Bactericidal Efficacy of Allium sativum (garlic) Against Multidrug Resistant Vibrio cholerae O1 Epidemic Strains

In recent years, emerging trend of antibiotic resistance in Vibrio cholerae associated with cholera epidemics is a matter of serious concern for the management of the disease. Indiscriminate use of antibiotics generally results in selection of antibiotic resistant strains. Introduction of newer antibiotics is a challenging task for the researchers as bacteria soon attain resistance. Therefore, identifying natural compounds of medicinal importance for control of cholera would be the best alternative. Garlic (Allium sativum) was recognised for many centuries in early Chinese, Egyptian and Indian civilisations as an herbal or traditional medicine. In present study, garlic was selected for screening of antimicrobial efficacy against V. cholerae. A total of 55 V. cholerae strains isolated from various outbreaks/epidemics were subjected to antimicrobial testing as per CLSI, USA 2010 guidelines. Antimicrobial screening of garlic extract was performed against all the multidrug resistant strains of V. cholerae. The garlic extracts showed antibacterial activity against all the V. cholerae strains tested, irrespective of their origin, multidrug resistance and virulence. Antibacterial efficacy of garlic on V. cholerae was also evident from in vivo study on sealed adult mice model. Thus, the Garlic extract harnesses the potential to control infection of multidrug resistant V. cholerae, especially in outbreak like situations in remote and under developed areas where drug supply itself is a challenge

Test Tube Tooth: The Next Big Thing

Unlike some vertebrates and fishes, humans do not have the capacity for tooth regeneration after the loss of permanent teeth. Although artificial replacement with removable dentures, fixed prosthesis and implants is possible through advances in the field of prosthetic dentistry, it would be ideal to recreate a third set of natural teeth to replace lost dentition. For many years now, researchers in the field of tissue engineering have been trying to bioengineer dental tissues as well as whole teeth. In order to attain a whole tooth through dental engineering, that has the same or nearly same biological, mechanical and physical properties of a natural tooth, it's necessary to deal with all the cells and tissues which are concerned with the formation, maintenance and repair of the tooth. In this article we review the steps involved in odontogenesis or organogenesis of a tooth and progress in the bioengineering of a whole tooth.

Cadaveric study using radio-opaque contrast to determine arterial communication between the two bellies of gastrocnemius muscles

INTRODUCTION

Gastrocnemius muscle is a workhorse flap to cover upper third tibial defects but has a limitation in covering middle one-third tibial defects. The inferiorly based hemi gastrocnemius muscle flap can be useful for reconstruction of the middle third of the leg. The arterial communication between the gastrocnemius muscle heads has been demonstrated, the consistent location, however, was not studied in large specimens.

MATERIALS AND METHODS

This study was conducted on sixty specimens of gastrocnemius muscles harvested from thirty fresh cadavers to determine arterial communication between two heads of gastrocnemius muscle using radio-opaque contrast with future application of taking one head of muscle distally based for coverage of middle third defect of tibia. A total of 60 specimens were obtained from thirty fresh cadavers. In thirty specimens, medial sural artery ligated and divided and 20 ml iohexol (350) given through popliteal artery. In remaining thirty specimens lateral sural artery ligated and divided and 20 ml iohexol (350) given through popliteal artery. Digital X-rays of gastrocnemius muscle specimens were taken, and collaterals between two bellies in lower half were noted and the distance of collaterals from the muscles top edge was also noted.

RESULTS

We found the communications between both bellies of the gastrocnemius muscle in all specimens in both legs. The mean distance of communications from the upper edge of the medial belly was 15.88 cm and from upper edge of the lateral belly was 14.72 cm in the right leg, respectively. The mean distance of communications from upper edge of the medial belly was 16.01 cm and from upper edge of the lateral belly was 13.78 cm in the left leg. The distal communications between gastrocnemius bellies were not constant in their location, but all the connections were present in distal 3.79 cm of raphe.

CONCLUSION

This study supports the future application of inferior-based hemigastrocnemius muscles flap to cover defects of middle third leg. When distally based hemigastrocnemius flap is planned roughly 1/3(rd) of distal attachment or distal 3.79 cm of connection between raphe should be maintained to preserve the vascular communications between the two bellies.

Trends of hospitalization for schizoaffective disorder (SD) in USA: A nationwide analysis

Objectives

Schizoaffective disorder (SD) is an important cause of morbidity and mortality in hospitalized patients. While SD has been extensively studied in the past, the contemporary data for impact of SD on cost of hospitalization are largely lacking.

Methods

We queried the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample (HCUP-NIS) dataset between 1998–2011 using the ICD-9 codes. Severity of comorbid conditions was defined by Deyo modification of Charlson comorbidity index. Primary outcome was in-hospital mortality and secondary outcome was total charges for hospitalization. Using SAS 9.2, Chi2 test, t-test and Cochran-Armitage test were used to test significance.

Results

A total of 4,66,800 patients were analyzed; 50.90% were female and 49.10% male (P < 0.0001); 61.15% were white, 25.97% black and 12.88% of other race (P < 0.0001). Rate of hospitalization increased from 13,035.05/million to 26,703.21/million from 1998–2011. Overall mortality was 0.50% and mean cost of hospitalization was 20,995.19$. The in-hospital mortality increased from 0.46% to 0.50% (P < 0.0001) and mean cost of hospitalization increased from 11,504.94$ to 31,460.67$. Total spending on SD related admissions increased from $1.2 billion/year to $6.6 billion/year.

Conclusions

While mortality has slightly increased from 1998 to 2011, the cost has significantly increased from $1.2 billion/year to $6.6 billion/year which leads to an estimated $5.4 billion/year additional burden to US health care system. In the era of cost conscious care, preventing SD related hospitalization could save billions of dollars every year. Focused efforts are needed to establish preventive measures for SD related hospitalization.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Trends of hospitalization for schizophrenia in USA: A nationwide analysis

Objectives

Schizophrenia is an important cause of morbidity and mortality in hospitalized patients. While schizophrenia has been extensively studied in the past, the contemporary data for impact of schizophrenia on cost of hospitalization are largely lacking.

Methods

We queried the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample (HCUP-NIS) dataset between 1998–2011 using the ICD-9 codes. Severity of comorbid conditions was defined by Deyo modification of Charlson comorbidity index. Primary outcome was in-hospital mortality and secondary outcome was total charges for hospitalization. Using SAS 9.2, Chi2 test, t-test and Cochran-Armitage test were used to test significance.

Results

A total of 443,659 patients were analyzed; 38.78% were female and 61.22% were male (P < 0.0001); 48.19% were white, 35.30% black and 16.51% of other race (P < 0.0001). Rate of hospitalization increased from 56,768.47/million to 79,44466/million from 1998–2011. Overall mortality was 0.70% and mean cost of hospitalization was 23,568.47$. The in-hospital mortality decreased from 0.75% to 0.73% (P < 0.0001) and mean cost of hospitalization increased from 12,775.64$ to 36,768.58$. Total spending on schizophrenia related admissions have increased from $1.75 billion/year $6.23 billion/year.

Conclusions

While mortality has slightly decreased from 1998 to 2011, the cost has significantly increased from $1.75 billion/year to $6.23 billion/year which leads to an estimated $4.48 billion/year additional burden to US health care system. In the era of cost conscious care, preventing schizophrenia related hospitalization could save billions of dollars every year. Focused efforts are needed to establish preventive measures for schizophrenia related hospitalization.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Synthesis and Sensing Applications of Fluorescent 3-Cinnamoyl Coumarins

We have synthesized two novel fluorescent 3-(4-diethylaminocinnamoyl) coumarins that exhibit fluorescence quenching upon exposure to a nerve agent simulant, diethylchlorophosphate (DCP), providing a basis for rapid and sensitive DCP chemosensing. Furthermore, these coumarin derivatives display two-photon fluorescence upon illumination with near-infrared laser pulses and their two-photon (TP) absorption cross-section was evaluated. The potential for TP bio-imaging of these compounds was investigated by their cellular uptake in HeLa cells by TP confocal microscopy.

Clinical significance of TP53 (R72P) and MDM2 (T309G) polymorphisms in breast cancer patients

INTRODUCTION

TP53 gene is the most frequently altered tumor suppressor gene in breast cancer. It has been observed that MDM2 plays a central role in regulating the TP53 pathway. This study aimed to investigate the role of TP53 Arg72Pro and MDM2 T309G polymorphisms in breast cancer patients.

MATERIAL AND METHOD

The TP53 (Arg72Pro) and MDM2 (T309G) polymorphisms were studied in a hospital-based case control study by AS-PCR in 100 breast cancer patients and 100 healthy control subjects.

RESULTS

It was observed that TP53 Arg72Pro polymorphism was significantly associated with breast cancer (χ (2) = 9.92, p = 0.007). A significantly increased breast cancer risk was associated with the Proline allele [odds ratio 1.84 (95 % CI: 1.22-2.77), risk ratio 1.34 (95 % CI: 1.11-1.63), p value 0.003], HER2/neu status (p = 0.01) and distant metastasis (p = 0.05). On the other hand, we have found a significant correlation between MDM2 (T309G) polymorphism with HER2/neu status (χ (2) = 11.14, p = 0.003) and distant metastasis (p value = 0.04).

CONCLUSION

Our finding suggests that TP53 (Arg72Pro) polymorphism may play a significant role as risk factor for breast cancer in north Indian breast cancer patients. While MDM2 (T309G) polymorphism may not be directly associated with the risk of breast cancer occurrence in the same population, but it may play role in disease progression by triggering TP53.

DNA polymorphisms in chickpea accessions as revealed by PCR-based markers

Chickpea is a food legume which is alleged to be a preferred source of protein next only to milk. Germplasm of cultivated chickpea available is deficient in desired genetic variation. Genetic manipulations therefore, necessitate the genetic exploitation of its related annual and wild species. 42 RAPD and 41 ISSR markers were employed to ascertain polymorphism across 20 genotypes which were collected from 10 different geographical areas of the world. RAPD marker detected 51% genetic polymorphisms while ISSR marker detected 54 %. With an average of 6.5 each RAPD primer amplified 5&mdash;8 bands. Similarly with an average of 7.9 each ISSR primer amplified 4&mdash;12 bands. The cluster dendrogram demonstrated a similarity coefficient range from 0.80 to 0.92 due to RAPD markers, whereas with ISSR primers the cluster dendrogram showed similarity coefficient of 0.60 to 1.00. Accessions from same geographical area seem to be genetically similar than those from geographically distant and isolated ones. When however compared, interestingly the ISSR dendrogram showed more correlation with pedigree data than the RAPD dendrogram. The variability index worked out in the present study ranges from 0.79 to 0.96. Since the ultimate reason for such studies is selection of diverse genetic accessions for their recommendation to breeding programmers, the accessions like ICC6263, ICC6306 and ICC17160 can be recommended as parents. Further breeding programmes can therefore be planned to procure additional variation complexes in chickpea genetic stocks.

Predictors for the need of surgery in antenatally detected hydronephrosis due to UPJ obstruction--a prospective multivariate analysis

INTRODUCTION

Disagreement exists over the ability of different diagnostic tests to define obstruction, indications and timing of surgery and which patients will benefit from surgical intervention in antenatal hydronephrosis (ANH) due to ureteropelvic junction obstruction (UPJO). We try to find a way to predict which patients of ANH due to UPJO will eventually need surgery during conservative management.

MATERIAL AND METHODS

Prospective single centre study involving 122 renal units at a referral centre in India. Patients on conservative management were followed using a standard protocol and operated for pre-defined indications defining failure of conservative management. Patients who underwent surgery were compared with the non-operated group in terms of sex, side, baseline grade of hydronephrosis, maximum anterioposterior diameter on first postnatal ultrasound and differential renal function on first renal scan.

RESULTS

A total of 109 renal units qualified for conservative management. Of those, 23.9% required operative intervention during follow-up. Median time to failure of conservative management was 37 weeks. The median follow-up of non-operated cases was 54 months. Univariate analysis revealed that society of fetal urology (SFU) grade of hydronephrosis, anteroposterior diameter (APD), cortical thickness (CT), and pre-operative differential renal function (DRF) had a significant association with surgery (P < 0.05). Multivariate analysis revealed APD and pre-operative DRF as the only independent predictors for requiring surgery, while CT and initial SFU grade of hydronephrosis were not. Receiver operating curve analysis showed that an APD of 24.3 mm could predict the need for surgery, with a sensitivity of 73.1% and a specificity of 88.0%.

CONCLUSIONS

APD and DRF are the predictive factors for surgery. We stop short of recommending surgery only on the basis of APD. Instead we recommend that efforts be made to improve the specificity of this criterion, or by using APD in perspective with the differential renal function. We can reduce the burden of investigations in those with APD <24 mm while those with APD >24 mm can be more comprehensively monitored.

Chromones and their derivatives as radical scavengers: a remedy for cell impairment

Chromones (1-benzopyran-4-ones) are natural occurring compounds present in representative amounts in a normal human diet and are associated with interesting physiological activities such as antiinflammatory, antidiabetic, antitumor, anticancer etc. These biological activities are thought to be related to the antioxidant properties of chromones i.e. to neutralize active oxygen and to cut off free radicals processes that can delay or inhibit cell impairment which leads to various diseases. In this review, we have summarized the literature reports published in about 70 research articles during the period January 2004 to March 2014 on more than 400 naturally as well as the synthetically derived chromone derivatives having antioxidant potential. The literature reports suggest that the double bond, a carbonyl group of chromone and 3´,4´-dihydroxy group (catechol) in ring B along with the C-3 and C-5 hydroxyl groups are important for radical scavenging activity. In turn, a decrease in the radical scavenging potential has been observed upon methylation / glycosylation of the hydroxyl groups on chromone nucleus.

Biomedical Biopolymers, their Origin and Evolution in Biomedical Sciences: A Systematic Review

Biopolymers provide a plethora of applications in the pharmaceutical and medical applications. A material that can be used for biomedical applications like wound healing, drug delivery and tissue engineering should possess certain properties like biocompatibility, biodegradation to non-toxic products, low antigenicity, high bio-activity, processability to complicated shapes with appropriate porosity, ability to support cell growth and proliferation and appropriate mechanical properties, as well as maintaining mechanical strength. This paper reviews biodegradable biopolymers focusing on their potential in biomedical applications. Biopolymers most commonly used and most abundantly available have been described with focus on the properties relevant to biomedical importance.

Refractory giardiasis: a molecular appraisal from a tertiary care centre in India

PURPOSE

The intestinal flagellate Giardia lamblia includes many genetically distinct assemblages, of which assemblage A and B, predominantly infect humans. Nitroimidazoles derivatives (metronidazole and tinidazole) and nitazoxanide are some of the therapeutic agents for treatment of giardiasis. Nevertheless, some individuals with giardiasis are non-responsive to standard therapy. The present study highlights cases of refractory giardiasis and attempts to elucidate if genetic heterogeneity in the parasite is associated with treatment failure.

MATERIALS AND METHODS

Three stool samples were obtained on three consecutive days from 4000 patients with diarrhoea and were microscopically examined for the detection of trophozoites, and/or cysts, using both normal saline and Lugol's iodine. A hemi-nested polymerase chain reaction (PCR) assay using triose phosphate isomerase (tpi) as the target gene was performed to determine the assemblages. Sequencing of the PCR products of the patients showing failure to treatment of giardiasis was also performed.

RESULTS

Two per cent (82/4000) of the total patients were microscopically positive for Giardia lamblia in the stool samples. All these patients were treated with metronidazole/tinidazole as per the standard regimens. However, eight patients showed treatment failure to giardiasis as stool examinations were repeatedly positive even after treatment with multiple courses of anti-giardial therapy. Genetic characterisation of all eight Giardia isolates showed that they belonged to Assemblage B and had homogeneous sequences. These patients were either treated with extended regimens or with combination therapy of anti-giardials.

CONCLUSION

In our experience, combination of two or more drugs for a longer duration is the treatment modality to treat refractory giardiasis.

Clonal diversity and drug resistance in Mycobacterium tuberculosis isolated from extra-pulmonary samples in central India--a pilot study

In India, extrapulmonary tuberculosis (EPTB) accounts for 10 - 15% of all types of tuberculosis. To identify and compare predominant spoligotypes and drug-resistance patterns in strains of Mycobacterium tuberculosis isolated from extrapulmonary and pulmonary specimens in central India, drug susceptibility testing and spoligotyping were carried out. Spoligotyping data was analyzed using SITVIT2 database. ST11/EAI3_Ind with 33% isolates among extrapulmonary specimens and ST26/CAS1_DEL with 28% isolates among pulmonary specimens were the most predominant lineages. Multidrug resistance was found in 5.5% of the strains isolated from extrapulmonary specimens in contrast to 17% isolated from pulmonary specimens.

Expression of serum miR-200a, miR-200b, and miR-200c as candidate biomarkers in epithelial ovarian cancer and their association with clinicopathological features

BACKGROUND

MicroRNAs (miRs) have been implicated in the etiology of various human cancers. The aim of this study was to investigate the association of the expression of three members--miR 200a, miR 200b, and miR 200c belonging to the miR-200 family with clinicopathological characteristics and their impact on the progression of epithelial ovarian cancer (EOC).

MATERIALS AND METHODS

Total RNA from serum was isolated by Trizol method, polyadenylated, and reverse transcribed into cDNA. Expression levels of miR-200a, miR-200b, and miR-200c were detected by using miRNA qRT-PCR. We measured miR expression in 70 serum samples of EOC patients with matched controls using U6 snRNA as a reference. Levels of miR expression was compared with distinct clinicopathological features.

RESULTS

Expression of miR-200a was found to be greater than six-fold (p = 0.01), miR-200b and miR-200c greater than three-fold (p = 0.01) in comparison with matched normal controls. Association of miRNA expression with clinicopathological factors and progression was statistically evaluated. The expression levels of miR-200a and miR-200c were found to be significantly associated with disease progression (p = 0.04 and p < 0.001, respectively). miR-200a overexpression was found be associated with tumor histology and stage. Patients with lymph node metastasis showed significant elevation of miR-200c (p = 0.006). The AUC in ROC curve also indicated that serum levels of miR-200a and miR-200c might be worthwhile as a diagnostic tool in the near future.

CONCLUSION

Our findings suggest that miR-200a, miR-200b, and miR-200c overexpressions are associated with the aggressive tumor progression and be recognized as reliable markers to predict the prognosis and survival in EOC patients.

Molecular characterisation of Giardia intestinalis assemblages from human isolates at a tertiary care centre of India

PURPOSE

The aim of the study was to determine the genetic heterogeneity of Giardia intestinalis isolates detected in stool samples of the study population using polymerase chain reaction assay and restriction fragment length polymorphism. We also tried to correlate the association/differences between the clinical symptomatology and infection by different assemblages (genotypes) of G. intestinalis.

MATERIALS AND METHODS

This cross-sectional study was conducted from April 2008 to June 2010. A total of 40 adults (n = 40) and 42 children (n = 42) below the age of 12 years with the clinical suspicion of giardiasis and with the onset of one or more of the following five symptoms, i.e., loose stool, nausea, weight loss, fatigue and foul smelling faeces and confirmed laboratory diagnosis of giardiasis at least once during the current episode of diarrhoea were included in this study.

RESULTS

Of the 82 patients (males 66) enrolled in the study, 70 (85%) presented with diarrhoea (56 males) and 12 (15%) without diarrhoea (10 males). Out of 70 diarrheic patients, 61 (87%) had chronic diarrhoea, 8 (11.5%) had acute diarrhoea and 1 (1.5%) had persistent diarrhoea. Of the total patients, 63 (77%) were clinically assessed and were apparently immunocompetent, whereas, 19 (23%) immunocompromised patients had different underlying conditions besides giardiasis. Genotyping identified all 82 (100%) isolates as assemblage B.

CONCLUSION

We found that assemblage B of G. intestinalis presents with all kinds of clinical features ranging from asymptomatic carriage to acute, persistent or chronic diarrhoea.