Airborne fungal cell fragments in homes in relation to total fungal biomass

Fungal exposure may induce respiratory symptoms. The causative agents are compounds in the fungal cell wall. Fragments of microbes may be present in air samples but are not measurable using conventional spore counting or by the determination of viable organisms. This study assesses the proportion of fungal cell biomass and endotoxin in different particle size fractions in air samples from homes. Air samples were collected from 15 homes using a cyclone sampler, collecting particles in three aerodynamic size fractions: <1.0, 1.0-1.8, and >1.8 μm. N-Acetylhexosaminidase (NAHA) was determined as a marker of fungal cell biomass. Endotoxin was determined using the Limulus amebocyte lysate method. NAHA and endotoxin in the size range <1.0 μm comprised up to 63% (mean 22.7%) and 96.3% (mean 22.6%) of the total concentrations, respectively. There were significant relationships between the amounts of NAHA and endotoxin in the total amount and in the size fraction >1.8 μm but not in the smaller fractions. The results demonstrate significant amounts of fungal cell biomass and endotoxin in particles <1.0 μm. Homes with reported mold damage had a lower concentration of NAHA in particles <1.0 μm than homes without mold damage. To assess airborne exposure for diagnostic and preventive purposes, measurement techniques that include this fraction should be considered.

Evaluation of virulent multidrug resistant Klebsiella infection status in a tertiary care hospital in Eastern India

Klebsiella especially Klebsiella pneumoniae is gaining renewed interest because of emergence of multidrug resistance among klebsiellae associated with infections.These are now being recognised as one of the major threats to effective management of patients in hospital, especially in developing country like India. Pathogenic mechanism of klebsiella Infections are associated with virulence factors such as capsule and mucoid phenotype, etc. The present study was designed to determine the virulence factors and antibiogram of klebsiellae, isolated from various clinical specimen in a tertiary care hospital of West Bengal, India. A total of 2370 clinical specimens which include blood, urine, wound swab, sputum were processed for isolation and identification of klebsiella to the species level. For each klebsiella isolate demonstration of capsule was done by capsule relief stain and detection of mucoid phenotype was done by string test. Antibiogram was studied by Kirby-Bauer disc diffusion method according to Clinical and Laboratory Standard Institute (CLSI) guidelines. The results showed that klebsiella species were isolated and identified from 139 clinical samples (5.9% prevalence rate) among which 4 (2.9%) were Klebsiella oxytoca and the remaining 135 Isolates (97.1%) were Klebsiella pneumoniae. Out of 139 klebsiella isolates, capsule was demonstrated in 118 (84.9%) and 116 (83.4%) were positive for string test. Antibiogram revealed that most of isolates of Klebsiella pneumoniae were multidrug resistant.

Lateral sinus thrombosis and haemorrhagic ischemic stroke with protein S deficiency in a young

Stroke or cerebro-vascular disease is one of the most important causes of high morbidity and mortality throughout the world. Stroke in young individuals poses a major problem as these individuals are the earning members of the family. Ischemic strokes are increasingly being attributed to causes other than athero-thrombotic disease. Protein S deficiency is a disorder with increased risk of venous thrombosis. Our patient, 19 years old lady presented with haemorrhagic venous infarction in right temporo-occipito-parietal region with right sided lateral sinus thrombosis.

Adjunct therapy of Ayurvedic medicine with anti tubercular drugs on the therapeutic management of pulmonary tuberculosis

BACKGROUND

Pulmonary tuberculosis (PTB) is an age old disease described in Vedic Medicine as 'Yakshma'. Later on, in Ayurveda it earned a prefix and found way into mythology as 'Rajayakshma'. After the discovery of streptomycin, the therapeutic management of PTB received a major breakthrough. The treatment module changed remarkably with the formulation of newer anti-tubercular drugs (ATD) with appreciable success. Recent resurgence of PTB in developed countries like United States posed a threat to the medical community due to resistant strains. Consequently, WHO looked toward traditional medicine. Literature reveals that Ayurvedic treatment of PTB was in vogue in India before the introduction of ATD with limited success. Records show that 2766 patients of PTB were treated with Ayurvedic drugs in a tertiary care hospital in Kolkata in the year 1933-1947.

OBJECTIVES

To evaluate the toxicity reduction and early restoration by adjunct therapy of Ayurvedic drugs by increasing the bio-availability of ATDs.

MATERIALS AND METHODS

In the present study, treatment response of 99 patients treated with ATD as an adjunct with Aswagandha (Withania somnifera) and a multi-herbal formulation described in Chikitsa-sthana of Charaka samhita i.e. Chyawanprash were investigated. Hematological profile, sputum bacterial load count, immunoglobulin IgA and IgM, blood sugar, liver function test, serum creatinine were the assessed parameters besides blood isoniazid and pyrazinamide, repeated after 28 days of treatment.

RESULTS

The symptoms abated, body weight showed improvement, ESR values were normal, there was appreciable change in IgA and IgM patterns and significantly increased bioavailability of isoniazid and pyrazinamide were recorded.

CONCLUSION

This innovative clinical study coupled with empowered research may turn out to be promising in finding a solution for the treatment of PTB.

A study on evaluation of antidepressant effect of Imipramine adjunct with Ashwagandha and Bramhi

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Histological changes of placentas associated with intra-uterine growth restriction of fetuses: a case control study

Placenta is the maternal-fetal contact zone. The placentas of "idiopathic" intra-uterine growth restriction (IUGR) babies may hold the key to the etiology of growth restriction. The present study primarily aimed at evaluating the structural peculiarities of IUGR placenta. The study was conducted on 35 IUGR and 25 control placentas. Placental tissues were processed for routine histological studies, to determine numbers of syncytial knots in villi and X-cells in the basal plate. Light microscopy suggested that syncytiotrophoblastic lining was more degenerated and number of syncytial knots increased in IUGR placentas than that of the control placentas. X cells were present in both the cases, though more in IUGR. Intravillous and perivillous fibrin depositions were markedly increased in IUGR; also there were more hypovascular/avascular villi and large areas of infarction. Cumulative effects of several placental injuries, e.g. poor perfusion, presence of increased number of X-cells, increased fibrin deposition; etc for a sufficient time were likely cause of IUGR.

A study on evalution of antidepressant effect of imipramine adjunct with Aswagandha and Bramhi

Depressive disorders increase the risks of self-harm or even suicide in patients. Indigenous drugs are being tried to treat such patient along with conventional antidepressant drugs. This study was planned to investigate the antidepressant action of Ashwagandha and Bramhi and also to confirm its efficacy in the behavioural despair animal model of depression. Normal saline as control (5 ml/kg), Imipramine as standard (16, 32, 64 mg/ kg) and Ashwagandha (50, 100, 150 mg/kg), Bramhi (20, 40, 80 mg/kg) as test drugs were introduced to the albino rats weighing between 200-250 gm for 2 weeks, 1 hr before electric shock in Learned helplessness test (LHT) and swimming in Forced swimming test (FST). Effects of individual drugs as well as their combination were evaluated. Avoidance response, escape failure and immobility period in case of Imipramine and Ashwagandha showed highly significant (p < 0.01) result on individual use. There was no significant result in case of Bramhi used alone except in escape failure and immobility period (FST), where at higher doses it showed significant (p < 0.01) result. But combination of Bramhi and Ashwagandha in low doses with low dose of Imipramine gave a highly significant result (p < 0.01) in all the parameters. Ashwagandha had significant antidepressant action, but Bramhi had not when used alone. Combination of these two indigenous drug with Imipramine showed high efficacy in animal model.

3α-Dimethylamino-20-(N-methylacetamido)pregn-5-ene

The title compond, C₂₆H₄₄N₂O, is an steroidal alkaloid isolated from the medicinally important plant Sarcococca saligna. The mol­ecule consists of four fused rings (A–D), having chair, half-chair, chair and envelope conformations, respectively. The dimethyl­amino group is axially oriented on ring A, whereas the (N-methyl­acetamido)­ethyl group is attached equatorially on ring D. The crystal structure is stabilized only by van der Waals forces.

Attitude of medical students about different teaching aids used in lectures in anatomy

Nowadays medical teachers use different audiovisual (AV) aids of teaching in their classes to make the subject more interesting and understandable. To assess the impact of three common lecture delivery methods, viz Blackboard (BB), Transparency and Over Head Projector (OHP) and Powerpoint Presentation (PP), a questionnaire based study was carried out among first year MBBS students of R.G.Kar Medical College, Kolkata. One hundred fouty students of academic session 2010-2011 were exposed to different aids of teaching, viz. Black Board (BB), Over Head Projector (OHP), power point presentation (PP) for ten months. They were taught Anatomy by different teachers who used all the three AV aids in their lectures. Then they were asked to respond to a questionnaire regarding these three AV aids of teaching. The students preferred Black Board teaching over OHP and result was statistically significant (p value < 0.0001). BB teaching was also preferred over PP presentations (p < 0.02). But in comparison to OHP, students preferred PP though the difference is not statistically significant (p < 0.10). Most of the students still prefer Black Board teaching to other modern AV aids like OHP and PP. For better understanding of a subject by students and improvement of their performance, a teacher should match the lectures with preferred AV aids and use the AV aids prudently.

Drug utilization pattern in pregnant women in rural areas, India: cross-sectional observational study

AIM

The aim of this study was to evaluate the drug-utilization trend of pregnant women in rural areas of central India.

MATERIALS AND METHODS

This was a prospective, observational study using a questionnaire, face-to-face interview and a prescription audit.

RESULTS

The majority of the subjects were primigravida (51.4%), from the lower socioeconomic group (71.3%) and with poor formal education. Although the drugs prescribed for them per prescription (2.66) were within rational limits, there was scope for improvement in generic (21%) and essential drugs (18%), antibiotics (9.6%) and injections (10.97%).

CONCLUSIONS

Morbidity and mortality during the antenatal period occur due to different factors. Regular drug-utilization studies following the guidelines of the World Health Organization and information, education and communication factors related to drug use by pregnant women can be improved.

Drug use behaviour of pregnant women in rural India

OBJECTIVE

To evaluate the drug use habit of pregnant women in villages of central India.

METHODS

An observational, cross sectional study was conducted among six hundred fifty pregnant women from different randomly selected villages of Wardha district of central India through interviews on medicine use behaviour and evaluation of prescriptions.

RESULTS

Pregnant women of younger age group from lower socio economic status constituted the majority of the study population. Major portion (97.7) of this socioeconomically backward population followed the doctor's advice as far as dose, frequency and duration of the drug was concerned. The antenatal mothers were of the opinion that, if the instructions on the drug envelop or foil was in written in the local language, it could be more helpful for them.

CONCLUSION

Majority of the study population used drugs or medicines regularly but some mothers were reluctant. This indicated that even in this age of advancement of scientific knowledge, all antenatal mothers were not conversant with the advantages of drug use.

A study on habit of preservation of prescriptions by pregnant women in India

Irrational use of medicine is very common in developing countries like India. Drug or medicine use during pregnancy is an important event for both mother and child. Thalidomide disaster showed the adverse effects of drugs on the unborn child. Knowledge about use of medicines can play a crucial role in rational drug use. Prescription is an important tool to assess the past clinical condition of patients and the use of medicines for them. The present study explored the habit of preservation of previous prescriptions in the pregnant women of villages of Wardha District of Maharashtra state of India. This is an observational cross sectional survey using predesigned, precoded and pretested questionnaire. This study showed an interesting habit of these women. 81% of pregnant women have a habit of preservation of prescription as an important document. It was clear that with increasing level of formal education there is a definite increase in habit of preservation of prescription among the pregnant women in rural areas of India.

Influence of spontaneous calcium events on cell-cycle progression in embryonal carcinoma and adult stem cells

Spontaneous Ca(2+) events have been observed in diverse stem cell lines, including carcinoma and mesenchymal stem cells. Interestingly, during cell cycle progression, cells exhibit Ca(2+) transients during the G(1) to S transition, suggesting that these oscillations may play a role in cell cycle progression. We aimed to study the influence of promoting and blocking calcium oscillations in cell proliferation and cell cycle progression, both in neural progenitor and undifferentiated cells. We also identified which calcium stores are required for maintaining these oscillations. Both in neural progenitor and undifferentiated cells calcium oscillations were restricted to the G1/S transition, suggesting a role for these events in progression of the cell cycle. Maintenance of the oscillations required calcium influx only through inositol 1,4,5-triphosphate receptors (IP(3)Rs) and L-type channels in undifferentiated cells, while neural progenitor cells also utilized ryanodine-sensitive stores. Interestingly, promoting calcium oscillations through IP(3)R agonists increased both proliferation and levels of cell cycle regulators such as cyclins A and E. Conversely, blocking calcium events with IP(3)R antagonists had the opposite effect in both undifferentiated and neural progenitor cells. This suggests that calcium events created by IP(3)Rs may be involved in cell cycle progression and proliferation, possibly due to regulation of cyclin levels, both in undifferentiated cells and in neural progenitor cells.

Ubiquitin-mediated activation of TAK1 and IKK

Transforming growth factor beta activated kinase-1 (TAK1), a member of the mitogen-activated protein kinase kinase kinase family, has emerged as a key regulator of signal transduction cascades leading to the activation of the transcription factors nuclear factor-kappa B (NF-kappaB) and activator protein-1 (AP-1). Stimulation of cells with cytokines and microbial pathogens results in the activation of TAK1, which subsequently activates the I-kappa B kinase complex (IKK) and mitogen-activated protein (MAP) kinases, culminating in the activation of NF-kappaB and AP-1, respectively. Recent studies have shown that polyubiquitination of signalling proteins through lysine (Lys)-63-linked polyubiquitin chains plays an important role in the activation of TAK1 and IKK. Unlike Lys-48-linked polyubiquitination, which normally targets proteins for degradation by the proteasome, Lys-63-linked polyubiquitin chains act as scaffolds to assemble protein kinase complexes and mediate their activation through proteasome-independent mechanisms. The concept of ubiquitin-mediated activation of protein kinases is supported by the discoveries of ubiquitination and deubiquitination enzymes as well as ubiquitin-binding proteins that function upstream of TAK1 and IKK. Recent biochemical and genetic studies provide further insights into the mechanism and function of ubiquitin signalling and these advances will be the focus of this review.

Gauze packing of open surgical wounds: empirical or evidence-based practice?

INTRODUCTION

Most surgical wounds are closed primarily, but some are allowed to heal by secondary intention. This usually involves repeated packing and dressing of the raw wound surfaces. Although the long-term care of such wounds has devolved to the care of nurses in the community or out-patient setting, the initial wound dressing or cavity packing is done by the surgeon in the operating theatre. Many surgeons are unaware of the growth of the discipline of wound care, and still use traditional soaked gauze for dressing and packing open surgical wounds and cavities.

RESULTS

This review summarises the some of the modern alternatives available and the evidence--or the lack of it--for their use in both the acute and chronic setting.

Relationship between indoor and outdoor bio-aerosols collected with a button inhalable aerosol sampler in urban homes

This field study investigated the relationship between indoor and outdoor concentrations of airborne actinomycetes, fungal spores, and pollen. Air samples were collected for 24 h with a button inhalable aerosol sampler inside and outside of six single-family homes located in the Cincinnati area (overall, 15 pairs of samples were taken in each home). The measurements were conducted during three seasons - spring and fall 2004, and winter 2005. The concentration of culturable actinomycetes was mostly below the detection limit. The median indoor/outdoor ratio (I/O) for actinomycetes was the highest: 2.857. The indoor of fungal and pollen concentrations followed the outdoor concentrations while indoor levels were mostly lower than the outdoor ones. The I/O ratio of total fungal spores (median=0.345) in six homes was greater than that of pollen grains (median=0.025). The low I/O ratios obtained for pollen during the peak ambient pollination season (spring) suggest that only a small fraction penetrated from outdoor to indoor environment. This is attributed to the larger size of pollen grains. Higher indoor concentration levels and variability in the I/O ratio observed for airborne fungi may be associated with indoor sources and/or higher outdoor-to-indoor penetration of fungal spores compared to pollen grains. Practical Implication This study addresses the relationship between indoor and outdoor concentrations of three different types of bio-aerosols, namely actinomycetes, fungal spores, and pollen grains. The results show that actinomycetes are rare in indoor and outdoor air in Midwest, USA. Exposure to pollen occurs mainly in the outdoor air even during peak pollen season. Unexpectedly high fungal spore concentrations were measured outdoors during winter. The presented pilot database on the inhalable levels of indoor and outdoor bio-aerosols can help apportion and better characterize the inhalation exposure to these bio-aerosols. Furthermore, the data can be incorporated into existing models to quantify the penetration of biological particles into indoor environments from outdoors.

Evaluation of ionic air purifiers for reducing aerosol exposure in confined indoor spaces

Numerous techniques have been developed over the years for reducing aerosol exposure in indoor air environments. Among indoor air purifiers of different types, ionic emitters have gained increasing attention and are presently used for removing dust particles, aeroallergens and airborne microorganisms from indoor air. In this study, five ionic air purifiers (two wearable and three stationary) that produce unipolar air ions were evaluated with respect to their ability to reduce aerosol exposure in confined indoor spaces. The concentration decay of respirable particles of different properties was monitored in real time inside the breathing zone of a human manikin, which was placed in a relatively small (2.6 m3) walk-in chamber during the operation of an ionic air purifier in calm air and under mixing air condition. The particle removal efficiency as a function of particle size was determined using the data collected with a size-selective optical particle counter. The removal efficiency of the more powerful of the two wearable ionic purifiers reached about 50% after 15 min and almost 100% after 1.5 h of continuous operation in the chamber under calm air conditions. In the absence of external ventilation, air mixing, especially vigorous one (900 CFM), enhanced the air cleaning effect. Similar results were obtained when the manikin was placed inside a partial enclosure that simulated an aircraft seating configuration. All three stationary ionic air purifiers tested in this study were found capable of reducing the aerosol concentration in a confined indoor space. The most powerful stationary unit demonstrated an extremely high particle removal efficiency that increased sharply to almost 90% within 5-6 min, reaching about 100% within 10-12 min for all particle sizes (0.3-3 microm) tested in the chamber. For the units of the same emission rate, the data suggest that the ion polarity per se (negative vs. positive) does not affect the performance but the ion emission rate does. The effects of particle size (within the tested range) and properties (NaCl, PSL, Pseudomonas fluorescens bacteria) as well as the effects of the manikin's body temperature and its breathing on the ionic purifier performance were either small or insignificant. The data suggest that the unipolar ionic air purifiers are particularly efficient in reducing aerosol exposure in the breathing zone when used inside confined spaces with a relatively high surface-to-volume ratio.

PRACTICAL IMPLICATIONS

Ionic air purifiers have become increasingly popular for removing dust particles, aeroallergens and airborne microorganisms from indoor air in various settings. While the indoor air cleaning effect, resulting from unipolar and bipolar ion emission, has been tested by several investigators, there are still controversial claims (favorable and unfavorable) about the performance of commercially available ionic air purifiers. Among the five tested ionic air purifiers (two wearable and three stationary) producing unipolar air ions, the units with a higher ion emission rate provided higher particle removal efficiency. The ion polarity (negative vs. positive), the particle size (0.3-3 microm) and properties (NaCl, PSL, Pseudomonas fluorescens bacteria), as well as the body temperature and breathing did not considerable affected the ionization-driven particle removal. The data suggest that the unipolar ionic air purifiers are particularly efficient in reducing aerosol exposure in the breathing zone when they are used inside confined spaces with a relatively high surface-to-volume ratio (such as automobile cabins, aircraft seating areas, bathrooms, cellular offices, small residential rooms, and animal confinements). Based on our experiments, we proposed that purifiers with a very high ion emission rate be operated in an intermittent mode if used indoors for extended time periods. As the particles migrate to and deposit on indoor surfaces during the operation of ionic air purifiers, some excessive surface contamination may occur, which introduces the need of periodic cleaning these surfaces.

Incidence of allergenically significant fungal aerosol in a rural bakery of West Bengal, India

The frequency of fungal spores in the air of three different sections of a rural bakery was analyzed using a Burkard personal slide sampler and Andersen two stage viable sampler. In average concentration of spores (No./m3) was 228-26770/m3 and concentration of viable colony forming units (CFU/m3) was 65-2061 CFU/m3. Dominant fungus species both culturable and nonculturable, were species of Aspergillus and Penicillium, Cladosporium sp., Aspergillus niger, Aspergillus flavus, Aspergillus fumigatus, Cladosporium cladosporioides, Penicillium citrinum and Alternaria alternata. Seasonal variations in the spore concentrations were clearly observed in case of some fungi. Total culturable mould concentration of different bakery sections sometimes exceeded the acceptable limit for a healthy indoor environment. Antigenic extracts prepared from some dominant culturable fungi showed high level of allergenicity in skin prick tests indicating that they could be responsible for allergic respiratory dysfunction of bakery workers.

Kinetic characterization of rat brain type IIA sodium channel alpha-subunit stably expressed in a somatic cell line

1. The rat brain type IIA Na+ channel alpha-subunit was stably expressed in Chinese hamster ovary (CHO) cells. Current through the expressed Na+ channels was studied using the whole-cell configuration of the patch clamp technique. The transient Na+ current was sensitive to TTX and showed a bell-shaped peak current vs. membrane potential relation. 2. Na+ current inactivation was better described by the sum of two exponentials in the potential range -30 to + 40 mV, with a dominating fast component and a small slower component. 3. The steady-state inactivation, h infinity, was related to potential by a Boltzmann distribution, underlying three states of the inactivation gate. 4. Recovery of the channels from inactivation at different potentials in the range -70 to -120 mV were characterized by an initial delay which decreased with hyperpolarization. The time course was well fitted by the sum of two exponentials. In this case the slower exponential was the major component, and both time constants decreased with hyperpolarization. 5. For a working description of the Na+ channel inactivation in this preparation, with a minimal deviation from the Hodgkin-Huxley model, a three-state scheme of the form O<-->I1<-->I2 was proposed, replacing the original two-state scheme of the Hodgkin-Huxley model, and the rate constants are reported. 6. The instantaneous current-voltage relationship showed marked deviation from linearity and was satisfactorily fitted by the constant-field equation. 7. The time course of activation was described by an m chi model. However, the best-fitted value of chi varied with the membrane potential and had a mean value of 2. 8. Effective gating charge was determined to be 4.7e from the slope of the activation plot, plotted on a logarithmic scale. 9. The rate constants of activation, alpha m and beta m, were determined. Their functional dependence on the membrane potential was investigated.

Effect of treatment for Hodgkin's disease on pulmonary function: results of a prospective study

PURPOSE

Because each of very different treatments for Hodgkin's disease (HD) may result in a high rate of cure, attention is currently focused on toxicity. This prospective study was designed to assess the effects of mediastinal irradiation and bleomycin chemotherapy on pulmonary function.

PATIENTS AND METHODS

Patients were treated from 1980 to 1990 on randomized controlled trials at Stanford University. Pulmonary function was tested before treatment (baseline), early after treatment (< 15 months), and more than 36 months posttherapy. Treatment options in the 145 patients were grouped as I (mediastinal radiotherapy), II (mediastinal radiotherapy plus bleomycin), and III (bleomycin) for analyses of variance (ANOVAs). A variety of regression models were used to predict early and late effects on pulmonary function.

RESULTS

A decrease in forced vital capacity (FVC) and diffusing capacity (DLCO) in the first 15 months after treatment followed by recovery after 36 months was observed for most patients. Patients who received mediastinal radiotherapy (RT) had a more pronounced reduction in pulmonary function and less complete recovery. Overall, 3 or more years after treatment, 32% of group I patients, 37% of group II patients, and 19% of group III patients had FVC values less than 80% of predicted, while only 7% of patients had a DLCO less than 80% of predicted. Linear regression identified baseline measurement as the only significant predictor of change in percent predicted FVC or DLCO; patients with higher baseline values had greater decrements after therapy. Mantle RT was the only significant treatment variable, predictive of FVC and DLCO within 15 months and FVC at 36 or more months. No patient experienced pulmonary toxicity severe enough to require hospitalization.

CONCLUSION

This prospective analysis of pulmonary function after treatment for HD showed that mediastinal RT was the only treatment variable that achieved statistical significance. Although there were no significant interactions between mediastinal RT and bleomycin or Adriamycin (doxorubicin; Adria Laboratories, Columbus, OH) chemotherapy, the patient numbers were small after correction for mediastinal mass size and drug regimen such that an effect could have been missed. The mild reduction in pulmonary function should be factored into the overall assessment of morbidity risk for each of the potentially curative treatments included in this study. As with all reports of late effects, these data should be interpreted with respect to the population tested, details of the treatment administered, methods of measurement, and length of follow-up.