m e d i c a l j o u r n a l a r m e d f o r c e s i n d i a 7 2 ( 2 0 1 6 ) s 4 3 -s 4cations hence the blood transfusion practices should be streamlined and adhered to and reviewed periodically. This retrospective study was undertaken at one of the tertiary care hospital to find out the blood demand and utilization practices among the delivery cases and suggest measures if any to improve the existing practices. Methods:The study was performed over two years; normal standard practice like in any other hospital is being followed. Urgent blood demand is requisitioned whenever there is an emergency like a patient having post partum hemorrhage or abruptio placenta etc. Blood demand forms, blood administration and delivery records were checked and analyzed.Results: 121 cases were given blood transfusion indicating the incidence as 2.67% among total delivery cases, blood transfusion among elective CS cases was 1.58% and 3.84% in emergency cesarean section; 2.82% of vaginal delivery were given blood transfusion for various unforeseen indications. Conclusion:In spite of taking all measures hemorrhage can still occur at times so perilous that it must be managed energetically and promptly. The mode of delivery has some influence on blood transfusion. It is suggested that blood demand could be restricted only to high risk cases both for normal delivery and CS. This will reduce the work load on blood banks and there by improve efficiency. #

BackgroundConcurrent dengue and mixed malaria infections in a single patient present with overlapping clinical manifestations which pose a diagnostic challenge and management dilemma in areas of common endemicities.MethodsWe report a case of a young male who tested positive for both Plasmodium vivax and Plasmodium falciparum along with dengue infection. He showed signs of early treatment failure to artemisinin combination therapy (artesunate with sulfadoxine+pyrimethamine). Molecular analysis for the drug resistance genes viz: chloroquine resistance (pfcrt), multidrug resistance (pfmdr-1), sulfadoxine (pfdhps), pyrimethamine (pfdhfr), and artemisinin resistance (keltch 13) was performed.ResultsA rise in parasitemia from <2% to 5% was observed after 3 days of treatment. Mutations in pfcrt, pfmdr-1, pfdhfr, and pfdhps genes were detected as a possible cause of treatment failure.ConclusionIncreased severity, overlapping symptoms, and suspected resistance to treatment warrants a multidimensional diagnostic approach and diligent therapeutic monitoring.

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Introduction. Fluoroquinolone (FQ) resistant Salmonella are classified as high priority pathogens by WHO. FQ resistance among Salmonella Typhi has emerged rapidly and is predominantly mediated by mutations in the topoisomerase genes gyrA, and parC. Mutations in GyrA result in classical FQ resistance (DCS-NAR) i.e. decreased susceptibility to ciprofloxacin (MIC of 0.12 to 0.5 µg ml−1) (DCS) and resistance to nalidixic acid (NAR). Previously a nalidixic acid disc test was proposed for detection of DCS. Recently isolates with non-classical FQ resistance caused by plasmid-mediated quinolone resistance (PMQR) and mutations in GyrB have emerged. These mechanisms also result in DCS but are nalidixic acid susceptible (NAS) and thus pose diagnostic challenges. CLSI and EUCAST have recommended use of 5 µg pefloxacin discs for detection of DCS in Salmonella . Hypothesis. The CLSI and EUCAST recommendations for use of 5 µg pefloxacin for detection of DCS has not been validated on typhoidal Salmonella and resistance mediated by GyrB mutation in Salmonella species. Aim. The aim of the present study was to validate the performance of the 5 µg pefloxacin discs to detect isolates of S. Typhi with DCS with special reference to GyrB mutations. Methodology. A total of 180 clinical isolates of Salmonella Typhi (2005–2014) were investigated for genetic mechanisms of resistance. Zone diameters for nalidixic acid (30μg), ciprofloxacin (5μg) and pefloxacin (5µg) and minimum inhibitory concentration (MIC) for ciprofloxacin were determined using CLSI guidelines. Performance of the three discs was evaluated to detect FQ resistance in S. Typhi. Results. Topoisomerase mutations in GyrB +/ ParC and GyrB were detected in 112 and 34 isolates respectively. Different mutations have a varied effect on the MIC for ciprofloxacin. The current breakpoints for susceptible (≤0.06 µg ml−1) and non-susceptible (≥0.125 µg ml−1), failed to detect all isolates with a resistance mechanism. Performance of both ciprofloxacin and pefloxacin discs were excellent compared to nalidixic acid in differentiating isolates with non-classical resistance mediated by GyrB from wild-type. Conclusion. The pefloxacin disc can be used to detect FQ resistance among S. Typhi. This is the first report of validation of pefloxacin for detection of FQ resistance in S. Typhi mediated by GyrB mutation.

Chronic canaliculitis is an inflammation of the lacrimal canaliculus. Inflammation of lacrimal canaliculus can occur secondary to dacryocystitis, but the most common cause is infection. 1 Bacteria, fungi and viruses can cause infection. The most common presenting symptom of canaliculitis is chronic conjunctivitis. Actinomyces species is classically cited as the most common organism causing canaliculitis. 2-4 Concretions in the lower palpebral conjunctiva/fornix with conjuctivitis can also be the presenting symptom of Actinomyces infection. 5 We hereby report two cases of chronic conjunctivitis, one with canaliculitis and the other with palpebral concretions, both were positive for Actinomyces and responded to topical 5% cefazoline eyedrops. Case Report-1 A 50 year old male presented to us with complaints of chronic irritation,watering and occasional redness of the right eye since past 8 months. He was prescribed various topical antibiotic drops but he did not respond to any of them. On examination, his vision was 6/6 in both eyes. Examination of the right eye revealed a tender swelling in the medial one third of the right lower lid with congestion of adjacent lower palpebral conjunctiva and pouting lower punctum (Figure 1