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author:("Banu, arima")
1.  A rare case of onychomycosis in all 10 fingers of an immunocompetent patient 
Onychomycosis, traditionally referred as a non-dermatophytic infection of the nail, is now used as a general term to denote any fungal nail infection. It is an important public health problem due to its increasing incidence and has significant clinical consequences in addition to serving as a reservoir of infection. We report a case of Onychomycosis in all 10 fingers of an immunocompetent male with no co-morbid conditions caused by a non-dermatophytic fungus, Aspergillus niger. To the best of our knowledge, this is the first case of its kind to be reported.
PMCID: PMC3853896  PMID: 24350011
Aspergillus niger; onychomycosis; superficial infections
2.  Baseline antibody titres against Salmonella typhi in apparently asymptomatic HIV positive individuals in a tertiary care hospital 
The Australasian Medical Journal  2013;6(7):354-357.
Enteric fever is common in tropical regions and is caused by Salmonella enterica serotype typhi (S typhi ). For diagnosis of enteric fever, the Widal test is the most widely used test after blood culture. In HIV infected individuals false positive and false negative Widal reactions are common. The result is variable titres and baseline titres that are unusual in this patient population.
This study was done to determine the baseline antibody titres for S typhi among HIV infected individuals.
Average baseline antibody titres against O and H antigens of S typhi were measured by standard Widal test in 200 HIV positive asymptomatic individuals, as well as 200 age and sex-matched controls. The results were compiled and statistically analysed.
A total of 84 (42%) of the cases had an H antibody titre of >1:20 and 105 (52.5%) had a titre of >1:20 against O antigen. This implies that positive titre of H and O antigen is significantly associated with HIV positive cases with P<0.001. Correlation of CD4 count with antibody titres shows that there is no significant association between CD4 counts and antibody titres against either H (P=0.634) or O antigen (P=0.765)
This study shows that HIV infected individuals had increased titres of antibodies against S typhi from the baseline. This indicates a need for evaluation of current cut-off values of diagnostic titres for this group. We also suggest that it is best to perform baseline titres against S t yphi for each patient at the time of diagnosis of HIV status, and to use this for future reference.
PMCID: PMC3737764  PMID: 23940495
Salmonella typhi; Widal test; HIV/AIDS
3.  Post-traumatic endophthalmitis due to Brevibacterium casei : A case report 
Endophthalmitis is a serious post-traumatic ocular complication that can lead to loss of vision. We report a case of acute post-traumatic endophthalmitis following a penetrating injury caused by an unusual organism, Brevibacterium casei . The patient was successfully treated with intravitreal antibiotics like ceftazidime and vancomycin, along with topical cefazolin and tobramycin. Brevibacterium casei can be added to the list of rare bacteria causing endophthalmitis and should be kept in mind by clinicians as a potential source of pathology.
PMCID: PMC3593521  PMID: 23483044
Ocular complications; Endophthalmitis; Brevibacterium casei
4.  Inadvertent Intramuscular Administration of High Dose Bacillus Calmette Guerin Vaccine in a Pre-term Infant 
This case report examined the natural course of reaction after accidental intramuscular administration of high dose Bacille Calmette-Guιrin (BCG) vaccine into the anterolateral aspect of thigh of a pre-term infant as a part of routine vaccination instead of intra-dermal injection into the arm. There is no consensus on the best management of this complication, although in this case healing was prolonged but was spontaneous without anti-tubercular chemotherapy.
PMCID: PMC3894009  PMID: 24479056
Bacille Calmette-Guérin; tuberculosis; vaccination
5.  White Coats as a Vehicle for Bacterial Dissemination 
White coats are known to be potential transmitting agents of multi-drug resistant organisms. This study was conducted to determine the level and type of microbial contamination present on the white coats of medical students in order to assess the risk of transmission of pathogenic micro-organisms by this route in a hospital setting.
Materials and Methods
A cross sectional survey of the bacterial contamination of white coats in a tertiary care hospital. 100 medical students working in various specialties were included in the study. Swabs were taken from 4 different areas of the white coat – collar, pocket, side and lapel and processed in the Microbiology department according to standard procedures.
Although most of the white coats had been washed within the past 2 weeks, the sides of the coats were the most highly contaminated areas followed closely by the collar and pockets. Staphylococcus aureus was the most common isolate followed by coagulase negative Staphylococci and Gram negative non fermenters. Most of the Gram positive cocci were resistant to Penicillin, Erythromycin and Clindamycin.
White coats have been shown to harbor potential contaminants and may have a role in the nosocomial transmission of pathogenic microorganisms. Thus, a yearly purchase of white coats and the possession of two or more white coats at any point in time should be made compulsory. There is pressing need to promote scrupulous hand washing before and after attending patients and alternatives to white coats, including universal use of protective gowns, should be considered.
PMCID: PMC3471503  PMID: 23205352
White coat; Bacterial contamination; Nosocomial infection
6.  Efficacy of fresh Aloe vera gel against multi-drug resistant bacteria in infected leg ulcers 
The Australasian Medical Journal  2012;5(6):305-309.
Infected leg ulcers are major health problems resulting in morbidity and disability and are usually chronic and refractory to antimicrobial treatment.
The present study is aimed at determining the bacteria involved in leg ulcers and their resistance patterns to commonly used antibiotics as well as to determine whether Aloe Vera has antibacterial activity against multi-drug resistant organisms and promotes wound healing.
A total of 30 cases with leg ulcers infected with multi-drug resistant organisms were treated with topical aloe vera gel and 30 age and sex-matched controls were treated with topical antibiotics. Culture and sensitivity was done from the wounds on alternate days and the ulcer was clinically and microbiologically assessed after 10 days. The results were compiled and statistically analysed.
Cultures of the study group who were using aloe vera dressings showed no growth by the fifth day in 10 (33.3%) cases, seventh day in another 16 (53.3%) and ninth day in two of the remaining four cases (6.7%) while in two (6.7%) cases there was no decrease in the bacterial count. This means that of the 30 cases, 28 showed no growth by the end of 11 days while two cases showed no decrease in bacterial count. Growth of bacteria in study group is decreased from 100% (30 cases) to 6.7% (2 cases) by day 11 with P<0.001. Cultures of the control group did not show any decrease in the bacterial growth by day 11.
Aloe vera gel preparation is cheap and was effective even against multi-drug resistant organisms as compared to the routinely used topical anti-microbial agents.
PMCID: PMC3395293  PMID: 22848328
Leg ulcers; multi-drug resistant bacteria; Aloe vera
7.  Immunological failure despite virological suppression in HIV seropositive individuals on antiretroviral therapy 
Some individuals experience a discordant response during antiretroviral therapy (ART), with a blunted CD4+ cell count response despite low HIV-1 RNA plasma levels.
Materials and Methods:
CD4 counts and viral load of 251 individuals on ART referred to the center were analysed for immunological failure. The viral load tests of 28 patients revealed a discordant response, characterized by low CD4 counts despite viral suppression (<47 copies in 23, <5000 in 4 patients and <10000 in one patient). Univariate and multiple regression analysis was done to determine factors associated with immunological failure in patients with viral suppression.
Twenty-eight patients developed immunological failure over a duration of 3.7±1.14 years despite viral suppression. In univariate analysis of discordant patients, low CD4 counts(<100cells/μl) at start of ART(P=0.0261), less than 50% gain in CD4 count (P=0.048) after one year of start of ART and duration on ART for more than 3 years (P=0.0436) were associated with immunological failure. In multiple regression, duration on ART, age and nadir CD4 count (lowest ever) on treatment were predictors of immunological failure in these patients. Overall females (n=8) demonstrated much higher CD4 counts of 136±72 than males (n=20) 79±38 cells/μl at the time of diagnosis of immunological failure.
Discordance was observed in 13.59% of patients. Detection of failure to first line therapy based on immunologic criteria, without viral load testing, can result in unnecessary switches to 2nd line therapy.
PMCID: PMC3195189  PMID: 22021970
Antiretroviral therapy; discordant response; immunological failure; viral load; viral suppression

Results 1-7 (7)