Background: Infection is a common cause of morbidity and mortality in burn patients. Clinical diagnosis of bacteremia and/or sepsis in burn patients is difficult for a number of reasons. It could be symptomatic and/or asymptomatic as a result of immune deficiency secondary to thermal injury.Methods: A retrospective study was conducted at Mahatma Gandhi Hospital Burn Unit Associated with Dr. S. N. Medical College, Jodhpur, Rajasthan. Fifty burn patients were investigated for bacterial profile of burn wound infections. Specimens were collected on 3rd and 7th day of burns in the form of wound swabs. The organisms were isolated and identified by standard microbiological methods. Antimicrobial susceptibility test was done by Kirby -Bauer disc diffusion method.Results: Gram negative organisms were found to be more prevalent. The most common isolate was Pseudomonas aeruginosa (P. aeruginosa) -38%, followed by Staphylococcus aureus (S. aureus) -35%, Klebsiella spp.-8%, Acinetobacter spp -5%, Staphylococcus epidermidis - 5%, Proteus spp. -3% and Escherichia coli -1%.Conclusions: Pseudomonas was the commonest cause of infection in fire burn patients in our setting followed by S. aureus. About 82% of the isolates showed multiple resistances. In light of our findings, regular antibiotic resistance test has to be done for each patient in order to select an appropriate antimicrobial agent.

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The contribution of dietary Ca and P in renal stone formation is debated. Thus, the main objective was to investigate if there were any differences in the dietary, serum and urine values of Ca and P in stone formers (SF) compared with healthy controls (HC). The secondary aim was to analyse if dietary, serum and urine Ca and P correlated. The study enrolled ten patients with renal stones admitted for stone removal and ten healthy controls. Their dietary macronutrients, Ca and P intakes were calculated from 2-d dietary records. On the second day of dietary record 24-h urine was collected and on the third day morning a 5 ml blood sample was collected. Biochemical analyses were conducted for serum and urine Ca, P and uric acid with qualitative renal stone analysis. All the dietary intakes and urine P were significantly higher (P < 0.05) in SF than in HC. Correlation results showed that in SF dietary Ca correlated to serum and urine Ca. No such correlations were seen for P. Additionally, in SF urine Ca correlated to dietary proteins and fats but not to carbohydrates. None of the biochemical values lay outside the normal range of values. The study suggests urine P rather than urine Ca to be probably at work in the formation of renal stones. Limitation of protein intake with normal Ca intakes could provide a suitable measure to avoid renal stone formation.

Background and objectiveSince early 2020, the novel coronavirus disease 2019 (COVID-19) has turned into a global healthcare concern. The usual clinical presentation of COVID-19 infection includes myalgia, headache associated with pyrexia, and sore throat. Our study aimed to assess the severity of lower urinary tract symptoms (LUTS) in COVID-19 patients and determine its correlation with the prognosis of the disease. MethodsWe conducted an observational study in the COVID-19 care unit at a tertiary care teaching center in Rajasthan on patients diagnosed as COVID-19-positive. The overactive bladder (OAB) symptom scoring system for LUTS and the CT scoring system for lung involvement in COVID-19 patients were used to evaluate the sample population. ResultsWhile our findings showed a non-significant association between OAB and CT score (p>0.05), correlation analysis revealed that the length of hospital stay was significantly longer and oxygen needs were significantly more frequent with severe LUTS. ConclusionsBased on our findings, de novo LUTS, particularly storage symptoms, may be present in COVID-19-positive cases, and the severity of these symptoms may have an impact on the patient's length of stay in the hospital. Hence, doctors and other medical professionals should consider COVID-19-related bladder dysfunctions such as de novo LUTS as part of COVID-19 symptomatology.

Background: A diagnostic approach for complicated appendicitis is still controversial. We analyzed the preoperative laboratory markers that may predict complicated appendicitis.Methods: To study the role of leukocytosis, hyperbilirubinemia, decreased mean platelet volume (MPV) and increased international normalized ratio (INR) in the prediction of complicated appendicitis. Total 60 patients were enrolled and divided them into 2 groups, un-complicated (AUA) and complicated (ACA) acute appendicitis, each having 30 cases.Results: Total leucocyte count (TLC) >10000 mm³ was found in 70% of AUA cases and 80% of ACA cases serum bilirubin >1 mg/dl was found in 66.67% of AUA cases and 80 % of ACA cases. MPV<7.6 fL was found in 60% of AUA and 80% of ACA cases INR >1.2 was found in 20 % of AUA and 40% of ACA cases. TLC >10000/mm³, serum bilirubin >1 mg/dl and MPV <7.6 fL was found in 46.67% of AUA cases and 70 % of ACA cases.Conclusions: Total leucocyte count, serum bilirubin and mean platelet volume have a predictive potential for the diagnosis of complicated appendicitis.

IntroductionLiver abscesses are rare, but whenever they occur, it is predominantly among males over 60 years of age. The paradigm in the treatment has changed, and percutaneous drainage is now the initial treatment for drainage of the abscesses. Open surgery is reserved for patients with septated abscesses and those greater than 5 cm. ObjectiveTo study the etiological, clinical, pathological, and demographic characteristics of individuals with liver abscesses and to evaluate the outcome associated with different treatment strategies. MethodsThis clinico-epidemiological study was carried out at a tertiary care hospital in Jodhpur. One hundred patients with liver abscesses were studied. Patients were assigned to three groups: Group 1 -medical management alone (in non-aspirable uncomplicated abscess), Group 2 -USG-guided needle aspiration or pigtail percutaneous catheter drainage plus medical management (in unruptured aspirable abscess), Group 3 -open surgical drainage plus medical management (In ruptured abscesses). Of the total patients, 36% were treated with medical therapy alone, 45% with USG-guided needle aspiration, 10% with USG-guided percutaneous catheter drainage, and 9% with open surgical drainage. ResultsIn our study, fever and hepatomegaly were the commonest presentations, observed in 91% and 62% of cases, respectively. Escherichia coli (E.coli) was the predominant organism cultured in 28 (43.75%) patients followed by Klebsiella growing in 24 (37.50%) patients. The right lobe was affected more (83%) than the left lobe and in the majority (83%), a solitary abscess was present. The mean age of liver abscess presentation was 40.72 years, with a 5.67:1 male-to-female ratio. Alcohol consumption was reported by 33% of patients, the majority of whom were men. Serum bilirubin was elevated in 56% of liver abscess patients, while it was normal in 44%. The mean serum bilirubin was 2.08 mg/dl. The mean value in group 1, group 2, and group 3 was 1.44 mg/dl, 2.23 mg/dl, and 2.57 mg/dl, respectively. Liver abscesses were identified in 76% of patients with right lobes; 83% had solitary liver abscesses and 17% had numerous abscesses. Abscess culture showed E. coli in 21 (32.81%) and Klebsiella in 17 (26.56%) patients. ConclusionRight-sided solitary pyogenic liver abscess caused by E.coli is the most common liver abscess, with fever and hepatomegaly as the most common presentation. Non-aspirable liver abscesses, regardless of aetiology, can be successfully treated by medical therapy alone. Needle aspiration or catheter drainage is standard for liver abscesses. Thus, needle aspiration has replaced the surgical exploration of liver abscesses.

Rosai-Dorfman-Destombes disease (RDD) is an uncommon histiocytic disorder of unknown aetiology. Extranodal involvement occurs in a significant proportion of patients but involvement of the kidney is rare. Here we present a case report of extranodal RDD of the kidney. Imaging revealed a heterogeneously enhancing solid mass lesion in left renal hilum infiltrating renal medulla and deeper layers of renal cortex. With the clinical diagnosis of suspected left renal cell cancer, laparoscopic left radical nephrectomy was performed. Macroscopic examination showed specimen covered with Gerota’s fascia and perinephric pad of fat. Renal capsule could be easily split off. On cut section, ill circumscribed solid lesion having variegated appearance with areas of necrosis and haemorrhage, involving middle and lower pole, was noted. Renal sinus appeared to be involved. Microscopic examination showed sheets of histiocytes with abundant eosinophilic to vacuolated cytoplasm. There was emperipolesis of intact lymphocytes. Also, seen were sheets of plasma cells, lymphocytes with intervening dense hyalinised stroma. Retro peritoneal lymph nodes and para-aortic lymph nodes also showed similar histological picture. Immunohistochemistry showed that the histiocytes were positive for S100 and CD68. IgG4-positive plasma cells were not seen. These findings showed that the lesion represented and extranodal RDD of the kidney. Although rare, extranodal RDD should also be included in the differential diagnosis of a renal mass and frozen section be advised whenever feasible.