STUDY OF LEVELS OF SERUM CREATINE PHOSPHOKINASE AND LIVER ENZYMES AS A PROGNOSTIC INDICATORS IN ACUTE ORGANOPHOSPHORUS POISONING

Background: Organophosphorus (OP) poisoning is one of the most common poisoning in rural and in developing country. Due to their easy availability and cost effective it is used frequently for homicidal and suicidal attempts. Routinely used biochemical markers like Erythrocyte cholinesterase (EChE) and Plasma cholinesterase (PChE) are used for the diagnosis of acute organophosphorus (OP) poisoning but estimation of these are very costly and not easily available. The mortality increases with increase in initial creatine phosphokinase level and can be used as alternative biomarker. Hence study was done to estimate levels of serum Creatine Phosphokinase (CPK) and liver enzymes in acute OP poisoning patients and its prognostic significance. Methodology: Patients (80) admitted in our hospital were included in this study. A brief history and detailed clinical examination was performed and patients were categorized on the basis Modified Dreisbach\u27s clinical criteria classification. Serum levels of Creatine kinase (CK) and Liver enzymes were analysed at the time of admission. The outcome of the patients were observed. Results: Out of 80 patients recruited for the study, 41 cases (51.3%) were females, and 39 cases (48.8%) were males. Majority of them were in the age group of 21-30 years. More cases of OP poisoning were among agriculturalists 28 (35%) and housewife 21 (28.8%) and among students 15 (18.8%). Malathion was the most common compound used followed by Monocrotphos. 60% had mild, 31.3% had moderate and 8.8% had severe poisoning. There is increase in Creatine Phosphokinase (CPK) levels in 6 patients who survived with ventilator support and also in 2 patients who died with ventilator support which was statistically highly significant (p<0.05). Serum liver enzymes were within normal limits. Conclusion: Elevated Creatine kinase is commonly seen in OPC poisoning. High initial serum Creatine Phosphokinase (CPK) levels are associated with severe degree of poisoning and are associated with complications and mortality. Serum liver enzymes (SGOT AND SGPT) are not elevated in OP poisoning

STUDY OF LEVELS OF SERUM CREATINE PHOSPHOKINASE AND LIVER ENZYMES AS A PROGNOSTIC INDICATORS IN ACUTE ORGANOPHOSPHORUS POISONING

Background: Organophosphorus (OP) poisoning is one of the most common poisoning in rural and in developing country. Due to their easy availability and cost effective it is used frequently for homicidal and suicidal attempts. Routinely used biochemical markers like Erythrocyte cholinesterase (EChE) and Plasma cholinesterase (PChE) are used for the diagnosis of acute organophosphorus (OP) poisoning but estimation of these are very costly and not easily available. The mortality increases with increase in initial creatine phosphokinase level and can be used as alternative biomarker. Hence study was done to estimate levels of serum Creatine Phosphokinase (CPK) and liver enzymes in acute OP poisoning patients and its prognostic significance. Methodology: Patients (80) admitted in our hospital were included in this study. A brief history and detailed clinical examination was performed and patients were categorized on the basis Modified Dreisbach's clinical criteria classification. Serum levels of Creatine kinase (CK) and Liver enzymes were analysed at the time of admission. The outcome of the patients were observed. Results: Out of 80 patients recruited for the study, 41 cases (51.3%) were females, and 39 cases (48.8%) were males. Majority of them were in the age group of 21-30 years. More cases of OP poisoning were among agriculturalists 28 (35%) and housewife 21 (28.8%) and among students 15 (18.8%). Malathion was the most common compound used followed by Monocrotphos. 60% had mild, 31.3% had moderate and 8.8% had severe poisoning. There is increase in Creatine Phosphokinase (CPK) levels in 6 patients who survived with ventilator support and also in 2 patients who died with ventilator support which was statistically highly significant (p<0.05). Serum liver enzymes were within normal limits. Conclusion: Elevated Creatine kinase is commonly seen in OPC poisoning. High initial serum Creatine Phosphokinase (CPK) levels are associated with severe degree of poisoning and are associated with complications and mortality. Serum liver enzymes (SGOT AND SGPT) are not elevated in OP poisoning

A VERY INFREQUENT ASSOCIATION OF WILLIAM-BEURAN SYNDROME AND TETRALOGY OF FALLOT

WB-S Autosomal Dominant Disorder is the most common genetic disorder. We report a case of 20 year old with infrequent association of WBS and TOF. Clinical examination and ECHO confirmed TOF, WB-S was suspected based on the clinical signs used in the scoring system of WB-S which were described by AAP(2001), FISH study was performed in this patient because of having more than 3 clinical signs of WB-S and FISH study showed 7q11.23 deletion and remains the gold standard laboratory investigation for WB-S. KEYWORDS: Tetralogy of Fallot; William Beuren Syndrome; Clinical Diagnosis; Fluroscence In Situ Hybridisation

A VERY INFREQUENT ASSOCIATION OF WILLIAM-BEURAN SYNDROME AND TETRALOGY OF FALLOT

WB-S Autosomal Dominant Disorder is the most common genetic disorder. We report a case of 20 year old with infrequent association of WBS and TOF. Clinical examination and ECHO confirmed TOF, WB-S was suspected based on the clinical signs used in the scoring system of WB-S which were described by AAP(2001), FISH study was performed in this patient because of having more than 3 clinical signs of WB-S and FISH study showed 7q11.23 deletion and remains the gold standard laboratory investigation for WB-S. KEYWORDS: Tetralogy of Fallot; William Beuren Syndrome; Clinical Diagnosis; Fluroscence In Situ Hybridisation

Utility of a novel chromogenic medium as a screening method in the detection of carbapenemase producing Enterobacteriaceae

INTRODUCTION: With the emergence of multidrug resistant Gram-negative bugs, there is an urgent need for rapid detection of these resistant organisms. AIM: This study was performed to assess the utility of a novel chromogenic medium in the detection of carbapenemase producing Enterobacteriaceae from various clinical specimens. MATERIALS AND METHODS: A total of 202 isolates of Enterobacteriaceae, which were resistant to meropenem (10 μg) disc by standard disc diffusion method, were analyzed over a period of 6 months. These isolates were subjected to the modified Hodge test (MHT) and inoculated onto the chromogenic medium. Following which the results were analyzed. RESULTS: It was observed that 76.73% of the Enterobacteriaceae gave a positive result on the MHT, 18.31% were negative and 4.95% gave indeterminate result. While 88.11% produced growth on the chromogenic medium, 6.93% yielded no growth and 4.95% gave variable results. Concordance in the results of the two tests was found to be 65.34%. CONCLUSION: Enterobacteriaceae are emerging to be carbapenem resistant and are responsible for the soaring rates of Healthcare Associated Infections (HAIs), especially among critically ill patients. Hence, early detection of the same is important in controlling HAIs

Evaluation of phenotypic tests and screening markers for detection of metallo-β-lactamases in clinical isolates of Pseudomonas aeruginosa: A prospective study

Purpose: This study was conducted to estimate the prevalence of metallo-β-lactamases (MBL)-producing Pseudomonas aeruginosa isolates obtained from various clinical samples and to compare the diagnostic strength of different phenotypic MBL-detection tests and also to know the performance of ethylene diamine tetraacetic acid (EDTA) disk potentiation test (PT) which is the least studied. Materials and Methods: This study included 160 nonconsecutive isolates of P. aeruginosa collected over a period of 1-year. Resistance to carbapenems and ceftazidime was used for screening of isolates. Positively screened isolates were further subjected to five different MBL detecting phenotypic tests-MBL Epsilometer test (E-test), combined disk test (CDT), double-disk synergy test (DDST), EDTA disk PT using four cephalosporins and modified Hodge test (MHT). MBL E-test was considered as gold standard for MBL detection. Results: Based on the screening criteria for MBL production, 66 isolates were screened positive. The prevalence of MBL producing isolates of P. aeruginosa was 15% (24/160) based on E-test result. MHT showed the highest sensitivity (87.5%), followed by CDT (79.2%), while specificity was highest for DDST (100%), followed by PT (95.2%). Out of 24 MBL producers, 15 isolates (62.5%) were resistant to both imipenem (IPM) and meropenem. Conclusion: The early detection of MBL-producing P. aeruginosa may help inappropriate antimicrobial therapy and avoid the development and dissemination of these strains. Hence, routine detection of MBL production in P. aeruginosa should be undertaken. We recommend that all IPM and/meropenem-resistant P. aeruginosa isolates should be routinely screened for MBL production using CDT and the positive isolates may further be confirmed by MBL E-test or PCR. EDTA disk PT had low sensitivity