Association of Vitamin D Levels and type 2 Diabetes Mellitus in Asian Indians is Independent of Obesity

Background A large proportion of subjects with type 2 diabetes mellitus (T2DM) in India are non-obese. Asian-Indian subjects with diabetes have been shown to have low vitamin D levels. Whether low vitamin D levels and T2DM in Asian-Indians is attributable to the associated obesity as in caucasians is unclear. Hence we studied the association of vitamin D levels and T2DM in Asian-Indians with or without obesity.

Methods Total of 213 subjects were recruited in four groups, group 1-Non-obese diabetic, group 2-Non-obese non-diabetic, group 3-Obese diabetic and group 4-Obese non-diabetic. Subjects recruited under various groups were matched for age and sex. Anthropometry, skin-fold thickness, fasting and postprandial plasma glucose, HbA1c, fasting insulin, lipids and vitamin D levels were measured in all study subjects and were compared between the groups.

Results Mean age of study population was 41.23±7.43 years. Mean BMI in groups 1,2,3 and 4 was 21.34±1.41, 20.53±2.27, 27.72±2.94 and 27.62±3.37 kg/m2 respectively. Overall 64.3% study subjects had vitamin D deficiency and 27.7% had insufficient vitamin D levels. Significantly lower vitamin D levels were found in diabetic groups 1 and 3 compared to non-diabetic groups 2 and 4. No significant difference was observed in vitamin D levels between groups 1 and 3. Similarly, no significant difference was observed in vitamin D levels between groups 2 and 4. Vitamin D levels did not show any significant correlation with BMI, waist or body fat.

Conclusion Vitamin D levels do not appear to be related to obesity in diabetic as well non-diabetic Asian-Indian individuals.

Study of microbial growth on silicone tubes after transcanalicular laser-assisted dacryocystorhinostomy and correlation with patency

INTRODUCTION

Intubation in primary transcanalicular laser assisted dacryocystorhinostomy (TCLADCR) is performed to increase the success rates. However, the associated inflammation and infection can have adverse effects.

OBJECTIVE

To study the microbial infection and drug susceptibility of extubated silicone tubes and final anatomical patency in patients undergoing TCLADCR.

MATERIALS AND METHODS

A non-randomised prospective interventional study was conducted in a tertiary care eye centre. The study included twenty consecutive adult patients with primary nasolacrimal duct obstruction. They underwent TCLADCR with bicanalicular silicone intubation. The stents were removed at 2 months and subjected to culture sensitivity, followed by administration of appropriate antimicrobial agents. Main outcome measures studied were the microbial spectrum on the cultured tubes, their sensitivity profile and its correlation with final anatomical patency.

RESULTS

A positive culture was obtained in 100% cases, comprising of normal commensals and pathogenic organisms. Of the total 24 isolates, 16 (66.6%) Gram positive bacteria (75% Staphylococcus aureus) and 8 (33.3%) Gram negative bacteria (commonest E.coli) were found, with 4 tubes having more than one isolate. No fungal growth was seen. Ninety percent success rate was achieved at one year following appropriate antimicrobial therapy except in 2 patients with gram negative isolates who had failed to take the prescribed antibiotics following sensitivity reports. There was no correlation between multiple infections and success rate. However, by using the Fisher exact test, a positive correlation was obtained between appropriate antibiotic treatment and the final anatomical patency (p less than 0.05).

CONCLUSION

Silicone intubation predisposes to microbial growth, which if neglected, can lead to failure of TCLADCR.

Bacteriological profile and their antimicrobial susceptibility pattern in central venous catheter tip culture

Background: Bacterial colonization of central venous catheter (CVC) carries risk of developing catheter-related blood stream infections (CRBSI). The purpose of this study is to find out the frequency of colonization of CVC by different bacterial pathogens and their antibiotic sensitivity pattern.Materials and Methods: A total of 53 CVC tip were received in one-year duration for culture and antibiotic sensitivity pattern. The isolated organisms were identified by standard microbiological procedure and subjected to antimicrobial sensitivity.Results: out of 53 CVC tip sent for culture and sensitivity, 21 (39.6%) showed significant growth. Out of 21 culture positive 52.3% were gram negative bacilli, 33.3% were gram positive cocci, 4.8% were Candida spp. Acenitobacter baumannii and Staphylococcus aureus were frequent pathogens isolated. Gram negative bacteria were less sensitive to antibiotics whereas gram positive bacteria were sensitive to Vancomycin.Conclusion: Though various organisms were isolated as colonizer of CVC, Acenitobacter baumannii is the most common colonizer. Antibiotic resistance has already emerged and represents a major problem.  

Virulence versus fitness determinants in Escherichia coli isolated from asymptomatic bacteriuria in healthy nonpregnant women

PURPOSE

Escherichia coli isolated from asymptomatic bacteriuria (ABU) correlated genotypically and phenotypically with cystitis isolates may help in distinguishing urovirulence determinants from 'fitness factors', latter necessary only for survival of E. coli in urinary tract; for gaining insight into the pathogenesis of urinary tract infection.

MATERIALS AND METHODS

In this cross-sectional study, we compared genotypic (phylogroups and 15 putative virulence genes), and phenotypic profiles of ABU E. coli strains with our previously genotyped collection of cystitis isolates. Virulence score was calculated for each isolate as a number of virulence genes detected.

RESULTS

Significant differences were observed in the proportion of four phylogenetic groups (P=0.009) amongst cystitis and ABU isolates. Average virulence score was higher for ABU isolates (6.6) than cystitis strains (4.2); and hlyA (P=0.001), cytotoxic necrotising factor 1 (P=0.00), fyuA (P=0.00), ibeA (P=0.00), kpsMII (P=0.01), and malX/pathogenicity-associated island (P=0.01) were more frequently present in ABU strains.

CONCLUSIONS

The expression of adhesins, haemolysin, aerobactin, and capsule synthesis gene were similar in two groups suggesting their role as fitness factors. ABU isolates were better biofilm producers, reflecting its importance in silent persistence. Serum resistance gene which was more expressed in cystitis isolates may represent virulence determinant. Genetic makeup of E. coli does not change much rather genes helping in survival and colonisation are expressed equally in ABU and cystitis isolates as opposed to phenotypic attenuation of those that helps in invasion or inflammation in ABU isolates.

The mysterious Zika virus: Adding to the tropical flavivirus mayhem

Until now, known as the demure cousin of dengue virus (DENV) inhabiting Africa, Zika virus (ZIKV) has reinvented itself to cause explosive epidemics captivating the Western hemisphere. The outbreak causing potential for ZIKV was realized when it made its way from Africa to Yap Island Micronesia in 2007, and in French Polynesia in 2013. From there, it moved on to Brazil in 2015. Now ZIKV has infected people in more than 33 countries in Central and South America and the Caribbean. Moreover the epidemiological and subsequent virological association with microcephaly cases in Brazil has prompted the World Health Organization to declare a public health emergency of International Concern. ZIKV shares not only its vector Aedes aegypti with dengue and chikungunya but also the geographic distribution and clinical features, which makes the laboratory confirmation mandatory for definitive diagnosis. The serological cross-reactivity with other Flavivirus, particularly with DENV makes laboratory confirmation challenging and will place additional burden on health systems to establish molecular diagnostic facilities. The evidence of additional nonvector modes of transmission, such as perinatal, sexual as well as transfusion has made preventative strategies more difficult. As ZIKV disease continues to mystify us with several unanswered questions, it calls for coordinated effort of global scientific community to address the ever growing arboviral threat to mankind.

Behavioral and Psychosocial Risk Factors Associated with First and Recurrent Cystitis in Indian Women: A Case-control Study

Background:

The risk factors for urinary tract infections (UTIs) from developed countries are not applicable to women from developing world.

Objective:

To analyze the behavioral practices and psychosocial aspects pertinent to women in our region and assess their association with acute first time or recurrent UTI.

Materials and Methods:

Sexually active premenopausal women with their first (145) and recurrent (77) cystitis with Escherichia coli as cases and women with no prior history of UTI as healthy controls (257) were enrolled at a tertiary care hospital in India, between June 2011 and February 2013. Questionnaire-based data was collected from each participant through a structured face-to-face interview.

Results:

Using univariate and multivariate regression models, independent risk factors for the first episode of cystitis when compared with healthy controls were (presented in odds ratios [ORs] with its 95% confidence interval [CI]): Anal sex (OR = 3.68, 95% CI = 1.59-8.52), time interval between last sexual intercourse and current episode of UTI was <5 days (OR = 2.27, 95% CI = 1.22-4.23), use of cloth during menstrual cycle (OR = 2.36, 95% CI = 1.31-4.26), >250 ml of tea consumption per day (OR = 4.73, 95% CI = 2.67-8.38), presence of vaginal infection (OR = 3.23, 95% CI = 1.85-5.62) and wiping back to front (OR = 2.52, 95% CI = 1.45-4.38). Along with the latter three, history of UTI in a first-degree female relative (OR = 10.88, 95% CI = 2.41-49.07), constipation (OR = 4.85, 95% CI = 1.97-11.92) and stress incontinence (OR = 2.45, 95% CI = 1.18-5.06) were additional independent risk factors for recurrent cystitis in comparison to healthy controls.

Conclusion:

Most of the risk factors for initial infection are potentially modifiable but sufficient to also pose risk for recurrence. Many of the findings reflect the cultural and ethnic practices in our country.

Larger and near-term baby retinopathy: a rare case series

PURPOSE

To report retinopathy in a series of four babies unusually beyond the screening standards reported so far in the literature.

METHODS

During routine screening for retinopathy of prematurity, we detected retinopathy in four babies who were surprisingly bigger and older than the screening standards. The gestational age (GA), birth weight (BW), post menstrual age at first examination and significant perinatal events were noted. The retinopathy details imaged by the RetCam were classified as per ICROP revisited standards.

RESULT

The GA ranged from 36 to 39 weeks and BW from 2.4 to 3.0 kg. Three of them had retinopathy in zone III that regressed spontaneously and one had marked plus with vascular arcades and shunts in zone II that regressed after laser photocoagulation. All of them had fetal distress and multiple systemic comorbidities in the neonatal period.

CONCLUSION

This report makes one aware of the possibility of retinopathy in newborn of older GA and larger BW especially with fetal distress and stormy neonatal course.

Virulence determinants in Escherichia coli associated with recurrent cystitis in sexually active women

More than a quarter of women who experience acute cystitis develop recurrence but information on specific urovirulent genetic profile of uropathogenic Escherichia coli associated with recurrent cystitis is still limited. In this prospective cohort study, index episode E. coli from a cohort of 46 sexually active women with acute cystitis who reported recurrence during followup were grouped into repeat infection (RI) and single infection (SI) isolates, based on enterobacterial repetitive intergenic consensus (ERIC) PCR profile comparison with subsequent E. coli isolated from same women. PCR for phylogrouping and 15 virulence genes along with test for biofilm formation were done. Virulence score was calculated for each isolate as number of virulence genes detected. Among 46 index E. coli, 22 were RI, and 24 were SI isolates. RI isolates had phylogroup B2 as majority (54.5%) which is typically described as more virulent phylogroup and virulence score for RI isolates was also significantly higher compared to SI isolates. Virulence gene malX (p = 0.03) was significantly associated with RI isolates. 68.2% RI isolates were strong to moderate biofilm producers in comparison to 33.3% SI isolates, an important survival strategy to reside in bladder and or vagina. Overall, E. coli associated with recurrent cystitis appear to be more virulent and malX seems to have a role in causing repeat infection.

Role of special pathogenicity versus prevalence theory in pathogenesis of acute cystitis caused by Escherichia coli

Escherichia coli is the most common pathogen causing acute cystitis in sexually active women. Human faeces are generally considered the primary reservoir for infection and the faecal-perineal-urethral pathway is the accepted route of infection. Two theories have been proposed for the pathogenesis of acute cystitis: (1) special pathogenicity, where uropathogenic E. coli (UPEC) encoding special virulence factors causes infection; and (2) prevalence, wherein ordinary faecal E. coli causes infection by simple mass action. The aim of this study was to compare concurrent urinary E. coli isolates from women with acute cystitis with their own dominant faecal, vaginal E. coli isolates; thus, these patients served as their own control. E. coli isolates from 80 women were analysed by phylotyping, virulence profiling (for 15 putative virulence genes) and enterobacterial repetitive intergenic consensus (ERIC) PCR. A virulence score was calculated for each isolate based on the number of virulence genes detected. Four host ecological groups of E. coli were created on the basis of ERIC PCR: group UVF, where vaginal and faecal isolates yielded the infecting urine clone; group UV, where only vaginal isolates yielded the infecting urine clone; group UF, where faecal isolates yielded the infecting urine clone; and group U, where the infecting urine clone was distinct. In the majority of cases the infecting E. coli clone from urine was also the dominant faecal clone (56.3%; groups UVF and UF possessing high virulence scores of 4.6 and 3.9, respectively), indicating that both mechanisms play a role in pathogenesis. Non-dominant yet virulent faecal clones or an external source of E. coli seems a possibility in the UV group (13.7%, VF score 4.8). In 30% of patients (U group) the infecting urine clone was non-dominant and possessed a low virulence score (2.7); suggesting a possible role for host factors in establishing infection.

Expression of ADAMTS1 mRNA in bovine endometrium and placenta during gestation

A disintegrin and metalloproteinase with thrombospondin motifs 1 (ADAMTS1) is a secreted protease. Through the regulation of extracellular matrix remodeling or developmental processes or both, ADAMTS1 is involved in several biological functions, including ovulation and embryo receptivity. However, the expression and possible role of ADAMTS1 in bovine endometrium is unknown. In this study, we analyzed ADAMTS1 mRNA expression in bovine endometrium during the estrous cycle, peri-implantation period, and at different stages of gestation by using quantitative real-time RT-PCR (qPCR) and in situ hybridization. The qPCR results indicated that the expression of ADAMTS1 mRNA was not affected by the day of the estrous cycle and was similar to cyclic levels on day 35 of gestation; however, the expression was more abundant in cotyledonary tissues of the placenta during late gestation. The in situ hybridization study showed that ADAMTS1 mRNA was detected mainly in uterine luminal epithelia and stromal cells during the estrous cycle and peri-implantation period. A disintegrin and metalloproteinase with thrombospondin motifs 1 mRNA was also expressed in the peri-implantation conceptus as well as in trophoblast cells, which include binucleate cells, and increased during late gestation. Furthermore, treatment of stromal cell with progesterone (300 nM) stimulated the expression of ADAMTS1 mRNA. This study indicates that ADAMTS1 participates in bovine endometrial remodeling, which is required for implantation and placental development in coordination with ovarian steroids.

Latex Agglutination Test for Early Detection of Causative Organism in Acute Bacterial Meningitis

Introduction: Acute bacterial meningitis is one of the leading causes of mortality and morbidity in children. Identification of the causative organism is crucial to its management and outcome. The objective of this study was to see the usefulness of latex agglutination test in the early diagnosis of acute bacterial meningitis. Materials and Methods: A hospital based prospective cross-sectional study was conducted at Kanti Children’s Hospital during December 2004 to August 2005. Cerebrospinal fluid from 150 consecutive clinically suspected cases of acute bacterial meningitis between the age group of 2 months to 14 years were analyzed. Bacterial culture and latex agglutination test was done on cerebrospinal fluid obtained from all 150 suspected cases of acute bacterial meningitis. Latex agglutination test was done using the BD DirectigenTM Meningitis Combo test kit (Becton, Dickinson and company, USA) for Streptococcus pneumoniae, group B Streptococcus, Escherichia coli, Neisseria meningitidis group A,C and Y/ W135, and Hemophilus influenzae type b. Data was analysed by using SPSS Version 11.5. Results: Of the 150 Cerebrospinal fluid samples analysed bacterial culture identified only 4 meningitis cases giving an isolation rate of 1.3% whereas latex agglutination test identified 29 cases giving an isolation rate of 19.3% from 150 samples. Streptococcus pneumoniae, Hemophilus influenzae type b and Group B Streptococcus were the most common causative organism. Conclusion: Latex agglutination test has a better yield, higher sensitivity, provides microbiological diagnosis earlier than the traditional cerebrospinal fluid culture and is easy to perform. DOI: http://dx.doi.org/10.3126/jnps.v33i1.7047 J Nepal Paediatr Soc. 2013;33(1):34-38

Effect of gibberellic acid and calliterpenone on plant growth attributes, trichomes, essential oil biosynthesis and pathway gene expression in differential manner in Mentha arvensis L

Extensive research is going on throughout the world to find out new molecules from natural sources to be used as plant growth promoter. Mentha arvensis L. is the main source of menthol rich essential oil used commercially in various food, pharmaceutical and other preparations. Experiments were conducted on field grown plants for understanding the effect of calliterpenone (CA), a stereo-isomer of abbeokutone, in comparison to gibberellic acid (GA3) on growth attributes, trichomes, essential oil biosynthesis and expression of some oil biosynthetic pathway genes. The exogenous application of CA (1 μM, 10 μM and 100 μM) was found to be better in improving plant biomass and stolon yield, leaf area, branching and leaf stem ratio than with counterpart GA3 at the same concentrations. CA treated plants showed higher glandular trichome number, density and diameter and also correlated with enhanced oil biogenetic capacity as revealed by feeding labeled (14)C-sucrose for 72 h to excised shoots. Semi-quantitative PCR analysis of key pathway genes revealed differential up regulation under CA treatments. Transcript level of menthol dehydrogenase/menthone reductase was found highly up regulated in CA treated plants with increased content of menthone and menthol in oil. These findings demonstrate that CA positively regulated the yields by enhanced branching and higher density of trichomes resulting into higher accumulation of essential oil. The results suggest CA as a novel plant derived diterpenoid with growth promoting action and opens up new possibilities for improving the crop yields and essential oil biosynthesis in qualitative and quantitative manner.

Genotypic characteristics and biofilm formation among Escherichia coli isolates from Indian women with acute cystitis

BACKGROUND

The purpose of present study was to characterize uropathogenic Escherichia coli (UPEC) associated with acute cystitis in Indian women.

METHODS

In this prospective descriptive study we investigated phylogenetic background and virulence genotypes for 15 genes by multiplex PCR and in vitro biofilm formation ability of 172 E. coli strains and explored possible association amongst them.

RESULTS

Most isolates (81, 47.1%) belonged to group B2 and A (50, 29.1%); few were from groups B1 (22, 12.7%) and D (19, 11.1%). The mean virulence scores of phylogroups A, B1, B2 and D were 3.3, 4.0, 4.6 and 4.9, respectively. We found higher prevalence of fimH, traT iutA, kpsMII, papG allele II and fyuA genes indicating putative role of adhesins, iron acquisition systems and protectins in causing bladder infection. Total 145 (84.3%) isolates produced biofilm; majority were weak biofilm producers and there was no significant difference in intensity and biofilm formation ability amongst various phylogroups or virulence scores. The phylogenetic distribution was different from western studies, including a lower prevalence of group B2 (dominant but not a majority), followed by group A, and some traditionally group B2-associated virulence genes were more prevalent in phylogroup A isolates.

CONCLUSIONS

Distribution of virulence genotypes and phylotypes can vary with geographical location and the isolates from western countries cannot be treated as prototypes for Asian cystitis isolates.