombus). CFD examination of this patient was also negative for thrombus. CONCLUSION: UVC did not provide any additional information for the diagnosis of DVT. If CFD demonstrates the presence of DVT, venous compression is not necessary, although it can further confirm the presence of DVT. No additional DVTs were diagnosed by using venous compression alone (Tab. 2, Fig. 2, Ref. 27).

Inflammatory pseudotumors of the head and neck in pathology-proven cases.

The purpose of this case series is to characterize the CT and MRI features of pathology-proven inflammatory pseudotumors in the head and neck. Our search identified three orbital, one maxillary sinus, and one skull base inflammatory pseudotumor. All of the lesions demonstrated some degree of infiltrative features on imaging. On CT, all of the orbital inflammatory pseudotumors were of homogeneous soft tissue density. One of the orbital inflammatory pseudotumors demonstrated bone erosion and two others demonstrated stranding of the orbital fat. The maxillary sinus lesion initially appeared aggressive with bone erosion and orbital invasion. Calcifications were identified in the dural inflammatory pseudotumor. Among the lesions that were given contrast during CT or MRI. All exhibited some degree of enhancement. The two pseudotumors that underwent MRI were isointense on T1 and T2, with scattered areas of low signal. The orbital inflammatory pseudotumors underwent orbitotomy. However, the maxillary sinus and skull base lesions regressed with steroid therapy. Inflammatory pseudotumors of the head and neck regions typically manifest as enhancing soft tissue masses associated with infiltrative changes. Despite their sometimes-aggressive appearance, these lesions may respond well to steroid treatment. Imaging plays an important role in diagnosing and following inflammatory pseudotumors.

Crohn's disease: Multimodality Imaging of Surgical Indications, Operative Procedures, and Complications.

Surgical management is considered for specific indications in Crohn's disease and a wide variety of surgeries is performed. The purpose of this pictorial essay is to depict manifestations of Crohn's disease that indicates surgery, various surgical procedures that are performed, and the complications arising from these surgical procedures. Surgical indications including obstruction due to strictures or adhesions, fistulae and abscesses, and surgeries for these conditions, such as, ileocecectomy, stricturoplasty, small bowel resection, fecal diversion, segmental colectomy, and lysis of adhesions and their complications will be discussed and their imaging will also be illustrated.

Emerging Capripoxvirus disease outbreaks in Himachal Pradesh, a northern state of India.

Both sheep and goat pox are contagious viral diseases and affect small ruminants and are caused by sheep pox virus and goat pox virus respectively that belong to genus Capripoxvirus of Poxviridae family. Huge economic losses emanating from the disease outbreaks are the results of the wool and hide damage, subsequent production losses and also the morbidities and mortalities associated with the disease. This communication highlights clinico-epidemiological observations from the two sheep pox and one goat pox outbreaks. Grossly, multisystemic nodular lesions, mucopurulent nasal discharges and respiratory symptoms were observed in the affected animals. The morbidity, mortality and case fatality rates were 5.18%, 2.45% and 32.37%, respectively. Histopathological, haematological, molecular and serological techniques and also isolation of virus in embryonated chicken eggs were used for the diagnosis of the diseases. The spatial distribution of the disease signifies the role of common pasturelands used for grazing the animals while temporally all three outbreaks occurred in winters and were probably associated with cold stress and fodder scarcity. This is the first recorded report of Capripoxvirus infection in recent times and it highlights the disease as one of the emerging diseases in the northern state of Himachal Pradesh in India.

Quantitative diffusion tensor imaging for evaluation of motor function in patients with brain infarcts.

OBJECTIVE: To evaluate the quantitative diffusion value in ipsilateral cerebral peduncle of patients with differing motor function abilities and analyse the thresholds discriminating the poor motor function disability. METHOD: Twenty-nine patients who previously suffered stroke underwent diffusion tensor imaging examinations. Motor function was evaluated 8 months after the event. The ipsilateral apparent diffusion coefficient (ADC) and fractional anisotropy (FA) of cerebral peduncle and ADC ratio and FA ratio of patients with different motor function scales were analysed. RESULTS: The ipsilateral FA value and FA ratio were distinctly different in patients with different motor function scales, and significantly correlated with the motor function scales. There was no significant difference of ipsilateral ADC and ADC ratio, and neither had correlation with motor function scale. The patients with poor motor function scale could be discriminated by the cutoff value of ipsilateral FA of 0.453 and FA ratio of 0.623 with sensitivity of 90%, 75% and specificity of 88.9%, 88.9% respectively. CONCLUSIONS: The ipsilateral FA value and FA ratio were feasible and better imaging indices in discriminating patients with poor motor function ability.

Antopol-Goldman lesion of the kidney diagnosed by radiology: a case report of observation.

Antopol-Goldman lesions are extremely rare and are characterized by subepithelial hematoma in the renal pelvis. There have been at least 28 case reports in the literature, with all being diagnosed histologically after partial or total nephrectomy for a presumed malignancy. We report the first case in the literature to be diagnosed by radiological imaging and followed on an observatory basis.

Hydatid cyst of mediastinum.

We report a case of hydatid cyst of the mediastinum in a 32-year-old female patient who was admitted with chest pain. CT scan reported posterior mediastinal mass towards the right side. Surgical exploration revealed a loculated cyst in posterior mediastinum on the right side, adherent to the overlying lung and underlying bone. Posterolateral thoracotomy was performed for cyst aspiration and excision. The patient was discharged on albendazole.

Imaging of renal leiomyomas.

BACKGROUND: Renal leiomyomas are rare benign tumors of the kidney which can be found at autopsy as small capsular nodules in about 5% of cases. The clinical incidence of such lesions is much smaller, and only case reports or small series have been reported in the imaging literature. PURPOSE: To describe the imaging characteristics observed in a series of eight patients with pathology-proven asymptomatic leiomyomas of the kidney. MATERIAL AND METHODS: We reviewed the imaging findings observed in eight patients with pathologically proven asymptomatic renal leiomyomas discovered during studies performed for reasons unrelated to the kidney. All patients had undergone computed tomography (CT), two ultrasonography, and one magnetic resonance imaging (MRI). RESULTS: Lesions ranged in size from 1.2 to 13 cm. Six were at the periphery of the kidney, compressed its outer surface, but did not cause disruption of the cortex; two involved the renal cortex. All had regular outer margins. A cleavage plane between the tumor and the kidney was revealed at CT and/or ultrasonography in three of the cases located at the periphery. At ultrasonography, leiomyomas appeared hypoechogenic. At CT, they were slightly hyperdense before contrast medium injection; all were hypodense to the renal cortex after contrast medium. Four were homogeneous, two were slightly heterogeneous, and the remaining two were frankly heterogeneous. The lesion studied by MRI, which was homogeneous at the postcontrast CT study, had a heterogeneous structure on both T1- and T2-weighted images, with internal areas of hypointensity on T1. CONCLUSION: There are some imaging findings that can help to suggest the diagnosis of renal leiomyomas. First, their density: all tumors examined before contrast were hyperdense to the kidney, with density similar to that of muscles, and all had lower enhancement than the adjacent renal parenchyma. Second, the location and margins of the tumors: most were peripheral, without involvement of the renal cortex and with well-defined margins. Although not pathognomonic for a renal leiomyoma, the combination of these findings should include leiomyoma in the list of differential diagnoses.

Pararectal paraganglioma.

Paragangliomas are neoplasms that arise from neural crest cells and histologically resemble their adrenal counterpart, the phaeochromocytoma. The majority of extra-adrenal tumours develop within the abdomen and are associated with the coeliac, superior and inferior mesenteric ganglia, which run parallel to the aorta. The organ of Zuckerkandl origin is most common. Pararectal paragangliomas are extremely rare. This case report presents ultrasound, magnetic resonance and histological features of such a case.

[Benign space-occupying cysts in the testis. An overview]. / Benigne zystische Raumforderungen des Hodens. Eine Ubersicht.

Testicular cysts are increasingly diagnosed in the course of scrotal ultrasound examination. Among other things this is due to the general availability of modern high-resolution ultrasound devices. Benign and malignant diseases with testicular cyst formation need to be differentiated by differential diagnosis and by their aetiology. Benign diseases with cystic space-occupying lesions of the testicle are tubular ectasia of the rete testis, cystic dysplasia, epidermoid cysts, simple intraparenchymatous testicular cysts and cysts of the tunica albuginea. Testicular dermoid cyst was long misleadingly regarded as potentially malignant, but is now classified as benign. On diagnosis of a benign lesion of the testis an organ-conserving surgical therapy or an observational watch-and-wait strategy can be recommended in most cases.

Doppler evaluation of erectile dysfunction - part 1.

Erectile dysfunction (ED) is the consistent inability to achieve and maintain an erection sufficient for satisfactory sexual activity. Erectile dysfunction affects as many as 30 million men in America, with an increasing prevalence with age. Erectile dysfunction is secondary to organic, psychogenic and combined causes. The first part of this review article describes the guidelines for evaluation and treatment plans for men with ED. It also describes the normal sonographic anatomy of the penis, sonographic technique for evaluation of ED and the normal phases of erection.

Doppler evaluation of erectile dysfunction - part 2.

Doppler evaluation in erectile dysfunction (ED) has a significant role in determining the cause of ED. The advantages of penile Doppler and pharmacologic duplex ultrasonography include objective, minimally invasive evaluation of penile hemodynamics at a relatively low cost. Arteriogenic ED may be secondary to peripheral vascular disease and diabetes, or may be seen in association with coronary artery disease. Various parameters, such as diameter of the cavernosal artery, peak systolic flow velocity, degree of arterial dilatation and acceleration time, have been suggested for the diagnosis of arteriogenic ED, but peak systolic flow velocity is the most accurate indicator of arterial disease. This second part of the review article describes the various causes of ED and the interpretation and evaluation of color flow Doppler examination in ED.

Tubercular pancreatic abscess: a case report.

Primary involvement of the pancreas in bacterial and parasitic diseases is exceptional. Infection of the pancreas is usually secondary to necrosis and inflammation after serious necrotizing pancreatitis. Although a rare manifestation of a common disease, pancreatic tuberculosis can present to a clinician as a difficult diagnostic dilemma. The clinical manifestation may vary from painless obstructive jaundice to fever of unknown origin. Here, we report a case of pancreatic tuberculosis in a young alcoholic patient.

Catheter associated urinary tract infections in neurology and neurosurgical units.

OBJECTIVE: Catheter associated bacteriuria is the most common infection acquired in hospitals. The objective of the study was (1) to study the incidence of bacteriuria following indwelling urethral catheterization in patients with short-term vs long-term catheterization (2) to define the antibiotic resistance pattern among these isolates so that the study can provide guidelines for choosing an effective antibiotic against infections in catheterized patients. METHODS: This is a prospective study carried out over a period of 18 months in Neurology/Neurosurgical patients who had indwelling catheters for > or =48 h. RESULTS: In this study, 68 out of 800 (8.5%) adult inpatients acquired urinary tract infection following indwelling bladder catheterizations. The risk was significantly higher for female, elderly patients, critically ill and patients on prolonged catheterization. Among the bacterial pathogens, Escherichia coli was the commonest organism isolated (32.9%) followed by Pseudomonas sp. (15.1%) and Staphylococcus aureus (12.3%). Candida sp. comprised 13.7% of all isolates. Among Gram negative bacterial pathogens maximum number of isolates were sensitive to Amikacin (sensitivity of 42%). All Gram positive organisms were however sensitive to Vancomycin. CONCLUSIONS: Our results provide guidelines for choosing salvage therapy against hospital resistant strains causing infection in catheterized patients. However, antibiotics seem to prevent urinary tract infections but primarily in patients catherized for short duration, i.e. 3-14 days and not in patients with long-term catheterization.

Benign intratesticular cystic lesions: US features.

Benign intratesticular lesions are rare, but recognition is important to avoid unnecessary surgical intervention. The ultrasonographic (US) features that help differentiate benign from malignant intratesticular lesions are emphasized by the authors. Benign lesions include intratesticular simple cysts, tubular ectasia, epidermoid cyst, tunica albuginea cyst, intratesticular varicocele, abscess, and hemorrhage (infarction). US features of cystic malignant neoplasms that help in differentiation of them from benign cystic lesions are also presented. The US appearance of epidermoid cysts varies with the maturation, compactness, and quantity of keratin present. Of the cystic malignant testicular tumors, which can occur anywhere in testicular parenchyma, teratomas are the most frequent to manifest as cystic masses. An abnormal rind of parenchyma with increased echogenicity usually surrounds these lesions. An intratesticular spermatocele communicates with the seminiferous tubules, whereas simple ectasia of the rete testis does not do so directly. These cysts contain spermatozoa and can be septate. The US findings of intratesticular varicocele are similar to those of extratesticular varicocele and include multiple anechoic, serpiginous, tubular structures of varying sizes. Improvements in gray-scale and Doppler US technology allow subtle distinctions between benign and malignant testicular lesions that were not possible a decade earlier.

Reversal of diastolic plateau in partial testicular torsion.

Testicular torsion is a urologic emergency. The ability of color and power Doppler sonography to diagnose partial testicular torsion definitively remains uncertain. We present a case in which color Doppler findings were indeterminate and the diagnosis of partial testicular torsion was made on the basis of spectral waveform analysis. The characteristic findings in the spectral waveform were asymmetry between the 2 testes, with a higher intratesticular resistance index on the affected side, and reversal of the diastolic plateau on the affected side.