Protective effects of the ethanolic fenugreek seeds extract and its potentiation with nitric oxide modulators in adjuvant induced changes in arthritic index, proinflammatory/anti-inflammatory cytokines imbalance and oxidative stress markers in rats

Objectives: The current study was designed to evaluate protective role of the ethanolic fenugreek seed extract (FSE) and potentiating its effects with nitric oxide (NO) modulators in experimental arthritis and its comparison with the standard drug methotrexate. Materials and Methods: The FSE was prepared using standard procedures. Fifty-four male Wistar rats were equally distributed into nine groups of six animals in each group. Rheumatoid arthritis was induced by administration of complete Freund’s adjuvant (CFA) in sub-plantar region of rt. hind paw. FSE alone and with L-arginine or N?-Nitro-L-arginine methyl ester hydrochloride (L-NAME) were administered on day 10 of CFA inoculation, i.p. Animals were evaluated for arthritic parameters, cytokines and oxidative stress markers estimation. Statistics: The data were analysed by two-way ANOVA followed by Newman Keul’s post hoc test for inter group analysis by GraphPad Prism 6.0 and P < 0.05 was taken as significant. Results: Adjuvant inoculated rat shows significant increase in arthritic and inflammatory parameters as well as oxidative stress biomarkers in serum, paw homogenates and joint synovial fluid. CFA inoculation significantly decreased anti-inflammatory cytokine-10 and SOD activity. These adjuvant-induced arthritic changes were significantly attenuated by ethanolic FSE administration from 10 to 28 days. These results are comparable to standard drug methotrexate. NO modulators further potentiated protective effects of FSE when given in combination. These results were more prominent when ethanolic seed extract was given with iNOS inhibitor, L-NAME. Conclusion: These findings suggest that FSE shows protective effects in CFA induced arthritic changes that may be mediated through pro-inflammatory/anti-inflammatory cytokines imbalance and it is associated with modulation of oxidative stress and NO-signalling.

Hypoplastic right ventricle with multiple associated anomalies: A challenging case for biventricular repair or univentricular approach? – A case report

Hypoplastic right ventricular is a rare congenital heart disease. A few cases have been reported. We presented a case with hypoplastic right ventricular and multiple associated anomaly (Ventricular septal defect, atrial septal defect and pulmonary stenosis) in whom the main concern was whether biventricular repair or Fontan type surgery would be the optimal management in this patient. Biventricular repair was done successfully using the multimodality cardiac imaging with intraoperative transesophageal echocardiography.

Acardiac twin – A case report

Acardiac twinning is a rare congenital anomaly of monozygotic twin pregnancy which often results from abnormal placental vascular anastomosis. It leads to twin reversal arterial perfusion with complex pathophysiology. Current information on early recognition and treatment for salvation of the normal twin is based on individual case reports in the literature. Mortality of Acardiac twin is 100%. Pump twin though structurally normal suffers due to heart failure and prematurity and has high morbidity and mortality all due to pumping blood to the acardiac twin. The acardiac twin receives all its blood supply from the pump twin through anastomotic channels, the term reversed perfusion is used to describe this condition because blood enters the acephalic twin through umbilical artery and exit through umbilical vein which is opposite to the normal blood supply. The acardiac twin loses direct vascular connection with the placental villi and receives its entire blood supply from the pump twin. Here, we have presented a primigravida of 24-26 weeks of gestation with twin gestation of monochorionic diamniotic type in preterm labor. One of the twin was acardiac acephalous and another a pump twin with hydrops.

Peters anomaly with post axial polydactyly, ocular hypertelorism, a low nasal bridge, retrognathia, undescended testis, microphthalmia, and club foot in an Indian neonate: A case report

A case of Peters anomaly with bilateral post axial polydactyly, convex soles, ocular hypertelorism, a low nasal bridge, retrognathia, undescended testis, microphthalmia and club foot was examined in a neonatal Indian baby girl who had been delivered in the hospital and admitted to the newborn unit. She died aged five days. There were no cases of Peters anomaly recorded in India according to a literature search. In addition, available data point to the majority of the principal associations in Peters anomaly to be genitourinary anomalies, making this case a rare one in its isolated collection of musculoskeletal associations. A Indian baby girl of who was born through a Cesarean section presented in the new born unit of our hospital with bilateral corneal opacities, bilateral polydactyly, camptodactyly and club foot. This is a rare case of Peters anomaly and its association with Patau syndrome makes it special

Correlates of cervical cancer screening among underserved women.

Background and Objectives: Substantial subgroups of Indian women, specifically those of ethnic minorities, had not been screened for cervical cancer or are not screened at regular intervals. We aim to find out the magnitude of cervical cancer and precancerous lesions among women in the age group 15-60 years, and to identify the various socio-demographic and reproductive correlates among those with the cervical lesions. Patients and Methods: Nine hundred and sixty-eight adult women in the age group 15−60 years were selected by simple random sampling technique in a population based descriptive cross-sectional study in a cervical cancer screening camp in a primary health center at the East Sikkim, during 1st September to 30th November 2006. Main outcome measures were the extent and correlates of cervical cancer without any interventions. The data collection tool used for the study was a pre-tested questionnaire prepared prior to the study for ensuring feasibility, acceptability, time management, validity and reliability. Information on socio-demographic and reproductive variables was collected by interview method using this questionnaire. Results: Out of 968 women in the study population, overwhelming majority 921 (95.15%) had no overt or pre-cancerous cervical lesion. Only 47 were found to have changes in their cervical epithelium. None of these 47 women was proved dyskaryotic on cytopathological screening of the cervical smear. No significant difference was noted among those with or without lesions among women below 30 years of age with those above, among illiterate women with literates, in per capita monthly family income difference, age at marriage and childbirth. Low-grade and high-grade squamous intraepithelial cervical lesions were associated with Hindu women only and were related with past history of abortion and still birth in women significantly. Conclusion: There was an imperative need for identifying prevalence of asymptomatic cervical dysplasia in all population.

Incidence of -lactamase producing organisms causing various infections and comparison of their antimicrobial susceptibility testing.

Higher generation cephalosporins, resistant to ß-lactamases were designed to combat bacterial resistance to first generation ß-lactam antibiotics. This led to the emergence of extended spectrum ß-lactamases (ESBLs), which conferred bacterial resistance to these drugs. Now, combination drugs employing a ß-lactam drug + a ß-lactamase inhibitor (Clavulanate, Sulbactam, Tazobactam) are used against ESBL-producing pathogens. This study aimed to evaluate the efficacy of these combination drugs against ESBL-producers and also screening for the presence of inducible AmpC ß-lactamase producers. Enterobacteriaceae family culture isolates exhibiting resistance to the 2nd / 3rd generation cephalosporins by the Disk Agar Diffusion test were tested for ESBL production by the Double Disk Synergy Test. Staphylococcal species culture isolates were tested for ßlactamase production by the Nitrocefin spot test. The Disk Antagonism test was used to screen for the presence of inducible Amp C ß-lactamase producers. The combination drugs included in this study were Cefepime/Tazobactam, Cefoperazone/Sulbactam, Cefotaxime/ Sulbactam, Ceftriaxone/ Sulbactam & Ceftriaxone/ Tazobactam. 128 clinical isolates were tested for ß-lactamase activity. Of the 26 S.aureus isolates, 88.4% (23) were ß-lactamase positive and 57.1 % coagulase negative Staphylococci were positive. Amongst Enterobacteriaceae family, 67.8% of E.coli; 53.1% of K.pneumoniae and 53.8% of Proteus species were confirmed ESBL producers. For E.coli, the best drug was Cefepime/ Tazobactam. All drugs were effective against Proteus spp. K.pneumoniae and S.aureus isolates were resistant to these drugs due to the production of AmpC ß-lactamases. 3.4% of E.coli, 4.5% of S.aureus and 14.2% of Proteus spp were confirmed inducible AmpC ß-lactamase producers.

In vitro study to compare sensitivity of amoxicillin+clavulanic acid and cefpodoxime+clavulanic acid among beta-lactamase positive clinical isolates of gram-positive and gram-negative pathogens.

The present study was carried out to compare the in vitro sensitivity of cefpodoxime + clavulanic acid and amoxicillin + clavulanic acid against 55 Gram-positive and 123 Gram-negative beta-lactamase positive clinical isolates. Micro-organisms isolated from different clinical specimens were tested for beta-lactamase/ESBL by using nitrocefin disc test and for metallo beta-lactamase by using double disc synergy test. A total of 299 (93 Gram-positive and 206 Gram-negative) clinical isolates were tested for beta-lactamase. Among 93 Gram-positive clinical isolates 25 (78.12%) out of 32 coagulase positive S. aureus, 23 (60.52%) out of 38 coagulase negative S aureus, 7 (63.63%) out of 11 enterococci and 0 (0%) out of 12 Strept pneumoniae were positive for beta-lactamase /ESBL. Notably Strept pneumoniae was found to be beta-lactamase/ESBL negative. Among 206 Gram-negative clinical isolates, 25 (69.44%) out of 36 acinetobacter spp, 20 (41.66%) out of 48 Branhamella catarrhalis, 24 (64.86%) out of 37 E. coli, 7 (46.66%) out of 15 H influenzae and 22 (62.85%) out of 35 proteus were positive for beta-lactamase/ ESBL/metallo beta-lactamase. Positive strains were tested for comparative sensitivity to amoxicillin+ clavulanic acid and cefpodoxime+clavulanic acid by Kirby Bauer disc diffusion method. As regards comparative sensitivity among beta-lactamase/ESBL positive Gram-positive strains, 84% and 92% strains of coagulase positive S aureus, 65.21% and 86.95% strains of coagulase negative S. aureus, 83.33% and 100% strains of Strept pneumoniae and 71.42% and 100% strains of enterococci were found sensitive to amoxicillin +clavulanic acid and cefpodoxime + clavulanic acid respectively. Sensitivity to amoxicillin+ clavulanic acid and cefpodoxime +clavulanic acid among beta lactamase/ESBL positive Gram-negative strains of acinetobacter spp, Branhamella catarrhalis, E. coli, H. influenzae and proteus spp were found to be 20% and 28%, 100% and 100%, 50% and 75%, 71.42% and 100%, 50% and 68.18% respectively. This study demonstrated that cefpodoxime +clavulanic acid combination has more potent in vitro activity in comparison to amoxicillin+ clavulanic acid combination against beta-lactamase producing strains of Gram-positive and Gram-negative bacteria. Given this broad spectrum of activity, cefpodoxime+clavulanic acid appears well suited for use in the treatment of a variety of healthcare-associated infections.

Distribution profile of paraoxonase phenotypes among the Gujaratis.

BACKGROUND: Paraoxonase (PON1) can hydrolyze organophosphate pesticides (OP) and has a key role in the susceptibility of human in OP toxicity. The human-enzyme shows polymorphism and variations in the distribution profile of its phenotypes among different ethnic groups have been observed. AIMS: To see the distribution pattern of total PON1 activity in 45 healthy attendants of poisoning cases; 121 healthy unrelated farm-labours and 59 normal subjects of trauma. MATERIALS AND METHODS: The PON1 activities from serum/plasma samples of these healthy normal individuals were estimated with/without addition of 1M NaCl in order to determine salt-stimulated and basal activity. The PON 1 phenotypes were determined on the basis of percent activation of enzyme activity. RESULTS: Tri-modal distribution of basal PON1 activity was observed among all these individuals. 52.0% of the individuals belonged to Phenotype A, 46.6% to phenotype AB while 1.4% to Phenotype B with gene frequency of allele-A and allele-B being 0.753 and 0.247 respectively in excellent agreement with Hardy-Weinberg equilibrium. CONCLUSION: Maximum number of individuals belonged to phenotype-A (low PON1 activity) showing potential vulnerability towards Op-poisoning.

Cases referred for tests of thyroid function disorders at a tertiary care teaching hospital of Bihar: some experience.

In the absence of valid hospital protocol for clinical departments of M.G.M. Medical College and L.S.K.Hospital, Kishanganj, as many as, 76.78% of patients was referred to biochemistry laboratory, in which disease was not present. Of 196 diseased (23.22% of total), male and female was respectively 44 and 152. There was no significant sex difference in positivity among patients referred for investigation. Hypothyroid was major diagnosis, yet hyperthyroid was noticeable.

Garlic hepatotoxicity: safe dose of garlic.

Information on the effect of garlic on the liver and optimal dose of garlic to avoid liver damage is not known. This study was planned to determine the safe dose of garlic. Male wistar rats (110-170g) were fed fresh garlic homogenate (FSH) orally in three different doses (1.0, 2.5 and 5.0 g/kg body weight/day) daily for 28 days. Liver histology, serum transaminases, bilirubin and alkaline phosphatase were estimated at 0, 14, 21 and 28 days in control and experimental animals. 1.0, 2.5 and 5.0 g/kg body weight/day of garlic showed significant (P<0.001) deterioration in liver function tests (LFT's) after 21, 14 and 7 days respectively. A 1.0 g/kg body weight/day dose of garlic was associated with marked histological damage in liver after 21 days. Therefore, three lower doses of garlic (0.1, 0.25 and 0.5 g/kg body weight/day) were given orally to another group of similar rats to determine the safe dose of garlic. LFT's were serially measured and animals were sacrificed on the 29th day of experiment. All three lower doses showed significant deterioration in the LFT's values of animals after 28 days of feeding the freshly prepared garlic homogenate. Both doses of garlic i.e. 0.1 and 0.25 g/kg body weight/day were associated with normal histology of liver, but 0.5 g/kg body weight/day dose of garlic showed morphological changes in the liver of one animal. Therefore, the present study suggests that garlic with high dose has the potential ability to induce liver damage and low doses (0.1 or 0.25 g / kg body weight/day) are safe doses of garlic.

Study of KAP of the private medical practitioners about national disease control programmes.

This study was carried out among the Private Allopathic Medical Practitioners (PMPs) at Khardah Municipal area (West Bengal) to find out their perception & practice about management protocol of diseases like acute respiratory infections and diarrhoel diseases in children, malaria and tuberculosis. Data was collected by interviewing the PMPs with pre-designed open-ended questionnaire. It was supplemented by analysing sample prescriptions of the same diseases. The study revealed that PMPs knowledge and practice were not at par with national guidelines. The need for periodic sensitization of PMPs regarding national disease control programme was emphasized.

Polymerase chain reaction for the rapid diagnosis of tuberculous meningitis.

(i) AIM OF THE STUDY: The study was carried out with the aim to evaluate a polymerase chain reaction (PCR) based on the amplication of a 169 bp DNA fragment specific for the Mycobacterium tuberculosis complex for the rapid diagnosis of tuberculous meningitis (TBM). (ii) METHODOLOGY: A total of 105 CSF specimens from clinically suspected cases of TBM were studied. Clinical details of the cases and cytochemical parameters of the CSF specimens were recorded. In addition to the 105 specimens, 10 CSF specimens from cases other than TBM, 4 non-mycobacterial culture isolates (1 strain of E. coli, 1 strain of Proteus species and 2 strains of Salmonella species) and 1 sample of sterile distilled water were processed as negative controls. For positive control standard culture of Mycobacterium tuberculosis H37Rv was processed with every batch of specimens. Besides PCR, smear for AFB by the Ziehl Neelsen Carbol Fuchsin (ZNCF) and the fluoro chrome method and culture on LJ medium was also carried out. (iii) RESULTS: By PCR, 31.42% specimens were found positive, whereas by conventional culture on LJ medium only 3.8% specimens were positive. Only 1.9% specimens were found to be smear positive by the fluorochrome staining method, while none was positive by the ZNCF method.The PCR results showed complete correlation with the clinical findings of the patients. (iv) CONCLUSION: The PCR was found to be superior to the currently available techniques for the diagnosis of tuberculous meningitis in terms of sensitivity, specificity and rapidity and could play a critical role in the diagnosis of suspected cases.

Polymerase chain reaction based diagnosis of systemic fungal infections and sensitivity testing of the fungal isolates.

PURPOSE: To highlight the usefulness of polymerase chain reaction (PCR) for the rapid diagnosis of systemic fungal infections. METHODS: Clinical samples were collected from 50 clinically suspected cases of systemic mycosis and subjected to smear, culture, antifungal sensitivity and PCR (based on 18S rRNA gene). RESULTS: Of the 50 clinical specimens tested by PCR, 39 were found to be positive. PCR gave more positive results than smear and culture examination. Out of the 50 clinical specimens 35 were found to be fungal culture positive. The sensitivity testing results of these fungal isolates showed that there was a good correlation between the in vitro results and the clinical response of the patient to antifungal therapy. Itraconazole exhibited maximum antifungal activity followed by fluconazole, ketoconazole and amphotericin B. CONCLUSIONS: PCR technology provides rapid and accurate diagnosis of fungal infection, however, it must be used with caution to avoid false positives.

Chromogenic agar for rapid presumptive identification of yeast species:--a preliminary report.

A chromogenic medium for the rapid presumptive identification of yeasts was devised and studied. The medium was found to be effective in differentiating the yeast species studied on the basis of colony colour. With further modification the medium can be used as a primary isolation medium.

Klebocin typing of Klebsiella species isolated from nosocomial infection in intensive care unit.

Klebocin typing and antibiotic resistance have been studied for 518 strains of Klebsiella pneumoniae, [106 from intensive care unit (ICU) sites, 182 from ICU staff flora, 192 from patient flora and 38 from clinical specimens]. The overall typability was 71.62%. The most common mnemonic types among various sources were 111, 211, and 112. Of the total strains tested, 28.37% strains were found to be untypable. These strains are labelled as "444". When klebocin typing was used in association with antibiogram, in 86.84% cases of clinical infection probable source of infection could be detected. Thus a combination of two typing methods poses a significant contribution in epidemiological studies.

Prevalence of hepatitis C virus (HCV) infection in Mumbai.

A study was carried out to determine the prevalence of Hepatitis C virus (HCV) in Mumbai among certain high risk groups such as renal transplant recipients, multitransfused and haemodialysis patients; professional and voluntary blood donors and viral hepatitis cases for comparison. Repeated testing of 602 subjects for antibodies to HCV using a second generation ELISA assay (Abbott, USA) showed an overall prevalence of 16.9%. We found 36.4% of multitransfused patients, 27.8% of renal failure cases and 26.2% of renal transplant recipients to be seropositive. Voluntary blood donors in our series showed a surprisingly high prevalence of 15.9%, and this group needs further investigation. Fifty-six of these sera (of which 45 were anti-HCV positive) were tested for HCV RNA by PCR and 14(31.1%) of the seropositive samples were also HCV RNA positive. The present investigation not only shows a high prevalence of HCV in the study groups but also proves the presence of HCV genomes in a significant proportion.

Serial blood phosphine levels in acute aluminium phosphide poisoning.

Serial blood phosphine (PH3) levels were done in patients with severe (Group I, n = 30), mild (Group 2, n = 10) and minimal or nil toxicity due to aluminium phosphide compound. Blood phosphine levels were significantly higher (p < 0.001) in patients of Group I than other two groups. Phosphine was not detectable in Group 3 patients. Therefore, blood phosphine levels were positively correlated to clinical grades of toxicity and to dose of active pesticide consumed. Higher the blood phosphine, higher was the mortality. Patients having blood phosphine levels equal to or less than 1.067 +/- 0.16 mg% survived, hence, it appeared to be limit of phosphine toxicity.

Safety of intrauterine administration of purified neem seed oil (Praneem Vilci) in women & effect of its co-administration with the heterospecies dimer birth control vaccine on antibody response to human chorionic gonadotropin.

Praneem Vilci (PV), purified neem oil was reported to exercise a reversible antifertility effect after a single intrauterine instillation in rodents and primates without any adverse effects. After toxicology, drug regulatory and ethical clearances, a phase I clinical trial was conducted on PV. Eighteen healthy tubectomised women were enrolled to evaluate the safety of a single intrauterine instillation of PV and to determine the effect of its co-administration on anti-hCG response to the heterospecies dimer (HSD) hCG vaccine. Eight women received PV alone and ten women were given the HSD-hCG vaccine in addition. Base-line and post-treatment haematological and biochemical profiles were determined as also the mid-luteal serum progesterone. Endometrial biopsies were examined to assess ovulatory status and the effect of intrauterine treatment with PV on the endometrium. Anti-hCG antibody titres were estimated in women who were concurrently immunized with the HSD vaccine. No untoward reaction was observed in any woman. Menstrual pattern and ovulatory status remained unaltered. Endometrial biopsy after PV instillation in one woman showed non-specific endometritis but she remained asymptomatic. Mild eosinophilia was seen in two women and this reverted to normal on its own. All women receiving PV and the HSD vaccine generated antibodies against hCG. Our data show that intrauterine administration of PV is safe and does not prevent the antibody response to HSD-hCG vaccine.

Tuberculosis screening: usefulness of new KREATECH IgA ELISA test.

A total of 71 sera from 15 proved cases of pulmonary tuberculosis, 2 cases with doubtful radiological report and 54 suspected cases, contacts, donors etc. were subjected to Elisa IgG, IgM and IgA tests for tuberculosis, with a view to comparing the merits of IgA test with those of IgG and IgM. Kreatech IgA test which is claimed to indicate presence of active tuberculosis was positive in 13 of the proved cases and negative in both the doubtful cases. These preliminary results indicate that KREATECH IgA is a promising new ELISA test which can be a useful laboratory aid in the diagnosis of active tuberculosis, both pulmonary and extrapulmonary, for screening of suspected cases, and for monitoring cases undergoing therapy.