Role of sequential chemical peel in cutaneous amyloidosis: a pilot case series.

Cutaneous amyloidosis can be a part of a systemic disease or can result from a localized process limited to the skin. It usually presents as pruritic hyperpigmented macules, papules or nodules, which are notoriously resistant to treatment. We performed a hospital-based pilot case series to assess the efficacy and safety of sequential salicylic acid (SA) and glycolic acid (GA) chemical peels. Patients underwent sequential chemical peel therapy with SA 20% and GA 35% used alternately each week for a total of 6 weeks. At subsequent follow-up visits, good clinical outcome and long-term maintenance was observed. This study highlights the promising role of chemical peels in this difficult and distressing disorder.

New Delhi metallo-ß-lactamase and extended spectrum ß-lactamases co-producing isolates are high in community-acquired urinary infections in Assam as detected by a novel multiplex polymerase chain reaction assay.

BACKGROUND: The ability of microorganisms to evade antibiotic pressure is challenging in healthcare as patients have little or no drug treatment options. Detection of the prevalence of antibacterial resistance pattern helps towards improved antibiotic policy and empirical treatment. OBJECTIVES: We carried out antibiogram profiling and documented the prevalence and co-prevalence of New Delhi metallo-ß-lactamase (NDM) and extended spectrum ß-lactamases (ESBL) encoding genes in urinary Escherichia coli and Klebsiella pneumonia isolates. MATERIALS AND METHODS: Antibiotic susceptibilities were tested for 241 isolates of E. coli and K. pneumoniae from urine samples collected from out- and hospitalised patients. Polymerase chain reaction (PCR) was carried out on isolates tested positive for phenotypic production of metallo-ß-lactamase and ESBL. A multiplex PCR assay was designed to detect the genes. RESULTS: Multiplex PCR assay designed had a limit of detection of 10 3 CFU/mL in vitro. NDM detected was significantly higher among K. pneumoniae compared to E. coli (69.2% vs. 18.2%; P = 0.001). Of 17, 14 NDM positive isolates also harboured ESBL genes. The co-production of CTX-M + TEM + NDM (3/9; 33.3% and 5/8; 62.5%) was most common in K. pneumoniae and E. coli, respectively while CTX-M + TEM + SHV + NDM was found in one isolate. Of the 156 phenotypically ESBL producing isolates, CTX-M, TEM and SHV was detected by PCR in 85, 53 and 24 isolates, respectively. CONCLUSION: NDM and ESBL co-producing isolates were both community (64.7%) and hospital (35.29%) acquired among E. coli. Antibiotic resistance can be effectively evaluated by a cost and time effective molecular method, such as the multiplex PCR used in this study, which complement culture and sensitivity tests.

Acremonium strictum: Report of a Rare Emerging Agent of Cutaneous Hyalohyphomycosis with Review of Literatures.

We present a case of cutaneous hyalohyphomycosis due to Acremonium strictum in an immunocompetent individual along with an overview of fungal infections caused by A. strictum. The diagnosis was confirmed by the presence of hyphae in microscopic examination of cutaneous biopsy and discharge, positive culture for A. strictum and sequencing of the isolate at reference centre. The infection resolved with itraconazole and terbinafine. Cutaneous or subcutaneous infections of A. strictum have rarely been reported. Fungemia or disseminated infection often with fatal outcome in immunocompromised patients was the most common presentation of A. strictum infection found in the literatures. The studies also reveal worldwide variation in the treatment regime and outcome of the treatment.

Incidence of bla NDM-1 gene in Escherichia coli isolates at a tertiary care referral hospital in Northeast India.

PURPOSE: Increasing reports on New Delhi metallo-ß-lactamase-1 (NDM-1) producing Escherichia coli constitute a serious threat to global health since it is found to be highly resistant to most of the currently available antibiotics including carbapenems. This study has been performed to find out the incidence blaNDM-1 in E. coli isolates recovered from the various clinical samples at a tertiary care referral hospital in Northeast India. MATERIALS AND METHODS: A total of 270 non-duplicated E. coli isolates were recovered from the various clinical samples at a tertiary care referral hospital in Northeast India. All isolates with reduced susceptibility to meropenem or ertapenem (diameter of zones of inhibition, ≤ 21 mm) were further phenotypically confirmed for carbapenemase production by modified Hodge test. All screened isolates were also subjected to the polymerase chain reaction detection of blaNDM-1 gene and additional bla genes coding for transmission electron microscopy, SHV, CTX-M, and AmpC. RESULTS: Out of 270 E. coli isolates, 14 were screened for carbapenemase production on the basis of their reduced susceptibility to meropenem or ertapenem. All screened isolates were found to be positive for blaNDM-1 . Each of the blaNDM-1 possessing isolate was also positive for two or more additional bla genes, such as blaTEM , blaCTX-M and blaAmpC . Phylogenetic analysis showed very less variation in blaNDM-1 gene with respect to blaNDM-1 possessing E. coli isolates from other parts of India and abroad. CONCLUSIONS: Our findings highlight the incidence of blaNDM-1 in E. coli isolates with a reduced susceptibility to meropenem or ertapenem.

Hypertension subtypes and angiotensin converting enzyme (ACE) gene polymorphism in Indian population.

OBJECTIVE: To find out the association of angiotensin converting enzyme (ACE) gene polymorphism with hypertension subtypes in a population from India. METHODS: Consecutive subjects of either sex, aged > or =18 years attending in temporary field clinics arranged in various localities of Assam and Mizoram were interviewed to record information about socio-demographic characteristics, alcohol consumption and smoking. Three readings of blood pressure, height and weight of all subjects were measured. Hypertension and its subtypes were defined as per JNC-VI criteria. Fasting venous blood samples were collected to estimate blood glucose level and to extract genomic DNA followed by PCR analysis for ACE gene polymorphism. RESULTS: A total of 916 (male=465, female=451) consecutive subjects comprising of 407 (44.4%) hypertensive subjects and 509 (55.6%) normotensive controls were included in the study. Of the hypertensive subjects, majority (69.0%) had systolic diastolic hypertension with male predominance (70.3% vs. 67.6%) which was followed by isolated diastolic hypertension (16.7%) and isolated systolic hypertension (14.3%). The predominant ACE genotype was Ins/Ins (50.0%) and Del/Del genotype showed lowest prevalence (11.4%). After adjusting confounding variables, the Del/Del genotype revealed significant association with isolated systolic hypertension. CONCLUSION: Del/Del polymorphism of ACE gene showed significant association with ISH in our study population.

Population-specific left ventricular hypertrophy in three groups from the northeastern region of India.

BACKGROUND: People living in the hills are continuously exposed to strenuous physical activity for their day-to-day work. Besides hypertension, left ventricular hypertrophy in different populations may be related to continuous physical activity. METHODS: Electrocardiogram, blood pressure and sociodemographic information of 12 252 subjects > or = 30 years of age from three different population groups living in Mizoram (hilly) and Assam (plain) were recorded. Of them, 8058 were from Mizoram and 3180 and 1014 were Indigenous Assamese and tea garden workers of Assam. RESULTS: Among the subjects from Mizoram the percentage of smokers (41.9%), mean (SD) BMI (21.9 [3.8]) and waist-hip ratio (0.87 [0.02]) were significantly higher than in those from other groups. Tea garden workers had a higher mean systolic blood pressure (145.2 [25.7]) and diastolic blood pressure (87.6 [13.6]). The prevalence of left ventricular hypertrophy was highest among tea garden workers (16.5%) followed by people from Mizoram (3.7%) and the indigenous Assamese (2%) people. In spite of a significantly higher prevalence of hypertension among the indigenous Assamese community than among those from Mizoram, left ventricular hypertrophy was found to be lower in the former. CONCLUSION: High prevalence of left ventricular hypertrophy among tea garden workers was possibly related to a higher prevalence of hypertension but the higher prevalence of left ventricular hypertrophy among people from Mizoram might be related to more physical activity.

Gnathostomiasis of the anterior chamber.

Ocular involvement with Gnathostoma spinigerum occurs years after the initial infection that is acquired by ingestion of poorly cooked, pickled seafood or water contaminated with third stage larvae. Here we report a case of gnathostomiasis of the left eye of a 32-year-old lady hailing from Meghalaya, India. Her vision had deteriorated to hand movement. Slit lamp examination revealed a live, actively motile worm in the anterior chamber, which was extracted by supra temporal limbal incision and visual acuity was restored.

Nutritional status of adolescents among tea garden workers.

OBJECTIVE: The study was conducted to evaluate growth and nutritional status using weight and height based indicators among tea garden adolescent boys and girls of Assam aged between 10-18 years. METHODS: A cross sectional study was carried out in the tea gardens of Dibrugarh district of Assam through house to house visit. Households were selected through two stage sampling design to reach out the adolescents. Height and weight were measured using standard procedures. Body mass index (BMI) was computed from height and weight. Height-for-age below 3rd percentile values of NCHS reference was classified as stunting. BMI-for-age below 5th percentile values of WHO recommended reference was classified as thinness. RESULTS: Total numbers of 605 adolescents (boys-291, girls-314) participated in the study. School enrollment rate was only 59.2%. Prevalence of stunting was 47.4% and 51.9% among boys and girls respectively relative to NCHS reference, which reduced to almost 30% while Indian reference data was used. Prevalence of thinness was higher among boys (59.5%) than girls (41.3%) counterparts. Mean BMI among girls was higher at all ages than boys. CONCLUSION: Almost half of the adolescents were stunted and most of them were thin. Problem of overweight was seen in less than 0.5% of adolescents. Factors typical to underdeveloped society seems to contribute to the moderate to high prevalence of undernutrition among adolescents working in tea gardens.

A serological study of cytomegalovirus infection in pregnant and non-pregnant women at Gauhati Medical College and Hospital.

Primary cytomegalovirus infection is the most common infection during pregnancy that may have long-term neurodevelopmental sequelae in children born to these mothers. It is also associated with many obstetric complications. So the aim of this study was to determine the seroprevalence of cytomegalovirus infection in local antenatal population with bad obstetric history and to see the effects, if any, of age, socio-economic status, presenting features and different gestational periods. Seventy-five pregnant women with bad obstetric history were screened for the presence of cytomegalovirus specific IgM and IgG antibodies by doing enzyme-linked immunosorbent assay, out of which 17(22.66%) had evidence of recurrent cytomegalovirus infection as demonstrated by the presence of cytomegalovirus specific IgM antibodies. All were found to be positive for cytomegalovirus specific IgG antibodies. This indicates that the presence of cytomegalovirus specific IgM antibodies in this population is an evidence of reactivation of a latent infection or re-infection with a different strain of cytomegalovirus. Increased IgM seropositivity was found to be associated with advancing age, poor, socio-economic status, third trimester of pregnancy and bad obstetric history like premature delivery, stillbirth, recurrent spontaneous abortions, intra-uterine growth retardation. Out of 25 randomly selected non-pregnant women of childbearing age, all showed presence of cytomegalovirus specific IgG antibodies and none was found to be positive for primary or recurrent cytomegalovirus infection.

Tobacco and alcohol use among the youth of the agricultural tea industry in Assam, India.

A cross-sectional study was conducted to assess tobacco use (both smoking and non-smoked tobacco) and alcohol use among tea garden youths of Assam, India during the period 2002-2003. A total of 650 tea plantation youth age 15-24 years (255 males, 395 females) from eight randomly selected tea plantations, Dibrugarh District, Assam, were interviewed to collect information on alcohol and tobacco use using a pre-designed, pre-tested questionnaire. Nearly 59% of the respondents had no formal education. Fifty-eight percent of the youth used at least one substance and 27.4% were concurrent users of both alcohol and tobacco. The smoking rate was only 2.2% (4.7% in males, 0.5% in females). However, 52.5% of the study population used non-smoked tobacco (56.9% males, 49.6% females). The prevalence of alcohol consumption was 32.2% (43.9% males, 24.6% females). A higher rate of alcohol and tobacco use was found among the respondents who had no formal education or were school dropouts. A higher rate of alcohol and tobacco use were seen among respondents in whom both parents were illiterate. Working as a manual worker in the tea industry is significantly associated (p<0.01) with higher rates of alcohol and tobacco use. We recommend a vigorous campaign against tobacco and alcohol use among tea plantation youth to reduce the health risks associated with the use of these two substances.

Health problems and disability of elderly individuals in two population groups from same geographical location.

OBJECTIVE: To compare morbidity, disability (ADL-IADL disability) along with behavioral and biological correlates of diseases and disability of two elderly population groups (tea garden workers and urban dwellers) living in same geographical location. METHODS: Two hundred and ninety three and 230 elderly from urban setting and tea garden respectively aged > 60 years were included in the study. Subjects were physical examined and activity of daily living instrumental activity of daily living (ADL-IADL) was assessed. Diagnosis of diseases was made on the basis of clinical evaluation, diagnosis and/or treatment of diseases done earlier elsewhere, available investigation reports, and electrocardiography. Hypertension was defined according to JNC-VI classification. BMI (weight/height2) was calculated. Logistic regression analysis was performed to see the impact of important background characteristics on non-communicable diseases (NCD) and disability. RESULTS: Hypertension (urban--68% and tea garden--81.4%), musculoskeletal diseases (urban--62.5% and tea garden--67.5%), COPD and other respiratory problems (urban--30.4% and tea garden--32.2%), cataract (urban 40.3% and tea garden--33%), gastro-intestinal problems (urban--13% and tea garden--6.5%) were more commonly observed health problems among community dwellings elderly across both the groups. However in contrast to urban group, serious NCDs like Ischaemic Heart Disease (IHD), diabetes were yet to emerge as health problems among tea garden dwellers. Infectious morbidities, undernutrition and disability (ADL-IADL disability) were more pronounced among tea garden dwellers. Utilization of health service by tea garden elderly was very low in comparison to the urban elderly. Both tea garden men and women had very high rates of risk factors like use of non-smoked tobacco and consumption of alcohol. On the other hand, smoking and obesity was more common in urban group. Most morbidities and disabilities were associated with identifiable risk factors, such as obesity, tobacco (smoked and non-smoked) and alcohol consumption. Educational status was also found to be an important determinant of diseases and disability of elderly population. Age showed a J-shaped relationship with disability and morbidity. Sex difference in health status was also detected. CONCLUSION: This study highlights the physical dimension of health problems of elderly individuals. Social circumstances and health risk behaviours play important role in the variation of health and functional status between the two groups. Life-style modification is warranted to prevent onset of chronic diseases. To improve quality of life, rectification of poor health status through affordable health service for disease screening and better management of illness, nutritional improvement and greater health awareness are necessary particularly among low socio-economic group. Low-cost intervention like cataract surgery could make a difference in the quality of life of elderly Indian.

Study of health problems and nutritional status of tea garden population of Assam.

BACKGROUND: Assam is the highest tea producer state in the country. There is scarcity of reliable information on health and nutritional status among tea garden population of Assam to enable initiating public health response to their health needs. AIMS: To describe health problems and nutritional status among tea garden population of Assam. SETTINGS AND DESIGN: Community-based cross-sectional survey in eight randomly selected tea gardens of Dibrugarh district of Assam. MATERIALS AND METHODS: Socio-demographic and behavioral characteristics of participants were recorded. Health problems and nutritional status were assessed through medical examination, evaluation of medical records, anthropometry and laboratory investigations. STATISTICAL ANALYSIS: Percentage prevalence; Chi-square test was applied wherever applicable. RESULTS: Out of 4,016 participants, 1,863 were male and 2,153 were female. They were mostly illiterate and nearly 52.9% (1,197 of 2,264) of adults were manual workers in the garden. Alcohol and oral tobacco use were common. Prevalence of underweight among children was 59.9% (357 of 596) and thinness among adults was 69.9% (1,213 of 1,735). Anemia was widespread. Worm infection (65.4%, 217 of 332); skin problems; respiratory infections, including tuberculosis; filariasis were present in a significant way. Children suffered more in various diseases. Major noncommunicable diseases like hypertension, stroke were emerging in the community and were associated with modifiable risk factors like alcohol and tobacco use. CONCLUSION: Health status of the population can be ameliorated through better hygienic practices, environmental sanitation, creating health awareness, nutritional intervention and overall improvement of socioeconomic conditions of the population.

Correlates of alcohol consumption and tobacco use among tea industry workers of Assam.

An epidemiological study on alcohol and tobacco (smoking and nonsmoked tobacco) use was carried out in tea garden population of Assam, one of the largest agroindustries of India. A total sample of 2,264 individuals (male, 1,033; female, 1,231) aged 15 years and older was interviewed in 2002-2003 to collect information about alcohol and tobacco use using a predesigned and pretested questionnaire. Age-adjusted prevalence of alcohol consumption was 59.2% (male, 69.3%; female, 54%). Smoking was more common among males (13.2%) than females (2%). However, use of nonsmoked tobacco was almost as popular among female (71.9%) as among males (75.3%). More than half of the respondents (54.7%) were multiple users of alcohol and tobacco. Prevalence of alcohol consumption, nonsmoked tobacco use, and smoking among the young age group (15-24 years) was 32.2%, 52.5%, and 2.2%, respectively. Prevalence of smoking increased with age, and more than a quarter of males above 54 years were smokers. Similar age trends in the prevalence of alcohol and nonsmoked tobacco was not observed. Sociodemographic correlates, like education, occupation, and marital status, emerged as important predictors of substance uses irrespective of sex. Association of income with substance use was weak in this study, perhaps due to homogeneity of income level. Users of alcohol and tobacco were mostly illiterate, manual workers, and widows/widowers. However, smokers were more common among sedentary worker. Not withstanding the limitations of the study, the findings of the study are useful for planning interventional strategy to control alcohol and tobacco use for better health outcome.

Loa loa in the anterior chamber of the eye: a case report.

An unusual case of loiasis from Assam is reported here. Loa loa is a subcutaneous filarial parasite of man and is transmitted to humans by chrysops flies. The patient presented with foreign body sensation and visual disturbances of the right eye. Examination revealed a white coiled structure in the cornea. Routine blood and other investigations were within normal limits. A live adult worm was extracted and identity was confirmed by microscopy to be Loa loa. Patient was treated with diethylcarbamazine and steroid. We found this case interesting as the worm was present in the anterior chamber--an unusual site and there were no other positive findings besides the lone worm.

Perceptions of unmarried young women regarding family size, sexually transmitted diseases at residential regional institutes in northeastern India.

This study sought to assess the knowledge and attitudes of young unmarried women regarding family size and sexually transmitted diseases, including HIV, in three residential regional institutes of northeastern India. The data is expected to help in reinforcing various methods of Information, Education and Communication (IEC) implementation. A representative sample of 574 female students, 16-25 years of age, were interviewed by a pretested questionnaire to assess their knowledge of the determinants of family size and sexually transmitted diseases. Of the participants, 48.43% stated that the suitable age for marriage is > 18 years old for women. More than half the respondents stated that the interval between child birth should be 3-5 years. Most of the respondents (96.17%) were of the opinion that both parents are responsible for determining the number of children. Knowledge of STDs and HIV was found in 91.8% and 74.04% of respondents, respectively.

Hypertension in the native rural population of Assam.

BACKGROUND: Recent studies have reported an increasing prevalence of hypertension in India. However, there are few epidemiological data with regard to the occurrence of hypertension in the native population of Assam. METHODS: Three thousand one hundred and eighty individuals (1441 men and 1739 women), > or =30 years of age and from 25 villages of 5 districts in Assam were selected by the stratified random sampling method. They were interviewed and their blood pressure measured along with other anthropometric variables. Hypertension was defined according to the Sixth Report of the Joint National Committee on prevention, detection, evaluation and treatment of high blood pressure (JNC-VI). RESULTS: The overall prevalence of hypertension was 33.3%. Among the patients with hypertension, 21.6% were aware of their illness. The determinants of hypertension were age, intake of extra salt in the diet, body mass index and waist-hip ratio (derived by multiple logistic regression analysis with backward elimination of non-significant factors). Multivariate analysis showed that females had a higher risk of hypertension than males. CONCLUSION: The prevalence of hypertension in the native population of Assam is high. Implementation of an effective awareness programme with lifestyle modifications is necessary to control the cardiovascular disease burden in this population.