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Table of Contents
July-September 2016
Volume 6 | Issue 3
Page Nos. 65-89
Online since Wednesday, June 15, 2016
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REVIEW ARTICLE
Critical congenital heart disease screening
p. 65
Mohammed A Chamsi-Pasha, Hassan Chamsi-Pasha
DOI
:10.4103/2231-0770.184062
PMID
:27390667
Critical congenital heart disease (CCHD) is a heart lesion for which neonates require early surgical intervention to survive. Without intervention, the rates of mortality and survival with significant disability are extremely high. Early diagnosis can potentially improve health outcomes in newborns with CCHD. Until recent years, no routine screening protocol existed. In the last few years, pulse oximetry screening for CCHD in newborns has been added to the list of recommended uniform screening panels and advocated by several health-care authorities. A positive screening test result warrants an echocardiogram to evaluate for CCHD. Newborn screens do not usually require parental consent. However, most of the states mandates in the United States include a statement allowing exemption from the screen on the basis of parental religious or personal beliefs.
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ORIGINAL ARTICLES
CD10 and CD138 can be expressed in giant cell tumor of bone: An immunohistochemical study
p. 69
Mousa A Al-Abbadi, Mohammed J Al-Yousef, Mohammad M Yousef, Salwa S Sheikh, Nidal M Almasri, Samir S Amr
DOI
:10.4103/2231-0770.184063
PMID
:27390668
Giant cell tumor of bone (GCTB) is a primary bone neoplasm which is characterized by the presence of mononuclear cells (MCs) and osteoclast-like multinucleated giant cells (MNGCs). Up to our knowledge, CD10 immunoreactivity in GCTB has not yet been studied, and only one study touched on CD138 immunoreactivity in GCTB. The objective of this study is to investigate the immunoreactivity of CD10 and CD138 in GCTB. We offer a discussion of our findings in the context of the differential diagnosis, particularly in small biopsy material. We retrieved and reviewed 15 well-documented cases of GCTB from January 2008 to December 2014. Well-controlled standard immunohistochemical satins were performed on these cases for CD10 and CD138 and few other selected antibodies. Immunoreactivity for CD10 was membranous and was found in 14 (93%) cases. This immunoreactivity was found only in the MCs, whereas the MNGC were all negative. CD138 showed variable positivity in 11 (73%) while 4 (37%) were completely negative. Similar to CD10, staining for CD138 was only seen in the MC; however, the immunoreactivity was predominantly concentrated in the peri-vascular areas. Most of GCTB cases can show variable immunoreactivity for CD10 and CD138. The aforementioned immune-expression raise the possibility of a role in the pathogenesis of GCTB. Paying attention to this immunoreactivity is recommended when considering the clinical and radiological differential diagnosis, especially in small biopsy specimens.
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Detection of inducible and constitutive clindamycin resistance among
Staphylococcus aureus
isolates in a tertiary care hospital, Eastern India
p. 75
Subasini Majhi, Muktikesh Dash, Dharitri Mohapatra, Ashoka Mohapatra, Nirupama Chayani
DOI
:10.4103/2231-0770.184066
PMID
:27390669
Introduction:
Clindamycin is an excellent drug for skin and soft tissue
Staphylococcus aureus
infections, but resistance mediated by inducible macrolide-lincosamide-streptogramin B (iMLS
B
) phenotype leads to
in vivo
therapeutic failure even though they may be
in vitro
susceptible in Kirby-Bauer disk diffusion method.
Objective:
The study was aimed to detect the prevalence of iMLS
B
phenotype among
S.
aureus
isolates by double disk approximation test (
D
-test) in a tertiary care hospital, Eastern India.
Materials
and
Methods:
A total of 209 consecutive
S.
aureus
isolates were identified by conventional methods and subjected to antimicrobial susceptibility testing by Kirby-Bauer disk diffusion method. Erythromycin-resistant isolates were tested for
D
-test.
Results:
From 1282 clinical specimens, 209 nonrepeated
S.
aureus
isolates were obtained. Majority of isolates 129 (61.7%) were methicillin-resistant
S.
aureus
(MRSA). There was statistically significant difference between outpatients 60.1% and inpatients 39.9% (
P
< 0.0001). From 209
S.
aureus
isolates, 46 (22%) were
D
-test positive (iMLS
B
phenotype), 41 (19.6%) were
D
-test negative (methicillin sensitive [MS] phenotype), and 37 (17.7%) were constitutively resistant (constitutive macrolide-lincosamide-streptogramin B phenotype). The incidence of inducible, constitutive, and MS phenotype was higher in MRSA isolates compared to MS
S.
aureus
(MSSA). The constitutive clindamycin resistance difference between MSSA and MRSA isolates were found to be statistically significant (
P
= 0.0086).
Conclusion:
The study revealed 22% of
S.
aureus
isolates were inducible clindamycin resistant, which could be easily misidentified as clindamycin susceptible in Kirby-Bauer disk diffusion method. Therefore, clinical microbiology laboratory should routinely perform
D
-test in all clinically isolated
S.
aureus
to guide clinicians for the appropriate use of clindamycin.
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Assessment of the cardiac autonomic neuropathy among the known diabetics and age-matched controls using noninvasive cardiovascular reflex tests in a South-Indian population: A case-control study
p. 81
Pradeep Sukla, Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava, Nambaru Lakshmana Rao
DOI
:10.4103/2231-0770.184067
PMID
:27390670
Aim:
Diabetes mellitus is a chronic condition characterized by hyperglycemia. The objective of the study was to estimate the prevalence of cardiac autonomic neuropathy in a rural area of South India, among the known diabetics after comparing them with the age-matched healthy controls, utilizing noninvasive cardiac autonomic neuropathy reflex tests.
Materials and Methods:
A case-control study was conducted for 4 months (October 2014 to January 2015) at an Urban Health and Training Center (UHTC) of a Medical College located in Kancheepuram district, Tamil Nadu. The study was conducted among 126 diagnosed Type 2 diabetes patients and in 152 age- and sex-matched healthy controls to ensure comparability between the cases and controls and, thus, reduce variability due to demographic variables. All the study subjects (cases and controls) were selected from the patients attending UHTC during the study duration, provided they satisfied the inclusion and exclusion criteria. Study participants were subjected to undergo noninvasive cardiac autonomic neuropathy reflex tests. The associations were tested using paired
t
-test for the continuous (mean ± standard deviation) variables.
Results:
The overall prevalence of cardiac autonomic neuropathy among diabetic patients was found to be as 53.2% (67/126). On further classification, positive (abnormal) results were obtained in 56 (sympathetic - 44.4%) and 51 (parasympathetic - 40.5%) diabetic cases. Overall, heart rate variation during deep breathing was found to be the most sensitive test to detect parasympathetic autonomic neuropathy while the diastolic blood pressure response to sustained handgrip exercise was the most sensitive method to detect sympathetic neuropathy dysfunction.
Conclusion:
The overall prevalence of cardiac autonomic neuropathy among diabetic patients was found to be as 53.2%. Even though cardiac autonomic neuropathy can be detected by various invasive tests, noninvasive tests remain a key tool to detect it in the remote settings in a cost-effective and user-friendly manner without making people visit higher centers.
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CASE REPORT
Recurrent angina from chronic coronary obstruction following transcatheter aortic valve implantation
p. 86
Mohamad Kabach, Abdulah Alrifai, Stefanie Furlan, Fares Alahdab
DOI
:10.4103/2231-0770.184069
PMID
:27390671
Severe aortic stenosis and coronary artery disease often coexist. Coronary angiography (CA) and percutaneous coronary intervention (PCI) can be challenging in patients with prior transcatheter aortic valve implantation (TAVI). Depending on the type and position of the implanted valve, the procedure can be challenging or even unfeasible due to interference of diagnostic catheters and valve parts. The correct positioning of the TAVI prosthesis during TAVI was identified as an important factor with regard to the feasibility of subsequent CA or PCI. TAVI has been also associated with vascular, cerebrovascular and conduction complication. One is rare but life-threatening complication, coronary ostial obstruction. Coronary ostial obstruction can develop, especially if a safety check of more than 10 mm of coronary ostial height is not taken into consideration during TAVI. This complication can cause recurrent episodes of angina and can severely worsen the patient's cardiac systolic function.
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LETTER TO THE EDITOR
Victims or survivors?
p. 89
Mustafa Alachkar
DOI
:10.4103/2231-0770.184070
PMID
:27390672
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