scholarly journals Fungal Keratitis in Northern Thailand: Spectrum of Agents, Risk Factors and Putative Virulence Factors

2021 ◽  
Vol 7 (6) ◽  
pp. 475
Author(s):  
Siriporn Chongkae ◽  
Sirida Youngchim ◽  
Joshua D. Nosanchuk ◽  
Angkana Laliam ◽  
Chulaluck Tangmonkongvoragul ◽  
...  
Keyword(s):  
Virulence Factors ◽  
Vision Loss ◽  
Proteolytic Enzymes ◽  
Tertiary Care ◽  
Fungal Keratitis ◽  
High Rate ◽  
Ocular Infection ◽  
Fungal Culture ◽  
Care Hospital ◽  
Northern Thailand

Fungal keratitis (FK) is a serious ocular infection that can result in various degrees of vision loss, including blindness. The aim of the study was to identify and retrospectively review all FK cases diagnosed between August 2012 and December 2020 at a tertiary care hospital in northern Thailand with a specific focus on epidemiologic features, including season, patient sex and age, the spectrum of pathogens, and presence of certain putative virulence factors. Of 1237 patients with corneal ulcers, 294 (23.8%) were confirmed by direct microscopic examination and/or fungal culture. For the positive cases, direct examinations of Calcofluor white (CW) stains and KOH mounts were found in 97.3% (286/294) and 76.5% (225/294), respectively (p < 0.05). Of the cases diagnosed by microscopy and culture, fungi were isolated in 152 (51.7%), with Fusarium spp. being the most frequently identified (n = 69, 45.5%) followed by dematiaceous fungi (n = 45, 29.6%) and Aspergillus spp. (n = 18, 11.8%). The incidence of FK was higher in the rainy season of July to October. The mean age was 54.4 ± 14.4 (SD) years, with a range of 9–88 years. Males (75.8%) were affected significantly more than females (24.2%) (p < 0.05). Of 294 patients, 132 (44.9%) were middle-aged adults (41–60 years) and 107 (36.4%) were older than 60 years. Trauma to the eye by soil or vegetative matter were the most common preceding factors (188/294; 64.0%). We assessed two virulence factors. First, 142 of the 152 culture-positive FK cases were due to molds, indicating that hyphal morphogenesis is extremely important in disease. We also demonstrated that fungal melanization occurs in the molds during the course of FK by applying a melanin-specific monoclonal antibody (MAb) that labeled fungal elements in corneal samples of patients, and melanin particles derived from the hyphae were also recovered after treatment of the samples with proteolytic enzymes, denaturant and hot concentrated acid. In summary, we demonstrate that northern Thailand has a high rate of FK that is influenced by season and males engaged in outside activities are at highest risk for disease. Moulds are significantly more commonly responsible for FK, in part due to their capacity to form hyphae and melanins. Future studies will examine models of fungal corneal interactions and assess additional factors of virulence, such as secreted enzymes, to more deeply decipher the pathogenesis of FK.

scholarly journals The Clinical Features and Prognostic Factors for Treatment Outcomes of Dematiaceous Fungal Keratitis over 9 Years at a Tertiary Eye Care in Northern Thailand

2021 ◽  
Vol 7 (7) ◽  
pp. 526
Author(s):  
Chulaluck Tangmonkongvoragul ◽  
Susama Chokesuwattanaskul ◽  
Napaporn Tananuvat ◽  
Monsicha Pongpom ◽  
Phit Upaphong ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Foreign Body ◽  
Clinical Features ◽  
Ocular Trauma ◽  
Monsoon Season ◽  
Tertiary Care ◽  
Fungal Keratitis ◽  
Care Hospital ◽  
Dematiaceous Fungi ◽  
Northern Thailand

Dematiaceous fungal keratitis is an important etiology of visual loss, particularly in an agricultural society. From a retrospective review of medical records from 2012 to 2020, 50 keratitis cases of cultured-positive for dematiaceous fungi were presented at a tertiary care hospital in Northern Thailand. The study aimed to identify the isolated causative dematiaceous species using the PCR technique and to explore their related clinical features, including treatment prognoses. Sequencing of the amplified D1/D2 domains and/or ITS region were applied and sequenced. Of the 50 dematiaceous fungal keratitis cases, 41 patients were males (82%). In most cases, the onset happened during the monsoon season (June to September) (48%). The majority of the patients (72%) had a history of ocular trauma from an organic foreign body. The most common species identified were Lasiodiplodia spp. (19.35%), followed by Cladosporium spp. and Curvularia spp. (12.90% each). About half of the patients (52%) were in the medical failure group where surgical intervention was required. In summary, ocular trauma from an organic foreign body was the major risk factor of dematiaceous fungal keratitis in Northern Thailand. The brown pigmentation could be observed in only 26%. Significant prognostic factors for medical failure were visual acuity at presentation, area of infiltrate, depth of the lesions, and hypopyon.

Virulence factors associated with organisms causing asymptomatic bacteriuria in pregnant females attending a tertiary care hospital

2017 ◽  
Vol 6 (05) ◽  
pp. 5373
Author(s):  
Prabha Ponnusamy* ◽  
Radhika Katragadda ◽  
Thyagarajan Ravinder
Keyword(s):  
Virulence Factors ◽  
Host Defense ◽  
Virulence Factor ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Asymptomatic Bacteriuria ◽  
Phenotypic Expression ◽  
Care Hospital ◽  
Cross Sectional ◽  
Pregnant Females

Asymptomatic bacteriuria (ASB), most common during pregnancy is endangering as it may lead to maternal and fetal complications. Various organisms causing ASB combats the host defense mechanisms through virulence factors exhibited by them. In order to understand the pathogenesis and sequelae of infections, virulence factors like hemolysin production, gelatinase production, haemagglutination, biofilm production and many more should be identified. Hence, we aimed at studying the distribution of virulence factors among each organism causing asymptomatic bacteriuria in pregnant females attending a tertiary care hospital. Materials and Methods: This cross-sectional study was conducted in Department of Microbiology over a period of one year and six months (January 2014 to June 2015) at a tertiary care teaching hospital. A total of 1000 urine samples were included in study taken from pregnant women with asymptomatic bacteriuria. Isolation, identification of organisms was done according to standard microbiological techniques and virulence factors for individual organisms by phenotypic method were tested. Results: Out of 1000 samples screened for ASB, organisms were isolated in following frequency distribution: Escherichia coli, the commonest 54/118 (45.76%), Klebsiella pneumoniae 21/118 (17.80%), Staphylococcus aureus 19/118 (16.10%), Staphylococcus saprophyticus 10/118 (8.45%), Enterococcus faecalis 9/118 (7.63%), Pseudomonas aeruginosa 3/118 (2.54%) and Proteus mirabilis 2/118 (1.69%). Virulence factors for individual organisms and biofilm detection for all organisms were done. Conclusion: Multifactorial mechanisms determine the pathogenicity of an organism and it needs to be explored by analyzing each virulence factor and mechanism of invasion in combating the host defense systems. Hence analyzing the phenotypic expression of each virulence factor helps in better understanding about the complications of ASB.

scholarly journals Sure Shot Technique for Management of Ranula

2020 ◽  
Vol 28 (1) ◽  
pp. 54-58
Author(s):  
Chiranjib Das ◽  
Pritam Chatterjee
Keyword(s):  
Salivary Gland ◽  
Tertiary Care ◽  
High Rate ◽  
Main Concern ◽  
Care Hospital ◽  
Review Of Literature ◽  
Submandibular Duct ◽  
Recurrent Case ◽  
One Year ◽  
A Prospective Study

Introduction Ranula is a pseudocyst in the floor of the mouth originating from the sublingual salivary gland.A variety of surgical procedures have been quoted in the literature. But the main concern is high rate of recurrence. Aim of the present study is to describe a definitive technique for managing ranula and compare the result with review of literature. Materials and Methods A prospective study was done in the department of ENT in a tertiary care hospital of West Bengal from 1st April, 2014 to 31st March, 2019. Patients presenting with ranula irrespective of age and sex; size of the mass; whether primary or recurrent case were included in the study. Patients presenting with congenital and plunging ranula were excluded. Patients were treated with total excision of ranula along with sublingual salivary gland. Patients were followed up regularly for at least one year post-operatively. Results We treated thirteen primary and four recurrent cases of ranula. Among them eight were male and nine were female. Patients were from seven to thirty three years of age with most being in the second decade of life. There was no injury to lingual nerve or submandibular duct in any patient. We did not observe any recurrence till date. Conclusion Successful management of a ranula includes identification of the extent of the cyst and removal of the cyst along with the sublingual salivary gland.  When done meticulously, this technique gives 100% success without any complication. 

scholarly journals Utilization of diabetic retinopathy screening among diabetic patients at a tertiary care hospital in Kerala, India

2021 ◽  
Vol 8 (10) ◽  
pp. 4938
Author(s):  
Sona Sabitha Kumar ◽  
Lathika Vasu Kamaladevi ◽  
Sruthi Mankara Valsan
Keyword(s):  
Diabetic Retinopathy ◽  
Vision Loss ◽  
Adult Population ◽  
Tertiary Care ◽  
Health Concern ◽  
Diabetic Patients ◽  
Care Hospital ◽  
Screening Programs ◽  
Diabetic Retinopathy Screening ◽  
Retinopathy Screening

Background: Diabetes is a major public health concern that affects nearly 463 million (9.3%) of global adult population. Diabetic retinopathy, which affects around 35% of all diabetic patients, is the fifth leading cause of preventable global blindness. This study was done to determine the status of diabetic retinopathy screening and the factors that influence its uptake among diabetic patients attending a tertiary care setting in Kerala, India.Methods: 200 patients with diabetes mellitus on physician care were enrolled for a questionnaire-based survey which collected information on patient demographics, education, occupation, patient’s awareness of retinopathy, screening, diabetic blindness and their source of such knowledge.Results: 83% were aware that diabetes can result in vision loss. 61% were aware that diabetic blindness is preventable. 42% patients were aware of screening options for retinopathy. The awareness of retinopathy screening was significantly associated (p=0.0001) only with duration of diabetes.Conclusions: Awareness of diabetic retinopathy among diabetic patients in Kerala was sub optimal. Better patient education and use of mass media can increase awareness on diabetes retinopathy screening programs. 

scholarly journals Spectrum of Opportunistic Fungal Infections in HIV/AIDS Patients in Tertiary Care Hospital in India

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Ravinder Kaur ◽  
Megh S. Dhakad ◽  
Ritu Goyal ◽  
Preena Bhalla ◽  
Richa Dewan
Keyword(s):  
Fungal Infections ◽  
Tertiary Care ◽  
North India ◽  
Clinical Samples ◽  
Fungal Culture ◽  
Care Hospital ◽  
Aids Patients ◽  
Cell Counts ◽  
Fungal Isolates ◽  
Hiv Aids

HIV related opportunistic fungal infections (OFIs) continue to cause morbidity and mortality in HIV infected patients. The objective for this prospective study is to elucidate the prevalence and spectrum of common OFIs in HIV/AIDS patients in north India. Relevant clinical samples were collected from symptomatic HIV positive patients (n=280) of all age groups and both sexes and subjected to direct microscopy and fungal culture. Identification as well as speciation of the fungal isolates was done as per the standard recommended methods. CD4+T cell counts were determined by flow cytometry using Fluorescent Activated Cell Sorter Count system. 215 fungal isolates were isolated with the isolation rate of 41.1%.Candidaspecies (86.5%) were the commonest followed byAspergillus(6.5%),Cryptococcus(3.3%),Penicillium(1.9%), andAlternariaandRhodotorulaspp. (0.9% each). AmongCandidaspecies,Candida albicans(75.8%) was the most prevalent species followed byC. tropicalis(9.7%),C. krusei(6.4%),C. glabrata(4.3%),C. parapsilosis(2.7%), andC. kefyr(1.1%). Study demonstrates that the oropharyngeal candidiasis is the commonest among different OFIs and would help to increase the awareness of clinicians in diagnosis and early treatment of these infections helping in the proper management of the patients especially in resource limited countries like ours.

Abstract 2567: Paclitaxel Eluting Stents are associated with a high rate of Stent Thrombosis compared to Bare Metal Stents in an Underserved Hispanic Population Presenting with Acute ST Segment Myocardial Infarction

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Atman P Shah ◽  
David M Shavelle ◽  
Kathleen Swenson ◽  
Sandra Jaquez ◽  
Michelle Martinez ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Tertiary Care ◽  
Bare Metal Stents ◽  
High Rate ◽  
Metal Stents ◽  
Care Hospital ◽  
Cardiac Events ◽  
St Segment Elevation ◽  
St Segment ◽  
Hispanic Patients

Background: Paclitaxel-eluting stents (PES) are shown to reduce restenosis and target lesion revascularization (TLR). The effectiveness of PES in Hispanic patients who present with acute myocardial infarction with ST segment elevation (STEMI) is not well established. Methods: A non-randomized, retrospective analysis was performed on 236 Hispanic patients presenting with STEMI between 8/2002 and 4/2006 at an academic tertiary care hospital serving a primarily indigent population. 150 patients received a PES and 86 received an uncoated stent (BMS). The incidence of cardiac death, myocardial infarction (MI), TLR, subacute thrombosis (SAT), and a composite of these major adverse cardiac events (MACE) was assessed at 1 year. Results: Baseline clinical characteristics in both groups revealed no statistically significant differences. All patients had clinical follow up at one year. There were statistically significant reductions in MI [2.0% (n=3 PES) vs. 10.5% (n=9 BMS), p=0.037] and TLR [6.0% (9) vs. 18.6% (16), p=0.04]. There was no difference in death [0.7% (1) vs. 1.1% (1), p=0.99]. SAT was increased in the PES group (6.0%, n=9) compared to the BMS group (1.1%, n=1, p=0.03). MACE was 14.7% in the PES group and 31.2% in the BMS group (p=0.017). Premature clopidogrel discontinuation (<6 months) was the etiology of SAT in 8 of the 9 patients. Conclusions: Use of DES is associated with lower rates of MI and TLR in Hispanics presenting with STEMI. There is an increased incidence of SAT in this population primarily due to premature clopidogrel discontinuation. The role of socioeconomic factors in premature antiplatelet discontinuation and its effects on SAT need further evaluation.

Clinico-epidemiological study and microbiological correlation of tinea incognito at a tertiary care hospital

2021 ◽  
Vol 7 (3) ◽  
pp. 212-216
Author(s):  
Monisha K ◽  
Jagannath Kumar V
Keyword(s):  
Tertiary Care ◽  
Fungal Culture ◽  
Care Hospital ◽  
Diagnostic Dilemma ◽  
Steroid Abuse ◽  
Systemic Corticosteroids ◽  
Study Population ◽  
Tinea Incognito ◽  
General Physical ◽  
Systemic Examination

Tinea incognito also known as steroid-modified tinea are dermatophytic infections modified by the use of topical or systemic corticosteroids. Dermatophytic infection being very common and very simple to diagnose, is a diagnostic dilemma due to steroid abuse. Hence making a simple curable infection into a chronic persistent dermatological condition. As a treating doctor it’s important to recognize and educate the patients regarding the tinea infections and steroid abuse. To study the various morphological presentations, epidemiology and etiological agent of tinea incognito. An observational study was performed with 100 cases from 2017 to 2019 in the department of Dermatology & Venerology, SS Institute of Medical Sciences and Research, Davangere, Karnataka, India. The baseline data, thorough general physical, local, and systemic examination were done with reference to clinical features of tinea incognito. Skin scraping were collected and subjected to potassium hydroxide (KOH) preparation. The part of the sample was inoculated into Sabouraud’s Dextrose Agar (SDA) media for fungal culture. Later the fungus was identified by standard techniques. The mean age of study population was 32.83 years. The males outnumbered females in our study. Almost 29% cases remain asymptomatic followed by 34% itching and 37% burning sensation. The source of drug responsible for tinea incognito were highly suggested by friends (29%) with the combination use of drugs account for 35% of study population. 77% cases showed erythema followed by 48% of hypopigmentation. The scraping of lesion showed positive KOH mount in 71% and T.mentagrophytes were the most common dermatophyte grown in SDA medium. Misuse of steroid formulations in dermatophytic infections may lead to adverse effect as well as chronicity. Awareness of this problem is needed for prevention of steroid modified dermatophytosis, which is a rising menace.

scholarly journals Trends of caesarean section: an analytical overview of indications

2019 ◽  
Vol 9 (1) ◽  
pp. 288
Author(s):  
Shruti A. Gavhane ◽  
Shilpa N. Chaudhari
Keyword(s):  
Caesarean Section ◽  
Caesarean Delivery ◽  
Graphical Representation ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
High Rate ◽  
Care Hospital ◽  
Chi Square ◽  
Chi Square Test ◽  
Evidenced Based

Background: Caesarean section is one of the commonly performed surgical procedures in obstetrics. An increasing trend has been observed in both primary and repeat caesarean sections. The reasons for its increase are multifaceted. So, this study was carried out to compare the rates of caesarean delivery and to analyse various indications contributing to it.Methods: This retrospective study was conducted over a period of three year from 1st January 2016 to 31st December 2018 at the department of obstetrics and gynaecology, tertiary care hospital Pune, Maharashtra, India. All caesarean delivery (primary and repeat) taken place during the study period. The rate and indications of caesarean section was calculated over the study period to find out the trends in caesarean delivery. The data so collected was presented with graphical representation. Statistical analysis was performed with SPSS software and t-test was used for continuous data and pearson chi square test for discrete data.Results: There were a total of 12373 deliveries during the study period out of which, 3701 had delivered via Caesarean Section. So, the rate of caesarean section in the study was found to be 29.91%.Conclusions: Being a tertiary care hospital, a high rate of caesarean deliveries was observed, Individualization of the indication and careful evaluation, following standardized guidelines, practice of evidenced-based obstetrics and audits in the institution, can help us limit caesarean section rates.

scholarly journals Estimation of Serum Uric Acid Levels in Bangladeshi Gestational Diabetic Mothers Attending a Tertiary Care Hospital

2019 ◽  
Vol 9 (1) ◽  
pp. 55-58
Author(s):  
Farzana Akonjee Mishu ◽  
MA Muttalib ◽  
Mst Shaila Yesmin ◽  
Gazi Sharmin Sultana ◽  
Nadia Ferdous ◽  
...  
Keyword(s):  
Uric Acid ◽  
Serum Uric Acid ◽  
Uric Acid Level ◽  
Acid Level ◽  
Serum Uric Acid Level ◽  
Tertiary Care ◽  
High Rate ◽  
Oral Glucose ◽  
Care Hospital ◽  
The Metabolic Syndrome

Background: The hyperuricaemia in gestational diabetes mellitus (GDM) has been explained to be a component of the metabolic syndrome which reflects insulin resistance. Gestational huperuricaemia was found to be significantly associated with a high rate of maternal and foetal complications along with proteinuria and hypertension. Aims of this study were to evaluate the serum uric acid levels in Bangladeshi women with GDM in their second and third trimesters of pregnancy. Methods: This descriptive cross-sectional study was conducted at Mymensingh Medical College Hospital from July 2013 to June 2014. Pregnant women, in their second and third trimester, attending the outpatient department of Obstetrics and Gynecology and the Department of Endocrinology were enrolled by purposive sampling technique. GDM was diagnosed on the basis of oral glucose tolerance test (OGTT) as defined in WHO criteria 2013. Results: Out of 172 participants, 86 had GDM (case) and 86 were normoglycemic (control). The mean age of GDM and control groups was 28.6±3.2 years and 27.3±3.1 years respectively. The BMI was 26.4±1.5 kg / m 2 and 26.3±1.3 kg / m 2. In this study we found serum uric acid levels in GDM and without GDM were 4.47±0.42 mg/dl and 4.48±0.41 mg/dl respectively (p>0.05). Serum uric acid level in GDM group was significantly (p<0.001) higher in third trimesters (4.48 ±0.41 mg/dl) compared to those without GDM (3.52 ±0.74 mg/dl). Conclusion: There was distinct alteration of serum uric acid level in GDM compared to normal pregnancy. Estimation of serum uric acid levels might be incorporated in every GDM cases for prevention of complications. Birdem Med J 2019; 9(1): 55-58

scholarly journals The profile of patients’ complaints in a tertiary care hospital in South India

2018 ◽  
Vol 5 (8) ◽  
pp. 3567
Author(s):  
Mohammed Jezeel Nalakath ◽  
P. M. Thasneem ◽  
K. V. Deepak ◽  
N. A. Uvais
Keyword(s):  
Medical Staff ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
High Standard ◽  
Cross Sectional Study ◽  
High Rate ◽  
Care Hospital ◽  
Cross Sectional ◽  
Study Results ◽  
Research Population

Background: Complaints from patients and their carers are important indicators of problems in a healthcare system and provide valuable insights into safety-related problems within healthcare organisations. The objectives of the present study are to identify the frequency distribution of the people complained about, the units complained about and the total number of complaints.Methods: We employed a descriptive, cross-sectional study to conduct this research. The research population included cases registered at the complaints unit of a tertiary care hospitals in selected months of May 2017 to August 2017. The data were collected through observation of available documents. Excel software program was used for data analysis.Results: The administration received 692 complaints between the study period. The highest rate of complaints was filed against admission process (30.06%) and the lowest rate of complaints are filed against staff (2.51%). Our study results showed a significantly less complaints against nursing staff and no complaints against medical staff, indicates that the nursing and medical staff of the hospital might be observing medical ethics and professional commitment to a high standard and communicating well with the patients. High rate of complaints against admission unit, house keeping unit and high billing amount indicates the unrealistic expectations prevailing in the minds of clients from the health care provider.Conclusions: The current study generated the profile of patient’s complaints in a tertiary care hospital running in a charitable model. Such data can be utilised to identify common problems and to plan strategies. 

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