To study the role of antibiotic+steroid irrigation of the middle ear in active chronic otitis media with small perforation and pulsatile discharge

OBJECTIVE

To evaluate the usefulness of antibiotic+steroid irrigation of the middle ear in patients with otitis media with small perforation and pulsatile discharge.

METHOD

A prospective, randomised, evaluator-blinded study was carried at a single tertiary care centre over eight years, looking at 100 patients with chronic suppurative otitis media involving small tympanic membrane perforations and pulsatile mucopurulent discharge. The patients were randomised and divided into two groups. In group A, the examination under microscope, with suction cleaning of the external canal, was followed by irrigation of the middle ear with antibiotic+steroid solution for up to one week, while group B was prescribed self-administration of the same drops with systemic antibiotics. The patients were followed up daily for 10 days to monitor otorrhoea relief and on a weekly basis subsequently to monitor the healing of the tympanic membrane.

RESULTS

Forty-nine patients in group A had a dry ear after 3-7 days of daily suction and the irrigation of middle ear with the antibiotic+steroid solution and 44 had a healed tympanic membrane after an average three months of follow-up. Five patients with dry ear but persistent perforation underwent tympanoplasty, while only one patient with a persistent ear discharge underwent mastoid exploration. In group B, eight patients on oral antibiotics and self-administration of the same drops had dry ear while 34 had dry ear after receiving intravenous antibiotics. Thirty perforations healed spontaneously and 12 required tympanoplasty. In 8 patients, the tympano-mastoid was explored and these patients had dry, hearing ears only after surgery.

CONCLUSION

Patients with chronic suppurative otitis media involving small perforations and pulsatile discharge can be managed conservatively with simple suction cleaning + middle ear irrigation with antibiotics + steroid drops.

Superior vena cava obstruction (SVCO) in patients with advanced non small cell lung cancer (NSCLC)

INTRODUCTION

To report on prognostic and treatment factors influencing the response of SVCO and related survival outcomes in advanced non small cell lung cancer.

MATERIAL AND METHODS

From November 2008 through December 2011, 18 consecutively diagnosed NSCLC patients with SVCO were included in this study. The patient, tumor and treatment related factors were analyzed. Median overall survival (OS), Kaplan -Meier survival plots, T-test, Cox Proportional Hazards models were generated by multiple covariates (MVA) and analyzed on SPSS software (version 19.0; SPSS, Inc., Chicago, IL).

RESULTS

Thirteen patients (72%) had presented with SVCO before the pathological diagnosis of underlying lung malignancy, while 5 (28%) progressed to SVCO after initiating treatment with chemotherapy. Twelve (68%) patients achieved subjective relief from the obstruction at the completion of palliative radiation therapy. Treating oncologists preferred 4 Gy per fraction in 11 (62%), while the median biologically equivalent dose delivered was 28 Gy. Six (33%) patients received chemotherapy during the course of treatment. Median OS of the entire cohort was 3±1.85mths and 1-year survival rate of 7%. Univariate analysis confirmed that SVCO patients with good performance score (p=0.02), and partial response to chemotherapy (p= 0.001) have superior OS. However, Cox regression modeling for MVA demonstrated only good performance SVCO patients (p = 0.05) have a better OS.

CONCLUSION

RT effectively relieves SVCO but overall poor survival associated in our clinical scenario needs to be improved with multimodality approach. Adjuvant chemotherapy is to be considered after initial radiation therapy in good performance patients.

KEYWORDS

superior vena cava obstruction (SVCO), radiation therapy, chemotherapy, non small cell lung cancer (NSCLC), BED (biologically equivalent dose).

Simultaneous pectoralis major muscle and orbital metastasis as the primary presentation of pulmonary adenocarcinoma

A 63-year old male with chronic shoulder pain and painful left eye with binocular diplopia of sudden onset was seen independently by Ophthalmologists and his family Doctor and investigated first non-invasively where masses were found both in the orbit and pectoralis muscle. Further investigations including biopsy confirmed non-small cell lung carcinoma with metastasis to these sites; unusual sites of tumour metastasis and the first reporting of such tumour behaviour.

Dual diagnosis vs. triple diagnosis in HIV: a comparative study to evaluate the differences in psychopathology and suicidal risk in HIV positive male subjects

INTRODUCTION

The problem of triple diagnosis of HIV, substance abuse and psychiatric disorders is a complex one with difficult solutions. HIV disease progression is affected by substance use as well as psychiatric illness burden due to both direct as well as indirect factors. Continuing substance abuse with poor drug adherence coexists with psychiatric disorders leading to increased morbidity and mortality.

METHOD

A total of 100 HIV positive subjects comprising of two groups each having 50 subjects with and without substance abuse were assessed using detailed history, mental state examination, WHO schedule for clinical assessment in neuropsychiatry (SCAN 2.0) and Beck's Scale for Suicidal Ideation (BSS). Statistical analysis used Chi-Square test, Fischer's exact test, Student's t-test, Pearson's correlation coefficient, univariate and multiple regression analysis, univariate and multiple logistic regression analysis. p-Value<0.05 was considered to denote statistical significance.

RESULTS

Subjects with substance use disorder had higher rates of psychiatric morbidity (52% vs. 24%, 95% CI=0.5200, p<0.05). The rate of antiretroviral therapy default was almost double in subjects with substance abuse, as compared to subjects without substance use. Suicidal risk was significantly increased (p<0.05) in subjects with co-morbid medical disorders but substance abuse did not increase the risk.

CONCLUSION

Substance abuse inflicts a much greater burden on HIV positive individuals as compared to subjects without substance use. Concomitant substance abuse resulted in significantly increased duration of illness and psychiatric morbidity.

Optimization of fermentation conditions for green pigment production from Bacillus cereus M¹ 16 (MTCC 5521) and its pharmacological application

Optimal culture conditions for the production of green pigment was investigated. The optimal culture condition for the production of an extracellular green pigment by growing Bacillus cereus M(1) 16 (MTCC 5521) in a complex medium containing (g l(-1) ) Peptone-4.0, Beef Extract-9.0, NaCl-7.0, MgSO4 .7H2 O-1.0 and KH2 PO4 -5.0 was as follows pH-7.0 at 30°C for 72 h in a 5 l fermenter. Aeration rate and agitator speed had no effect on the pigment production. Thin layer chromatogram of the pigment extracted from the fermented broth with chloroform on silica gel GF254 using ethyl acetate and hexane (1 : 1) as solvent showed three fractions. The major fraction (C3 ) was separated out and identified as 9-methyl-1, 4, 5, 8-tetra-azaphenanthrene. Acute toxicity test revealed the nontoxic nature upto a dose of 2000 mg kg(-1) , b.wt., of mice. MTT assay showed the cytotoxic nature in HL60 cells having an IC50 of 2.47 mmol. So, this biopigment may have application in food, textile colorant and pharmaceutical industry.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study demonstrated the optimum production of a biopigment (9-methyl-1, 4, 5, 8-tetra-azaphenanthrene) by fermentation of a complex medium with Bacillus cereus M(1) 16 (MTCC 5521) in submerged fermentation. This is the first investigation of toxicity and cytotoxicity activities of this biopigment. The study showed that the purified pigment had no toxicity to healthy albino mice but a high cytotoxicity activity in HL60 cancer cell line in vitro. The biopigment had further displayed dyeing capability to both solidified agar and cotton cloth. Therefore, it may represent a nontoxic and natural alternative to chemical dyes and pigments.

Temporal changes in pregnancy-associated glycoproteins across different stages of gestation in the Barbari goat

The objective of this study was to characterize the temporal profile of pregnancy-associated glycoproteins (PAGs; isoforms 1-11) across different stages of gestation in the Barbari goat. Placentae were collected from local abattoir, classified according to crown rump length of the corresponding foetus into five groups (0-30, 31-60, 61-90, 91-120, and 121-150 days of gestation), and used for relative quantification of mRNA expression by Pfaffl method. In addition, adult female goats (pregnant, n = 7; non-pregnant, n = 5) were used to estimate weekly plasma PAG and progesterone (P4) concentrations. The relative mRNA expression of PAGs was greater (p<0.05) during 31-60 days of gestation, which correlated well with the temporal changes in plasma PAG concentrations. Relative expression of PAGs decreased steadily as gestation advanced with minimum expression observed just before parturition, except for PAG-4 and PAG-8 that showed constantly higher expression throughout pregnancy. Plasma PAG and P4 concentrations showed a distinct temporal pattern with a significant increase beginning at 2 weeks and return to basal levels by 20 weeks of gestation. However, PAG concentrations reached a peak earlier in gestation (8 weeks) than P4 (10-14 weeks). Correlation analysis indicated a strong positive association (r = 0.748, p<0.01) between plasma PAG and P4 concentrations. In conclusion, results of this study indicate a distinct temporal pattern of PAG expression and secretion during gestation in the Barbari goat. The temporal changes in PAGs and the positive association with P4 are suggestive of their role in maintenance of pregnancy and progressive foetal development.

Epigenetic mechanisms of protein tyrosine phosphatase 6 suppression in diffuse large B-cell lymphoma: implications for epigenetic therapy

Protein tyrosine phosphatases such as PTPN6 can be downregulated in various neoplasms. PTPN6 expression by immunohistochemistry in 40 diffuse large B-cell lymphoma (DLBCL) tumors was lost or suppressed in 53% (21/40). To elucidate the molecular mechanisms of PTPN6 suppression, we performed a comprehensive epigenetic analysis of PTPN6 promoter 2 (P2). None of the DLBCL primary tumors (0/37) had PTPN6 hypermethylation on the CpG1 island using methylation-specific PCR, pyrosequencing, and high-resolution melting assays. However, hypermethylation in 57% (21/37) of cases was found in a novel CpG island (CpG2) in P2. PTPN6 gene suppression was reversed by 5-aza-deoxycytidine (5-Aza), a DNA methyltransferase inhibitor, and the histone deacetylase inhibitor (HDACi) LBH589. LBH589 and 5-Aza in combination inhibited DLBCL survival and PTPN6 hypermethylation at CpG2. The role of histone modifications was investigated with a chromatin-immunoprecipitation assay demonstrating that PTPN6 P2 is associated with silencing histone marks H3K27me3 and H3K9me3 in DLBCL cells but not normal B cells. 3-Deazaneplanocin A, a histone methyltransferase inhibitor, decreased the H3K27me3 mark, whereas HDACi LBH589 increased the H3K9Ac mark within P2 resulting in re-expression of PTPN6. These studies have uncovered novel epigenetic mechanisms of PTPN6 suppression and suggest that PTPN6 may be a potential target of epigenetic therapy in DLBCL.

A Parametric Study of Sink Marks in Injection-Molded Plastic Parts using the Finite Element Method

A numerical procedure to simulate the formation of a sink mark near the base of a rib in an injection-molded plastic part has been developed. This method uses two commercially available software packages, C-Mold and Abaqus, to model the injection molding process. The C-Mold software uses a generalized Hele-Shaw formulation to simulate the mold filling, packing and cooling stages of injection molding. From this analysis, pressure and temperature histories in the rib area are derived. These are used to determine the initial conditions and boundary conditions for a sequentially-coupled thermal / structural finite element analysis of a cross-section of the rib, using the Abaqus software. An elastic-plastic material model with temperature-dependent material properties is employed. The thermal/structural finite element analysis provides an accurate model of the two-dimensional cooling and shrinkage behavior of the part during molding. To verify the accuracy of the method, the dependence of sink mark depth on various geometric and molding parameters has been analyzed. The predicted sink mark depth is found to be in good agreement with experimental results from the literature.

A Comparison of the Axisymmetric and Planar Elongational Viscosities of PE-LD

The elongational viscosities of a low density polyethylene in axisymmetric and planar flows are compared. The experimental data on entrance pressure loss is matched with the corresponding finite element predictions to estimate the parameters in the elongational viscosity model proposed by Sarkar and Gupta. The entrance losses in the capillary and slit rheometers are used to predict the elongational viscosities for axisymmetric and planar flows respectively. The power-law region of the axisymmetric as well as planar elongational viscosity is found to follow the time-temperature superposition principle. The vortices encountered in the flow near the abrupt contraction for the planar and axisymmetric cases are compared. The vortex near the abrupt contraction is found to reduce in size as the flow rate is increased for planar as well as axisymmetric entrance flow.

Effect of Elongational Viscosity on the Flow in a Flat Die

The flow of a low-density polyethylene in a flat die is simulated using the axisymmetric and planar elongational viscosities estimated in an earlier publication by Beaupre and Gupta. Elongational viscosity is found to have only a limited effect on the velocity distribution at the die exit. However, the predicted pressure drop in the die and the temperature distribution at the die exit changed significantly when the effect of elongational viscosity was included in the simulation.

Clinical efficacy of various root canal obturating methods in primary teeth: a comparative study

AIM

The purpose of this in vivo study was to evaluate and compare the efficacy of different obturating methods used in primary teeth, when obturated using a combination of zinc oxide and iodoform paste (Endoflas F.S.).

MATERIALS AND METHODS

A group of 29 patients aged 3-9 years and a total of 64 teeth were selected. These 64 teeth (32 anterior teeth=32 canals, and 32 posterior teeth=80 canals) were randomly divided into 4 groups. Teeth were obturated with Lentulo spiral, pressure syringe, bi-directional spiral and Pastinject. Post-operative evaluation was done for: quality of canal obturation, (underfilled, optimally filled, overfilled) and presence of voids.

RESULTS

Pastinject exhibited the highest number of optimally filled canals, while the highest number of underfilled canals were observed with bi-directional spiral, and the highest number of overfilled canals were observed with pressure syringe. A minimum number of voids was present in canals filled with the Pastinject technique and pressure syringe.

CONCLUSION

These results suggest that Pastinject was the most effective technique for obturation of primary teeth.

Infant illness spanning the antenatal to early neonatal continuum in rural northern Ghana: local perceptions, beliefs and practices

OBJECTIVE

To explore community understanding of perinatal illness in northern Ghana.

STUDY DESIGN

A cross-sectional descriptive study design.

RESULT

253 community members participated in in-depth interviews and focus group discussions, including women with newborn infants, grandmothers and health care providers. Four overarching themes emerged: (1) Local understanding of illness affects treatment practices. Respondents recognized danger signs of illness spanning antenatal to early neonatal periods. Understanding of causation often had a distinctly local flavor, and thus treatment sometimes differed from mainstream recommendations; (2) Mothers are frequently blamed for their infant's illness; (3) Healthcare decisions regarding infant care are often influenced by community members aside from the infant's mother and (4) Confidence in healthcare providers is issue-specific, and many households use a blended approach to meet their health needs.

CONCLUSION

Despite widespread recognition of danger signs and reported intentions to treat ill infants through the formal health care system, traditional approaches to perinatal illness remain common. Interventions need to be aligned with community perceptions if they are to succeed.

Melting in a Single Screw Extruder: Experiments and 3D Finite Element Simulations

The melting of an ABS resin was simulated using a three-dimensional finite element simulation of the two-phase flow in the compression section of a single-screw extruder. Screw freezing experiments were also conducted to compare the numerical predictions with the corresponding experimental data. Numerical simulations as well as experiments exhibited the Maddock melting mechanism and numerical predictions were in good agreement with the corresponding experimental data. The sensitivity of the melting profile to various material properties and processing conditions was numerically analyzed. With a constant flow rate enforced at the entrance of the screw channel, the screw and barrel temperature were found to have a minor effect on the melting profile. However, these parameters were found to have a significant effect on the predicted pressure profile along the screw channel. When the zero-traction boundary condition was imposed at the entrance of the screw channel, a change in the screw or barrel temperature affected the flow rate in the screw channel, which resulted in a significant change in the solid fraction at the same cross-section.

Simulation of Core Deflection in Powder Injection Molding

Core deflection in powder injection molding is one of the main causes of the structural defects in the molded part. Simulation of the core deflection in the injection molding process requires solution of the fluid-solid interaction problem, in which the fluid flow and solid deformation problems are coupled along the fluid-solid interface. A three-dimensional finite element program was developed in this work for a non-isothermal injection molding simulation including the fluid-solid interaction effects. With the assumption of small deformation in the solid structure, the fluid flow problem is formulated in an Eulerian frame-work, whereas the solid structure problem is formulated in a Lagrangian framework. Numerical simulation of the filling stage of injection molding for an airfoil-shaped part is presented and compared with the experimental data. The predicted melt-front advancement as well as the pressure is in good agreement with the corresponding experimental results. The predicted core deflection during the filling stage of the injection molding process is also compared with the measurements on a molded part.

Long term effects of anti-VEGF agents: patho-physiological perspectives

Monoclonal antibodies directed against different targets have become a new tool for the treatment of various disorders. More than 20 monoclonal antibody-based therapies have been approved in the USA and hundreds more are in development. Some of these therapies are finding applications in ocular disorders. The role of anti-VEGF in the treatment of wet ARMD is now well known. Anti-VEGF, which were initially discovered to treat carcinomas like bevacizumab in metastatic colorectal carcinoma, have now found place in ophthalmology to treat disorders where neovascularization/angiogenesis leads to blindnes. Nepal J Ophthalmol 2013; 5(9):100-105 DOI: http://dx.doi.org/10.3126/nepjoph.v5i1.7834

First Report of Bacterial Leaf Spot of Coriander Caused by Pseudomonas syringae pv. coriandricola in India

A new disease was observed during the early spring of 2011 and 2012 on coriander (Coriandrum sativum L.) in the Himachal Pradesh state of India. Disease incidence was estimated as 10% in approximately 5 ha. Symptoms were observed as brown leaf spots (1 to 2 × 3 to 5 mm) surrounded by a water soaked area. The leaf spots were often angular, being limited by veins. Leaf spots merged to cause a more extensive blight. Symptomatic leaf tissues were surface sterilized in 0.1% HgCl₂ for 30 sec followed by three successive rinses in sterilized water. Small sections of tissue were excised aseptically from leaf spot margins and transferred to several drops of sterile distilled water in a petri dish for 30 min. The diffusate was streaked onto King's B medium and incubated at 25°C for 24 to 48 h. Six representative strains of bacteria were isolated from five infected leaves. The bacteria were characterized as Gram negative, rod shaped, with few polar flagella and nonfluorescent on KB, and positive for levan production and tobacco hypersensitivity reaction but negative for oxidase reaction, rot of potato slices, and arginine dihydrolase. Preliminary identification of bacterial isolates was made on the basis of morphological and biochemical characters (3) and confirmed for one isolate by partial 16S rRNA gene sequencing. Using primers PF:5'AACTGAAGAGTTTGATCCTGGCTC3' and PR:5'TACGGTTACCTTGTTACGACTT3', a 1,265-bp DNA fragment of the 16S rDNA region was amplified. A BLAST search of this sequence (JX 156334) in the NCBI database placed the isolate in the genus Pseudomonas, with 99% similarity to accession P. syringae GRFHYTP52 (GQ160904). The sequence also showed 97% similarity to P. syringae pv. apii and P. syringae pv. coriandricola isolates from California (1). Identification of the bacterium to pathovar was based on host symptoms, fulfillment of Koch's postulates, cultural characteristics, physiological and determinative tests, and specificity of host range (2). Host range studies were conducted on celery, carrot, fennel, parsley, and parsnip, and no symptoms developed on any of these hosts. Pathogenicity was confirmed by artificial inoculation of five 1-month-old coriander plants with all isolates. A bacterial suspension (10⁸ CFU ml^-1) was injected into four leaves for each isolate with a hypodermic syringe and inoculated plants were placed in growth chamber at 25°C and 80% relative humidity. Initial symptoms were observed on leaves within 5 days of inoculation. No symptoms were observed on control plants inoculated with sterile water. Reisolation was performed on dark brown lesions surrounded by yellow haloes on the inoculated leaves and the identity of isolated bacteria was confirmed using the biochemical, pathogenicity, and molecular techniques stated above. All tests were performed three times. To our knowledge, this is the first report of P. syringae pv. coriandricola causing leaf spot disease on coriander in India. References: (1) Bull et al., Phytopathology 101:847, 2011. (2) Cerkauskas, Can. J. Plant Pathol. 31:16, 2009. (3) R. A. Lelliott and D. E. Stead, Methods for the Diagnosis of Bacterial Diseases of Plants, Blackwell Scientific, Sussex, UK, 1988.

Human fascioliasis with biliary complications

We report a case of human fascioliasis adding to the few of the previously reported cases in India. A young boy from rural background in Bihar presented with diarrhea, vomiting, hepatic tenderness, jaundice and fever along with peripheral eosinophilia. Examination of stool revealed yellow-brown eggs of Fasciola hepatica. Human fascioliasis should be kept in mind in patients with cholangitis and eosinophilia especially in areas of sporadic occurrence.

School eye survey in rural population in UP, India

OBJECTIVE

To find out the prevalence of refractive errors and pattern of ocular morbidity amongst the school children of a rural village.

MATERIALS AND METHODS

A cross sectional study was carried out in children of age group 3 - 12 years in a rural village of Hathras, Uttar Pradesh, India. All the children were examined including visual acuity measurement using Snellen's E chart, retinoscopy and refraction under cycloplegia. Examination of the anterior segment, media, and fundii was also done. Myopia was defined as spherical/cylindrical equivalent refractive error of at least -0.50 D and hypermetropia as +0.50 D or more (Dandona et al 2002).

RESULTS

In the survey 220 eyes of 110 children were examined, majority of them were in 5-10 year age group. The prevalence of uncorrected visual acuity of 6/6 was 85.40%. Refractive error was the cause in 6.81% of eyes with vision impairment, out of which myopia and hypermetropia were present in 26.67% of eyes. Blepharo-conjunctivitis was present in 15.45% of children and Bitot's spots were present in 0.90% of them. Colour blindness was found in one child.

CONCLUSION

The prevalence of refractive error in rural school is 6.81 %. Blepharitis is the commonest cause of ocular morbidity.

Polymeric nanomedicines as a promising vehicle for solid tumor therapy and targeting

Inspite of demanding research that has been undertaken for cancer treatment, cancer is a major cause of mortality. Available conventional treatment options of solid tumor are associated with serious side effects. Nanomedicines mediated fascinating approach may be effectively utilized for efficient tumor targeting by avoiding all the problems associated with conventional chemotherapy. Polymeric nanomedicines such as polymer micelles, polymeric nanoparticles, polymersomes and polymer conjugates currently developed for solid tumor treatment have proved to be efficacious cancer therapeutics. These polymeric nanostructures are able to reach tumor tissue or angiogenic endothelial cells either passively or actively. To date, more advancement in the tumor targeting field includes stimuli sensitive polymeric nanocarriers that pass through the intracellular delivery barriers and release the bioactives in response to the microenvironmental trigger of tumor cell. This review discusses the molecular aspects of solid tumor pathophysiology and its dramatic impact on research for innovative and novel therapeutic approaches linked with tumor-targeting polymeric nanomedicines.