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Objective: In spite of continuous refinements in tympanoplasty techniques, results are variable, and it is not uncommon to see a discharging eardrum even after a good graft uptake. This study aimed to evaluate the efficacy of total annulus excision tympanoplasty in comparison with conventional underlay tympanoplasty. Method: This was a double blinded, randomised, controlled trial performed at a tertiary care centre. After inclusion and exclusion criteria were met, 56 patients were enrolled and randomised, and 28 patients were allocated to each group (group A (conventional tympanoplasty) and group B (total annulus excision)). Patients and evaluators were blind to the procedure performed. Results: Patients in group B (total annulus excision) showed better graft uptake and no discharge with better gains in air conduction thresholds (p < 0.05) when compared with group A (conventional tympanoplasty). Conclusion: In view of the advantages it offers, total annulus excision tympanoplasty may be preferred over the conventional techniques in patients with central perforations. [ABSTRACT FROM AUTHOR]

Objectives Women of reproductive age represent a large proportion of the global population living with HIV/ AIDS. With improvements in morbidity and mortality since the advent of combination antiretroviral therapy, contraception and pregnancy planning are an increasingly important issue for women living with HIV. This review aims to outline the key considerations when choosing contraceptive methods in HIV-positive women and provides a review of the literature to inform decision-making. Methods Pubmed was searched using the terms ' HIV', 'contraception', ' HIV progression', ' HIV acquisition', ' HIV transmission' and the combination of 'antiretroviral' and 'contraception'. Abstracts were reviewed and relevant articles were retrieved. Reference lists were also reviewed for pertinent citations. Results HIV and contraceptive methods can interact in several clinically meaningful ways. Concomitant use may result in altered contraceptive efficacy, drug−drug interactions, or increased toxicity. Hormonal contraceptives have not been shown to affect HIV progression. Notably, the impact of hormonal contraceptives on HIV transmission and acquisition remains unclear, particularly for injectable forms. Data are lacking on several newer methods of contraception including contraceptive rings, patches and intrauterine systems. Conclusions Effective, reliable contraception is important for HIV-positive women. Efficacy, toxicity, drug interactions, and potential impacts on HIV disease progression, transmission, and acquisition must be assessed when making clinical decisions. [ABSTRACT FROM AUTHOR]

The role of quantitative hepatitis B surface antigen ( HBs Ag) levels in patients receiving highly potent oral antiviral therapy is controversial, and here, we determined the HBs Ag response in 121 chronic hepatitis B patients treated with tenofovir 300 mg daily. During tenofovir treatment, HBs Ag decline of ≥1.0 log from baseline was seen in 16.1%, 16.3%, 18.4%, 34.6%, 36.4% and 11.8%, 15.2%, 14.8%, 28.6%, 20% at years 1, 2, 3, 4, 5 for HBe Ag-positive and HBe Ag-negative patients, respectively. Early decline in HBs Ag levels at week 4 was predictive of subsequent significant HBs Ag level decline. HBe Ag seroconversion occurred in 29.9% of HBe Ag-positive patients. On multinomial logistic regression, HBs Ag level decline from baseline at week 4 and week 12 or any time subsequently did not correlate with HBe Ag seroconversion and HBV DNA level decline from baseline at week 4 and week 12 ( OR = 3.704; 95% CI = 1.511-9.076; P = 0.006 and OR = 1.732; 95% CI = 1.032-2.867; P = 0.037, respectively) was significantly predictive of seroconversion. A small proportion of chronic HBV-infected patients treated with tenofovir exhibit a significant (≥1.0 log) decline in HBs Ag levels. Early decline in HBs Ag levels at week 4 was predictive of subsequent and significant HBs Ag level decline. The HBs Ag decline did not correlate with HBe Ag seroconversion in HBe Ag-positive patients. Reduction in HBV DNA levels at week 4 and 12 correlated with seroconversion. [ABSTRACT FROM AUTHOR]

The present study aims to see the effect of systematic desensitization and group therapy on different type of phobic patients viz: hydrophobia, zoophobia, nyctophobia and astraphobia. One hundred and ten (110) phobic patients matched on Socio-economic status, ranging from 12 to 19 years (Mean age of 16.7 years) with mean length of abnormal fear for three years at least. The Rorschach Inkblot Test was administered using Beck's method to ascertain personality characteristics on selected indices viz: R, W, obvious details, rare details, M, C, CF, FC, Vista, Shading, Affective ratio, H, Hd, Anatomy, Good form, Animal, Popular, Lambda, White space, T/IR and Rejection of cards. The Mean scores obtained on different variables were analyzed using Chi Square test. The patients were evaluated at S. I. Mental and Physical Health Society (SIMPHS) Varanasi (India). Results indicated that the two groups differ significantly on total Responses, Whole responses, obvious details, rare details, Movement, CSum, Vista, Human, Human detail, Good form, Animal, Popular, Lambda, T/IR and Rejection of cards. After 7 months of psychotherapy most of the patients became symptom free. The findings of Rorschach test and efficacy of Psychotherapy is discussed in the paper. [ABSTRACT FROM AUTHOR]

The present study attempts to examine the effect of cognitive behavior therapy and relaxation practices on chronic migraine patients. 50 treated and 50 non-treated patients were evaluated at SIMPHS Varanasi (India). The two groups were matched on age range from 20 to 55 years with a mean age of 38.4 years and mean length of intolerable pain of 6.8 years. Indian adaptation of T.A.T. (Seven cards: 1, 3B, 4, 6BM, 7BM, 13MF, and 16), Defense Mechanism Inventory and Questionnaire for Dependency were administered to ascertain personality, defense mechanism and dependency characteristics on eleven selected dimensions viz: need, press, interpersonal relations, outcome, reversal, principalization, turning against self, projection, turning against object, internal dependency and external dependency. Mean scores obtained on different variables were analyzed using t-test of significance. Results indicated that the characteristics associated with treated chronic migraine patients were cognizance, dominance, autonomy, achievement, counteraction, affiliation, sex capacity, interpersonal relations, outcome, projection turning against object and internal dependency whereas the characteristics associated with non-treated chronic migraine patients were aggression, rejection, passivity, acquisition, anxiety, , reversal, principalization, turning against self, internal dependency, external dependency and press. [ABSTRACT FROM AUTHOR]

Persistent Staphylococcus aureus bacteremia (SAB-P) is well known but poorly delineated due to unclear definition. We retrospectively studied 78 patients with SAB-P using a stringent definition (bacteremia for ≥7 d), in a single teaching hospital, during 1 January 2002 to 30 June 2003 and 1 November 2005 to 31 December 2006 to determine whether the frequency, risk factors and outcome changed over time. SAB was encountered in 354 and 259 instances during the 2 periods, respectively. Patients' characteristics changed with increasing organ dysfunction score (2.9±1.7 vs 3.4±1.4; p <0.001), patients with invasive devices (27.7% vs 41.3%; p=0.001), hemodialysis dependence (19.2% vs 27.8%; p=0.04), MRSA (50.8% vs 64.5%; p=0.001), and vancomycin treatment (57.9% vs 67.2%; p=0.02). SAB-P frequency increased slightly (11.0% vs 15.1%). Risk (associated) factors for SAB-P (identified by logistic regression) were metastatic infection (OR=5.60; 95% CI 3.00 - 10.47), vancomycin treatment (OR=4.17; 95% CI 2.14 - 8.11), endovascular sources (OR=3.35; 95% CI 1.92 - 5.85) and diabetes (OR=2.14; 95% CI 1.26 - 3.64). SAB- and SAB-P-associated case-fatality did not change (23.2% vs 18.5% and 25.6 vs 30.8%, respectively). All survivors ultimately achieved clearance. These findings suggest that patients with SAB are changing over time. Additionally, SAB-P frequency is higher than previously reported. SAB-P rise is probably due to increasing SAB, MRSA, and patients at risk for complications. Innovative approaches should target novel treatment modalities and risk reduction. [ABSTRACT FROM AUTHOR]

Daptomycin is bactericidal against Staphylococcus aureus, with susceptibility defined as a minimal inhibitory concentration (MIC) ≤1 μg/ml. Higher MIC developed in a few cases during therapy. The frequency of MIC rise in persistent bacteremia is unknown. We evaluated all patients with S. aureus bacteremia (SAB) treated with daptomycin (≥2 days) from 1 April 2004 to 30 October 2006. All patients with post-daptomycin-exposure saved isolates were studied. Daptomycin susceptibility was determined (in duplicate) on all pre- and post-daptomycin-exposure isolates by the broth (Mueller-Hinton) microdilution method. Among 74 treatment courses in 67 patients, 18 were for SAB. Ten had persistent bacteremia (median = 11 days; range = 1–21) and post-daptomycin-exposure saved isolates. The patient age was 29–84 years (median = 57.5 years). Intravascular catheter was the most common source (50%). Most patients (90%) failed therapy prior to starting daptomycin. The initial daptomycin dose was 4 mg/kg in four (40%) cases. The pre-exposure MIC was 0.125–0.5 μg/ml. The post-exposure MIC increased in four cases and was elevated in two cases (60%), to 2 μg/ml in five and 4 μg/ml in one. MIC rise was noted within 5–15 days of exposure and persisted up to 247 days after stopping daptomycin. Pulse-field gel electrophoresis (PFGE) band pattern of isolates with increased MIC revealed 1–3-band differences, implying genetic relatedness. All patients with non-susceptible isolates relapsed or failed therapy. These findings illustrate that daptomycin susceptibility often decreases during the treatment of persistent SAB. Therefore, susceptibility should be closely monitored during therapy. [ABSTRACT FROM AUTHOR]

Background: Limb girdle muscular dystrophy (LGMD) is a phenotypic expression of a heterogeneous group of diseases and sarcoglycanopathy is one of the causes of LGMD. There is only one study on sarcoglycanopathies in the Indian literature. No data is available from northern India. Materials and Methods:All cases of muscular dystrophies, which were diagnosed in our laboratory in the last six years, were reviewed. Immunohistochemistry for various sarcoglycan proteins was done. Clinical features and pathological findings of the cases that were diagnosed as sarcoglycanopathies were reviewed. Results: In the last 6 ½ years (1998-June 2004), we received 1435 muscle biopsies, of which 498 cases were of muscular dystrophies, and 13 cases were of sarcoglycanopathies (8 of gamma, 3 of alpha, 1 of both alpha and gamma, and 1 with absence of all four sarcoglycans). Sarcoglycanopathies comprised 2.6% of all muscular dystrophies, 11.8% of LGMD and 0.90% of all muscle diseases diagnosed in our laboratory. The mean age of onset was 7.2 years and the M:F ratio was 1.1:1. Most of them presented with difficulty in getting up, climbing stairs, calf hypertrophy and markedly raised CPK levels. Histological features were like dystrophinopathies. Conclusion: Sarcoglycanopathies are a relatively rare cause of LGMD and should be confirmed by immunohistochemistry as it will facilitate counseling and also prognostification. Although rare, in patients with muscle weakness, calves hypertrophy and raised CPK levels this possibility should be considered and needs to be differentiated from dystrophinopathies. [ABSTRACT FROM AUTHOR]

Gamma glutamyl transpeptidase (GGTP), glutamic oxaloacetic transaminase (GOT), and glutamic pyruvic transaminase (CII') were measured serially in the serum and cerebrospinal fluid (CSF) of 22 patients with fresh stroke and an equal number of age- and sex-matched healthy control subjects. ft was observed that levels of these enzymes in the CSF of control subjects were very low but were significantly elevated (p < 0.001) in both serum and CSF in patients with stroke. The elevation was greater in the CSF than in the serum and was maximum during the first four days of stroke. Thereafter, the enzymatic activity declined. Of all these enzymes, GGTP in CSF correlated best with the clinical picture. It was possible to differentiate between the ischemic and hemorrhagic type of stroke on the basis of CSF levels of GGTP (> 60.0 units in hemorrhagic stroke). There was no correlation between GGTP levels in CSF and serum or among GOT, GPT, and GGTP in CSF. It can be concluded, therefore, that estimation of GGTP in CSF is helpful not only in predicting the degree of cerebral damage and functional outcome of the patient following stroke but also in differentiating the type of stroke. [ABSTRACT FROM AUTHOR]

The article offers information on the case of a 25-year-old female patient with Sjögren syndrome (SS), a medical condition where the functions of the salivary and lacrimal glands are compromised, who is also diagnosed with thrombocytopenia and autoimmune haemolytic anemia. Topics discussed include the results of her laboratory tests, confirmation of the SS diagnosis and success of a four-week treatment with prednisolone.

The article presents a case study of clinical acute pancreatitis ina 37-year-old woman following anterograde single balloon enteroscopy (SBE). The patient underwent capsule endoscopy with suspicion of Crohn's disease, but the capsule remained in the small bowel even after 14 days. The capsule was retrieved through SBE, but found multiple ulcers and one major stricture in the distal bowel. It suggests evaluating patients for acute pancreatitis in patients with posprocedural abdominal pain.

A letter to the editor is presented which discusses a case study of a 32-year-old woman diagnosed with cardiac septal hypertrophy and sporadic progressive external ophthalmoplegia (PEO) and ragged red fibers (RRF) in muscle biopsy with relapses.

Objective: To compare the serum profile of malondialdehyde (MDA) lipid peroxidation and major antioxidant (Vitamins E and C) in patients with Plasmodium falciparum and vivax malaria. Methodology: This comparative study was conducted at Department of Biochemistry, Sardar Patel Medical College, Bikaner, India. A total of 150 patients were studied. This included 100 patients with confirmed malaria (50 with Falciparum and 50 with vivax) and 50 healthy age matched subjects as control. Serum malondialdehyde (MDA) was measured to assess the degree of lipid peroxidation. Antioxidant status was measured by estimating the levels of Vitamins E and C. Result: This study suggests that serum malondialdehyde levels were significantly increased in malaria patients. The patients with Plasmodium falciparum infection showed significantly increased levels of lipid peroxides(Mean ±S D 3.22+1.09 ; p< 0.001)when compared to Plasmodium vivax malaria (2.49 + 0.86 ; p< 0.001). The antioxidant Vitamins E (p< 0.001) and C (p< 0.001) were decreased significantly in malaria patients in both the groups. Maximum decline in Vitamin C (0.20 + 0.07 ; p< 0.001) was observed in Plasmodium vivax malaria. Conclusion: Lipid peroxides are significantly raised in malaria patients; more in falciparum than vivax malaria. The antioxidants (Vitamins E and C) are decreased in both types of malaria. The protective role of routine antioxidant therapy in malaria patients needs further investigation. [ABSTRACT FROM AUTHOR]

Background: Nearly 100,000 presentations to non-tertiary hospitals per year result in an inpatient transfer [1]. The timely inter-hospital transfer of patients for cardiothoracic surgery is significant to their overall outcomes. We hypothesised that patients with a prolonged pre-operative admission were at risk of nosocomial infection, leading to prolonged hospitalisation, morbidity and mortality.Methods: Patients admitted to a non-tertiary centre (Frankston Hospital, Group 1) and requiring transfer to tertiary centres for cardiac surgery were compared to patients presenting directly to tertiary centres (Alfred Hospital, Group 2; St Vincent's Hospital, Group 3) from June 2011-July 2012. Data was obtained from medical records and the National Cardiac Surgery Database.Results: Eighty-seven patients in Group 1, 78 patients in Group 2 and 65 patients in Group 3 were identified. A higher proportion of total admission time was spent awaiting surgery in Group 1 compared to Group 2 (52.8% vs. 38.3%, p≤0.001) and Group 3 (52.8% vs. 26.3%, p≤0.001). Nosocomial infections occurred more frequently in Group 1 compared to Group 2 (20.7% vs. 5.1%, p=0.04) and Group 3 (20.7% vs. 6%, p<0.001).Conclusion: Presentation to a non-tertiary centre requiring inpatient cardiothoracic surgery is associated with longer pre-operative waiting time and higher rates of hospital-acquired infections. [ABSTRACT FROM AUTHOR]