A clinical study of cardiac rhythm disturbance in patients with chronic obstructive pulmonary disease using 24 hour Holter monitoring

Background: Chronic obstructive pulmonary disease (COPD) has been defined by GOLD (guidelines for obstructive lung disease) as a disease state characterised by airflow limitation that is not fully reversible, with FEV1/FVC <70%. COPD increases the risk of cardiac arrhythmias. In acute exacerbation and also in stable COPD, it has been found that arrhythmias are associated with more mortality. Holter monitoring enhances the possibility of observing cardiac rhythm during symptoms and can detect arrhythmias in asymptomatic patients. The aim of this study was to estimate the prevalence and types of arrhythmias in COPD patients and to correlate them with severity.Methods: This was a cross-sectional prevalence, analytical study conducted for a period of two years. Fifty cases with sign and symptoms of COPD diagnosed on pulmonary function tests (PFT) as per GOLD’s criteria were included. Diagnosis of arrhythmia in COPD was on the basis of Holter monitoring. 24 hour Holter monitoring was done with Release 2.9 Digitrak XT Philips. The data was analysed using chi square test.Results: The most common arrhythmias on Holter monitoring were atrial pair and atrial premature beats which were present in 29 (58%) and 25 (50%) patients respectively, atrial run (32%), ventricular premature beats (32%), ventricular couplets (30%), ventricular triplets (24%), ventricular trigeminy (24%) and ventricular run (22%). Atrial fibrillation was noted in 7 patients (14%).Conclusions: The significant presence of supraventricular and ventricular arrhythmias in patients with COPD were detected on Holter monitoring.

Multilocus sequence typing of Ochrobactrum spp. isolated from gastric niche

SummaryThe human stomach is colonized by diverse bacterial species. The presence of non-Helicobacter pylori bacteria in urease-positive biopsies of individuals has been reported. Bacteria belonging to the Ochrobactrum genus have been documented in the human gastric niche. The co-occurrence of Ochrobactrum spp. with H. pylori was previously reported in an antral biopsy of a non-ulcer dyspeptic (NUD) subject from Northern India. There is no information on the genetic diversity of Ochrobactrum spp. isolated from the gastric niche in the stomach. We aimed to study the species distribution and diversity of Ochrobactrum spp. with and without H. pylori in urease-positive biopsies across three different geographical regions in India. Sixty-two Ochrobactrum isolates recovered from patients with an upper gastric disorder (n=218) were subjected to molecular identification and multilocus sequence typing. H. pylori DNA was found in the majority of biopsies, which had a variable degree of Ochrobactrum spp present. Interestingly, some of the urease-positive biopsies only had Ochrobactrum without any H. pylori DNA. Based on phylogenetic analysis, the Ochrobactrum isolates were distributed into the O. intermedium, O. anthropi and O. oryzae groups. This indicates there are multiple species in the gastric niche irrespective of the presence or absence of H. pylori. Antibiotyping based on colistin and polymyxin B could differentiate between O. intermedium and O. anthropi without revealing the resistance-driven diversity. Considering the prevalence of multiple Ochrobactrum spp. in the human gastric niche, it is important to evaluate the commensal and/or pathogenic nature of non-H. pylori bacteria with respect to their geographical distribution, lifestyle and nutrition needs

Platelet derived exosomes disrupt endothelial cell monolayer integrity and enhance vascular inflammation in dengue patients

BackgroundThrombocytopenia is the most notable phenomenon in dengue. Activation status of platelets and interaction of platelets with endothelium contribute towards dengue disease pathogenesis. Platelets are the major cell types known to release extracellular vesicles, especially exosomes in circulation. However, the role of platelet derived exosomes (PLT-EXOs) in endothelial dysfunction during dengue infection remains unknown.MethodsIn this study, we recruited 28 healthy subjects and 69 dengue patients categorized as WS- (n=31), WS+ (n=29) and SD (n=9). Platelets were isolated from platelet rich plasma of dengue patients and their activation was assessed by flow cytometry. PLT-EXOs were isolated by ultracentrifugation method. Western blot analyses were performed to characterize the exosomes. Exosome uptake experiment was carried out to see the internalization of exosomes inside endothelial cells (HUVECs). To observe the effect of exosomes on endothelial cells, exosomes were added on HUVECs and expression of adherens and tight junctional proteins were examined by immunofluorescence assay and western blot. Expression levels of vascular injury markers were measured in the culture supernatants of Exosome-HUVEC coculture and sera of dengue patients by MSD-multiplex assay.ResultsAs compared to healthy subjects, CD41/CD61 expression was significantly reduced (p&lt;0.0001) and CD62p expression was significantly increased (p&lt;0.0001) on platelets in dengue patients. PLT-EXOs isolated from the dengue patients showed higher expression of CD63 and CD9 proteins than the healthy subjects. With in-vitro immunofluorescence assays, we illustrated the internalization of PLT-EXOs by the HUVECs and observed disruption of endothelial cell monolayer integrity in the presence of PLT-EXOs from WS+ and SD patients. Furthermore, the significant reduction in the expressions of ZO-2, VE-Cadherin and CD31 in endothelial cells following exposure to PLT-EXOs from the dengue patients provide direct evidence of PLT-EXOs mediated vascular permeability. PLT-EXOs stimulated the release of inflammatory markers CRP, SAA, sVCAM-1 and sICAM-1 in the supernatants of HUVEC cells. Importantly, significantly higher levels of CRP, sVCAM-1 and sICAM-1 in the sera of severe than mild dengue patients (p&lt;0.0001) suggest their role in disease severity.ConclusionsIn summary, our data suggest that PLT-EXOs promote vascular leakage via release of proinflammatory mediators and compromise vascular barrier integrity in dengue patients

High risk for occupational exposure to HIV and utilization of post-exposure prophylaxis in a teaching hospital in Pune, India

<p>Abstract</p> <p>Background</p> <p>The risk for occupational exposure to HIV has been well characterized in the developed world, but limited information is available about this transmission risk in resource-constrained settings facing the largest burden of HIV infection. In addition, the feasibility and utilization of post-exposure prophylaxis (PEP) programs in these settings are unclear. Therefore, we examined the rate and characteristics of occupational exposure to HIV and the utilization of PEP among health care workers (HCW) in a large, urban government teaching hospital in Pune, India.</p> <p>Methods</p> <p>Demographic and clinical data on occupational exposures and their management were prospectively collected from January 2003–December 2005. US Centers for Diseases Control guidelines were utilized to define risk exposures, for which PEP was recommended. Incidence rates of reported exposures and trends in PEP utilization were examined using logistic regression.</p> <p>Results</p> <p>Of 1955 HCW, 557 exposures were reported by 484 HCW with an incidence of 9.5 exposures per 100 person-years (PY). Housestaff, particularly interns, reported the greatest number of exposures with an annual incidence of 47.0 per 100 PY. Personal protective equipment (PPE) was used in only 55.1% of these exposures. The incidence of high-risk exposures was 6.8/100 PY (n = 339); 49.1% occurred during a procedure or disposing of equipment and 265 (80.0%) received a stat dose of PEP. After excluding cases in which the source tested HIV negative, 48.4% of high-risk cases began an extended PEP regimen, of whom only 49.5% completed it. There were no HIV or Hepatitis B seroconversions identified. Extended PEP was continued unnecessarily in 7 (35%) of 20 cases who were confirmed to be HIV-negative. Over time, there was a significant reduction in proportion of percutaneous exposures and high-risk exposures (p < 0.01) and an increase in PEP utilization for high risk exposures (44% in 2003 to 100% in 2005, p = 0.002).</p> <p>Conclusion</p> <p>Housestaff are a vulnerable population at high risk for bloodborne exposures in teaching hospital settings in India. With implementation of a hospital-wide PEP program, there was an encouraging decrease of high-risk exposures over time and appropriate use of PEP. However, overall use of PPE was low, suggesting further measures are needed to prevent occupational exposures in India.</p

An adolescent girl with Rapunzel syndrome: Case report with review of literature

Trichobezoar is a collection of dense mass of hair in stomach. When this extends into any part of the small intestine it is called Rapunzel Syndrome (RS). We report here, a case of RS in an adolescent girl who had presented with epigastric pain and swelling. Gastroscopy confirmed the presence of trichobezoar. She underwent gastrotomy and a large dense mass of hair extending up to first part of duodenum was removed. Her parents revealed their daughter′s impulsive nature of scalp-hair pulling. Following surgery, Psychiatric consultation was sought to prevent recurrence. Trichobezoar is a very rare cause of upper abdominal mass and should be considered if there is a very strong history of impulsive hair pulling. Surgical removal of a large trichobezoar is the only treatment of cure and psychiatric treatment that prevents its recurrence

A clinical study of cardiac rhythm disturbance in patients with chronic obstructive pulmonary disease using 24 hour Holter monitoring

Background: Chronic obstructive pulmonary disease (COPD) has been defined by GOLD (guidelines for obstructive lung disease) as a disease state characterised by airflow limitation that is not fully reversible, with FEV1/FVC &lt;70%. COPD increases the risk of cardiac arrhythmias. In acute exacerbation and also in stable COPD, it has been found that arrhythmias are associated with more mortality. Holter monitoring enhances the possibility of observing cardiac rhythm during symptoms and can detect arrhythmias in asymptomatic patients. The aim of this study was to estimate the prevalence and types of arrhythmias in COPD patients and to correlate them with severity.Methods: This was a cross-sectional prevalence, analytical study conducted for a period of two years. Fifty cases with sign and symptoms of COPD diagnosed on pulmonary function tests (PFT) as per GOLD’s criteria were included. Diagnosis of arrhythmia in COPD was on the basis of Holter monitoring. 24 hour Holter monitoring was done with Release 2.9 Digitrak XT Philips. The data was analysed using chi square test.Results: The most common arrhythmias on Holter monitoring were atrial pair and atrial premature beats which were present in 29 (58%) and 25 (50%) patients respectively, atrial run (32%), ventricular premature beats (32%), ventricular couplets (30%), ventricular triplets (24%), ventricular trigeminy (24%) and ventricular run (22%). Atrial fibrillation was noted in 7 patients (14%).Conclusions: The significant presence of supraventricular and ventricular arrhythmias in patients with COPD were detected on Holter monitoring.