High antibiotic resistance and mortality with Acinetobacter species in a tertiary hospital, Nepal

SETTING

Nepal Mediciti Hospital, Bhainsepati, Lalitpur, Nepal.

OBJECTIVES

To determine antimicrobial resistance patterns, and the number and proportion of multidrug-resistant (MDR-) and extensively drug-resistant (XDR-) cases among all patients with Acinetobacter isolates between September 2018 and September 2019.

DESIGN

This was a hospital laboratory-based, cross-sectional study.

RESULTS

Acinetobacter spp. (n = 364) were more common in respiratory (n = 172, 47.3%) and invasive samples such as blood, body fluids (n = 95, 26.1%). Sensitivity to AWaRe (Access, Watch and Reserve) Group antibiotics (tigecycline, polymyxin B, colistin) remained high. MDR (resistance to at least three classes of antimicrobial agents) (n = 110, 30.2%) and XDR (MDR plus carbapenem) (n = 87, 23.9%) isolates were most common in the Watch Group of antibiotics and found in respectively 99 (31.0%) and 78 (24.5%) patients (n = 319). Infected patients were more likely to be aged >40 years (n = 196, 61.4%) or inpatients (n = 191, 59.9%); 76 (23.8%) patients had an unfavourable outcome, including death (n = 59, 18.5%).

CONCLUSION

A significant proportion of MDR and XDR isolates was found; nearly one patient in five died. Robust hospital infection prevention and control measures (particularly for respiratory and invasive procedures) and routine surveillance are needed to reduce infections and decrease the mortality rate. Tigecycline, polymyxin B and colistin should be cautiously used only in MDR and XDR cases.

Quality criteria for groundwater use from a rural part of Wanaparthy District, Telangana State, India, through ionic spatial distribution (ISD), entropy water quality index (EWQI) and principal component analysis (PCA)

The present study region comprises granite and granite gneisses aquifer system constituted by Precambrian rocks. Groundwater is the primary source for drinking and other domestic purposes. Many developing regions in the world suffer from lack of safe drinking water. A rural part of Wanaparthy District in Telangana State, India, is one of them. For this reason, the groundwater samples collected from the study region were analyzed for pH, TDS, Ca²⁺, Mg²⁺, Na⁺, K⁺, HCO₃^-, Cl^-, SO₄^2-, NO₃^- and F^- and evaluated groundwater quality criteria, using ionic spatial distribution (ISD), entropy water quality index (EWQI) and principal component analysis (PCA). The ISD maps show that some locations are not suitable for drinking purpose due to exceeding concentrations of TDS, Mg²⁺, Na⁺, K⁺, HCO₃^-, Cl^-, NO₃^-and F^-, compared to those with national drinking water quality standards. According to the EWQI, about 3%, 47%, 43% and 7% of the total area come under the excellent, good, medium and extremely poor water quality types for drinking purpose, respectively. Chadha's diagram classified the area as carbonate hardness (63%), non-carbonate alkali (17%), carbonates alkali (13%) and non-carbonate hardness (7%) zones. The binary diagrams (Na⁺ + K⁺ vs TC, Na⁺ vs Ca²⁺ and HCO₃^- vs TC) indicate that the quality of groundwater is controlled by influences of water-rock interactions, mineral weathering and dissolution, ion exchange and evaporation as well as the impact of anthropogenic sources. The PCA transferred the chemical variables into three principal components accounts for about 81% of the total variance. The high positive loadings of PC1 (Cl^-, TDS, SO₄^2-, Na⁺, NO₃^-, Mg²⁺ and HCO₃^-) stand for processes of silicate weathering and dissolution, ion exchange and evaporation, and the influence of domestic waste waters, irrigation return flows and chemical fertilizers on the groundwater system, the PC2 (F^- and pH) signifies the alkaline nature of groundwater, which causes fluorosis, and the PC3 (K⁺) is a result of potassium fertilizers. The study helps to take remediate measures at a specific site and hence suggests the treatment of water before its drinking and also the recharge of the aquifer artificially to improve the groundwater quality.

Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study

BACKGROUND

Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery.

METHODS

This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy.

RESULTS

Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51-19.97) than planned admissions (OR: 2.32, 95% CI: 1.43-3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8-51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI.

CONCLUSIONS

After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.

Pattern of Corneal Diseases in Paediatric Age Group at a Tertiary Eye Care Center in Nepal

Objective: It is to study the pattern of corneal diseases (including injuries) in paediatric population in a tertiary eye care center. Materials and methods: A descriptive, cross sectional study was carried out in a tertiary eye care center which included 176 cases. Results: Out of 176 cases studied, 6 cases (3.4%) presented with congenital causes, 4 cases (2.27%) were of dystrophy and ectasia, 63 cases (35.79%) had infective origin, 17 cases (9.65%) had inflammatory cause, 9 cases (5.11%) had systemic association and 77 cases (43.75%) had traumatic causes. Conclusion: Trauma was noted to be the most important cause for corneal diseases in paediatric population followed by infective conditions. Viral keratitis was found to be the most common type of corneal infection in the paediatric age group. 

Interaction between dyslipidaemia, oxidative stress and inflammatory response in patients with angiographically proven coronary artery disease

INTRODUCTION

Coronary artery disease (CAD) is emerging as the biggest killer of the 21st century. A number of theories have been postulated to explain the aetiology of atherosclerosis. The present study attempts to elucidate the interaction, if any, between inflammation, oxidative stress and dyslipidaemia in CAD.

METHODS

A total of 753 patients undergoing angiography were evaluated and 476 were included in the study. The parameters studied included complete lipid profile, and apolipoprotein B, ferritin and nitric oxide (NO) levels. Statistical analysis was carried out to determine the interrelationship between these parameters and the best predictor of CAD risk. Cut-off points were determined from the receiver operating characteristics curves, and the specificity, sensitivity, positive predictive value, negative predictive value, odds ratio and confidence intervals were calculated.

RESULTS

The levels of the parameters studied increased with the stenotic state and a positive correlation was observed between ferritin, NO and apolipoprotein B. NO emerged as the most reliable predictor of CAD, with an area under the curve of 0.992 and sensitivity and specificity of 97 and 98%, respectively.

CONCLUSION

Environmental and genetic risk factors for CAD interact in a highly complex manner to initiate the atherosclerotic process. These risk factors should be considered mutually inclusive, not exclusive when devising pharmacological interventions, as multi-factorial risk management is the cornerstone of CAD management.

Lamellar ichthyosis presenting as bilateral spontaneous corneal perforation

Introduction: Lamellar Ichthyosis is an autosomal recessive, inherited skin disorder characterized by thickening, fissuring and scaling of the skin. Objective: To report a case of lamellar icthyosis and highlight the importance of monitoring corneal health in these patients. Case: We report a rare case of bilateral spontaneous corneal perforation in a patient with lamellar ichthyosis .The patient presented with complaints of diminution of vision, foreign body sensation, watering and discharge in both of his eyes for the last three months followed by pain and redness for one week. Visual acuities were light perception in both the eyes. Cicatricial ectropion was seen in both the lower eyelids. Corneal perforation was seen in both the eyes. Lamellar ichthyosis was diagnosed on the basis of scaling and excessive dryness of the entire body skin and was confirmed by skin biopsy. Peneterating keratoplasty of both eyes was done with cataract surgery of the right. The systemic anti-ichthyosis therapy was started. Ectropion of the right eye was corrected, and on follow-up at three months, the patient had a visual acuity of 4 /60 and CFCF in the right and the left eye respectively. Conclusion: In patients with cicatricial ectropion and dry eye secondary to ichthyosis, corneal health should be closely monitored because of the perforation risk. Nepal J Ophthalmol 2013; 5(9):117-119 DOI: http://dx.doi.org/10.3126/nepjoph.v5i1.7838

Ocular manifestations in herpes zoster ophthalmicus

BACKGROUND

Ocular complications of herpes zoster ophthalmicus (HZO) may lead to substantial visual disability, severe post-herpetic neuralgia and rarely fatal cerebral complications.

AIM

To identify the pattern of ocular manifestation in herpes zoster ophthalmicus.

MATERIALS AND METHODS

A cross-sectional descriptive study was under taken including the clinically diagnosed cases of HZO. All of them underwent a complete ophthalmological evaluation.

RESULTS

Sixty-eight cases of HZO were examined, of which 37 (54.4 %) were male and 31 (45.6%) female. The mean age was 48.7 ± 18.5 years. Most of the patients (64.7 %) were above the age of 40 years. 77.94 % of the patients had some form of ocular involvement. Pain (77.9 %) was the commonest ocular complaint. In young patients less than 35 years, HIV was the most common risk factor (19.3 %).Visual status was good in the majority (73.5 %) of patients at presentation. Lid and adnexal findings (45.8 %) were most common ocular involvement followed by conjunctivitis (41.1 %). Corneal complication was seen in 38.2 % of cases, uveitis in 19.1 % and post-herpetic neuralgia (PHN) and secondary glaucoma each in 5.8 %.

CONCLUSION

Eyelid and ocular adnexal involvement is most commonly found in patients with herpes zoster ophthalmicus followed by corneal complication and uveitis. There needs to be awareness of ocular involvement, which can be sight threatening, among the HZO patients and other medical departments and an increased emphasis on regular ophthalmic examination.

Bacteriology and antimicrobial susceptibility of adult chronic dacryocystitis

INTRODUCTION

Chronic dacryocystitis results in chronic infection and inflammation of the lacrimal sac.

OBJECTIVE

To identify the aetiology of chronic dacryocystitis and to determine their antimicrobial susceptibility pattern.

MATERIALS AND METHODS

A cross - sectional study was undertaken including 120 lacrimal swab materials collected from patients aged above 15 years suffering from chronic dacryocystitis.

STATISTICS

Data analysis was done by using software "Win pepi'' ver 7.9.

RESULTS

The bacteria of eight different species were isolated from 76.66 % (92/120) culture positive samples. 85.86 % showed a single and 14.13 % showed a mixed growth pattern. Coagulase negative staphylococci were the most common bacteria (P= 0.018) accounting for 33.96 % followed by Staphylococcus aureus (25.46 %), Streptococcus pneumoniae ( 19.81 % ), Streptococci viridans (5.66 %), Escherichia coli (5.66 %), Haemophilus spp ( 4.71 % ), Streptococcus pyogenes (3.77 %) and Bacillus spp (0.94 % ). Staphylococcus aureus were the most predominant bacteria in mixed growth. Rate of infection was higher in males 81.39 % than in females 74.02 %. Infection was higher in the age group of above 31 years. In the antimicrobial susceptibility test, except staphylococcus aureus, all the Gram positive isolates were 100 % sensitive to chloramphenicol and were least sensitive to tobramycin, but Gram negative isolates were equally sensitive to Chloramphenicol and Nalidixic acid.

CONCLUSION

Coagulase negative staphylococci are the most frequently isolated bacteria. Staphylococcus aureus is predominantly found in mixed growth. Chloramphenicol is the most effective drug of choice for chronic dacryocystitis.

The role of the injection botulinum toxin A in cases of blepharospasm syndrome, hemifacial spasm and Meige's syndrome

BACKGROUND

Benign Essential Blepharospasm Symdrome is a neuropathologic disorder. The cause of blepharospasm is multifactorial. It is unlikely that a single defect in this elusive control centre is the primary cause of this disease.

OBJECTIVES

To evaluate the role of botulinum toxin A in treating cases of Essential Blepharospasm Symdrome, Hemifacial Spasm and Meige's Syndrome, and to assess orbicularis oculi muscle post treatment, in the patients who attended neuro-ophthalmology clinic and the general outpatient department of BP Koirala Lions Centre for Ophthalmic studies.

METHODS

A prospective, interventional study was carried out on all the patients of Essential Blepharospasm Symdrome, Hemifacial Spasm and Meige's syndrome who underwent treatment with botulinum toxin A in BP Koirala Lions Centre for Ophthalmic studies during a study period of one and half years. Pre- treatment grading of the spasm was done with Jankovic spasm grading and post treatment response was seen with assessment of orbicularis oculi muscle and improvement in functional impairment scale. Relevant findings were noted.

RESULTS

A total of 40 cases were enrolled in the study. The mean Jankovic spasm grading in cases of essential blepharospasm, hemifacial spasm and Meige's syndrome was 3.61 (+/- Standard deviation 0.50, range 3-4), 3.21 (+/- Standard deviation 0.63, range 2-4) and 3.67 (+/- Standard deviation 0.57, range 3-4) respectively. The mean value for reappearance of significant spasms (in months) in cases of essential blepharospasm, hemifacial spasm and Meige's syndrome was 4.3 (+/- Standard deviation 1.6, range 2.0-6.5), 5.8 (+/- Standard deviation 1.4, range 3-8) and 4.5 (+/- Std.deviation 2.8, range 2.5-6.5) respectively. Blepharoptosis was the commonest complication accounting for 66.6% of the complications.

CONCLUSIONS

The movement disorders like Essential Blepharospasm, Hemifacial Hpasm and Meige's syndrome are treated by different modalities. An acceptable and effective treatment modality has been a long felt need in these cases. Our study has shown that injection of botulinum toxin A has been a safe and effective method of treating these cases in Nepal.

Ocular Manifestations of Meningitis in Children

Introduction: Meningitis is the most common central nervous system disease affecting children leading to focal neurological deficits and various oculovisual anomalies including blindness in children. The objective of this study was to evaluate the oculovisual anomalies occurring in Nepalese children suffering from different types of bacterial meningitis. Materials and Methods: A Prospective, study was undertaken for 18 months at B.P.Koirala Lion’s Center for ophthalmic studies, TU Teaching Hospital to study the children suffering from bacterial meningitis admitted at Kanti Children’s Hospital for ocular involvement. A through history, anterior and posterior segment ocular examination and investigations like blood, CSF and CT scan were done. Results: A total of 182 cases of bacterial meningitis were screened. Tubercular meningitis cases were 40 (21.97%) and Pyogenic were 142 (78.02%). Oculovisual anomalies were seen in 70 (38.46%) cases. The ocular abnormalities included pupillary changes (34.28%), Cranial Nerve Palsy (22.86%), Fundus changes (35.72%), Cortical Blindness (4.28%), Panophthalmitis and Proptosis (1.43%). Third nerve involvement was seen in 17.14% cases, sixth nerve in 4.29% cases, Papilledema in 11.43 % and Optic atrophy in 22.86 %. Risk factors included late presentation; hydrocephalous and increased CSF cell count and protein level. Conclusion: Oculovisual anomalies formed an important group of clinical manifestations of bacterial meningitis. Incidence of oculovisual anomalies was more frequently seen in Tubercular meningitis (55%).Children with early presentation and intervention had better prognosis. Hence, timely intervention and health education is important. J. Nepal Paediatr. Soc. 32(2) 2012 136-141 doi: http://dx.doi.org/10.3126/jnps.v32i2.5534

Ocular manifestations in HIV/AIDS cases in Nepal

BACKGROUND

A significant number of patients with HIV/AIDS can have ocular manifestations. Almost every structure in the eyes can be affected in this condition.

OBJECTIVE

To study various ocular manifestations in the cases known to be infected with HIV.

MATERIALS AND METHODS

A cross-sectional descriptive study was carried out including 117 subjects positive for HIV using the purposive sampling method. Their demographic pattern and ocular findings were studied. Findings were recorded in the pro forma developed for the study.

STATISTICS

SPSS ver 14.0 was used for data analysis. The p value of < 0.05 was considered as significant.

RESULTS

A total of 117 HIV infected cases were included in this study. Among them, 76 (64.95%) were male and 41 (35.05%) female. The mean age of the subjects was 30.04 +/- 11.32 years. The duration of HIV detection ranged from 1-5 years. Ocular complaints were present in 26.49% of the subjects. Ocular manifestations were present in 56% of the patients with complaints and in 27.3% of asymptomatic patients. Ocular involvement was seen in 55 (47%) patients. The common anterior segment findings were herpes zoster ophthalmicus (4.27%), anterior uveitis (2.56%), blepharitis (2.56%) and conjunctivitis (1.7%), whereas HIV retinopathy (19.6%), CMV retinitis (5.1%), ocular toxoplasmosis (2.5%) and presumed ocular tuberculosis (0.85%) were common posterior segment findings.

CONCLUSION

Herpes zoster ophthalmicus, anterior uveitis, HIV retinopathy and CMV retinitis are common ocular manifestations associated with HIV infections.

Diagnosis of tuberculosis in an era of HIV pandemic: a review of current status and future prospects

HIV and tuberculosis co-infection interact in fundamentally important ways. This interaction is evident patho-physiologically, clinically and epidemiologically. There are several differences between HIV-infected and HIV-uninfected patients with tuberculosis (TB) that have practical diagnostic implications. TB is more likely to be disseminated in nature and more difficult to diagnose by conventional diagnostic procedures as immunosuppression progresses. As TB rates continue to increase in HIV-endemic regions, improved diagnostic techniques merit consideration as TB-control strategies. There is a need to develop more user friendly techniques, which can be adapted for use in the high-burden and low-income countries. This review focuses on the diagnostic challenges in HIV-TB co-infection with an update on the current techniques and future prospects in an era of HIV pandemic.

Alport's syndrome

Alport's syndrome (Haemorrhagic Familial Nephritis) is a rare syndrome. It encompasses a group of heterogeneously inherited disorders involving the basement membrane of the kidney frequently involving the cochlea and the eye. We describe here the detailed ocular findings and the systemic problems of a case of Alport's syndrome in a 30 years male from Nepal. The current understanding of the clinical features and aetiopathogenesis are also discussed.

Psoriatic triad in a patient presenting with oligodontia

Psoriasis is a common dermatological disease. It can occur at any age but usually develops between 15 and 35 years of age and may persist throughout a person's lifetime with periods of exacerbation and remission. The hyperproliferative state of the affected epidermis produces a turnover rate that is up to eight times greater than normal. Instead of being shed, the skin cells pile up, causing the visible lesions. Oral manifestations of psoriasis are rare clinical observations. Lesions have been reported on the lips, buccal mucosa, palate, gingiva, and floor of the mouth. We document a presentation of psoriasis showing a triad: skin lesions, arthritis, and oral manifestations (oligodontia being patient's chief concern). Dental rehabilitation done was in the form of partial dentures. This was done to address the immediate concern of the patient, that is, inability to chew properly. As put forth through this case report, a potential link between psoriasis and oligodontia has scope for further study.

Evaluation of Vancoplus versus ceftriaxone against cephalosporin resistance MRSA strain in experimental meningitis model

The aim of this study was to compare the efficacy of ceftriaxone plus vancomycin (Vancoplus) versus ceftriaxone alone against cephalosporin resistant methicillin-resistant Staphylococcus aureus (MRSA) strain by using meningitis mice model. The MRSA strain ATCC 43300 was used to induce meningitis in mice. The mice were fed standard pelleted diet and water ad libitum. The test room was air conditioned with temperature 23 +/- 2 degrees C, humidity 65+/- 5% and with artificial fluorescent light 10-14 hrs. of light and dark, respectively. Twenty four mice were divided into four group containing six rats in each group. The ceftriaxone group received 28.57 mg/Kg body weight/day and the vancoplus group received 42.8 mg/Kg body weight/day and control as well as infected group received normal saline. The bacterial susceptibility test in CSF was performed for cephalosporin resistance MRSA strain by determining the lytic zone for the vancoplus and ceftriaxone antibiotic. The lytic zone was more in vancoplus as compared to ceftriaxone. It was also found that activities of antioxidant enzymes such as catalase were significantly increased (p<0.001) along with decreased (p<0.001) in lipid peroxidation (malonaldialdehyde) level in CSF of vancoplus treated group as compared to infected as well as ceftriaxone resistance group and come back to normal level. It was concluded that vancoplus beneficial for the patients who suffered from cephalosporin resistant MRSA bacterial strain.

Fixed-dose combination of cefepime plus amikacin (potentox) inhibits pneumonia infection

Pneumonia is a severe infection that causes high morbidity and mortality rate worldwide. It is caused by Klebsiella pneumoniae, which generally causes upper respiratory tract infection. In case of such type of infection, levels of oxidant and antioxidant become imbalanced, which may contribute to lung injury. The present study was planned to evaluate the status of oxidant and antioxidant enzyme activities in plasma and lung tissue of pneumonia-infected rats model. Animals were randomly distributed into 3 groups of 8 rats each: groups I (control, normal saline treated), II (infected group), and III (infected + treated group). The findings showed that there was significant increase (P < .001) in body temperature along with decreased body weight in the infected group as compared to the control group. Similarly, all the activities of antioxidant enzymes (superoxide dismutase [SOD], catalase) were significantly decreased along with increased malonaldialdehyde (MDA) levels in plasma and lung tissue of the infected group as compared to the control group. These enzyme activities along with MDA levels were improved and came back near to normal level after administration of cefepime plus amikacin (potentox) for 7 days in group III. These studies concluded that fixed-dose combination of potentox improved oxidant and antioxidant levels in pneumonia infection.

Molluscum contagiosum and dental caries: a pertinent combination

BACKGROUND

In recent decades, there has been a tremendous surge of interest in issues related to child health. The present study was carried out to reveal the DMFT/deft status of children in the age group of 1-12 years, residing in orphanages from Pune, India.

AIMS AND OBJECTIVES

To explore the DMFT/deft status in various orphanages from Pune (India). To find out differences, if any, between the DMFT/deft status in orphanages from Pune, India, and the general population of children below 12 years of age in Maharashtra state, India as well as all over India.

RESULTS

DMFT/deft of the orphanages was found to be 2.58 in the age group 1-5 years and 2.5 in the age group 6-12 years with caries prevalence in 70.27% of the children. An incidental finding of Molluscum contagiosum was observed in a significant percentage of children. The total percentage of children afflicted by Molluscum contagiosum was found to be 24.32%.

CONCLUSION

The higher incidence of Molluscum contagiosum in children residing in orphanages as compared to the normal population of the same age group was reflected in the higher incidence of DMFT/deft in orphanages as compared to the normal population.

Actual Proliferating Index and p53 protein expression as prognostic marker in odontogenic cysts

BACKGROUND

The purpose of this study was to evaluate the biological aggressiveness of odontogenic keratocyst/keratocystic odontogenic tumour (KCOT), radicular cyst (RC) and dentigerous cyst (DC) by observing the actual proliferative activity of epithelium, and p53 protein expression.

METHODS

The actual proliferative activity was measured by Ki-67 Labelling Index and argyrophilic nucleolar organizing regions (AgNOR) count per nucleus. The p53 protein expression was also evaluated.

RESULTS

Ki-67 positive cells were observed higher in suprabasal cell layers of KCOT with uniform distribution, a few of them were predominantly observed in basal cell layer in RC and DC. The AgNOR count was significantly higher in suprabasal cell layers of KCOT. The actual proliferative activity was noted to be higher in suprabasal cell layers of KCOT. The p53 immunolabelling was dense and scattered in basal and suprabasal cell layers in KCOT. The weakly stained p53 positive cells were observed diffusely distributed in KCOT, whereas they were mainly seen in basal cell layer of RC and DC.

CONCLUSION

The quantitative and qualitative differences of the proliferative activity and the p53 protein expression in sporadic KCOT may be associated with intrinsic growth potential that could play a role in its development and explain locally aggressive biological behaviour. AgNOR count and p53 protein detection in odontogenic lesions can be of great consequence to predict the biological behaviour and prognosis.

East Central South African genotype as the causative agent in reemergence of Chikungunya outbreak in India

Chikungunya fever is an important arboviral infection prevalent throughout Africa and Southeast Asia. Recently, in 2006, it has reemerged in many parts of India, affecting more than a million persons. A detail serological, virological, and molecular investigation of this unprecedented outbreak was carried out by collecting and studying 540 samples from all the affected regions of India during this epidemic. An in-depth investigation revealed the presence of anti-Chikungunya antibodies in 68% of the samples and genomic RNA in 49% of them. In addition 32 Chikungunya viruses were isolated from 45 representative polymerase chain reaction-positive samples. The nucleotide sequences of partial E1 gene of 25 representative Chikungunya viruses were deciphered. The sequence analysis indicated that all the isolates of this epidemic belonged to the new Indian Ocean island clade of East Central South (ECS) African genotype. This study conclusively proved the genotype shift from Asian to ECS African as the major factor in the reemergence of Chikungunya in an unprecedented outbreak in India after a gap of 32 years.

Peyronie's disease with erectile dysfunction: penile modeling over inflatable penile prostheses

OBJECTIVES

To evaluate, retrospectively, the impact of penile correction by modeling of the penis over an inflatable penile prosthesis and the subsequent improvement in erectile function. Advanced Peyronie's disease with severe penile curvature and poor quality erections presents a challenge to the urologist.

METHODS

In our series, 46 patients with advanced Peyronie's disease and associated erectile dysfunction underwent insertion of an inflatable penile prosthesis between 1998 and 2003. Of the 46 patients, 28 (61%) underwent a standard modeling procedure; the other 18 patients (39%) did not need additional modeling, because their curvature was corrected by inflation of the prosthesis alone. Patients were evaluated postoperatively in the clinic, as well as by a postal questionnaire.

RESULTS

Of the 46 patients, 44 were satisfied with the penile correction and 2 (4.4%) underwent removal of their prosthesis because of infection. These 2 patients underwent revision surgery; subsequently both prostheses had to be removed, one for severe pain and the other for urethral erosion. None of the patients underwent reoperation for additional straightening. Of the 44 patients with intact prostheses, erectile function significantly improved in 41 (93%).

CONCLUSIONS

The results of our study have indicated that patients with severe Peyronie's disease and erectile dysfunction should be offered the choice of penile modeling over an inflatable penile implant to correct the curvature, as well as improve erectile function.

Starvation, leptin and epithelial cell proliferation in the gastrointestinal tract of the mouse

BACKGROUND/AIMS

Leptin, the ob/ob gene product, is a recently discovered peptide hormone, secreted by adipocytes, which can act as a satiety factor to regulate food intake. Its levels thus will be related to the presence of food in the lumen of the gut, and food intake is one of the most potent stimuli for intestinal epithelial cell proliferation. Leptin has a variety of other actions and the aim of this study was to see if one of these was to stimulate mucosal growth.

METHODS

Three groups of mice were fed ad libitum, starved for 48 h or starved for 48 h and given twice-daily intraperitoneal injections of recombinant leptin (1 microg/g).

RESULTS

Starvation led to a 20% decrease in body weight and a similar decrease in the weights of the intestines. Starvation also markedly inhibited intestinal epithelial cell proliferation. Leptin had little effect on the small intestine and did not stimulate proliferation. However, in the hind gut it was associated with small but significant decreases in caecal weight, distal colon mitotic counts (p = 0.036) and in colonic crypt area (approximately 20%, p<0.001).

CONCLUSION

Leptin did not stimulate intestinal cell proliferation, however it did have a paradoxical inhibitory action on the caecum and colon.

Vaginitis in non pregnant women in Haryana

Study was carried out in 100 patients of non-specific vaginitis (NSV) to find out the incidence of vaginitis due to G. vaginalis. Out of a total of 100 subjects 20 were positive for G. vaginalis as compared to only 6 in equal number of normal matched controls. One positive specimen showed concomitant presence of C. albicans and E. coli was found in another positive specimen. Presence of amines and clue cells in the discharge did not correlate with the isolation rate of G. vaginalis, thus emphasizing the necessity of culture to diagnose NSV due to G. vaginalis.

Evaluation of accuracy of an electric device (Neosono D-SE) for the measurement of tooth length

The study was conducted on 92 root canals selected from teeth advised for extraction to evaluate the efficacy of an electronic device (NEOSONO D-SE), Ingles method and Digital Tactile method for the measurement of working length of tooth. In 30% of anterior teeth and 30% of posterior teeth the electronic device was able to locate exact position of apical constriction of tooth, as measured after the extraction of the tooth. In 37% of anterior teeth and 13% of posterior teeth, the apical constriction was located exactly when digital tactile method was used. When Ingle's method for determining the working length was used it was successful in 30% of anterior teeth and 42% of posterior teeth. The study was also conducted to know the distance between apex of the tooth to apical foramen and distance between apical foramen and apical constriction. The findings of the study showed that the average distance between apex and apical foramen was 0.215mm and 0.289 mm in anterior and posterior teeth respectively. Whereas the distance between apical foramen and apical constriction was 0.610 mm and 0.504 mm in anterior and posterior teeth respectively.

Anticonvulsant and antiproteolytic properties of 3,5-disubstituted oxadiazole-2-thiones and their inhibition of respiration in rat brain homogenates

Eight 5-(3,4-methylenedioxyphenyl)-3-arylaminomethyl-1,3,4-oxadiazole-2-thiones were synthesized, characterized by their sharp melting points, elemental analyses, and IR spectra, and evaluated for anticonvulsant activity. All substituted oxadiazole-2-thiones possessed anticonvulsant activity, which was reflected by their ability to provide 10--70% protection against pentylenetetrazol-induced convulsions in mice at 100 mg/kg ip. These compounds inhibited in vitro nicotinamide adenine dinucleotide (NAD)-dependent oxidation of pyruvate, alpha-ketoglutarate, and NADH by rat brain homogenates as well as NAD-independent oxidation of succinate by rat brain homogenates. Antiproteolytic activity of these substituted oxadiazole-2-thiones was reflected by their ability to inhibit trypsin hydrolysis of bovine serum albumin. These results indicated that the inhibition of cellular respiration and antiproteolytic activity of these substituted oxadiazole-2-thiones is not the biochemical basis for their anticonvulsant activity.

Anticonvulsant and antiproteolytic properties of 2,5-disubstituted oxadiazoles and their inhibition of respiration in rat brain homogenates

Eight 2-(3,4-methylenedioxyphenyl)-5-arylamino1,3,4-oxadiazoles were synthesized, characterized by their sharp melting points, elemental analyses, and IR spectra, and evaluated for anticonvulsant activity. The protection afforded by oxadiazoles (100 mg/kg ip) against pentylenetetrazol (90 mg/kg sc)-induced convulsions ranged from 50 to 80%. All oxadiazoles inhibited the respiratory activity of rat brain homogenates during oxidation of pyruvate, alpha-ketoglutarate, and succinate. The presence of added nicotinamide adenine dinucleotide (NAD) to the reaction mixture during oxidation of pyruvate decreased the degree of inhibition. All oxadiazoles possessed antiproteolytic activity that was reflected by their ability to decrease trypsin-induced hydrolysis of bovine serum albumin. Such an inhibition was concentration dependent and ranged from 10.2 to 47.5 and from 15.7 to 71.8% by 0.5 and 1 mM oxadiazoles, respectively. All oxadiazoles competitively inhibited in vitro succinate dehydrogenase activity of rat brain homogenates.