Prospective study of Nosocomial Infection among Dermatology Inpatients in a Tertiary Care Centre in South India

INTRODUCTION : Nosocomial infection (NI) is defined as an infection developing in hospitalized patients, which was neither present nor in incubation at the time of their admission. Infections are considered nosocomial if they first appear 48 hours or more after hospital admission or within 10 days after hospital discharge. Nosocomial infections cause substantial morbidity and mortality, prolong the hospital stay of affected patients, and increase direct patient-care costs.3 NI is among the most difficult problems confronting clinicians who deal with severely ill patients. The incidence of these hospital-acquired infections varies with the size of hospitals, with specialties of wards, and with many other factors such as length of hospital stay, local trends in antibiotic usage, nursing and hygiene conditions, hospital design and geographical distribution of patients at risk. An average incidence of NI can be estimated at 5-10%, with higher rates in large university hospitals, and reaching up to 28% in the intensive care unit (ICU). The Study on the Efficacy of NI Control (SENIC) in 1975 in USA, found that NI develops in 5%-6% of hospitalized patients.5 Later in 1984, the National Nosocomial Infection Surveillance (NNIS) in USA, found an overall rate of 3.4 infections per 100 patients discharged and suggested that the true incidence is underestimated. In general, it is expected that the incidence of NIs in dermatology patients will be low, but information on the occurrence of NIs in dermatology care is very limited. However, as these infections may lead to a prolonged hospital stay and severe complications, it is useful to provide dermatologists with more detailed data on the incidence on NIs in this setting. The incidence of sepsis in dermatology inpatients in a study in AIIMS, Delhi in India was reported to be 6.6%. There is a paucity of data on the incidence of NI and of risk factors for acquiring NI among dermatology inpatients and this has prompted this study. AIMS AND OBJECTIVES : 1. To study the incidence of NI among a cohort of dermatology inpatients in a tertiary care centre. 2. To study the pathogens responsible for NI and their antibiotic susceptibility. 3. To study the risk factors for NI in these patients. MATERIALS AND METHODS : STUDY DESIGN : A prospective cohort study STUDY SETTING : The study was conducted in the dermatology inpatient ward of Christian Medical College Vellore, a tertiary care centre, in Tamil Nadu. The dermatology ward included a general ward of 20 beds (a room with 5 beds for females, 2 rooms with 7 beds each for males and a single room), isolation ward and 2 private ward blocks with single and double bed rooms. STUDY SUBJECTS: The patient population included all patients admitted under the department of Dermatology, Venereology and Leprosy during the study period. Inclusion criteria: All inpatients who were admitted with skin diseases to the dermatology ward during the study period and who gave informed consent were included in the study. Exclusion criteria: • Patients who had been hospitalized 10 days prior to the present. episode of hospitalization. • Patients hospitalized for < 48 hours. • Patients who did not give informed consent to participate in the study. DURATION OF STUDY: Patients were recruited in the study from 1st November 2006 till 15th September 2007. RESULTS : A total of 421 patients were admitted during the study period of which there were 260 males and 161 females. Their age ranged from 4 months to 84 years [mean 39.53 ± SD 18.42]. The details of underlying primary dermatological diagnosis of the study group are given in table 4. The most common dermatological condition was psoriasis which was seen in 71 patients (16.86%) followed by autoimmune-bullous disorders in 50 (11.87%), and Hansen’s disease in 43 patients (10.21%). Out of 421, 144 (34.2%) patients had diseases which predisposed to skin failure. CONCLUSIONS : 1. The incidence of NI in dermatology inpatient study group was 4.05 / 100 discharges with an incidence rate of 6.24 infections /1000 hospital days. 2. Autoimmune bullous diseases were the commonest dermatological diagnosis among patients who developed NI (7/17, 41%). 3. The types of NI seen were skin infections in 13 patients, SSI in 2 patients, urinary tract and blood stream infection in 1 patient each. 4. The commonest organism causing an NI in our study population was S. aureus (63.6%) and among these there was only one isolate of MRSA. 5. Gram negative organisms causing NI were 22.72% of the isolates, and pseudomonas, E.coli, and P.mirabilis were resistant to all first line antibiotics. 6. Median time to onset of NI was 11 days (IQR 8.10, 13.90.) 7. Nosocomial infection was significantly associated with the following factors. (a) Previous hospitalization (OR5.09, 95% CI 1.46 – 17.83) p value=0.01. (b) Infection at admission (OR 5.51, 95% CI 1.29 – 111.32) p value=0.029. (c) Invasive procedures (OR 18, 95% CI 3.08 – 93.68) p value=0.0000. 8. Median duration of hospital stay among patients with NI was 21 days (IQR 13, 25) and was significantly associated with NI (OR1.51, 95% CI 1.19 – 1.92) p value=0.001. 9. Overall mortality rate among the study population was 0.48%, and mortality among patients with NI was 11.76%

Dynamical Behaviour of Excimers

738-73

Retransformation of a male sterile barnase line with the barstar gene as an efficient alternative method to identify male sterile-restorer combinations for heterosis breeding

We report in this study, an improved method for identifying male sterile-restorer combinations using the barnase-barstar system of pollination control for heterosis breeding in crop plants, as an alternative to the conventional line × tester cross method. In this strategy, a transgenic male sterile barnase line was retransformed with appropriate barstar constructs. Double transformants carrying both the barnase and barstar genes were identified and screened for their male fertility status. Using this strategy, 66-90% of fertile retransformants (restored events) were obtained in Brassica juncea using two different barstar constructs. Restored events were analysed for their pollen viability and copy number of the barstar gene. Around 90% of the restored events showed high pollen viability and ~30% contained single copy integrations of the barstar gene. These observations were significantly different from those made in our earlier studies using line (barnase) &#215; tester (barstar) crosses, wherein only two viable male sterile–restorer combinations were identified by screening 88 different cross-combinations. The retransformation strategy not only generated several independent restorers for a given male sterile line from a single transformation experiment but also identified potential restorers in the T0 generation itself leading to significant savings in time, cost and labour. Single copy restored plants with high pollen viability were selfed to segregate male sterile (barnase) and restorer (barstar) lines in the T1 progeny which could subsequently be diversified into appropriate combiners for heterosis breeding. This strategy will be particularly useful for crop plants where poor transformation frequencies and/or lengthy transformation protocols are a major limitation

Myxoma of parotid gland: report of a rare case

Myxomas of head and neck and especially parotid gland are rare. These insidious soft tissue tumours have obscured pathogenesis, can occur at any age, mostly located in the cheek, palate or floor of mouth. They often present with non- specific symptoms like painless slow growing localised swelling in the cheek or around the jaw. Complete excision remains the mainstay of treatment with rare recurrence, no distant metastases and excellent prognosis. Here we reported a case of right sided parotid gland myxoma in a 37 years old man. There were no specific clinical, laboratory or radiological features. Fine needle aspiration cytology was reported as adenoid cystic carcinoma of right parotid gland. Histopathological examination of the specimen confirmed the diagnosis of myxoma. Immunohistochemistry can be helpful, but not necessary to come to a diagnosis

Sinonasal teratocarcinosarcoma: a rare case report from a tertiary care centre of North East India

Sinonasal teratocarcinosarcoma is an extremely rare malignant tumour arising in the sinonasal tract, that may extend intracranially to complicate the treatment and further worsen its dismal prognosis. Diagnosis is challenging because of its rarity and morphologic heterogeneity. Here, we reported a case of a 55 years old male who presented with complaints of left sided nasal blockage and facial swelling. CECT showed a large sinonasal mass with epicentre in the left nasal cavity extending to post nasal space and nasopharynx, eroding the left medial orbital wall and cranially the cribriform plate. Histopathologically, malignant epithelial component comprising of squamous cell carcinoma, mesenchymal component comprising of fibrosarcoma with focal chondroid differentiation, primitive blastemal component with extensive necrosis was noted. Immunohistochemistry demonstrated positivity for synaptophysin, chromogranin, Pan-CK, EMA, CD99, focal p63 in areas of squamous metaplasia; stromal cells showed Desmin, S100, SOX 10 expression: Ki-67 was 30-40%. Immunohistochemistry confirmed the diagnosis of sinonasal teratocarcinosarcoma. Knowledge about this tumour is important because of its heterogenous morphology which often leads to a misdiagnosis, necessitating repeated biopsies and thorough examination of the surgical specimen

Oral squamous cell carcinoma with clear cell change: a rare case report

Clear-cell variant of oral squamous cell carcinoma is an extremely rare entity. Clear-cell change can be seen in any of the neoplasms, but as pure form variant, it is difficult to find in head-and-neck SCC. We hereby present a case report of 71-year-old male who presented with a growth with erythematous patches on the lateral pharyngeal wall for the past 3 months. Histopathologic examination showed nests, islands and sheets of malignant squamous cells with vesicular nuclei and abundant clear cytoplasm. Neoplastic cells constituting majority of nests exhibited clear cell changes. Special stain was performed to identify the nature of clear cells. periodic acid Schiff-diastase (PAS-D) showed positivity in the clear cells. Immunohistochemical study using antibody for pan-cytokeratin revealed diffuse positivity in the tumor cells

Carcinosarcoma of the vulva: a rare case report

Carcinosarcomas are rare and clinically aggressive neoplasms with poor outcome. A very few cases has been reported in the literature. We present a case of a 54 yrs woman with bleeding per vagina for 1.5 months. On per vaginal examination, a lump of size 3×2 cm was found over the left anterior region of vulva. CECT abdomen revealed a well-defined heterogeneously enhancing lesion with calcific foci involving both labia minora. MRI pelvis reveals carcinoma left vulva with involvement of lower 3rd of vaginal wall. Histopathological examination showed features suggestive of carcinosarcoma of the vulva. This was further confirmed by immunohistochemistry which showed positivity for CK, SMA, caldesmon and negative for S100, CD34, desmin, CD31, ERG and MyoD1. Because it is a very rare tumor with severe prognosis, we presented this case as this case report can be a useful addition to the literature.

Comparative mapping of Brassica juncea and Arabidopsis thaliana using Intron Polymorphism (IP) markers: homoeologous relationships, diversification and evolution of the A, B and C Brassica genomes

Background: Extensive mapping efforts are currently underway for the establishment of comparative genomics between the model plant, Arabidopsis thaliana and various Brassica species. Most of these studies have deployed RFLP markers, the use of which is a laborious and time-consuming process. We therefore tested the efficacy of PCR-based Intron Polymorphism (IP) markers to analyze genome-wide synteny between the oilseed crop, Brassica juncea (AABB genome) and A. thaliana and analyzed the arrangement of 24 (previously described) genomic block segments in the A, B and C Brassica genomes to study the evolutionary events contributing to karyotype variations in the three diploid Brassica genomes. Results: IP markers were highly efficient and generated easily discernable polymorphisms on agarose gels. Comparative analysis of the segmental organization of the A and B genomes of B. juncea (present study) with the A and B genomes of B. napus and B. nigra respectively (described earlier), revealed a high degree of colinearity suggesting minimal macro-level changes after polyploidization. The ancestral block arrangements that remained unaltered during evolution and the karyotype rearrangements that originated in the Oleracea lineage after its divergence from Rapa lineage were identified. Genomic rearrangements leading to the gain or loss of one chromosome each between the A-B and A-C lineages were deciphered. Complete homoeology in terms of block organization was found between three linkage groups (LG) each for the A-B and A-C genomes. Based on the homoeology shared between the A, B and C genomes, a new nomenclature for the B genome LGs was assigned to establish uniformity in the international Brassica LG nomenclature code. Conclusion: IP markers were highly effective in generating comparative relationships between Arabidopsis and various Brassica species. Comparative genomics between the three Brassica lineages established the major rearrangements, translocations and fusions pivotal to karyotype diversification between the A, B and C genomes of Brassica species. The inter-relationships established between the Brassica lineages vis-&#224;-vis Arabidopsis would facilitate the identification and isolation of candidate genes contributing to traits of agronomic value in crop Brassicas and the development of unified tools for Brassica genomics