A clinico-mycological study of dermatophytoses in Goa, India.

The study was a clinico-mycological approach to find out the various clinical types of dermatophytoses and as well as the species of dermatophytes in Goa. Various socio-demographic and host factors were assessed to determine the predisposing factors for dermatophytoses. A detailed clinical history of the patients was recorded. Samples were collected aseptically in sterile black paper envelopes. The material was subjected to microscopy using potassium hydroxide mount. Culture was done by inoculating the material in Sabouraud's peptone glucose agar slants. Tinea corporis was found to be the most common clinical presentation (44.2 %). Among the dermatophytes, Trichophyton rubrum predominated (38.2 %), followed by Trichophyton mentagrophytes (27.2 %). Dermatophytoses was more common among the lower and upper lower strata of society. Majority of the patients were in the 21-40 years age group (62 %) with males predominating women in ratio 2.4:1.

Utilización de la sanidad privada por las embarazadas seguidas en un centro de salud público / Use of private health services by pregnant women followed up in a public health centre

Introducción. Nuestro objetivo fue conocer y analizar los motivos que conducen a las embarazadas, con cobertura sanitaria pública y seguidas en nuestro centro de salud, para utilizar además los servicios sanitarios privados durante el embarazo. Pacientes y métodos. Estudio cualitativo mediante cuestionario autoadministrado. Ámbito de atención primaria, centro de salud urbano. Embarazadas que parieron durante el año 2005 y que realizaron sesiones de educación maternal con la matrona (20 grupos). Se utilizaron las respuestas obtenidas de los cuestionarios cumplimentados. La saturación de la información se garantizó con el análisis por separado de los 20 grupos de participantes. Se realizó un análisis de contenido de las diferentes categorías. Resultados. Se construyeron 6 categorías (ecografías, tranquilidad y seguridad, seguimiento por el ginecólogo privado, el trato recibido, la comodidad y aspectos relacionados con el centro de salud). Los temas relacionados con las ecografías (número y calidad) y con el número de visitas subyacen en la mayoría de las respuestas. Las embarazadas consideran que deben realizarse más ecografías durante el seguimiento del embarazo. La atención recibida en el centro de salud es considerada de manera satisfactoria. Conclusiones. El número y la calidad de las ecografías son los principales motivos que inducen a las embarazadas a utilizar los servicios sanitarios privados. La seguridad y tranquilidad aparecen como motivos recurrentes. El seguimiento del embarazo por el médico de familia en atención primaria no aparece como motivo para utilizar la sanidad privada (AU)

Introduction. The objective of the study is to identify and analyse the reasons that lead pregnant women with public health cover and followed up in our public health clinic, to use private health services during pregnancy. Patients and methods. A qualitative study using a self-administered questionnaire completed during the year 2005. Setting: Urban Primary Care Health Centre. Pregnant women who delivered during 2005 and had maternal education sessions with the midwife (twenty groups). The responses from the questionnaires were analysed. Information saturation was ensured by the separate analysis of the 20 groups of participants. A content analysis was made of the different categories. Results. Six categories were constructed (ultrasound, tranquillity and safety, monitored by the private gynaecologist, the treatment, comfort and aspects relating to the ¿private? health centre). Issues related to ultrasound (number and quality) and the number of visits underlie most of the responses. Pregnant women believe there should be more follow-up ultrasound examinations during pregnancy. The care provided at the public health centre is considered satisfactory. Conclusions. The number and quality of the scans are the main reasons that lead pregnant women to use private health services. Safety and tranquillity appear as recurring themes. The monitoring of pregnancy by the family physician in primary care is not listed as a reason for using private healthcare (AU)

How does an Al-hyperaccumulator plant respond to a natural field gradient of soil phytoavailable Al?

The physiological ability of plants to cope with Al-toxicity has attracted considerable attention. In this study we used an endemic Al-hyperaccumulator plant, Plantago almogravensis, which is the only known representative of the Plantaginaceae with this trait growing under a field gradient of Al, to understand the root and shoot patterns of Al accumulation and tolerance in its natural environment. We analysed phytoavailable elements in the soil and their accumulation in the plant. For the first time under field conditions, the accumulation pattern of an Al-hyperaccumulator showed a saturation curve with a maximum accumulation capacity being reached (ca. 3.0 mg g(-1)). The Al toxicity was not associated with the expected reduction in the Ca and Mg uptake by the plant. Iron was accumulated in a more linear pattern. The magnitude and the proportion of the elements found in the apoplastic fraction of the root, compared to the soil and plant internal fractions, suggested that the control of uptake occurs at the rhizospheric level. Unlike the majority of the Al-hyperaccumulator plants that are found in tropical humid areas, this plant is described from a sub-arid Mediterranean climate, subject to drought conditions which give it a unique status that deserves to be studied further.

Utilización de los servicios sanitarios por las embarazadas seguidas en un centro de salud / Use of the health care services for pregnancies followed-up in a Health Care Center

Introducción: Nuestros objetivos son describir el perfil sociodemográfico de las embarazadas seguidas en el centro de salud, estimar la frecuencia de la utilización de los servicios sanitarios y analizar los factores que puedan influir en la diferente utilización. Pacientes y Métodos: Estudio descriptivo transversal con una segunda fase analítica. Centro de salud urbano. Población: embarazadas que hayan parido durante el año 2005. Variables: utilización de los servicios sanitarios, sociodemográficas, psicosociales, obstétricas y de morbilidad. Análisis estadístico: tablas de frecuencia para las variables cualitativas y resúmenes numéricos para las variables cuantitativas; análisis bivariante para relacionar cada variable independiente con cada una de las variables dependientes y creación de un modelo de regresión lineal multivariante para controlar los posibles factores de confusión. Resultados. Cuatrocientos diecinueve partos. El 64% de los embarazos se siguió en el centro, 25% en el segundo nivel y 11% en la medicina privada. La utilización media de los servicios sanitarios fue de 38,6 visitas (IC95% 37,31-39,89). Todas las mujeres acudieron al programa de control de embarazo: 7,37 visitas (IC95%: 7,24-7,50). El 98% acudió a la matrona (7,86 visitas; IC95% 15,03-16,93). El 99,6% utilizó los servicios de apoyo (media de 5,79 visitas; IC 95% 5,60-5,98). El 52% acudió a las urgencias hospitalarias (media de 0,84; IC95% 0,72-0,96). El 61% de las mujeres acudió en alguna ocasión al ginecólogo privado (media de 1,26; IC95% 1,08-1,44). Conclusiones. Se encuentra un elevado porcentaje de embarazos seguidos en Atención Primaria y una alta utilización de los servicios sanitarios durante el embarazo. La experiencia obstétrica previa parece disminuir la utilización (AU)

Introduction: We have aimed to describe the socidemographic profile of pregnant women followed-up in the health care center, estimate frequency of their use of the health care services and analyze the factors that may influence the different use. Patients and methods. Descriptive, cross-sectional study with the second analytic phase. Urban health care center. Population: pregnant women who gave birth in the year 2005. Variables: use of the health care, sociodemographics, psychosocial, obstetrics services and morbidity. Statistical analysis: frequency tables for qualitative variables and numeric summaries for the quantitative variables; bivariant analysis to compare each independent variable with each one of the dependent ones and creation of a multivariant linear regression model to control possible compounding factors. Results: Four-hundred and nineteen deliveries. A total of 64% of them were followed-up in the center, 25% were seen on the second level and 11% in private medicine. Mean use of the health care services was 38.6 visits (CI 95% 37.31-39.89). All the women came to a pregnancy control program: 7.37 visits (CI 95%: 7.24-7.50). A total of 98% came to the midwife (7.86 visits; CI 95% 15.03-16.93) and 99.6% used the support services (mean of 5.79 visits; CI 95% 5.60-5.98). A total of 52% came to the hospital emergency service (mean of 0.84; CI 95% 0.72-0.96). At some time, 61% of the women went to a private gynecologist (mean 1.26; CI 95% 1.08-1.44). Conclusions: A high percentage of pregnant women are followed-up in Primary Care. There is high use of the health care services during pregnancy. Previous obstetrics experience seems to decrease its use (AU)

Characterization of nonfermenters from clinical samples.

OBJECTIVE: Nonfermenters are a group of aerobic non sporing gram-negative bacilli found primarily free in nature and as commensals, whose pathogenic potentials are well established. The current study was conducted to assess the role of these nonfermenters in various infections and to characterize these isolates. METHODS: One hundred nonfermenters isolated from various clinical specimens were grouped according to Weaver-Hollis scheme based on growth on MacConkeys agar, oxidase activity and oxidation/fermentation of glucose. Species level identification was attempted based on a battery of biochemical tests. All isolates were then subjected to antimicrobial sensitivity. RESULTS: Majority of the isolates were encountered from pus and urine (50%). These isolates belonged to six of the seven Weaver-Hollis groups. Fifty six per cent of the isolates belonged to genus Pseudomonas. Multidrug resistance with resistance to more than three antimicrobials was frequently seen. Amikacin and ciprofloxacin were found to be most effective. CONCLUSION: Nonfermenting gram negative organisms are responsible for variety of infective conditions. Amongst them genus Pseudomonas and Acinetobacter calcoaceticus were more frequently encountered. Amikacin or ciprofloxacin (for nonfermenters other than Pseudomonas) appears to be the drug of choice for treatment of such infections.

Usefulness of quantitative buffy coat blood parasite detection system in diagnosis of malaria.

A rapid test for diagnosis of malaria based on acridine orange staining of centrifuged blood samples in a microhematocrit tube (QBC) was compared with thick and thin peripheral blood smears in 2274 samples. Malaria was diagnosed in 239 (10.5%) patients by Leishman's staining technique and QBC method. The QBC method allowed detection of an additional 89 (3.9%) cases. Thus the prevalence rate of malaria during the study was 14.4%. In 1946 patients who were negative by the QBC technique, the Leishman's stained smears did not provide any help in malaria diagnosis. Analysis of the relative quantity of parasites in the specimens, in the QBC method, revealed that 80 out of 89 QBC positive but smear negative cases, had a very low parasite number (less than 10 parasites per QBC field). Although QBC method was superior to the smear for malarial parasite detection, species identification was not possible in 26 (7.9%) cases by this technique. In 95.7% (n = 314) QBC positive cases, the buffy coat in the QBC tube appeared pigmented (gray to black). The colour of the buffy coat was therefore considered by us as a predictor of positivity and could be taken as an indicator for a careful and more prolonged search for the parasites. Thus, the QBC technique has its advantages in terms of speed, sensitivity and ease, especially in an endemic area as ours, where the level of parasitaemia is low and more than 70 to 80 smears need to be examined per day. However, the age old Romanowsky stains still appear superior for species identification.

Rapid diagnosis of falciparum malaria by detection of Plasmodium falciparum HRP-2 antigen.

OBJECTIVE: Malaria is a resurging problem all over the country and rapid diagnosis is mandatory to decrease the morbidity and mortality and for control of malaria. In the current study the aim was to evaluate the usefulness of rapid Plasmodium falciparum antigen detection and to compare its utility over conventional peripheral thick and thin smear examination. METHODS: Three hundred fifty seven randomly selected patients with pyrexia and or atypical presentations of malaria, found initially negative for malaria were subjected to thick and thin smear examination and Plasmodium falciparum antigen detection test by using commercially available Parasight F. kit. RESULTS: 54.6% of cases presented with pyrexia, while other presentations of falciparum malaria were less frequently encountered (162/357). Eighty five patients (23.8%) were diagnosed as having falciparum malaria based on smear/Parasight F. Test. Eighty- four of these patients were positive for Parasight F. test and only 34.51% of these cases were also positive on smear examination. CONCLUSION: The antigen detection test for Plasmodium falciparum is useful for rapid diagnosis of Plasmodium falciparum malaria. It could detect 65.5% cases of falciparum malaria which were initially negative by peripheral smear examination. Hence, this technique is superior to peripheral smear staining and helps early diagnosis.

Evaluation of HBsAg carrier rate in acute viral hepatitis and high risk individuals using RPHA and ELISA.

A total of 600 individuals including 500 cases of hepatitis and 100 individuals at high risk for developing hepatitis were screened for hepatitis B surface antigen (HBsAg) using reverse passive haemagglutination (RPHA) and enzyme linked immunosorbent assay (ELISA). HBsAg carrier rate in clinically diagnosed cases of hepatitis was 38% and 32.4% by RPHA and ELISA respectively. In high risk individuals, the carrier rate was 14% by RPHA and 11% by ELISA. Taking ELISA as gold standard, RPHA showed 5.33% false positivity and 0.33% false negativity. The over all correlation between RPHA and ELISA was to the tune of 82.66%.

Cholera epidemic in Goa.

Two hundred and fifty stool samples were studied during an outbreak of cholera in Goa during the months of July to September, 1988. 80 strains of Vibrio were isolated with an isolation rate of 32%. 72.5% of those affected were adults. All strains of Vibrio cholerae isolated belonged to Eltor biotype, Fifty three (66.25%) of them being Ogawa serotype while 21 (26.25%) were Inaba. NAG Vibrios accounted for 6 (7.5%) strains. Antimicrobial sensitivity pattern showed high degree of sensitivity to chloramphenicol, gentamicin and naladixic acid.

Extralobar bronchopulmonary sequestration: a case report.

Bronchopulmonary sequestration of the lung is a rare but well recognised congenital abnormality, which is clinically important because of the potential for medical and surgical complications. We report a case of extralobar bronchopulmonary sequestration on the left side in a newborn infant.

Bacterial pneumonias--evaluation of various sputum culture methods.

With an objective of improving diagnostic value of sputum in bacterial pneumonias, 50 uncomplicated 'community' acquired cases were studied using Gram staining of sputum along with bedside inoculation with/without dilution of the specimen. Gram staining of sputum samples collected before treatment revealed pneumococcal infection in 46% cases. The results were however inconclusive on samples sent by routine procedure involving logistic delay. Cultural analysis of sputum processed by three different techniques showed that bedside inoculation of sputum after dilution to be the most efficient technique yielding Streptococcus pneumoniae in 34% cases, Gram positive cocci in lesser number (20%), Gram negative rods (GNR) in 18% cases. Sputum samples processed bedside without dilution yielded a lower number of pneumococci and other Gram positive cocci (24% & 16% cases respectively). Routine processing of sputum, involving logistic delay yielded a high number of Gram negative rods (62%), indicating their overgrowth. Thus bedside inoculation of sputum after dilution coupled with direct Gram staining serves as a simple and yet valuable laboratory aid in the diagnosis of uncomplicated 'community' acquired bacterial pneumonias.

Clinico-microbiological study of dermatophytoses.

In the present series, 80 cases of dermatophytoses were subjected to mycological examination including microscopy and culture the mycological findings were correlated with clinical presentation of the patients. The isolation rate was 62.5 percent. Fungal culture was successful in 36.25 percent of cases, Trichophyton rubrum being the commonest etiological agent accounting for 55.18 percent of cases.