Background: Hemorrhoids are very common diseases of the anal region and creates physical and psychological disturbances and significantly affects the quality of life. This study was aimed to determine the risk factors and clinical symptoms associated with it.Methods: The study was conducted in Krishnarajendra Hospital, Mysore, for a period of one year from January 1984 to December 1984. A total of 40 patients with hemorrhoids were included in the study. The risk factors and clinical symptoms associated with incidence of hemorrhoids were noted in detailed and analysed.Results: Male preponderance was seen in the study (85%). Patients with age group between 20-39 years were found of high incidence of hemorrhoids (55%). Out of 40, 15 (37.5%) males and 2 (5%) females had habitual constipation and 7 (17.5%) males had occasional constipation. Farmers were found to the most commonly affected people with hemorrhoids (60%) followed by students (15%), households (15%) and business man (10%). The common clinical symptom observed was bleeding per rectum and mass per rectum in 85% of patients, pain during defecation in 77.5%, soiling of clothes observed in 22.5% and history of pruritus in 12.5% of males.Conclusions: The patients suffering with hemorrhoids were suggested to adopt healthy life style and modifications at their occupations accordingly.

ᰔMycobacterium mageritense is an uncommon cause of catheter-related bacteremia (1, 4).We report a 26-year-old pregnant woman who presented with fever for 3 weeks. A tunneled central venous catheter (CVC) had been placed due to hyperemesis. The patient did not have any immunocompromised conditions. Blood cultures were performed by use of BACTEC Aerobic Plus and Anaerobic Lytic. Anaerobic cultures from both the central line and a peripheral site showed beaded gram-positive rods. The time to detection was 103 h. A modified acid-fast stain was highly suggestive of a nontuberculous mycobacterium (NTM) which was identified as Mycobacterium mageritense by DNA sequencing. Susceptibility studies performed by a broth dilution MIC method showed the organism to be susceptible to ciprofloxacin (MIC, 0.5 g/ml) and trimethoprim-sulfamethoxazole (TMP-SXT) (MIC, 0.5 and 9.5 g/ml, respectively) and resistant to amikacin (MIC, 128 g/ml) and clarithromycin (MIC, Ͼ64 g/ml). The breakpoints were determined according to standards of the Clinical and Laboratory Standards Institute (CLSI).Intravenous TMP-SXT was initiated. The catheter was removed 1 week later, and the tip was cultured using the roll plate technique on sheep blood agar. No growth was observed after 5 days of incubation. The patient was treated for 2 weeks with intravenous TMP-SXT, with complete resolution of her symptoms.To our knowledge, this is the second reported case in the literature of a CVC-related bloodstream infection due to Mycobacterium mageritense. The first reported case occurred in a 32-year-old immunocompromised woman who was treated with linezolid and amikacin.Clinical disease produced by M. mageritense is uncommon and ranges from skin and soft tissue infection to health careassociated infections (4). It is a nonpigmented, rapidly growing mycobacterium, closely resembling the M. fortuitum third biovariant complex (2, 4). The source of M. mageritense in our case remains unclear.Although bloodstream infection with NTM usually occurs in immunocompromised patients with CVC, our case occurred in a patient with no immunocompromised state. The catheter tip did not grow the organism, which may be due to the patient's prior antimicrobial therapy. Also, since this catheter was cultured using the roll plate technique (which detects only extraluminal colonization), intraluminal colonization, frequently seen with long-term catheters, was not detected. CVC infection is documented with a positive catheter tip in only 15 to 25% of cases with presumptive CVC-related infection. There are no treatment guidelines for NTM bloodstream infections.The decision to remove the catheter from our patient was based on previously reported cases of M. fortuitum bacteremia in which a high relapse rate was seen if catheters were not removed (3).The susceptibility pattern of this isolate of M. mageritense resembles that of the M. fortuitum group. Given that isolates of M. mageritense have growth, biochemical, and drug susceptibility patterns of the M. fortuitum third biovariant complex, i...

A 30-year-old African student from Kumba, Cameroon, was evaluated in a university travel clinic for a " foreign body sensation " in his right eye which lasted for 5 hours. At the time of these symptoms, he had visualized a thin, clear worm traveling across the right eye. After the worm had passed, the foreign body sensation resolved but was followed with intense conjunctivitis. His past history was significant for malaria 6 years ago but was otherwise unremarkable. He had been residing in the United States for 2 years during which time he had no history of international travel. He denied any migratory swellings or rash. On evaluation the following day, he had conjunctival injection of the right eye, but no worm was visualized on gross examination or on evaluation under a slit lamp. Physical examination was otherwise unremarkable.Additional investigations showed a white blood count of 6,400/ L with 8% eosinophils (range: 1% -6%). Liver enzymes and renal functions were normal. Peripheral blood smear drawn at 3 pm was signifi cant for the presence of sheathed microfi lariae of Loa loa ( Figure 1 ). The microfi lariae were quantifi ed at 4,910 microfi lariae/mL of blood. Loa loa polymerase chain reaction was also positive, establishing the diagnosis of loiasis. Concomitant infection with onchocerca was ruled out by skin snips taken from bilateral shoulders, hips, and thighs. The patient was referred to the National Institute of Health for treatment and underwent apheresis on hospital days 1 and 2. Subsequently, he received prednisone 40 mg/d for 3 days which was rapidly tapered. Diethylcarbamazine (DEC) was then administered in incremental doses with 50 mg on day 1, followed by 50 mg three times per day for the next 3 days. The dose was gradually increased to 200 mg three times a day to complete 21 days of therapy. Microfi larial quantifi cation at the time of discharge was 2,250 microfi lariae/mL of blood. The treatment was tolerated well. On follow-up evaluation, no clinical relapse was detected and blood smear was negative for any microfi lariae. The patient will be followed at 6-month intervals to monitor for relapse. DiscussionLoiasis is endemic in the rain forests of Central and West Africa. Between 3 and 13 million people are estimated to be infected with it.2 The presence of three terminal nuclei and observation of sheathed microfi lariae (approximately 290 by 7.5 m) in a daytime blood specimen are features characteristic of L loa. These characteristics help differentiate this organism from the blood-borne microfi lariae of Wuchereria bancrofti and Mansonella perstans , whose geographic distribution overlap that of L loa.3 The microfi lariae of M perstans are much smaller, have no sheath, and have nuclei extending to the end of the tail, whereas those of W bancrofti are sheathed microfi lariae seen only on specimens drawn at night.

Health profession students work in close proximity to patients and could be a source of nosocomial influenza. We studied the proportion of health profession students presenting for immunization at an influenza immunization campaign. This assessment is useful to guide future campaigns as we prepare for pandemic influenza.

Orbital infection with nontuberculous mycobacteria is rare and usually presents as an inflammatory process. We report a case of a 34-year-old male hospital worker with a positive purified protein derivative skin test who had Mycobacterium fortuitum infection that presented as an orbital mass causing diplopia. This presentation is unlike previously published reports and demonstrates the importance of orbital biopsy and tissue culture.